[Original Voices: Perspectives on Practice]
Demonstrating Sustainability in the Practices of Music Therapists: Reflections from Bangladesh
By Lucy Bolger and Katrina Skewes McFerran
Abstract
Sustainability is a concept that has been implied but not overtly discussed in the music therapy literature. Although authors may not explicitly cite sustainability as an objective of their work, a sustainable orientation seems to be implicit in many descriptions of music therapy practice. In this article, a music therapist’s contribution to an international development project in rural Bangladesh is used to illustrate how music therapists can embed sustainability principles into their practice. We propose that a commitment to sustainability involve time, collaboration and realistic expectations and that these are relevant throughout the planning and process of programs that work towards the achievement of independent music outcomes. It is our contention that principles of sustainability are essential to contemporary music therapists’ practice and warrant further explicit discussion.
Keywords: sustainability, empowerment, collaboration, community music therapy, international development
The concept of sustainability is becoming increasingly relevant to music therapy, as the general trend towards increased consumer participation in areas of public interest such as health, community services and governance is reflected in the discipline. However, there is some ambiguity about sustainability as a concept, because it has a variety of meanings for people in different situations, and as a result can be interpreted in a number of ways. The increasing recognition of participant decision-making and ownership as central concepts in contemporary music therapy practice has been illustrated through an emphasis on concepts such as empowerment (Daveson, 2001; McFerran, 2009; Proctor, 2002; Rolvsjord, 2004), resource orientation (Rolvsjord, 2010; Schwabe, 2005), collaboration (Elefant, 2010; Molyneux et al., 2012; Pavlicevic, 2006, Pavlicevic & Ansdell, 2009; Register, 2002) and participation (Stige, 2006, 2010). Whilst sustainability is closely related to these concepts, it has not been directly addressed in the music therapy literature.
The specific definition that we propose is that a sustainable orientation to music therapy involves prioritising and planning for the ongoing impact of a program beyond the life of the music therapist’s direct involvement. This is founded in the understanding that professional music therapy input will cease at some point. A sustainable orientation to music therapy practice therefore involves working to improve the quality of life for an individual or community through music therapy projects (“qualitative improvement”), in a way that does not require ongoing access to professional music therapy services beyond a discrete intervention period (“without quantitative increase”).
There are many plausible explanations for the absence of this kind of sustainability from music therapy discourse. There are implications for the development of the profession that result from programs where the aim is to minimize the active role of the music therapist over time. The most obvious is the creation of jobs that are short-term contracts rather than ongoing positions and an abundance of this kind of work can be challenging for professions. Alternatively, the lack of reference to the concept of sustainability may be because it is not considered relevant to music therapy practice. It is the intention of this article to present a perspective on why sustainability should be a consideration in music therapy practice, and how this may be achieved.
To illustrate how relevant this definition of sustainability is to music therapy practice, we have drawn on examples from the literature that demonstrate a sustainable orientation. We aim to encourage music therapists to consider sustainable approaches as one of the spectrum of considerations that inform music therapy practice, but not to the exclusion of other considerations informing our practice. Further to offering a specific definition, we illustrate how this has been applied, drawing on Bolger’s practical experience as a music therapist collaborating with a community supporting abandoned and abused women and children in rural Bangladesh.
Sustainability in Context
Sustainable development has been defined in the 1987 UN-commissioned report “Our Common Future”, as “paths of progress which meet the needs and aspirations of the present generation without compromising the ability of future generations to meet their needs” (Brundtland, 1987, p. 5). This broad definition has subsequently been applied to various areas of global impact, with particular emphasis on economic, environmental and social development (Daly, 1996). More recently, the importance of culture has gained increased recognition in sustainable development (Hawkes, 2001) and the United Nations Compendium “Music as a Natural Resource” (2010) highlights and supports the importance of music in sustainable community planning. These global developments have implications for the discipline of music therapy and support the need for further consideration of sustainability.
Whilst providing a useful global view, the general definition provided by the “Our Common Futures” report takes a broad and trans-generational perspective that it is difficult to relate directly to music therapy practice. A key concept from sustainable economic development provides a more tangible perspective of the same concept, highlighting “qualitative improvement without quantitative increase” (Daly, 1996, p. 3).
Music Therapy Literature Illustrating Sustainability
Although authors may not explicitly cite sustainability as an objective of their work, a sustainable orientation seems to be implicit in many descriptions of music therapy practice. For the purposes of this paper the literature is presented in two general categories that highlight sustainable approaches. These are working towards self-supporting music programs; and programs that aim to build capacity.
Working Towards Self-Supporting Music Programs
The most overt approach taken to working towards self-supporting music programs in music therapy is through consultation. Consultative approaches to music therapy work appear to be increasingly used in music therapy practice, particularly in the field of special education (Twyford, 2009; Rickson, 2009; Register, 2004; Ropp, Caldwell, Dixon, Angell, & Vogt, 2006; Chester, Holmberg, Lawrence & Thurmond, 1999). In a 2002 survey of registered music therapists in the US, 44% of the 873 respondents identified themselves as undertaking consultative work (Register, 2002). Although the definition of consultative work was very broad in this survey, the fact that almost half of survey respondents identify consultation as part of their work indicates the relevance of consultative methods.
Some examples of consultative music therapy practice in music therapy literature work towards self-supporting music programs. Several authors have described integrating children with disabilities into mainstream schools and preschools. Brynjulf Stige (2002) describes consultative music therapy work with a six-year old boy who has significant social problems in addition to some language and learning problems (p. 141). Stige worked with the boy’s preschool teacher to design a music program that he could implement and then maintained contact by incorporating periodic video analysis and collaborative discussions. Supporting the teacher to be confident in using and adapting music therapy techniques was an equally important goal of the program along with addressing the boy’s socialization and communication needs.
Another two authors propose consultative music therapy models for children with disabilities in mainstream schools, in New Zealand (Twyford, 2009) and the United States (Chester et al., 1999). Interestingly, while the pragmatics of service delivery between the models is somewhat varied, there are similarities in the fundamental elements. Both models highlight the importance of working with the organisational culture in establishing a service model that is a good fit with the local context. Both models emphasise collaboration with staff, both in goal development and the implementation of the program. Additionally, both models prioritise working together with school staff to build confidence and skills, with the ultimate goal of handing over programs for staff to undertake independently.
Consultative models have also been advocated for adults with multiple social and health challenges. Smith (2007) describes how his work brought increased attendance and diversity to a community music therapy group where participants were involved as co-leaders of the music therapy program. This approach was in keeping with the philosophy of the organisation, and was also intended to address the need for program sustainability. The peer leaders were unable to maintain the program independently however and Smith advocates for a “co-leadership approach that incorporates the clinical expertise of a music therapist with the experiential expertise of the program consumers/co-leaders" (p. 110). Smith’s article clearly identifies that collaborating with community participants to independently implement a music program can be even more challenging than collaborating with other professionals.
The forum of international development provides a less clinical context for music therapists to explore consultative approaches and to work towards self-supporting music programs. The need for sensitivity to cultural differences is more prominent in this context, shifting the lens slightly from the culture of the institution, to ethnic, religious and broader cultural foci (Bolger, 2012; Coombes, 2011; Storsve, Westby & Ruud, 2010; Rickson, 2009).
Storsve et al. (2010) outline a music education program for young Palestinian refugees living in refugee camps in Lebanon. Music educators and music therapists from Norway worked collaboratively with local staff and young people in the camps to implement an ongoing music program that promoted self-identity, belonging and personal growth for the displaced youth. The program runs in an ongoing capacity by local staff, with ongoing consultative support from Norwegian professionals (Storsve et al., 2010).
Rickson (2009) outlines a consultative project in a Thai school where staff were supported to use targeted music interventions to achieve educative and development goals for pre-school students. The author noted that short time frames to undertake the consultative process and a noisy school environment may have limited the possibility of sustainable outcomes for the school (Rickson, 2009).
Coombes (2011) also offers an important case example of a short-term music therapy project with the explicit aim of developing an ongoing self-supporting music program, in a project run by UK-based charity Music as Therapy International. In this rare example from the music therapy literature, Coombes articulates a clear sustainability orientation as the underlying purpose of her work. Based in a children’s home and school in West Bank, the consultative approach described in this project was based on a train-the-trainer model, used to establish a self-supporting music therapy program to be led by staff from the community.
Programs that Aim to Build Capacity
Capacity building as a sustainable approach to music therapy practice is demonstrated in projects that focus on building the capacity of participants so that they can continue to use skills or techniques beyond the boundaries of music therapy. This approach is focused on giving individuals and communities opportunities to develop abilities they can utilise in their ongoing lives. Many music therapy programs in a variety of settings may identify with this objective, suggesting that a sustainable approach to music therapy practice has the potential to be broadly relevant across the discipline.
Sing and Grow is an early childhood music therapy program that aims to promote positive parent-child interactions for families at-risk of marginalisation (Abad & Edwards, 2004; Williams & Abad, 2005). A sustainable approach is implicit in elements of the Sing and Grow program although it is not explicitly stated as the purpose of the work. Instead, it is demonstrated in the development of parental skills and confidence in their interactions with their child, and the provision of a resource for families to use at home (Abad and Edwards, 2004).
The research of Batt-Rawden, DeNora and Ruud (2005) describes a non-music therapy project that exemplifies a sustainable approach by developing the independent skills of participants. This research aims to understand and foster independent music listening as a tool to promote wellness for the long-term ill. Over one year, participants contributed their personal music selections to group CDs with various themes, and undertook interviews regarding the meaning and use of music in their life. The authors found that participation in the study increased participants’ awareness of their ability to use music independently to promote their health, and promoted their active use of music for this purpose (Batt-Rawden, DeNora & Ruud, 2005).
Wood, Verney and Atkinson (2004) demonstrate a commitment to sustainability in their model for music therapy work in neurological rehabilitation. In this model, the process is tailored to the needs of individuals, who participate in music therapy in sequential stages, moving from individual to group therapy, and finally being supported to explore music options independently in the wider community (Wood, Verney & Atkinson, 2004). This model describes an ongoing music therapy program that aims to build the capacity of individuals in music therapy to the point where they can draw on their own skills and their community to address their needs.
These examples suggest that there is a reason to explore sustainable practices in music therapy further. Whilst several studies present models outlining the development of sustainable programs in different settings, the author has been unable to locate any literature that broadly outlines the key considerations for developing music therapy programs with a sustainable orientation. This article offers music therapists a way to conceptualise sustainable approaches to our work, using the backdrop of a year-long international development project in Bangladesh as an example. This project took place in a refuge for abandoned and abused mothers and their children, which will be called the village. The village provides safety, food, accommodation, health care, education and training, and psychosocial support for over 130 mothers and 400 children. Mothers and children stay at the village for 3-5 years, before being supported to return to the wider community. In this setting, Bolger drew on her music therapy skills in her role as a psychosocial support officer at the village.
Illustrating a Sustainable Approach to Music Therapy Practice
A three-stage therapy model of assessment, intervention, and evaluation is often considered to be a sound general structure for music therapy process and programs using a sustainable approach are no exception. When adopting a sustainable approach there are specific considerations that need to taken into account for each of these stages. The language used to represent each stage has been chosen to reflect the collaborative nature of sustainable approaches.
Figure 1. Stages of the therapeutic process for sustainable music therapy programs.
In describing this process, community will be used as a general term to describe the group with whom the music therapist works. Depending on the overall context of a group or individual, community can mean many different things. Stige’s (Stige, 2004) explanation of dimensions of practice in Community Music Therapy describes community as a continuum moving from groups of people who are connected by location, through to groups of people connected through a shared interest or issue (p. 104). This broad continuum of community can encompass the majority of music therapy settings, including institutions such as hospitals and schools, and it is in this expansive sense that the term community is used in this article.
Stage 1: Planning
Collaboration to Identify cCommunity Issue.
This is the point at which the focus of the music therapy program is established in close collaboration with a variety of community members. This may be a long-standing community issue or challenge, or one that is identified through a combination of local community knowledge and the skills and ideas brought by the therapist. It is important that the focus of the program is an issue or challenge that is acknowledged and prioritised by the community, so that they identify with and are committed to the program. This is particularly important for programs with a sustainability focus as the community will take ongoing responsibility for the program’s outcomes. This is the point where shared responsibility and ownership of the program is established.
Figure 2. Stage 1 of the therapeutic process for sustainable music therapy programs.
Goal Development.
Three different levels of goals are relevant to sustainable programs, the specifics of which need to be identified in collaboration with the community. These levels may be understood as ideals, since not all groups will be interested in each level. Some of the broader goals may emerge over time as the music therapist becomes more familiar with the context and is able to assist groups in articulating the challenges that keep them in place.
- Community goals outline the broad achievements being aspired to that are related directly to the issue or challenge that inspired the project
- Participant goals relate to the support or skills that participants may require in order for them to confidently take responsibility for their role in the project.
- Program goals are the aims for the development and implementation of the program, and relate to the intended community music outcome for the program.
Case vignette of the creative arts carnival. The creative arts carnival was a one-week event held in the tenth month of my one-year stay at the village. The planning stage for what culminated in this event was initiated in my first month at the village. The planning process began with a meeting with the directors of the village and a local colleague who was an occupational therapist, where we outlined some key focus areas for my stay. Based on my previous work experience in special education in Australia, one of the focus areas was to try to establish some support strategies for the children who were struggling in school. I will call these children slow learners as that was what they were called at the village.
As an initial step I went to talk to the teachers in the village school, who clearly identified those children considered to be slow learners. At this early stage, the language barrier presented a significant obstacle, and rudimentary translations back and forth left a great deal of room for misinterpretation and confusion. I identified some concern that I was there to check up on their work and report back to management, and I did not have adequate language skills to negotiate this with subtlety. Trust and rapport building would take time.
Together we planned for me to attend different classes throughout the week and observe the children in class. From this I identified two general groups of slow learners, those with learning difficulties who required academic support, and those with attention difficulties that lead to challenging behaviours, hindering their learning. I also learnt that teachers predominantly used a rote learning style, which presented a challenge for the slow learners who required more interactive and creative methods.
The teachers concurred that the children needed extra support, but did not believe they had time or the expertise to do this. At this time, I did not feel that they were receptive to discussions about how to incorporate interactive and creative methods into their teaching style. Adequate trust and rapport had not been established for this to be successful. In the mean time, to support the slow learners, an auxiliary support class was developed for them, in addition to their regular classes, with a separate teacher who was trained in special education and counseling. Whist this was a good addition for the students, it did not address the difficulties the teaching staff were experiencing meeting the slow learners’ needs in the classroom.
Over the next 5 months, whenever possible I took a tea break with the teachers in their staff room, attended school functions and generally got to know the teaching staff. In ongoing discussion with them, classroom teachers perceived three barriers to using creative methods in their work: 1) They did not feel they had the skills to work in creative ways; 2) They did not have time to undertake training and implement creative programs in their work day; and 3) They would need special resources that they did not have and that were expensive.
Considering the classroom teachers’ reluctance, a training program did not seem to be the most appropriate way to share skills in this area. At this time, an enthusiastic arts teacher joined the teaching team, who was very interested in creative methods. Together, with auxiliary support from staff from all over the village, we conceptualised a 6-day creative arts carnival. One-off events were significantly more common at the village than ongoing regular programs, and in keeping with this culture of the village, the program was devised as a one-week carnival, rather than an ongoing series of events.
The aim of the carnival was to showcase a variety of simple music, art and drama techniques that could be used by staff in their work with children at the village. It was also a chance for staff to try out new techniques and observe the children participating in different ways. To address the teachers’ concerns about the need for special resources, the carnival was run using only materials that were readily available at the village.
Three activities were held daily, targeting different groups of children and adults living at the village. Different staff members were involved in planning, facilitating and participating in the activities. Music activities included word-substitution songwriting, instrument making and improvisation using scrap objects from around the village, and dancing and singing groups. The week culminated in an art and music exhibition showcasing the work done during the carnival.
The community goal for this project was increased support for slow learners in school. One of the ways to do this was to support staff to learn some different interactive methods for engaging slow learners. To this end, the participant goals for the creative arts carnival were for staff to observe and participate in creative methods for engaging children, and to observe slow learners participating using these methods. The program goal for the creative arts carnival was skill and knowledge sharing with staff.
This project bought into clear focus the importance of coming to a mutual consensus on how to address an issue. In the case of the slow learners, whilst everyone agreed that extra support was needed, there was no clear consensus on an achievable way to address the need. The teachers were hesitant to participate in structured skill sharing, so modeling music therapy techniques was identified as the most appropriate strategy for sharing skills with staff in education settings (Register, 2004; Stige, 2002; Twyford, 2009).
As a community event, the creative arts carnival was a successful program with high levels of participation from the entire village. The extent to which the creative arts carnival achieved its program goal of skill and knowledge sharing was, to a large extent, dependent on the interest and motivation of individual staff members. Informal conversations with different staff members after the event indicated that their experiences and observations throughout the process were quite individual, although generally positive. If it were possible to undertake the process again the author would have been even more explicit about the different goals for the program, which it is believed were, to a degree, lost in translation. The author would also have included a formal staff debrief to share staff member’s individual perspectives.
Stage 2: Music Therapy Group Process
The music therapy process itself will always vary based on the resources available to the community, the amount of time available, and the discretion and skills of the therapist. Two key features are necessary when taking a sustainable approach to this process.
Figure 3. Stage 2 of the therapeutic process for sustainable music therapy programs.
Collaborative Work with an Independent Music Outcome in Mind.
Based on the definition of sustainability proposed in this paper, prioritising the impact of a music therapy project beyond the scope of the program itself (the independent outcomes) is a key feature of a sustainable approach to music therapy practice. Collaboration is a crucial component of this part of the music therapy process, because in order for programs to achieve sustainable ongoing outcomes for the community, participants must have a sense of ownership and a solid understanding of the purpose the project, so that they have the confidence and motivation to use the outcomes of the project (the focus of the program goals) independently.
Focus on a Movement Towards Independence.
This feature relates to the fact that the overall objective of a sustainable music project is a self-supported outcome. Towards this end, the music therapist’s role in the process becomes gradually less active and more supportive, working towards independence.
Case vignette of the baby house music group. The baby house music group was an early childhood development group established to promote positive social interaction and healthy early childhood development. With more than 400 children living together at the village, the children sometimes used challenging behaviour as an immediate and concrete way to attract attention or express themselves. The baby house music group aimed to provide a structured opportunity for the youngest children to practice and reinforce positive social interaction with peers and adults, and concurrently promote healthy physical and cognitive development. In addition, for some young children with developmental delay, the music group was also an early intervention opportunity.
The music therapy process took a series of steps: 1) Program development; 2) Weekly music groups; and 3) Resource development and launch.
Program development. The baby house music group was a structured early childhood music program using a series of songs developed to promote specific social, cognitive, physical and communication goals. The program consisted of a combination of 12 songs in Bengali, both original compositions and word-substitutions of famous Bengali children’s songs. These songs were written in collaboration with two Bangladeshi colleagues and six young girls involved in the village music program. The songwriting process involved writing and practicing the songs, and discussing the purpose of each song, so that everyone involved knew the reason for each activity.
Weekly music groups. All of those involved in developing the program also participated in facilitating the baby house music groups, which ran two evenings every week. The children in the group (all the residents who were under 5 years) were rotated weekly in groups of 10. At this time, all facilitators and one group of children did an education session for village staff about the baby house program, including a large-scale music session, so that the whole project had the opportunity to learn about the project. Over time the young girls, with support from myself and adult facilitators, took increased responsibility for facilitation. With the group running smoothly and regularly, it was time to make a recording of the music.
Resource development and launch. All the songs from the baby house music program were recorded using a portable recording device, and the girls began using the CD in my absence. In addition, we decided to create a manual, in both Bengali and English script, with pictures, so that anyone who wanted to participate in, or even facilitate the program would know how and why we did each activity. This manual was developed with two Bangladeshi colleagues and was launched to the entire village in a ceremony planned by the young girls. All staff were invited, and the Executive Director of the village and several areas, such as the school and the therapy departments, were presented with a copy to use.
The community goals for this project were to promote positive social interactions and early childhood development for young children living at the village. The participant goals for this project were for the young girls and local staff involved to develop the confidence, knowledge and leadership skills, and to foster a sense of community ownership of the project. The program goal for this project was to develop a concrete resource that could remain as a tool for the community, in this case a CD and manual of the program.
The baby house music project experience emphasised that having a group of people from the community involved and invested in a project from the beginning can contribute significantly to the success and potential sustainability of a music therapy project. Shared events such as the education session and CD launch served to reinforce community ownership and recognition.
In this case, having a concrete music outcome in the form of the CD and manual helped to transition the project towards independence, as it could be used in the absence of the music therapist. In this way the music therapist was able to gradually withdraw participation, in preparation for my permanent departure. The CD and manual itself was the independent music outcome, however, the process of working towards that outcome was a music therapy process addressing specific community, participant and program goals.
Stage 3: Independent Music Outcome
The final stage of the process is an ongoing independent music outcome, which is community directed and facilitated. At this stage, the therapy process is complete and the music therapist’s involvement ceases. The independent music outcome reflects the program goals for the community and can vary depending on the needs of the community.
Figure 4. Stage 3 of the therapeutic process for sustainable music therapy process.
Four general types of independent music outcomes, are proposed:
- The development of a resource,
- Skills/knowledge transfer,
- The development of links to the wider community,
- The establishment of an independent ongoing program to run in the absence of the music therapist.
Case vignette of the women’s music group. The women’s music group was an ongoing weekly group where the women of the village gathered to sing and dance and share stories. The group had been established by myself and a Bangladeshi colleague, following discussions with village staff and residents. These discussions highlighted that many women had very traumatic personal histories, and that it was a challenge to cope and adjust to life in the village. It was also identified that the women needed opportunities to develop as responsible leaders. They would need these skills when they left the village as female heads of households, traditionally a male role in Bangladesh. The community goals for the group were to support the women’s coping and adjustment, and provide opportunities to develop leadership skills.
The group was a place for the women to seek and give peer support and to practice leadership skills. These became the participant goals for the group. Given the focus on leadership, the program goal was for the group to eventually be run independently by the women as a peer support group. As such, the intended community music outcome was an independent ongoing program.
The details of the group’s progress are beyond the scope of this paper[1], however, over time, the women actively used the music group for peer support, and took increased responsibility and ownership for all elements of the group. As the women’s leadership in the group developed, my Bangladeshi colleague and I gradually withdrew our active support and took a supportive auxiliary role, often arriving late to the group or sometimes not at all. This gradual withdrawal process was discussed with the women throughout the process, so that they were prepared for this change in our roles over time. We were also fortunate in this residential environment to be able to incidentally follow up with women between sessions to ‘check in’ and hear how independently-run sessions progressed in our absence.
By the time I was departing from the group, the women were taking full responsibility for the running of the group and I was confident they could continue it in my absence, if they so chose. I had seen and participated in the evolving group for one year, and saw great potential for it to develop further if the women continued to meet in the future. However, the women communicated to me that they would find the group less fun without me, and that they considered my presence, in spite of my minimal input at this stage, to be an important role in the group. I concluded from these discussions that whilst the women were confident to run the group independently, they may be less inclined to do so if I was not present. This situation was discussed at length among group members, myself included, and we identified the success of the group thus far and the benefits and challenges of continuing independently.
Ultimately, as an independent, community-led project, the decision lay with the women. To continue or not, or to evolve the group into a different form to suit their changing needs or situation was up to them. It was a challenge and an important lesson for me to let go entirely and leave the future of the group in the hands of the community to whom it belonged. Inevitably the women’s music group will have changed and adapted over time. Perhaps the women now meet when there are visitors with whom they would like to share their music, as I received word of after my departure. Perhaps the women continue to seek peer support from one another, but in a more informal way. Perhaps the groups have developed a more lesson-based focus. Regardless, the women will choose how they wish to draw on the music group experience. It was a learning for me to acknowledge that this is a part of the process.
For programs taking a sustainability focus, this stage intends to maximise the possibility of a positive ongoing impact and an independent outcome for the community. The aim of working towards an independent music outcome is not to strictly mandate the outcomes of a project, but to provide a tangible objective for the community to work towards and own, and to draw on in the absence of a music therapist. Outcomes may manifest in a way that is informal and unstructured and take a very different format than anticipated, and this is an important step in authentically integrating them into the community. A project may result in a combination of outcomes, and may develop and evolve over time, in their use and in their objective.
Since leaving Bangladesh I have had several opportunities to hear how the work we did together at the village has continued in different ways. When visiting the village website I was excited to see that photographs and descriptions of the women’s music group had been included in a slideshow chronicling the daily live of women in the village. In addition, upon returning to Bangladesh five years later I ran a brief workshop for some occupational therapists at a rehabilitation hospital in another town. I used the original songs we had developed for the Babyhouse music program as a basis, and was surprised and pleased when they informed me that they already knew those songs and asked if I had any others to show them. It was exciting to hear of ways that the music has continued and evolved since my departure, and had been built on and expanded by others. However, the reality of this approach to practice is that it is not always possible to follow up, and as music therapists it is part of our job to be prepared and willing to relinquish ownership, and trust that communities will continue the music in their own way, without us.
Discussion
Three key principles overarch a sustainable orientation to music therapy work, based on the music therapist’s experience in Bangladesh and reports from music therapy literature:
- Collaboration
- Time
- Realistic expectations
Collaboration
Collaboration is not a principle that is exclusive to music therapy programs with a sustainable orientation, however, it is highlighted as a fundamental principle in several music therapy programs using a sustainable approach in the music therapy literature (Chester et al., 1999; Coombes, 2011; Register, 2002; Rickson, 2009; Stige, 2002; Storsve et al., 2010; Twyford, 2009). A shared focus and objective is a fundamental element of all stages in sustainable music therapy practice, as identified in the common factors research in the field of psychotherapy (Duncan, Miller & Sparks, 2007). This can be maximised through active community participation and a sharing of roles and responsibility throughout the process, as demonstrated in the case vignettes of this paper.
In the baby house music group, the community was actively involved at all stages in the process, fostering a shared sense of ownership and a solid understanding of the purpose of the project. This was in contrast to the creative arts carnival. Although the community was involved in discussion around the issues in this case, the carnival itself was, by necessity, primarily driven by the music therapist with support from one staff member. This reduced the depth of the community’s understanding of the purpose of the program and the program’s potential for ongoing impact.
Time
The amount of time required, particularly in the planning stage of programs, can often be underestimated, however taking sufficient time for planning can contribute to the long-term success of a sustainable music therapy project. It allows for the development of trust and rapport, which, as an outsider working with a community, can contribute to a better understanding of how to work effectively and appropriately (Rickson, 2009; Storsve, 2010; Williams & Abad, 2005). The development of trust and rapport can assist to foster a culture of open communication, which can help to identify challenges and concerns that may not be evident to people from outside the community.
Time also allows for the development of cultural understanding. Whilst this is particularly obvious as a priority in international development projects, on a more subtle level it is relevant to all settings, given that each community has a unique culture of its own. Several examples from the music therapy literature concur that time is required for fostering cultural understanding, be that across country borders from Thailand to the Middle East (Bolger, 2012; Coombes, 2011; Rickson, 2009; Storsve et al, 2010), working with other cultural groups within one’s own country (Williams, 2005) or working as a consultant in a new workplace, such as a school (Chester et al., 1999; Twyford, 2009).
Time taken in the planning stages of the creative arts carnival allowed me to develop trusting relationships with school staff, and to better understand the dynamics of the environment. Although the program still had limitations, taking the time to understand the situation allowed me to try a different, interactive way of information sharing, which represented the concepts of creative, interactive learning that I was attempting to convey.
Realistic Expectations
It is important to be realistic about what can feasibly be achieved in a project, given the project timeframes, and the priorities and motivation of the community. All three music therapy programs presented in the case examples had potential for development and further expansion, however, within the one-year timeframe of the posting, it was not possible to follow up on all of these possibilities. For example, whilst I saw the potential for the baby house program to be delivered as an early childhood resource in the wider community beyond the village, to expand the program on that scale would have required staffing, resources and support beyond the scope of the village at that time. Often ‘thinking small’ and concentrating and consolidating one idea can increase the potential of a program being sustained independently by a community in a realistic capacity.
Realistic expectations also refer to creating programs that do not require resources that are unavailable to the community, as we endeavoured to do in the creative arts carnival, and working in consideration of the environment in which a program takes place. This was a challenge encountered by Rickson (2009), who identified that the acoustic environment at the school where she was undertaking consultative music therapy work was not appropriate for the recommendations she made for support strategies for students. An environmental factor such as this may limit a program’s potential for sustainability.
Additionally, the women’s music group highlighted the importance of realistic expectations regarding the degree of ongoing impact of the music therapy program, and the form that impact will take. This requires music therapists working with a sustainable orientation to identify that programs will be integrated into community life in a variety of different ways after the completion of the music therapy process, and that this is ultimately at the discretion of the community participants themselves.
Conclusion
The diagram below proposes a succinct visual depiction of the key features and considerations outlined in this paper
Figure 5. Summary of a sustainable approach music therapy programs.
This paper presents sustainability not as a potential objective of music therapy programs, but as an orientation to music therapy work. Taking into consideration sustainable approaches to music therapy practice does not require music therapists to adhere exclusively to the approach presented in this paper. Instead, the intention of these paper is to propose broad features and considerations, within a widely acknowledged therapy model structure, that can be incorporated as one element of existing music therapy philosophy and practice in order to maximise to potential for sustainable outcomes for participants.
When participation in a significant activity ceases, it is highly likely that there is some kind of ongoing impact for participants. This impact may be positive, such as new friendships made, new skills developed, a different outlook on life or a situation, or it may be negative, such as a sense of loss or abandonment, or a more acute awareness of difficulties and challenges previously unacknowledged. Considering sustainability in music therapy programming is about taking responsibility for this possibility and maximising the potential for music therapy programs to have a positive ongoing impact on participants.
For short-term project-based work, such as the examples presented in this paper, it may be quite evident why sustainability is a priority, as the potential for music therapy input is for a discrete period. However, this paper proposes that a sustainable focus, alongside other treatment foci, should be a consideration in all music therapy practice. Although sustainability may not be the key priority of all music therapy work, including a sustainable element in music therapy sessions can support participants to take ownership and bring their experiences from music therapy into their broader lives, drawing on the networks and resources available to them.
Sustainability is a concept that warrants further attention in the music therapy discourse, in order to understand its relevance and applicability across the discipline. Is what happens beyond closure, when music therapy ceases, something music therapists should consider, or even be working towards? The perspective presented in this paper suggests that it is. After all, wouldn’t it be ideal if, through the process of music therapy, we could support participants to reach a point where they have don’t need us anymore?
Acknowledgments
The work described in this article was undertaken by Lucy Bolger as an Australian Youth Ambassador for Development, through a government supported volunteer program for young Australian professionals to collaborate in international development initiatives with partner organisations in developing countries. Katrina McFerran was the off-site supervisor for Lucy during this time and the practices of both women have been changed through their shared grappling with the challenge of providing a service that could be of value beyond the duration of the music therapist’s input. We are both grateful to the people who participated in these projects and who welcomed Lucy so generously.
Note;
[1]Refer to Bolger (2012) for a detailed exploration of the music therapy process with this group.
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