On Becoming a Music Therapist
[Editors note: The article presented here is republished from Canadian Journal of Music Therapy Vol. V, no. 1 1997 with the kind permission from the publisher and the author.]
Abstract
This article succinctly presents general concepts of learning and outlines salient characteristics of learning in the field of music therapy. The relationship between training in music therapy and becoming a music therapist is highlighted along with the place of experiential learning in this context. A description of the transformations perceived as resulting from experiential learning in the author's experience follows, in relation to the self, others and the potential space. The impact of these transformations on the genesis of the Author's practice and conception of music therapy is noted and compared to written accounts of various aspects of music therapy theory and practice. This perspective has implications for music therapy training: becoming a music therapist would then signify becoming a person whose forte lies in the utilization of sound to give freedom to the body and the voice, and sensitivity, intuition and creativity to complement the spoken word and rationality. It invites the therapist to do justice to the term "therapy" embedded in "music therapy" and, accordingly, to give weight to the experiential dimension in music therapy training programs.
Introduction
Learning in a new field such as music therapy is a challenge: it is not enough to become competent in the fields of both music and therapy; one has to become a music therapist, that is, develop an expertise in the use of music for therapeutic purposes, since music therapy is at the crossroads of these two domains. This is not an easy task. As Hesser (1985) says: "Being a music therapist is an in-depth, lifelong process, not begun or completed with a degree" (p. 67).
Becoming a music therapist is a maturing process during which the person integrates constitutive elements of both music and therapy in deeper and more effective ways until they become so intimately interwoven that music becomes therapy and therapy becomes music. On the one hand, the music therapist becomes able to assuredly locate the levers of therapeutic process embedded in the music and to use them knowingly; on the other hand, he comes to conceive the whole therapeutic process as a musical work-in-progress and to perceive the client through her musical being-in-the-world (Aldridge, 1989; Aigen, 1996). Such an osmosis implies an awareness of the respective attributes of both music and therapy and of their amalgamation. This maturation process takes time.
The prospective music therapist may be well trained as a musician or as a therapist, but the personal synthesis of these competencies is what is at stake when we speak of becoming a music therapist. A new gestalt arises then, actualizing itself in clinical practice and in a personal conception of music therapy.
Even though we learn all our life, what and how we learn in our formal education and training as music therapists has the potential to influence what kind of music therapist we will become in a decisive way. Since music therapy is a new discipline, prospective music therapists seldom have the occasion to observe a music therapist's clinical work or to becomed involved in a music therapy process as clients before entering in a music therapy training program. The development of their professional identity, of their own style in clinical practice and of a personal conception of music therapy can thus be attributed largely to what they've experienced during their formal education in music therapy[1]. This period of their life and the persons they meet in this context[2] are important for this reason.
Brookfield (1993) says it is important for the educator to come back to his own learning experiences in order to upgrade his teaching. This article (1) describes the characteristics of learning in the field of music therapy; looks back on the Author's formative years in music therapy to identify the transformations perceived as resulting from this learning in the domain of (2) the relationship to the self, (3) the relationship to others and (4) the potential space (Winnicott, 1971), highlighting the impact of these transformations on her clinical practice and relating her findings, whenever possible, to written accounts of music therapy theory and practice.
The characteristics of learning in the field of music therapy
The concept of learning
When we speak of learning, we immerse ourselves in a pedagogical situation which comprises the student, the content matter (here, music therapy), the agent (teacher, supervisor, etc.) and the milieu (school, internship placement, etc.). Each of these elements contributes to give a pedagogical situation its unique configuration. However, in all cases, learning remains the domain of the student (Legendre, 1993).
Despite many articles on music therapy education, only a few authors center on the learner's perspective: Stephens (1987) and Memory, Unkefer et Smeltekop (1987) have pondered on the issues and practices of supervision; Bruscia (1987b) noticed the differences in clinical training profiles and brought to the forefront the issue of professional identity in music therapy education; Scartelli (1987) looked at approval standards for music therapy training programs; Maranto (1987) looked at ethical concerns in music therapy education; Briggs (1987) presented music therapy training in the context of a creative arts therapies program. To put it briefly, we know more on the educator's task and on the content matter than on the learner's perspective in music therapy education, even though Clark and Krantz (1996) studied the profiles of new music therapy students, Allen (1996) looked into dimensions of educational satisfaction among music therapy majors and Grant and McCarthy (1990) studied the emotional stages in the music therapy internship.
All aspects of a pedagogical situation influence learning (Legendre, 1993). Thus, the nature of learning in the field of music therapy, the impact of the milieu, the attitude of educators and the student's disposition towards this type of learning all impact on learning. New learning does not just pile up on previous learning (Pépin, 1994; Glasersfeld, 1987; Legendre, 1993). It implies a new synthesis, a reorganization that is truly demanding:
Learning is inseparable from varying degrees of anxiety and discomfort in the learner because it is a continuous process of imbalance and disintegration followed by equilibrium and synthesis after a more or less lengthy period of uncertainty and hesitation leading to new and more evolved structures. (Legendre, 1993, p. 68.) [3]
Learning in the field of music therapy is no exception. Glider (1987) mentions her concern over the paucity of research available on manifestations of stress and burn-out among music therapy interns and those in their first year of clinical work, since those manifestations are generally found in the helping professions. She proposes that burn-out may be one of the reasons why 37.89% of interviewees in a survey by McGinty (cited in Glider, 1987, p. 195) have stopped working as music therapists, an increase of *over 10%+ from findings of other surveys. Ten years ago, in their important study on music therapy education in the United States, Maranto and Bruscia (1987, 1988) stated their perplexity:
Undoubtedly, some competencies may be too advanced for students at the entry level, either because they are too difficult to assimilate within the allotted time period, or because they require a level of maturity or experience (both personal and/or professional) that entry level students rarely have. . . . Is it realistic to expect music therapy students to understand "psychopharmacology" or "models of psychotherapy" within a four year degree program plus an internship? Can we really expect them to master verbal, musical, or group techniques at the undergraduate level, when students in other disciplines (e.g. psychologists, counselors) struggle to learn them at the master's or doctoral level? We may very well be deluding ourselves in believing that music therapy students actually gain these competencies, or we may be diluting and distorting the competency itself to accomodate the level of learning that students do achieve. (1988, p. 52)
Learning in the field of music therapy implies all the dimensions of a person's being : the body, through vocal and instrumental play[4] ; the mind, through the mastery of concepts; and the affective domain, through the music[5]. But these dimensions are already present when one learns music; this alone cannot account for the complexity of the task. The real challenge in music therapy lies in the "therapy" polarity of the discipline:
A therapist, in music therapy, is someone who has worked on his own person to open up new channels of communication based on music and sound. One has to accept to be immersed in one's own process, one has to dive into one's own resonance... One has to be fully aware of one's own problematic if one is trying to understand the other's. To accept training in music therapy means to accept to go through a process of opening up of one's own expressive space (to express is to let go)... One has to learn to listen to oneself to be able to listen to the other. (Vallée, 1995, p. 95, 96[6])
If personal process is a must in the training of psychoanalysts or Gestalt therapists, a prolonged and sustained experience in music therapy process would be desirable in the training of music therapists. Unfortunately, it is not often the case:
All efforts to increase knowledge and understanding of music therapy will be incomplete if we forget to (...) focus on the therapist him/herself. . . . Competence is not necessarily an outcome of training but a cumulative integration of many facets of learning, experience, knowledge, observation, and insight. . . . While the training of music therapists has been a much discussed topic on national and international levels in recent years, there has been little documentation of the intricate issues involved. In many instances training programs for music therapists simply follow traditional patterns of education and leave the development of the therapist to chance, supposedly a natural outcome of accumulated facts. (Munro, 1985, pp. 75-76)
Some programs have nevertheless chosen this path. At Aalborg University in Denmark, self experience is deemed necessary to music therapy training: "The aim of Self experience training is to prepare the students for therapy work" (Pedersen, 1995, p. 27[7]). How can we take into account the impact of the milieu in this type of learning? Some authors insist on the importance of context for learning, especially on the quality of interactions between peers (Vygotsky's "zone of proximal development" as presented in Manning and Payne, 1993) and on the supportive role of teachers (Bruner's scaffolfding principle as presented in Manning and Payne, 1993). At New York University, this point is seriously taken into account:
The program provides students with many opportunities to explore themselves through music, words, and the other arts. For this to be successful, an atmosphere where the student feels safe and supported is essential. This therapeutic environment is not easy to create in an academic setting, but it is possible with careful attention and the cooperation of staff and supervisors. . . . This is no way implies the lessening of professional standards nor total acceptance of all aspects of another's work, but a respect and openness to each other. This attitude of openness is communicated to students. . . . Staff and supervisors must be carefully chosen to exemplify these attitudes. (Hesser, 1985, pp. 68-67)
Music therapists in training are often encouraged to begin (if not continue) personal therapy on top of their training. When this is done, it is often through verbal therapy. This presents important limitations when for someone learning to intervene in music therapy. Guylaine Vaillancourt (1992) has advocated the necessity of music psychotherapy for music therapists[8]. However, such an incentive does not exempt the institution offering music therapy education of its responsibility to effectively train music therapists. This is precisely where the difficulty lies because learning music therapy implies more than the cognitive domain: the learner must become involved with his body and voice, with his affectivity, creativity, sensitivity and intuition:
The vulnerability of this way of learning owes much to the way western culture has attached importance to rationality in learning processes in general. The emotional side is - whether you reflect it or not - present as an important guide for acknowledgement in the psychical potential, but most often recognized as "irrational" in this culture (...). This creates an atmosphere where it is even more difficult and painful to reflect and get personal insight through emotional work. In western culture emotional work is most often separated from rational work and is practiced in subgroups, where it - in reverse - is totally separated from rationality. Therefore I think it is important for therapists - especially music therapists - to focus on the emotional side of development, acknowledgement and learning, integrated with the rational side of learning in their own training in the formal education process - as basic tools for their future professional work. An important aspect of the work is to focus on the students' ability to interchange between emotionality and rationality. (Pedersen, 1995, pp. 27-28)
What impact can the explicit acknowledgement of music's therapeutic potential have on the music therapist-to-be? If he is engaged in music therapy education, he is already a musician; thus, he has a personal relationship to music, beauty, creativity, intuition, sensitivity, rationality, the body, the voice and the spoken word that will have to be reframed in the context of a helping relationship. This new framing is what constitutes the genesis of becoming a music therapist. The review of the literature has not yet allowed us to identify exhaustive research dealing with the way the music therapist goes from his initial state (be he a musician, nurse, student or other) to the one where he is a music therapist. This article is about this author's journey on this path.
Experiential learning
The human being learns from experience (Kolb, 1984); but having an experience is not enough. One must come back and reflect consciously on it with the aim of learning from it (Boud, Cohen & Walker, 1993). Learning from experience can happen anytime after it has been had, even many years from it (Boud et al., 1993). Some experiences can have such an impact that they unsettle previous learning (Brew, 1993). We will concentrate on such experiences because they are decisive with regard to the transformation they trigger. The learning resulting from them is qualified as experiential:
Experiential learning is when changes in emotions, knowledge and/or capacities in an individual result from a specific event. It is learning that is at the same time cognitive, affective and behavioural. It results from having had an experience and not only from knowing about a fact objectively. (Dumas, 1995, p. 46[9])
Some music therapy training programs are resolutely geared towards that type of learning. Such is the case with the master's degrees in the New York University (Hesser, 1985) and the Aalborg University (Pedersen, 1995) programs. We offer here a reflection on the bearing of this type of learning on the process of becoming a music therapist.
During our music therapy training, fundamental elements in our relationship to ourself and others have been transformed, shaping our practice and conception of this discipline. Those transformations constitute the fruits of our learning[10]. They happened in the context of an experiential-based program taking into account the manifold dimensions of learning:
During training, students are supported as they struggle to identify their strengths and work through the weaknesses relevant to the work they plan to undertake. The full range of their emotions during this process may be shared freely with staff and supervisors without judgement. This openness is modeled by staff and encouraged from the beginning. Many students are surprised and pleased to have the opportunity to be open and honest in a university setting. (Hesser, 1985, p. 69)
This program is conceived as advanced clinical training for music therapists and advocates the students' personal implication in their own music therapy process, both as clients and therapists, in the midst of the courses offered in the program. The following sections present the transformations we attribute to learning music therapy in this program in the area of (2) the relationship to the self, (3) the relationship to others, and (4) the potential space.
Learning music therapy and the relationship to the self
Learning music therapy has provoked an upheaval in the area of the relationship to the self. We shall explore it by looking at the relationship to music and beauty; the body and the voice; creativity, sensitivity and intuition; and the spoken word.
The relationship to music and beauty
Music and beauty have always had a strong influence on us. Learning music therapy has meant that music and beauty have stopped being a shelter from the world and a way to escape it to become a way of meeting it: the aesthetic experience became a therapeutic experience (Salas, 1990). Music's purely formal qualities went to the background; musical play was transformed from being a performance ordeal to a quest for authentic expression: the "true" sound, i.e. the one which really expresses how one feels inside, became "beautiful." The quest for authenticity supplanted the quest for aesthetic perfection.
The musical world itself widened to include all sound phenomena and all movements producing sounds[11]. Everything became music-making matter. This universe revealed itself as profoundly liberating because, contrary to the spoken word, it gives oppenness to expression: every person owns and discovers their own referents in the world of sound and can communicate freely. We have thus learned that everything is communication and that we cannot "not communicate" (Watzlawick, Beavin & Jackson, 1967). This discovery constituted the first foundation for our practice.
The relationship to the body and the voice
The body or the voice are necessary to produce a sound. This very simple fact has had a deep impact on us. When before, we could deny what we felt inside, such denial became impossible once what we felt materialized in a "doing" that produced an audible effect: the hands at the piano contradicting by their stiffness the beautiful words of the song, the tone of the voice jumping up an octave and manifesting the loss of the therapist's stance and the immersion in the children's play, etc. By becoming aware of our body language and of all those signs in our nonverbal expression of which, more often than not, we are unaware, we can develop our congruence as therapists[12]. Learning music therapy has allowed us to make decisive steps in this direction, thanks to the quality of interactions with peers and staff: a lack of congruence was never a cause for blame, it was an invitation to explore a phenomenon. The relationship to the body and the voice became a privileged access to self-awareness and a diagnostic tool to assess our clients' self-awareness.
The relationship to creativity, sensitivity and intuition
We have always had a fruitful and fascinating relationship with creativity, sensitivity and intuition. At 16 years of age, we decided that our main task would be to have our sensitivity and rationality work together rather than against each other. We did not know then that such a decision was leading us directly to music therapy ! In the context of music therapy, creativity, sensitivity and intuition can blossom and collaborate with rationality rather than be treated as mere servants to it. Pedersen (1995) deems sensitivity to be high in the priorities of music therapy training; Ruud (1995), Forinash (1992) and Kenny (1989, 1993) have mentioned the importance of those characteristics for clinical improvisation. Many music therapists (Nordoff & Robbins, 1977; Boxill, 1985; Priestly, 1994; Bruscia, 1987a; Marcus, 1994) state that clinical improvisation is a key component in their practice. It is in ours as well.
The relationship to the spoken word
Our relationship to the spoken word was ambiguous prior to our music therapy training. The word clung to the rational dimension in an attempt to control everything; free association itself was too enmeshed in the spoken word's iron collar to be experienced as liberating. Music was needed to bring authentic verbal communication to the fore, through song. A song is embedded in both music's affective dimension and the spoken word's explicit character; a song is a living synthesis of two worlds, the cognitive and the affective. A song allows you to situate yourself by picking up the essence of your experience on a given theme (Jackson, 1995). The following excerpt is taken from a song composed during our last year of training; it sums up the situation: "To say what I want to say / Without hiding away / To say what I want to say / Without running away". As an authentic communication, this song was the occasion of becoming aware of an important fact:"Human existence cannot be silent, nor can it be nourished by false words, but only by true words, with which men transform the world. To exist, humanly, is to name the world, to change it." (Freire, 1974, p. 75)
Saying something always implies saying it to someone: "But with you it's not as hard / To mouth the words / With you it's not as hard / To risk it out" (last verse of the song, dedicated to the members of our music therapy group).
Learning music therapy and the relationship to others
Losing is not giving. There has to be someone there to receive (Saint-Exupéry, 1948)[13].
If our relationship to ourself was transformed in many fundamental ways by our training in music therapy, our relationship to others was changed as much. The way in which we usually related to others was often unconscious. This was drastically questionned by the therapeutic context that permeated every aspect of training and especially the music therapy group. This group was a true human relations laboratory. Benenzon (1992) uses the term "didactic music therapy"[14] to describe such a group and Priestly (1994), the term "Intertherap." This does not refer to single experiences dispersed in the curriculum; it refers to a personal committment to a music therapy group and to a reflection on the interactions of all types (verbal, non verbal and musical) that go on in the group each time it meets. As all our behaviors were scrutinized, none was "lost" in the way Saint-Exupéry meant: for better and for worse, we have been "received" there from the initial phase where everyone shows their nice side - the "group illusion"[15] as Lecourt (1992) describes it - through the turbulent phase where we discover the pitfalls in our usual ways of relating, as the masks fall (Bradford, 1964), to the final phase where everyone experiments with healthier ways of relating to others. Authenticity in our relationship to others comes from our experience in the music therapy group. This prolonged implication[16] has been decisive in our process of becoming a music therapist, since our task consists of being in relation (Brouard, 1996) in contexts where interpersonal relationships are threatened, limited or unfruitful.
If our school of congruence was the music therapy group, our school of empathy was the internship and the clinical improvisation courses (piano and voice) where we had to be client and therapist with the same partner[17]. In both cases, work consisted of experiencing something and reflecting on this experience, in conformity with the principles of experiential learning (Kolb, 1984). As a therapist, we learned to listen deeply to - Saint-Exupéry would say to "receive" - the client (Amir, 1995; Langdon, 1995; McMaster, 1995)[18], his personal "tempo", energy level and affective environment, and to respond to it musically in order to provide a "resonance" to his musical and affective universe. As a client, we learned that empathy helped us to become more attentive to our own experience. The second foundation for our practice is thus rooted here: to "receive" is essential because it allows the client to become aware of what he is experiencing; that, in turn, allows him to progress. No significant transformation is possible without an awareness of what is : Boxill (1985) develops her whole approach on this "continuum of awareness."
Another aspect of the relationship to others calls for our attention here : in order to ensure viability to the therapeutic process, the therapist must offer to his client, apart from congruence and empathy, unconditional positive regard (Rogers, 1959). The therapist will be able to offer unconditional positive regard to his clients if she has the capacity to accept herself with benevolence[19]. But training in music therapy puts oneself in contact with one's limitations (lack of congruence, of empathy, musical difficulties, etc.), which makes it hard to have a benevolent disposition towards ourself. Such was our situation. If the acute awareness of the difference between our aspirations and reality has not discouraged us, it is because of the enlightened support of our teachers and the solidarity of our colleagues. This says a lot about the importance of the milieu in this type of learning: we learned to center ourself resolutely on the learning process and to let time do its job: "you can't pull on grass to make it grow" (saying)[20]. We have adopted this as our third and last foundation in our practice.
Learning music therapy and the potential space
Listen to Winnicott (1971) presenting psychotherapy:
Psychotherapy takes place in the overlap of two areas of playing, that of the patient and that of the therapist. Psychotherapy has to do with two people playing together. The corollary of this is that where playing is not possible then the work done by the therapist is directed towards bringing the patient from a state of not being able to play into a state of being able to play. (p. 38)
The kind of playing Winnicott talks about here is spontaneous play, which could correspond to free improvisation in music therapy. Lecourt (1992) compares free improvisation to free association in psychoanalysis. Free improvisation is at the core of many training programs (Benenzon, 1992; Pedersen, 1995).
One could postulate that the task of the music therapist-to-be is to develop her capacity for clinical improvisation in order to be able to bring the client "from a state of not being able to play into a state of being able to play" (Winnicott, 1971). Kenny (1989) builds her theory of music therapy on the concept of a field of play where client and therapist relate through improvised musical play. Contrary to Winnicott though, she does not speak of two overlapping areas of play, but of the creation of a new field of play constituted by the merging of two "aesthetics", the therapist's and the client's. In our opinion, this distinction is due to the simultaneity possible in the musical domain but not verbally: many persons can make music and listen to the one made by others, thus creating a sound production. During our training, the experience of the musical potential space has been marked by the conviction that "the more we understand and explore music together and individually, the better we can bring it to our clients" (Hesser, 1985, p. 68). This conviction is still vividly living in us: it is because of it that we say that for a music therapist, music must become therapy and therapy, music.
Conclusion
Through our training in music therapy, music became the matrix of expression, freeing the spoken word, rehabilitating the body, creativity and intuition, and forging healthier relationship skills by establishing through the musical potential space an open, non-threatening mode of communication. Music thus became liberating: it opened new vistas for congruence and communication. This is why we consider, together with Benenzon (1992), Ducourneau (1989) and Vallée (1995), that the task of music therapy is to open up paths of communication.
This perspective has implications when we consider music therapy training: becoming a music therapist would then signify becoming a person whose forte lies in the utilization of sound to give freedom of expression to the body, the voice, sensitivity, intuition and creativity to complement the spoken word and rationality.
How else can music therapy have the place it rightly deserves ? In this article, we presented the potential of experiential learning for the genesis of the music therapist's professional identity, its impact on the genesis of the author's practice and conception of music therapy. We have suggested to take explicitly into account the therapeutic potential of music for the music therapist-to-be, when training in music therapy, in order to do justice to the term "therapy" embedded in "music therapy."
Notes
[1] The period considered here starts with the initial steps to be admitted in a music therapy training program and ends with professional accreditation.
[2] Educators and fieldwork supervisors in the program, internship supervisors, and any person acting as an educator, consultant or representative of the institution offering the training or receiving the student or intern during the period considered, in whole or in part.
[3] Author's translation.
[4] Since the body is necessary for the production of sound, ease and tension in the body automatically affect the sound produced with the voice and on acoustic instruments. This, in turn, directly impacts on the client.
[5] "Music sounds as feelings feel" (Langer, 1942). The analogy between music and affectivity has been highlighted by many authors (Meyer, 1956; Lecourt, 1992; Pedersen, 1995; Pavlicevic, 1995).
[6] Author's translation.
[7] Pagination corresponds to the Spanish publication. Mrs. Pederson graciously sent us the unplublished English version.
[8] The Québec Office des professions (Office of the Professions) (1992) classifies music therapy as a psychotherapy.
[9] Author's translation.
[10] Our point of view on learning comes from a reflection on our experience as a learner rather than from a review of the literature. It nevertheless has deep connections with proponents of experiential learning (Kolb, 1984; Weiner Weil & McGill, 1989; Boud, Cohen & Walker, 1993) and can be stated as follows: learning is living an experience and letting it take root in awareness, endeavouring to understand it by placing it in the context of our background (and, if necessary, by reinterpreting our background in relationship to this experience), thereby renewing and optimizing our relationship to ourself and to the world.
[11] See Benenzon (1992), pp. 13-14.
[12] Pedersen (in print) advocates psychodynamic movement in the course of music therapy training.
[13] Author's translation.
[14] Author's translation.
[15] Author's translation.
[16] Participation lasted two (2) years, at the rate of one meeting per week.
[17] In analytical music therapy, Priestly (1994) advocates the same type of training in a deeper way through "Intertherap."
[18] Such deep listening comes close to the contemplative attitude (Kenny, 1993), joining in with the aesthetic experience (Kenny, 1993) and, for some, the sacred (McMaster, 1995).
[19] Rogers (1959) says a parent can accept his/her child unconditionally if s/he has such an attitude toward him/herself.
[20] Author's translation.
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