The Role of Culture in Group Music Therapy in South Africa

By Andeline Dos Santos

Maiello (1999) describes how, historically in South Africa, cultural difference and white supremacy have been synonymous. In recent years, as a reaction to apartheid and racial segregation a pervasive universalist view of social phenomena emerged. Disregard and denial of cultural difference between ethnic groups resulted. For music therapy this is problematic. Denial of cultural differences between therapist and client or therapist and group members or between group members themselves catapults us back to the realm of white (the colour of music therapists in South Africa at present) supremacy. If there are no differences between us then my music must be your music, or you should at least be able to adjust to and appreciate my music. This is clearly not the case and may seem a ridiculous statement. The South African pendulum that swings between valuing equality and similarity while respecting and nurturing difference moves in a three dimensional space though. There is no neat middle point. We are a multicultural society with all the richness and all the challenges that that brings. Acknowledging cultural dynamics within music therapy is a widespread discourse as is the area of Community Music Therapy. This essay highlights specific cultural features which music therapists in South Africa are facing, using the idea of cultural "levels."

South Africa is not in an entirely unique position. We do have our own particular historical context and the specific mix of cultures in various areas of our country may be unique, but the fact that we live and work in a multicultural setting is not. Yehuda (2002, Abstract, para. 2), a music therapist working in Israel said,

The number of immigrants arriving in Israel from different cultures from all over the world, as well as the Arab population which lives with us, turns the Israeli society into a very complex society. It forces us to look carefully at the question of the role of culture in the therapeutic process.

Oksana (in Ansdell 2002, Introduction, para. 2) asks of the situation in Berlin, Germany, "How can music therapy bridge the extreme cultural diversity of the clients? Is a Western model of therapy appropriate?" Cole (2002, para. 1) in Mississippi, United States of America refers to her "own multicultural music therapy practice." Suarez (2002, para. 2) a music therapy graduate in Sydney, Australia speaks of Australia as "one of the most multicultural societies in the world."

We are not alone in facing the challenges of multicultural work. As mentioned, what does give the South African context a specific flavour though, is our history of segregation and the particular cultures that coexist in this country. With regard to this second characteristic, speaking of 'the role of culture in music therapy in South Africa' (especially with reference to group work) is a little like Stige's (2002a) critique of the word "Jambo" meaning hello in Africa. It is impossible to speak of culture in South Africa as if it was a unitary, stable, all-embracing, umbrella term. To discuss cultural factors as they impact a music therapy group of children in Kalafong Hospital's Orthopaedic ward and a music therapy group of children with learning difficulties in an 'upper class' suburban school may be a very different matter. As with all differences though, there is invariably a similarity (or two). I as the therapist bring my culture with me wherever I go. Through my way of being and through my musical choices I communicate that cultural system to my clients (Ruud in Stige 2002b). I am also required though, through a process of gaining knowledge, to communicate an understanding of the client's personal cultural experiences (Brown, 2002). Ruud stresses that:

acting musically in accordance with the client's repertoire of musical codes means not only a better foundation for musical dialogues but also a basic respect for the musical identity of the client, her "musical human rights", and ultimately her human dignity (1998, p. 26).

Culture is a rather pervasive concept. Segall (1990, in Weiten, 1995, p. 26) made the claim that "it is rare (perhaps even impossible) for any human being ever to behave without responding to some aspect of culture." Stige (2002c) cites an American literature review by Kluckhohn and Kroeber in 1952 that listed more than 160 definitions of 'culture'. Such a review compiled today would undoubtedly provide an exponentially larger figure. For the purposes of this essay, I would like to approach a conceptualisation of culture by distinguishing it from the word community. On the surface at least, these two words appear to be almost interchangeable (especially as the Encarta Concise English Dictionary (Rooney, 2001, p. 348) includes the phrase "people with shared beliefs and practices" when defining culture and "people with common background or with shared interests within society" (2001, p. 289) when defining community). Stige (2002c) reaches his own definition of culture and subtly distinguishes it from community:

Culture is the accumulation of customs and technologies enabling and regulating human coexistence (p. 38).
...
The aspects of culture focused upon in this definition may be studied at several levels: individual, group, community, society, and groups of societies (p. 40).

Culture then, manifests itself at various levels, community being one of them. It is important to bear in mind that these levels do not exist as isolated entities, but form a system (Stige, 2002b). Each level also functions as a system in itself (Pavlicevic, 2003).

One may ask how Stige (2002c) sees it possible to study culture at the level of the individual if it is involved with regulating human coexistence. Stige's understanding of 'coexistence' in this definition includes the individual's capacity to be part of a community (expressed and experienced broadly, even through thinking or dreaming) and his or her ability to use cultural artifacts.

These levels can be broadly understood. A music therapy group could fall at the 'group level'. A school or a neighbourhood could fall into the level of 'community'. The music therapy profession itself forms a community - music therapists share interests and common backgrounds. We can speak of the culture of a school or the culture of music therapy then - both in the ways in which they are similar to and different from the cultural nature of the 'whole'. This is clearly a highly simplistic and somewhat artificial picture (how does one define the whole?) but it is one that gives us reference points in the highly complex and shifting phenomenon called 'culture'.

In Western thinking, disease and disability strike an individual, in a fairly isolated manner (Stige 2002b, p. 12). A number of areas of practice in music therapy have developed (and are developing) that take a much broader view on illness and hence therapy. Some of these will be discussed in more detail at a later stage. Essentially, many of these approaches explore how music therapy could address the health of each 'cultural level' or, in relation to an individual client, to address a person's ability to function at each 'cultural level'. In his article, Community Music Therapy and the Winds of Change Ansdell (2002, Communal 'Possibilities of Action' : Towards Community Music Therapy. para. 3) elaborates on this idea by quoting Stige:

It is of specific importance to see the client as a cultural individual in the community. In fact, goals should be defined both for the individual, the music group (if the format is a group), the organizations in the community, the public institutions that are involved, the clients' neighbourhood, etc. Of course these goals will be on very different levels.

Let us examine how group music therapy relates to addressing the health of each 'cultural level' in South Africa.

The 'Individual Level'

Group music therapy has the potential to address various aspects of functioning at the individual "level" of culture. As mentioned earlier, Stige (2002c) understood this level to include the individual's capacity to be part of a community as well as his or her ability to use cultural artefacts. How does an individual's capacity to be part of a community and the desire to use cultural artefacts develop? As an infant, the individual is already "deeply embedded in a social matrix" (Stern 1998, p. 101). Pavlicevic (1997) explains that the infant enters the world with a motivation to participate in an emotional and intimate relationship. Through the exchange of shared meaning between mother and child - using essentially musical parameters - the infant experiences him or herself within a relationship. Trevarthen and Hubley (1978, in Trevarthen, 2002) described a crucial developmental stage in the last few months of the first year, where the infant seeks instruction in the ways close adult companions interact with the world. At this early stage the infant is already able to mimic, and through communication assimilates cultural meanings and conventions.

We gain [.]identity and keep it alive by celebrating the actions, feelings and experiences that we can share-and among the most intimate and powerful things to share are the ritualised patterns of art, and especially the temporal arts, of which music, song and dance can be the most spontaneous and sincere" (Trevarthen 2002, p. 34).

The capacity to be part of a community then includes the ability to relate, to communicate, to receive communications, to be accepted, and to be able to share with others.

Let us look at an example of where there could be difficulties with certain of these aspects and how group music therapy could be relevant. A music therapy group takes place at a school for children with learning difficulties in middle to upper class Johannesburg suburb. As an aside (but still on the 'individual level of culture' - especially in the Western understanding of illness afflicting an individual) the term "learning disability" could itself be understood as a cultural term. Our culture defines what is "normal" (Brown, 2002). Our cultural system also determines what kinds of learning are required for success. In one particular culture mathematical ability could be prized, whereas in another, difficulties in this area would impact minimally on functioning competently. The group of children in our example have each been referred in part for concentration difficulties. Hardwick (1998) reminds us that similar behaviours of impulsivity and multi-task attention would be valued in a different culture, for example hunter-gathering societies.

As a music therapist working with this particular group, it is enticing to immediately process the children's diagnosis of "learning disabled" from a Western cultural perspective. Although possibly sharing a common 'urban culture', I cannot automatically assume (even if it is improbable) that impulsivity or multi-task attention were not learned or valued as culturally appropriate behaviours. However, the general style of education in South Africa (as determined by the department of education) does require a certain type of concentration to succeed within the particular system. As a music therapist, assisting a child from any cultural background to function at their highest potential within the demands of this particular context is relevant, practical and does not necessarily discredit respect for cultural difference.

Before our brief diversion to the issue of culturally informed diagnostic practices, we were examining in what ways this group of children may be experiencing difficulties in their capacity to be part of community and how group music therapy could potentially assist in this process. Associated features of learning disabilities include low self-esteem, a sense of shame and humiliation due to continuing failure and frustration (Kaplan and Sadock, 1998). These can be seen as individuals' experiences in relation to the benchmark and 'norm' of achievement set by the values of his or her culture. Through providing opportunities for expression of such feelings and for experiencing success amongst peers, confidence and feelings of achievement and self-worth (Moss, 1999) may develop. The capacity to be part of a community also include social skills such as group awareness, cooperation, turn-taking and exploring roles each of which could be addressed within a group music therapy context (Hibben, 1991).

One may ask why it is relevant to address these issues in a group context as opposed to one-on-one music therapy. Apart from the broader scope of interpersonal dynamics which a group elicits (which will be discussed further in a moment) in South Africa there are other considerations. One of these is the small number of music therapists currently practicing in this country in comparison to the vast number of potential clients. Group work is the most effective means of addressing as many individuals' needs as possible. Another consideration is the "traditional African" understanding of a "group self" (Pavlicevic, 2003). Sub-Saharan African cultures use the term "Ubuntu" which, roughly translated means, "I exist because I see myself through you" (Pavlicevic 1997, p. 109). Individual suffering impacts the well being of many others and group empathy is compelled in the search for a remedy (Nzewi, 2002). "The active, supportive involvement of the community boosts the life energy of the sick" (Nzewi 2002, The African Knowledge of Sickness, para. 6) - hence community ritual healing ceremonies. To approach a problem that an individual is experiencing through group music therapy may be more compatible with this cultural system than a one-on-one approach. This 'community level' will be explored further in a few moments after we have considered the 'group level'.

The 'Group Level'

Although a group (in the theoretical framework which this essay is adopting) can be seen as a level within a larger culture, the group itself can have a 'culture' (as mentioned earlier). In this way, a group forms a "micro-society" (Pavlicevic, 2003, p. 138). A group develops a value system and norms which refer to beliefs about desirable and undesirable behaviours and objects (Benson, 1987). Pavlicevic (2003) emphasizes that the establishment of such norms needs to be a negotiated process, and it is here where multiculturalism again offers us a challenge.

Let us extend our example. The group receiving music therapy at the Johannesburg school for children with learning difficulties is comprised of the following children: two black children and four white children, one of whom has a typically Indian surname. Each child is fluent in English and this is the language used in the music therapy sessions. Although this information is not particularly enlightening regarding the group members' specific cultural backgrounds, we do get a clue that various cultural backgrounds are represented. As mentioned earlier however, there is also a more general 'urban culture' to consider as well as the dynamic results of various cultures intermingling. In a multicultural school such as this one, cultures overlap and it is within this overlap that the music therapy group is situated. Each cultural 'level' from each cultural group may influence the music therapy group in some way and integration of individual music therapy group members into each 'level' of their culture may be part of the therapeutic goals. As a music therapist one is interested in negotiating group norms as well as respecting and understanding individual cultural backgrounds - especially in light of South Africa's historical context. This is clearly a complex task.

Pavlicevic (2003, p. 133) mentions that providing music for all the subgroups within a group at the same time is complicated. She describes a group within which there are two distinct subgroups of mothers and toddlers. The group however, is still "harmonious" (2003, p. 126). The group still has a common focus although the different subgroups may experience the group differently. It is possible for everyone to feel part of the music even if certain members are not actively participating. Pavlicevic (2003) notes that subgroups and roles create dynamic, changing boundaries within the group as a whole. The therapist's challenge is to see and use these boundaries creatively.

Where toddlers possibly cannot sing and participate in the 'mothers' music', group members from different cultures are often able to participate in the music of others - in addition to being able to experience it without necessarily participating (or understanding its meaning?). Frohne-Hagemann (1990, in Stige, 2002b) described four "roads" to growth, healing and health, the fourth one being the experience of engagement, metaperspective and solidarity [responsibility for the interests of others]. According to Stige (2002b) the application of this in music therapy could be through using various different styles and genres of music (or through presentations of musical biographies (Pavlicevic, 2003)).

"In the 'partial engagement' of music as experience and expression of solidarity [.] possibilities for a better acknowledgement of oneself as a historically situated human being exist; one is given the possibility of exploring one's own position in one's own subculture, and thus also of developing intercultural solidarity" (Stige 2002b, Isabelle Frohne-Hagemann: Music as Experience of Solidarity, para. 8).

In our South African history of subjugating and separating cultures and cultural practices including music, an approach where various musical styles are used within a group music therapy session to explore, express and validate an individual's place in their own culture while developing intercultural solidarity is highly applicable.

Music therapists work with groups of society that have been marginalized (Stige, 2002). "Music therapy is important because it brings music, as cultural phenomenon and heritage, to people who have traditionally been excluded from the institutions of music in society" (Stige 2002b, Even Ruud: Music Therapy as Social Field and Cultural Movement, para. 4). We see that in group music therapy the group itself establishes a culture in which group members can gain a sense of belonging and through which they can experience aspects of social life. Within this space group members are also able (if facilitated by a culturally sensitive and educated music therapist) to express and explore music from their individual cultural background as well as experience music from other cultures, through which intercultural solidarity could develop. This contrasts the climate of disregard and denial for cultural difference mentioned in the introduction to this essay and facilitates a "celebration of diversity" (Pavlicevic 2003, p. 117).

Community, Society and Groups of Societies

Community music therapy acknowledges the cultural and social facets of illness, health, relationships and music (Ansdell, 2002). Music therapists are encouraged to consider their work along a continuum of individual to communal. "The aim is to help clients access a variety of musical situations, and to accompany them as they move between 'therapy' and wider social contexts of musicing" (Ansdell 2002, Defining Community Music Therapy, para. 3). Community music therapy rests on a notion similar to that found in "traditional African" thinking:

"an individual client is always an individual-in-context [.] sickness is seen as sickness-in-context, and consequently any 'treatment' must likewise be in context as far as possible.a community music therapist aims to enlist musicing's ability to generate well-being and potential in individuals, relationships, milieus and communities" (Ansdell 2002, Assumptions & Attitudes, para. 2).

Bruscia's ecological music therapy (in Stige, 2002b, Kenneth Bruscia: Ecological Practices of Music Therapy) also conceptualises the "client" as including the "community, environment, ecological context or individual whose health problem is ecological in nature." Even when the therapist works to facilitate changes in the individual, the belief is that such change will effect change in the ecology (and vicar versa). In this way both become healthier.

In the earlier example of a music therapy group taking place at a school for children with learning difficulties, it can be noted that this is a 'non-clinical setting' (Stige, 2002b). Music therapy has been introduced to the school's milieu, rather than asking the children to come to an external, 'clinical' venue where sessions could take place. The sound of music filters down corridors. Through communication with teaching staff and parents (that still protects confidentiality) a sense of the children's achievement, not failure; potential, not weakness; interpersonal engagement, not retreat can be conveyed. As a personal observation, this appears to instil hope and new excitement in the school community in general.

Community music therapy also requires music therapists to broaden their understanding of what music therapy 'is'. Tyson (in Stige, 2002b, Florence Tyson: The Community Music Therapy Center, para. 7) highlights how psychiatric outpatients often experience a sense of "terrifying isolation which results from the inability to relate to others." For her, the main goal of community music therapy is the resocialization of the patient and she therefore introduced group musical performances as part of a music therapy centre's activities. Through semi-annual musicales, individual development, development of the milieu at the centre, and positive development between the music therapy centre and the community were witnessed. Stige's (in Ansdell 2002, Communal 'Possibilities of Action' : Towards Community Music Therapy, para. 4) 'Upbeat' project in Norway provides another clear example. The aim was to assist adults with learning difficulties "access cultural participation through different contexts of music-making." Through 'traditional' group music therapy sessions in order to foster communication, confidence and skills followed by interaction with local community musical activities such as choral and band performances, the group was enabled to participate in their own cultural community.

To conclude, we have explored how group music therapy in South Africa can be viewed through the lens of 'cultural levels'. Group music therapy gives us a unique means of addressing the individual as an individual-in-context, as a group member, as a community member and as an active participant of society at large. This approach seems appropriate in the light of the three aspects of culture in South Africa mentioned in this essay: challenges of multiculturalism, our history of cultural segregation and the pervasive 'African' ideas concerning health and community: healing the individual involves healing the community and healing the community is seen to result in healing of the individual (Nzewi, 2002). Through group music therapy work with a music therapist who is aware of, sensitive to and respectful of cultural issues, group members who are representatives of different cultural backgrounds can be validated. Cultural diversity can be celebrated and intercultural solidarity approached. Utilizing a community music therapy approach, the individual is understood and integrated into their community.

"More and more cultures are coming into contact with each other every day. Whether that distance will become a place of understanding or a place of conflict depends on our ideas and feelings and attitudes about difference and change" (Stige and Kenny, 2002, p. 2).

Whether culture in music therapy in South Africa becomes a place of understanding or conflict depends on our ideas, feelings and attitudes about difference, certainly, and change, undoubtedly.

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