The Ontology of Music in Music Therapy

- A Dialogical View1

Music in Music Therapy

Every practice has a theoretical foundation. You cannot at all act without some conception, at some level, of what you are doing. Whether or not it is explicitly articulated, the structure of some underlying theory gives sense to what we are doing, also as practicing music therapists. The question has been raised whether music therapy may expect to find an external theory that will encompass the field (Aigen, 1991; Ansdell, 1997; Pavlicevic, 1997). I do not think so. I also have doubts as to whether it will be possible to simply compose an integrated theory of music therapy from a mixture of discourses from other fields. I presume that music therapy needs to develop some theory on its own terms, because we can hardly expect to find any ready-made theory that fits music therapy from other, related fields. There are unique features in music therapy, and these need to be accounted for. Music therapy then needs to work out a foundational theory; both to facilitate a professional discourse within the field itself and for establishing dialog with other related ones.

What is unique in creative music therapy is the therapeutic use of the non-verbal medium of music. Taking the central role of music as a point of departure; on what grounds can it be justified as therapy? This crucial question has several dimensions, and I will maintain that it may not be decided upon entirely by simply conducting some empirical research, quantitative or qualitative. That is to say, issues and stances of a philosophical nature are inadvertently implied here. Some questions are inherently philosophical, which, to put it very briefly, means that they are about the frame of reference chosen. And what frame is chosen is decisive for what the picture will look like. One such fundamental philosophical issue is what the nature of music may be considered to be, the ontological status of music. And what music considered to be, has bearings on how one may account for how it works. So this is the theme for this paper: The ontological status of music in music therapy, and implications of this for how one may account for its role and function in therapy.

The focus will be on the concept of dialogue. My choice of this concept is grounded on the assumption that it is indeed central and appropriate to apply to the field of music therapy, because it may be considered to be in close accordance with inherent values in music therapy as a practice. The term dialogue has had a broad application within several fields, from theology, to sociology, psychology, and education, to arts and the humanities (Friedman, 1996). Used as a foundational concept the term may serve to illuminate dynamics of relation. This I believe may be very relevant with regards to the many sided and complex question of the role and status of music in music therapy.

Ansdell (1995) makes a distinction between 'music in therapy' and 'therapy in music', the last of these phrases echoing a title by Nordoff and Robbins: Music in Therapy for Handicapped Children(Nordoff & Robbins, 1972). 'Therapy in music' is about therapy being a part of the music, coming as a direct result of being engaged in musical activities, rather than music being a part of a system of therapy, playing a subordinate role or function, in which case we have 'music in therapy'. Bruscia has made a similar, much referred to distinction between music in therapy and music as therapy, the last one stressing the primary role of music as a therapeutic agent (Bruscia, 1987). It is music therapy in the sense of therapy in music that is considered here, or in Bruscia's terms "music as therapy". Of course all such gross dichotomies may tend towards oversimplification, but I do find some sort of distinction along these lines useful.

A Philosophy of Dialogue

My interpretation of the concept of dialogue will be based on Martin Buber's original formulation of a dialogical outlook in the book I and Thou (Buber, 1970, first published in 1923). In the following I will give a brief sketch of some tenets in this dialogical philosophy. Buber makes a distinction between two fundamentally different ways of relating to the world, designated by the two pairs of words I-Thou and I-It. The world of It is a world of what Buber calls experience and use. It is the world of our daily practical affairs, in which we deal with various items and tools for diverse practical purposes. It is essentially a world of things. Speaking the word of I-Thou is not confronting some thing or another as an object, but taking a stand in relation: In entering into relation all fixed preconceptions are left behind, for the living encounter with another being. I-It relations may be considered to be third person relations, something or someone I talk about, whereas 'Thou' is someone I talk to. This implies that the I-Thou is a second person relation. The difference between the two ways of relating may then be seen as the difference between second and third person relations (Wood, 1999). One might as well have said I-He, I-She or I -It, including both the masculine, feminine and neuter forms when speaking the so-called primary word of I-It. And I-Thou might just as well, from a grammatical point of view, been written I-You.

What characterizes a second person I-You relation is first of all that it is immediate. The relation between I and You has nothing in between to qualify or to mediate it, it is a direct, face-to-face approach, one to another. In this immediacy the other does not appear merely as some means to an external end. The relation is its own fulfillment. This second person directly relating to one another is contrasted to the world of I-It, which is a world of prediction, reliability and use. What constitutes direct relating is presence, Buber holds forth. He contrasts this with what comes out of the saying of the primary word I-It, namely the object: The object has been placed within the scheme of things; it has no immediate presence before us. The relation of I towards You involves the whole being. It is furthermore directed towards the whole being of the other. Nothing particular of the other is singled out and set apart. Buber terms this the exclusiveness of the I-Thou relation: In the encounter the relation between I and You is mutual, a mutuality of one recognizing, accepting and affirming the other as an interactive partner. It is reciprocal, a relation of mutual influence.

I will use Buber's perspective, as it has been presented here as a point of departure. It is not Buber's opinion or view on the particular matter of music therapy (- of which there is no record to my knowledge), that is aimed at; it is the kind of dialogical perspective that he represents that I will attempt to apply to the issue set forth here.

Music as a Means

In music therapy music is clearly not an object to be valued and considered solely for its own inherent qualities. Music in this instance clearly serves some purpose. One suggestion, close at hand, might be that music here instead of being an autonomous art object is to be applied as a means towards a predefined end. The therapist applies music as a means for the betterment of the client.

Inherent qualities

From a dialogical perspective it may not be quite as simple as this, though. Music as a means pure and simple becomes an It, belonging to the technical and practical mode, becoming one of the expedient measures at hand to be applied on a regular basis for certain predefined objectives or aims. In consequence, to use music as an It in therapy necessarily brings about treating humans in an objectifying way, namely as that which this means works upon. To use music in a purely technical way in itself actually entails reification, a treatment of people as if they were things, which means defined and placed within a cause and effect chain.

This is not necessarily wrong. The It-mode is both practical and necessary in the sustaining of life. The question may nevertheless be raised whether a strictly instrumental perspective actually brings out all the qualities of music as a therapeutic medium. If the use of music within therapy is legitimatised solely on the ground of it being a means for a predefined aim, music as such becomes just a means besides any other means. And considered as a means bare and simple, it is of no particular interest in itself. Its interest then lies solely in what can be accomplished through its use. Justifying music as a means merely for other ends easily comes to a conflict with the inherent value of the musical activity as such.


Related to this is another aspect, which has to do with the issue of intentionality. If a simple means and end logic is held as primary there is no real space for the intention of the subject involved, because the desired outcome of a means unilaterally directed may be set up independent of this. Intentionality is thus not involved other than - at most - an arbitrary and inconsequential feature within the course of events, according to such a logic in its strictest sense.

This implies that to use music primarily as a means for training certain chosen functions tends not to take care of the particular qualities of music itself as a medium for the client. An issue is raised here: If you do not meet the music as music, you hardly can expect the beneficial "effects" of it either. You do not on the whole decide for instance to develop your social skills, and therefore join an orchestra, band or choir. You join these, and receive such benefits. But if you do not put the music first you will hardly gain the benefit that follows. This is not at all automatic. If you really do not care so much about the music activity, you may hardly expect to receive the positive gains connected with it. And this must also be the case for the client. For the client in music therapy the primary motivation for doing music is the music activity itself, and if it was not, one could hardly expect any improvement of functions following from this activity. Using music solely as a means for improving non-musical functions will tend to overlook this crucial intentional aspect of doing music.

Cause and effect

A further aspect of the ontology of music considered solely as a means is the question of how it works, what kind of effect music as a means may bring about. If one were to discover natural laws of physics for the effect of music, this necessarily would have to be based on a calculation of sound waves, measured in parameters as amplitude, frequency and wave shape. But this may hardly count as the effects of music as music. Sound may well be registered, measured and calculated, which is to say - quantified as a physical phenomenon. But to say that only this is what music is, and how it works entails "physicalism", a reduction that does not recognize the reality of music as music, in the way we know it as a sounding reality in our everyday life. And without taking this into consideration it would be hard to at all carry on any meaningful discussion on the effects of music as music considered.

Music dialogically viewed as an encounter implies that it cannot be reduced or determined purely on a physical basis. From this follows that the workings of music, according to this point of view, cannot be simply of the same sort as those found in the causal explanation of physical phenomena. This must be considered to be mixing terms on a basic descriptive level. It is describing something with a set of terms that belong to an altogether different sphere of reality, an ontological confusion. The effect of music, as music, is not like the effect of for instance the biochemical reaction coming from taking a pill. It is a different kind of effect that needs to be accounted for, on different terms than physical or biochemical cause and effect schemes. The one is not simply reduced to the other.

The encounter with music not predetermined

Music does not present itself as something completely determined and defined beforehand. In the encounter with music there will always be something surprising and unpredictable. In the last resort music will always be indefinable, indeterminate, because it is always in the given situation, in the given moment that it opens itself. How the encounter with music turns out cannot in any case be completely predetermined. From this it follows that music will not have any definitive and determined particular effect. Music as we encounter it in the moment, present and real, is immediate in its effect. It is through each new encounter it reveals itself to us, as a unique experience each time. Thus it is not reducible to a technical/mechanical cause and effect relation. It is a matter rather of an open reciprocity in relation to the music. This, I will maintain, is what a dialogical view entails.

Interrelations in Music Therapy

Now turning directly towards a dialogical view of the ontology of music in music therapy, I want to suggest another kind of perspective than a linear causal one. If reciprocity is to be the basis in accounting for the dynamics and workings of music in music therapy, a triangle may be set up rather than a unilateral arrowed line:

A triangle makes it possible to explicate the nature of the relations between all three sides to each other. It indicates that both the therapist and the client and the music are reciprocally interconnected, and thus a dynamic relation between each is made possible. Furthermore it may open for a perspective showing the interrelations of one to the other two: how one part mediates the relation between the two others.

First the relation between the therapist and the client may be seen to be mediated by the music. The music is not just sent off across a line in a single direction. Within this basic triangle model a reciprocal relation between therapist and client is indicated, through music. The therapist may address the client. And the therapist may also respond to the client's address to him. This becomes a process of reciprocity. Music between therapist and client may facilitate a communication, a mutual address and response through music. A triangle in this way indicates not simply a one to one connection between a therapist and a client, but a relation between the two mediated by music.

Secondly the therapist in this perspective mediates the client's relation to the music. The therapist as therapist is not simply engaging in some music activity, but has an active responsibility within the situation for how the client relates to the music. The therapist thus may be seen to mediate how music may serve in the therapeutic process of the client.

The third part of the triangle, the client, may be seen to mediate the therapist's relation to music, in an indirect or in a certain sense passive way. The therapist is not engaging in music primarily for his or her own personal expression. This is not what is in focus. What is in focus is the making of music for the client. The client does not have an active role in mediating the therapist's relations to music, but the therapist's relation to music is functionally mediated by the client, in that the client's needs are in focus in the therapist's relation to the music.

An Illustrative Example

I would like to give an illustrative example here, from my own practice as a music therapist, for a further explication of these three sides or aspects of mediation. Anne Brit is a girl of about 14 years of age, with Rett syndrome. This is a progressive neurological disease, almost exclusively contracted by girls, in which the child from a very early age starts losing basic already acquired abilities, like walking and talking, developing a multi handicap condition. Very often there is a characteristic movement of the hands resembling hand washing. I am having individual sessions of music therapy once a week with this girl, in a special education setting. The aim for these sessions is trying to engage her in some meaningful activity. She is very much in recluse, sitting quite self-absorbed in her wheelchair, and with a rather incessant movement of the hands. She does not have any functional verbal language, and remains very much in a world of her own, not being easy to "reach", or get in contact with.

I start by singing some songs for her. There is some response here it seems, but she is still rather withdrawn. I try to think about how to engage her somewhat more. I then ask her if I may take her hand, gently releasing one of her hands, which is "hand washing" with the other, and holding it for a while. I then gradually lead it down towards her lap, holding it here. She seems OK with this. The other hand is continuing a more or less automatic movement towards the other hand, though, which is not there, making a movement in the air. I now take a tambourine and place it before her, so that she hits the tambourine as she makes the movement with her hand. This startles her, again and again. I then start singing a song, which I make up spontaneously, in a mode that seems to fit in with the overall "beat" movement of the hand.

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This engages her more. After some time she apparently recognizes the song and the activity quite well. When the activity is about to start she is looking rather eagerly towards the instrument and making some effort it seems to get her hand started. So even if this initially was a quite automatic movement, she now seems intent on hitting and making a sound on the tambourine.

Eventually, as a further step in the development of the activity, I deliberately just sing the first part of the first phrase of the song "Anne Brit can..." - and then wait for her to actually hit the tambourine with her hand. The moment she does, the song continues: "play the tambourine!" This creates a musical suspension, which is released as she hits the skin of the instrument. What happens now is that she bursts into a laugh. Her whole face just lights up. I continue likewise through the song, singing part of a phrase, and waiting for her to hit the tambourine before continuing the song. And she just laughs and seems really to be delighted about this. She raises her eyes, and looks up at me in what seems to be astonishment and surprise, and when the song is finished we just sit looking at each other. She is smiling, bursting occasionally into a soft laugh. I am smiling too, having a very strong sense of contact in this moment. This has become a favorite activity for her. She may be quite distant and withdrawn when coming in to have the session, but for a long time really lights up whenever we start this activity.

The relationship between therapist and child mediated through music

Since this girl does not use verbal language one has to make some guess as to what gain she might have had from this activity, by observing what happens in the session. My own impression was that what really seemed to cause her to light up and become available for contact was that she had a clear feeling that what she did, had some consequence for another person. She might enjoy the song, and find playing the instrument rather fun in and of itself, but the big change in her reaction came when I very markedly adjusted the song to the tempo of her playing, creating a musical suspense that was directly tied up with what she was doing. In a way she was directing what was happening. The musical suspension that was built up was not released until the moment she hit the tambourine with her hand. I had a clear impression that this was what made her react with such apparent amazement. And then she looked up towards me, and smiled a big smile. It turns out that she was capable of making contact then, when there was some reason to! There were not many activities in which she could interact on any kind of even level with someone else. Through this activity we achieved some contact. As we were just sitting afterwards, looking at each other, it seemed very clear to me that we were achieving some mutual recognition of each other. Through the playing she could establish: "Yes, here am I, and I mean something to you. You recognize me for what I am, for what I am capable of doing". And I could affirm, "Yes, I see you, I see what you can do. I see who you are, and that we can do something together.

This communicative interchange happened through music, and the qualities of the medium are what facilitated it. Without music I would not have had this particular opportunity to reach through. Music became a channel so to speak for me to reach through, to get across to her in some way. It was possible for me as a therapist to address her in some way through music, through her playing to a simple song. And, very significantly, it was through the medium of music that she herself was able to reach out, and to respond. By her attempting to play, and me adjusting the song to her playing, we established a kind of musical interaction, an ensemble playing at a very basic level. The melody had become familiar, for both of us, and waiting for the song to be continued as the tambourine was struck became musically exciting and meaningful. It was music as something we shared that made contact and interpersonal interaction possible. The relation was mediated by the musical interaction.

The child's relationship to music mediated by the therapist

This girl could not use verbal language. Still it became possible for her to express herself, to make some kind of statement of significance for others, that could be recognized for what it was: her own. There is a compensating aspect here too. Because when it is not possible to use verbal language, which is so significant in overall human communication, other means for interaction may become increasingly more important. Musical communication in this setting may gain a relatively greater significance.

Music is very flexible when it comes to level of proficiency. It certainly allows for a rising to exceedingly high levels of artistry, but it may also be a powerful personal expression at a most elementary level, as seen in this case. This is a multi-handicapped girl, with rather limited options for activity. Music proved to be a medium flexible enough to facilitate participation at this level. Anne Brit was given a possibility to manage, to indeed succeed in this activity. Maybe she would conventionally not be considered a probable candidate at all for engaging in musical ensemble playing. Through taking Anne Brit's movements of the hand to be intentional, or creating a frame in which they might appear as intentional, the potential intentionality of the movements were actualized. The hitting of the tambourine became framed as an address, by the song given back in response to this. As a therapist I had to take into consideration her own experience and situation. I had to try to see, or actually imagine what the potentials were, where she was, and where she might go. This therapeutic imagination is what led to the activity, which could not have been realized without it. The basis for the development of the activity was a kind of imagining what it would be like for her to actively participate musically. The therapeutic responsibility furthermore consisted in actively and creatively mediating the child's relation to the music.

The therapist's relation to the music mediated by the client's needs

The song made a spontaneous creation in the moment, and would not have been made outside of this particular setting. The situation called forth the song; it sprang from this situation. This exemplifies the therapist's relation to music being mediated by the relationship to the client. The way the song came out was related to the therapeutic intention towards the child, and has to be evaluated according to this. The rhythm, the melody, the text and the playing activity all go together in the overall simple structure of the song. It was made for this specific situation, naturally including all these elements into a whole. The intent was to reach through to the child and engage her. The therapist's relation to the music then is mediated by its function for the child, and although there is a certain and necessary artistic or musically creative imagination involved too, the evaluation of such a song should not be based directly or exclusively on qualities of the song in itself, but on how the elements of the song may be related to its therapeutic purpose. That is, how it turns out with regards to the child's relationship to this particular music.

What Music Is, and How it Works

What this perspective of each side mediating the relation between the two others may reveal is that there is hardly any single cause and effect outcome to be found between one side and the other. There is rather reciprocity between all three sides, involving a relational dynamics, and not some or other plain directional A leading to B. There is no mechanical one-way connection between music and client, administered by the therapist, because the one side related to the other is mediated by the third. This implies that the workings of music in music therapy, according to such a view, must be found in the interrelations, rather than in one to one causal effects.

This is different than considering music as a means bare and simple, because such a perspective does not include the reciprocal aspect between client, therapist and the music in relation to each other. A dialogical perspective on the role of music in music therapy turns out different than a simple means and end logic. It indicates that it is in the world of relation, rather than in the predictable and manageable world of objects and things, that the workings take place.

Music in music therapy then, according to the dialogical perspective drawn here, is not aimed towards becoming an autonomous work, an independent entity valued on its own terms. Nor is it to be considered merely as an external and predictable means applied for some predefined end. The ontological status of music in music therapy may, in accordance with a dialogical view be considered to be between these two, as a medium, a medium for the integration and development of the person. The effect of music thus considered is not to be found in music itself. The way music works is seen rather in and through its interrelations. This suggests that the place to look for the actual effect or real power of music may be in the various ways in which it mediates, between means for an end, and end in itself: music as a medium.


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Ansdell, G. (1997). Musical elaborations: What has the new musicology of say to music therapy. British Journal of Music Therapy, 11(2), 36-44.

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Pavlicevic, M. (1997). Music Therapy in Context. Music, Meaning and Relationship. London: Jessica Kingsley.

Wood, R. E. (1999). The dialogical principle and the mystery of being - The enduring relevance of Martin Buber and Gabriel Marcel. International Journal for Philosophy of Religion, 45(2), 83-97.


1)This article is a somewhat revised version of a paper delivered at the the Vth European Music Therapy Congress in Naples, April 2001.

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