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"There are three things I have learned never to discuss with people: Religion, politics, and the Great Pumpkin." Linus van Pelt, Peanuts

The Problematization of Religion in Music Therapy

Eleazar the Maccabee and War "Elephant" Carrying Seleucid General, Based Upon Apocryphal Book of 1 Maccabees From Speculum Humanae Salvationis (Anonymous, 14th Century)

During recent years, the United States has experienced an intensification of the discourse on the role of religion and faith-based belief systems in public policy. At the core of this discourse is a fundamental tension between the basic civil rights to freedom of, and freedom from, religion. The discourse itself is nothing new, and it certainly comes as no surprise that such a discourse would arise, in an environment where demographic diversity abounds, including divergent sets of values and worldviews; but it has taken on a distinctly amplified character over the past decade or so, during an era when the US political arena has witnessed the emergence of movements that have challenged past precedent in new ways. This discourse has tended to become controversial, contentious, and even hostile in tone, wherever it has arrived at non-negotiable, fundamental impasses around such challenging issues as religious expression in public education, reproductive rights, marriage equality, and so forth. Further complicating matters are the sometimes subtle politics of privilege that are interwoven into the fabric of these issues. In spite of the great diversity of religious orientations that coexist among members of the US population, not every orientation (including those which are non-religious in character) is endowed with the same degree of public respect and socioeconomic legitimacy. This, in turn, has established multilayered, hegemonic structures that have readily contributed to implicit or explicit glorification of certain orientations and marginalization of others.

Paralleling this emerging, national discourse, many health professionals have become interested in the integration of spirituality and religion into their professional work, including in psychosocial fields such as psychotherapy (Miller, 1999; O'Hanlon, 2006). This has likely been due, in part, to demographic realities concerning the prevalence of religious worldviews in the US and elsewhere (Gallup, 2006; Myers, 2000), along with accompanying demands that health professionals find ways of respecting, acknowledging, and including spirituality and religious principles in their work (Miller, 1999). Also contributing to this trend may be research supporting the connections between faith and health itself (Koenig, McCullough, & Larson, 2001; Pargament, 1997; Plante & Sherman, 2001; Richards & Bergin, 1997). This growing focus on the role of religion in healthcare in general has also raised concerns specific to the profession of music therapy. These concerns have been centered on how client and therapist religious orientations may or may not impact upon how music, health, change, helping, and other components of music therapy are understood and integrated into the work.

Like the national conversation about religion in the US, discussion about the role of religion in music therapy has, at times, been met with tension, discomfort, defensiveness, dismissal, avoidance, etc., while remaining a matter of significant prominence. In essence, it has been a sort of "elephant in the room" for the field of music therapy. Again, because of the very sensitive nature of the moral and human rights issues tied to the topic, this "elephant" can be encountered as particularly large and contentious (a polemical pachyderm, if you will) in spite of genuine efforts to maintain civility and mutual respect (for example, as manifest in the context of social networking forums). Here, it is often the perpetual tensions between the fundamental principles of freedom of and freedom from that comprise the greater part of the elephant?s mass. For therapists who self-identify as observant of a given religious tradition, certain basic, moral values and directives may represent a core part of their identities, may serve as their guiding principles, and may constitute the basis for that which drives their professional work. At the same time, when clients do not share the religion-based, moral "compass" of the therapist, a dynamic of conflicting values and interests can emerge with respect to the client's well being. Yet, must the therapist be expected to face an ultimatum of sorts, involving a choice between becoming someone they are not, and leaving the profession? Likewise, when a therapist whose religious orientation differs from the client's—or when the therapist's orientation is nonreligious and the client?s is devoutly religious—how can the therapist be expected to meet the client authentically in a therapeutic relationship without a shared, religious worldview?

Examples of specific questions that have emerged at the heart of the discourse on music therapy and religion include:

• Can the music therapist's religion-based values drive ways of working with the music and within the therapeutic relationship, and still remain client-centered, particularly with clients who do not share the therapist's orientation?
• How can bias, stereotype, and prejudice manifest among the various constellations of religious orientation, and how can these impact upon the music therapy work?
• Can outward expressions of the music therapist's religious orientation (such as symbols of her/his religious orientation) ever become problematic?
  • If so, is it a valid solution for the music therapist to suppress these expressions?
• How might the music therapist act in response to client needs tied to particularly sensitive political issues, such as religious expression in public education, reproductive rights, and marriage equality?
• Are there ways in which certain views on reality (for example, whether human life is the result of natural selection or creationism/intelligent design) that diverge between client and therapist might impact the therapeutic relationship and process?
• What is the potential impact when the therapist's ultimate concern is for the state of a client's soul, and whether or not it is "saved"?
• When, if ever, is it acceptable for the therapist to pray for a client (whether in the client's presence and/or the client's absence)?
• How might any of these matters impact upon the therapist's selections of, or ways of engaging in, the music, for therapy?
• Is it possible for the therapist to support client diversity in the realm of religion, expressed through selections of music from religious traditions not shared by the therapist, while avoiding superficiality and stereotypy?
• How can the music therapist manage their own religion-based musical objections—based upon prohibitions dictated by their own or their client's religious orientation—or based upon reactions to religious music from the nonreligious perspective of client or therapist?

Music Therapy, Religion, Ethics

The assortment of example questions pertaining to the matter of music therapy and religion do not suggest any simple answers, and by all accounts, belong in the complex, multifaceted realm of ethics. From the perspective of the psychology profession, Plante (2007) has written about grappling with the "tumultuous" relationship between therapeutic fields and religion, particularly concerning the ethical dimensions thereof. Citing the American Psychological Association's (2002) Code of Ethics, Plante points to the core purpose of the Code as protecting the rights and welfare of the client, yet also cite, as part of upholding client welfare, the profession's general support for religious diversity. This is likewise the case within the field of music therapy, as articulated (for example) in several sections of the American Music Therapy Association's (2012) Code of Ethics:

The MT refuses to participate in activities that are illegal or inhumane, that violate the civil rights of others, or that discriminate against individuals based upon race, ethnicity, language, religion [emphasis added], marital status, gender, gender identity or expression, sexual orientation, age, ability, socioeconomic status, or political affiliation. In addition, the MT works to eliminate the effect of biases based on these factors on his or her work. (Section 2.0 General Standards, Subsection 2.3 Moral and Legal Standards, Item 2.3.2)

The MT will not discriminate in relationships with clients/students/research subjects because of race, ethnicity, language, religion [emphasis added], marital status, gender, gender identity or expression, sexual orientation, age, ability, socioeconomic status or political affiliation. (Section 3.0 Relationships with Clients/Students/Research Subjects, Subsection 3.3)

The MT will not discriminate in relationships with colleagues because of race, ethnicity, language, religion [emphasis added], marital status, gender, gender identity or expression, sexual orientation, age, ability, socioeconomic status or political affiliation. (Section 4.0 Relationships with Colleagues, Subsection 4.5)

Clearly, these components of the Code of Ethics comprise an imperative for music therapists to incorporate principles of religious diversity into their work, including instances involving the absence of any specific religious affiliation. In response to this imperative, it may be relatively easy to acknowledge, on a rational level, that a therapist's own orientation to religion should never interfere with her or his efforts to support the client in an nonjudgmental way, prioritizing consideration of the client's welfare, rights, safety, and therapeutic needs above the therapist's own needs and "comfort zones." But actually accomplishing this ideal may be quite another matter entirely. Calibrating one's perspectives on matters of diverging worldviews around religion as they manifest in music therapy can require thorough training, ongoing supervision, and conscientious self-inquiry. However, the music therapy literature does not demonstrate an emphasis upon these endeavors, and even outside of music therapy, few graduate and postgraduate training programs offer any training in the integration of therapy and religious diversity (American Psychological Association, 2006; Russell & Yarhouse, 2006; Shafranske, 2001). In fact, with the exception of optional continuing-education conferences, workshops, and seminars offered to professionals after they are licensed (Miller, 1999; O'Hanlon, 2006), not much training in this area exists at all, and the general research on therapy and religion is weak (Sloan, Bagiella, & Powell, 2001).

In light of the complexity of, and lack of training in, the matter of religion and music therapy, a model for ethical decision-making can serve as a support resource. Therefore, for the purposes of this essay, one model (as an example) is submitted for consideration here. The model, adapted from Plante (2007), was originally intended for psychologists; however, here, it will be presented in a manner specifically relevant to Music Therapy. In summarizing the primary components of the model, the role of, and impact upon, music experiences will be articulated.

Applying Principles from the RRICC Approach to Ethical Decision Making Regarding Music Therapy and Religion

According to Plante (2007), RRICC stands for the values of respect, responsibility, integrity, competence, and concern. The RRICC model was originally intended to highlight the values outlined in the American Psychological Association's (1992) Code of Ethics. However, these values are highlighted in the Codes of Ethics not only of psychologists, but also of many health professionals from the US and other countries. Therefore, the ethical principles in the RRICC model hold potential relevance for many health professionals in the United States and abroad. As Plante (2004) has observed, the professional codes, across professions, are more similar than different regarding ethical principles pertaining to religion.

Respect

Respect means upholding others' rights and dignity in light of a diversity of religious and nonreligious belief systems. Respect requires that the therapist maintain a nonjudgmental perspective, suspending and/or eradicating any prejudices tied to the client's belief system or to the therapist's own belief system, which can potentially impact upon ways of working with the client. Respect for the client must be maintained, with the client's health and well being always held as core priority, even when the therapist's values and worldview do not agree with those of the client.

Issues of respect can manifest in any number of different ways. For example, as Plante (2007) observes, while a therapist with a Christian orientation may feel comfortable and "at home" with his or her own denominational perspective (e.g., Catholic, Methodist, Seventh-Day Adventist), she or he may experience other denominations, non-Christian traditions, or non-religious orientations, as foreign and unfamiliar. Whether the former or the latter situation is the case, respect must be maintained, especially when a therapist is aware of discomfort or antagonism toward a given, particular orientation(s). This likewise applies when the therapist's orientation is nonreligious and the client's is religious, in which case the therapist must support the client on a basic, human level, at no time negating the client's view, nor challenging that view in any way that would marginalize the client.

Thus, as a basic aspect of respect, no matter how deeply held the therapist's beliefs may be, religious beliefs cannot be imposed upon, nor negated for, the client. This also means that the therapist must attempt to suspend religious objections or prohibitions of certain music styles, subjects, etc., that may otherwise support a client's therapeutic process. Likewise, when a therapist finds a particular religious orientation objectionable, and the music tied to that orientation distasteful, she/he must suspend this disposition in order that all options for beneficial music experiences remain available to the client and therapist.

Responsibility

Responsibility means taking the steps necessary for acting in accordance with client needs. Part of responsibility means collaborating/consulting with those who hold the appropriate qualifications and expertise whenever needed, in the service of client needs. This includes making referrals to religious and spiritual professionals such as clergy as needed (just as therapists make referrals to trained medical personnel when clients experience medical or biologically-based concerns, even if the therapist can assist in addressing those need areas).

Musically, part of responsibility for the therapist is to learn the music of various religious traditions, or—perhaps more significantly—learning how to facilitate a range of music experiences that can be supportive and meaningful, in the context of the client's unique orientation to religion and life in general. Another part of responsibility is understanding any prohibitions or other limits to music experiences that a client's religious orientation might dictate. This can refer not only to certain musical styles and lyric contents, but also to aspects of interacting connected with the music (such as physical touch).

Integrity

Integrity means being honest, just, and fair toward all those involved in the work of a therapist. Integrity means avoiding deception about competence, as well as about agreement with client worldviews, when they do not agree. In essence, the music therapist must be who she or he is. This requires careful monitoring of professional and personal boundaries, which can be blurred easily in music therapy where religion is involved. As Plante (2007) explains, health professionals are generally not members of the clergy, and when they are members of a particular religious faith tradition, it does not make them experts in religious areas that are not necessarily part of their professional training.

Integrity issues may emerge when the therapist views her or his primary role as one who "ministers" care to clients, in the form of music therapy, or when the therapist feels compelled to pray for the client, in the course of therapy (whether or not the client requests this of the therapist, and whether or not it takes place directly in the client's presence, or outside of therapy session times. The therapist must consider whether or not these ways of working with the client are actually part of her or his role, and whether they are meeting the client's needs, or her or his own needs. Integrity issues can also occur when clients wish to pray for the therapist, and the therapist has mixed feelings about this request. In these situations, honesty on the therapist's part dictates that she or he consider referring the client to qualified members of the religious community.

Integrity pertaining to music may include special considerations about religious tradition—such as how one member of a client group who observes certain prohibitions about music or music-making (for example, a woman from a sect of Judaism that forbids singing in the presence of men). Integrity in music may also apply to the quality of the music itself. Music from a religious tradition, like any music, must be meaningfully aesthetic, and not merely a superficial expression of a style. This requires of the therapist a certain degree of rigor in the process of learning music from religious orientations that are not her or his own.

Competence

Competence consists of the knowledge, skills, and abilities that permit the music therapist to provide quality services to her or his clients'in this case, with respect to the role and impact of religion upon the services provided. A music therapist must maintain professional competence in the area of therapy and religion through any and all means possible, including training, workshops, conferences, seminars, books, articles, etc. Moreover, even as competence is maintained, a music therapist must acknowledge the limits of her or his knowledge, skills, and abilities, and refer clients to other professionals whenever necessary.

As part of demonstrating competence in the matter of therapy and religion, the music therapist who is a member of a given faith tradition must acknowledge that she or he is not necessarily an expert in that tradition, and may not be able to respond in ideal ways to the sorts of needs that can arise in the context of professional work. Clients vary in their individual relationships to their own faith traditions, and thus there is no "standard protocol" that can be mastered by a music therapist in this area of care. Moreover, the therapist cannot assume that clients share her or his worldview, simply because they are self-identified with same religious orientation, by name. In addition, a music therapist must be clear in their role as therapist, as distinct from that of clergy, within the scope of the therapeutic relationship. Unless her or his professional role and expertise explicitly extends to such work as pastoral care, spiritual direction, or theological consultation, she or he should not engage in any of these.

Musically, the therapist's competence is based upon the quality and comprehensiveness of her or his mastery of repertoire that may serve the needs of clients, across various religious traditions. It is also based upon the therapist's ability to understand the difference between engaging in music experiences with the client for therapeutic versus pastoral purposes. In addition, the therapist's competence does not necessarily include providing the "right" music for the client based upon the client's religious orientation—rather, the type of expertise expected of the therapist is the capacity to respond meaningfully and sensitively to the unique circumstances surrounding the client's needs and reasons for participating in therapy, while supporting elements of the client's orientation, such as religion. This requires mastery of clinical musicianship—not merely learning a list of songs that may appear associated with a particular religious tradition.

Concern

Concern means prioritizing the client's rights, safety, and general welfare, above all other priorities tied to the matter of therapy and religion. At times, clients may experience abuse, neglect, and victimization, which may or may not occur under the banner of religion. When the therapist, in her or his best judgment, perceives the occurrence of this sort of harm, she or he must respond accordingly, in safe and responsible ways. Consider, for example, the case of corporal punishment as part of a parent's understanding of disciplining children. Certain interpretations of biblical text, for example, may legitimize this practice, whereas other interpretations may not. If a therapist comes to the conclusion that abuse is indeed occurring, whether or not scripturally justified, she or he may need to make a decision to act in response to her or his observations. In the process of assessing harm, the therapist must consider whether or not her or his assessment is based solely upon her or his own worldview (whether rooted in a religious or nonreligious orientation), or holds validity beyond this. Consulting a professional peer on the matter is often advisable to "triangulate" the assessment, and may help the therapist feel better "grounded" in making a decision on how to respond. In any event, concern for the welfare of others always trumps other ethical values (Plante, 2004), such as respect for diversity. This is not to say that the matter is not complex, and it can mean, at times, participating in such unpleasant measures such as reporting child abuse, supporting a team decision to go forward with involuntary commitment to a psychiatric facility, or engaging other legal means to avert harm (to self or other) by a client.

When incidence of abuse is disclosed through songwriting or lyric analysis (for example), the therapist can draw upon musical material as a basis for taking action in response, but must consider the implications carefully before doing so, including the various contexts of religious orientation. Likewise, when a client and/or a client's family members request musical support from a music therapist in lieu of other interventions that might be prohibited as per certain religious doctrine, the therapist is not automatically compelled to provide this support, if the therapist has grounds to believe that what is being requested of the therapist constitutes participation in an act of harm, whether or not under the banner of religious diversity.

Concluding Thoughts

Diligent consideration of ethical issues tied to the presence and role of religion in music therapy is of critical importance. Considering dimensions of ethical thinking such as respect, responsibility, integrity, competence, and concern for others, as well as a commitment to receiving appropriate training and ongoing supervision, can serve as invaluable resources when navigating the often rough waters associated with this topic (Plante, 2007).

Although uncomfortable at times, it is crucial that music therapists not only consider the ethics of religion individually, but as a community, via active, bold, and daring conversation, while maintaining as much civility and mutual respect in the process. Attempting to avoid acknowledging and confronting the matter only adds weight to the elephant, which is undoubtedly in the room, and is not going anywhere, anytime soon. Thus, it appears that members of the music therapy community are well advised to heed the wise words of Randy Pausch, Carnegie Mellon Professor, shared in his final lecture (before losing his battle to pancreatic cancer):

when there's an elephant in the room, introduce it.

References

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American Psychological Association. (1992). Ethical principles of psychologists and code of conduct. American Psychologist, 47, 1591-1611.

Gallup, G. (2006). The Gallup Poll: Public opinion 2006. Wilmington, DE: Scholarly Resources.

Koenig, H. G., McCullough, M. E., & Larson, D. B. (2001). Handbook of religion and health. New York: Oxford University Press.

Miller, W. R. (Ed.). (1999). Integrating spirituality into treatment. Washington, DC: American Psychological Association.

Myers, D. (2000). The American paradox: Spiritual hunger in a land of plenty. New Haven, CT: Yale University Press.

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Plante, T. G., & Sherman, A. S. (Eds.). (2001). Faith and health: Psychological perspectives. New York: Guilford Press.

Richards, P. S., & Bergin, A. E. (1997). A spiritual strategy for counseling and psychotherapy. Washington, DC: American Psychological Association.

Russell, S. R., & Yarhouse, M. A. (2006). Religion/spirituality within APA-accredited psychology predoctoral internships. Professional Psychology: Research and Practice, 37, 430-436.

Shafranske, E. P. (2001). The religious dimensions of patient care within rehabilitation medicine: The role of religious attitudes, beliefs, and professional practices. In T. G. Plante & A. C. Sherman (Eds.), Faith and health: Psychological perspectives (pp. 311-338). New York: Guilford Press.

Sloan, R. P., Bagiella, E., & Powell, T. (2001). Without a prayer: Methodological problems, ethical challenges, and misrepresentations in the study of religion, spirituality, and medicine. In T. G. Plante & A. C. Sherman (Eds.), Faith and health: Psychological perspectives (pp. 339-354). New York: Guilford Press.

How to cite this page

Abrams, Brian (2013). A Contentious Elephant in the Music Therapy Room: Daring to Consider the Ethics of Religion in Music Therapy Practice. Voices Resources. Retrieved January 11, 2015, from http://testvoices.uib.no/community/?q=fortnightly-columns/2013-contentious-elephant-music-therapy-room-daring-consider-ethics-religion-mus