View of Converging Reflections on Music Therapy With Children and Adolescents: A Collaborative Seminar on Diverse Areas of Music Therapy Practice and Research

[Original Voices: Report]

Converging reflections on music therapy with children and adolescents: A collaborative seminar on diverse areas of music therapy practice and research

By Karin Mössler, Simon Gilbertson, Viggo Krüger & Wolfgang Schmid

In November 2012, Karin Mössler, Simon Gilbertson, Viggo Krüger and Wolfgang Schmid, joined together to provide a symposium at the national conference «Barna og deres andre» [Children and their others] in Bergen, Norway.

Even though our offices are next to each other at the Grieg Academy Music Therapy Research Centre (GAMUT) affiliated with the University of Bergen and Uni Research, this was our first joined symposium where we enjoyed the possibility to reflect on our music therapeutic work with children and adolescents in different social and clinical contexts. At the outset, we started to collaboratively work on the idea of presenting a variety of perspectives on music therapy practice with children with traumatic brain injury, children with autism as well as adolescents in child welfare. During the collaborative process, two aspects emerged as being most important. First, the aspect of presenting diverse music therapy approaches with children and adolescents at a symposium. Coming from four different countries and being trained at four different places (Austria, United Kingdom, Norway, Germany,), the idea of sharing our perspectives and experiences was of interest as a matter of intra-disciplinary work. It gave us the opportunity to learn from each other and to become more familiar with each other’s work more closely. The second aspect was that this diversity of music therapeutic approaches, as well as their theoretical and scientific foundations, could be shared with an interdisciplinary audience from different fields such as child welfare, social work, child psychiatry and pedagogy. As music therapy is still a fairly new discipline in Bergen, and in Norway generally, the symposium provided an opportunity to communicate about music therapy to professionals and researchers working in health care services for whom the field may have been novel.

Although the three papers we finally presented focused on diverse areas of the application of music therapy, our process of collaboration in preparing, presenting and reflecting on the seminar led us to identify a convergence of our reflections and ideas surrounding music therapy with children and adolescents. Whereas there are some publications on inter-disciplinary work of music therapists with professionals from other disciplines (see e.g. Twyford & Watson, 2008), this paper focuses on intra-disciplinary teamwork within the music therapy discipline itself.

Following, we present the three seminar papers and the convergence of ideas identified through the collegial collaboration.

Music therapy with children and adolescents with severe traumatic brain injury(Simon Gilbertson’s symposium contribution)

The consequences of severe traumatic brain injury are catastrophic. The damage of severe traumatic brain injuries is caused by tearing and shearing of the structures of the brain and body and also impacts upon the relationships that make up the social substance of the injured individual’s life. Although it is tempting to focus only on the injured child, it is important to consider that these consequences affect not only the injured person, but also their families, friends, members of their communities and, ultimately, society as a whole (Gilbertson, 2008). As a result, the consequences of the physical and interpersonal trauma extend through many layers of relationships, including their senses, cognition and memory, expression, agency and participation and into the essence of their relationships within themselves and with other people.

In providing a response to the needs of people affected by severe traumatic brain injury, music therapy has been used worldwide as an integrated part of neurological rehabilitation (see Baker & Tamplin, 2006 for an overview). The human body and mind are integral in the making of music and are linked to fundamental elements in music such as rhythm, phrasing, dynamics of volume, timbre, text, and cultural content. Because of this, it is possible to generate therapeutic strategies based on individual elements or combinations of these elements. Some examples of these include how melody has been used in therapeutic techniques to rehabilitate speech following neurological trauma (Baker & Tamplin, 2006), rhythmic pulse in the treatment of gait (Thaut, 2005), and improving arm movement following stroke (Altenmüller, Marco-Pallares, Münte, & Schneider, 2009). In my earlier research (Gilbertson 2005), I chose to investigate how clinically relevant change can be identified and linked to musical changes in music improvisation between an individual with severe traumatic brain injury and a music therapist. Noting the ever-changing research ongoing on music and the brain (Altenmüller et al, 2009; Koelsch, 2009), I was more concerned with the ways in which real-time music improvisation could provide a unique field and means of interaction in early neurosurgical rehabilitation (Gilbertson, 2005; Gilbertson & Aldridge, 2008).

Case Reflection: Music Therapy With Bert

After surviving a serious road traffic incident as a pedestrian, a 15 year old boy, I will call Bert, suffered a severe traumatic brain injury with multiple, minor injuries (see Gilbertson & Aldridge, 2008 for a full presentation of this case study). At the time of referral to music therapy, Bert showed no clear signs of eye contact or speech or vocalization, but did have what seemed to be spontaneous, isolated movement of his left leg, and was referred to music therapy to explore and assess potential relational communication directed towards another person. In the initial music therapy sessions, I explored the ways in which Bert’s leg movements may be framed within music-based structures of the elements of rhythm, melodic phrasing, timing, and micro-synchronization. Through repeated viewing of the archived video footage of the music therapy session, it became possible to see how not only Bert’s foot movements influenced and determined my musical communication, but also how his slight mouth movements and the pulse and dynamic intensity of my music improvising were closely related temporally. At the close of one episode of improvisation, it was clear to see how my flexible temporal adjustment of a conventional cadential pattern of chords was directly linked to the movement of Bert’s foot. This episode raised initial questions about the ways in which Bert and myself were connected at this time of severe neurological injury and interpersonal and social isolation. Though an apparent unresolvable scenario in everyday terms of an absence and total loss of contact, the identification of the concept of isolation as “a form of having minimal contact” (Soanes & Stevenson, 2003) was critical in developing the form of minimal contact in musical and non-musical communication between Bert and myself. This step was an important indication of positive progression in the process of early neurosurgical rehabilitation. Following this early phase, changes in the way in which Bert was able to develop the use of his music making provided evidence regarding how music improvisation can be a means of developing and integrating newly re-gained skills and capacities.

Because of the interactional nature of real-time music making, it is possible for a music therapist to constantly change in response to changes in the patients’ music making. It is this form of reciprocal change and adaptation that generates the quality of a unique relationship; one formed by an understanding of musical expression that is at a very finely detailed level of interpersonal communication. In my earlier research study, it was possible to identify and describe a spectrum of relating whereby isolation is interrelated with the concept of integration. The term, integrate has been defined as “combine with another to form a whole, bring into equal participation in or membership of a social group” (Soanes & Stevenson, 2003). In the context of rehabilitation, it is easy to see how change leading to a positive increase in integration is significant both for injured individuals and those around them. Another axis of relations was identified as expressed on the spectrum of idiosyncrasy and convention. Through analyzing episodes of music improvisation taken from different patients at different time points in the therapy process, it was possible to also identify the relevance of the concepts of idiosyncrasy and convention in identifying and determining the nature of change. The term, idiosyncrasy means “a mode of behavior or way of thoughts peculiar to an individual” (Soanes & Stevenson, 2003) and highlights the individual way in which actions or thoughts can be performed or carried out. In early phases following severe neurological trauma, it is common that the injured individual can be observed to move, communicate and exist in a highly idiosyncratic manner. This concept is particularly significant because of the absence of a regulatory or normative expectation of compliancy. This said, my research led to the identification of the term “conventional” as an opposite pole on a spectrum of behavior to “idiosyncratic”. The verb root of the term conventional is taken from the Latin, “convenire” and has been defined as, “come or bring together for a meeting or activity” (Soanes & Stevenson, 2003). It is in this sense that the process of rehabilitation following traumatic brain injury can be understood as a process of interactions that initially may present qualities of isolation and idiosyncrasy that increasingly present the qualities of integration and convention. This process is achieved through implicit and explicit changes in the dynamics of musical interaction performed in real-time between the patient and therapist that places demands and provides a context for the re-acquisition or learning of skills and capacities inherent in music-making which include “communication, participation, emotionality, agency, musical expression and motility” (Gilbertson 2005, p. 232). The significance and inter-relation of the two pairs of concepts, isolated-integrated and idiosyncratic-convention is their relevance in determining and describing qualities of relationship, which is the central category of my research in neurorehabilitation and has been defined as “the way in which two or more people or things are connected” (Soanes & Stevenson, 2003).

Reconsidering a Relational Perspective: A Closing Thought

Music improvisation in the field of music therapy has been expressed and framed in a variety of ways: As a creative practice (Nordoff & Robbins, 1977/2007), a contextually informed practice (Pavlicevic, 1997), a practice informed by models of developmental psychology (Stern, 2010), a practice considered in recent neuroscientific modelling (Limb & Braun, 2008), and a practice informed by compositional and aesthetic form—as in Colin Lee’s, Aesthetic Music Therapy (Lee, 2003). The diversity of these frameworks is not surprising when considering the seemingly endless number of ways that music is conceived and perceived by human beings. I would suggest that what is important here is the way in which the framework contributes to defining the situated-ness and context of the use of music in and as therapy. If this proposal is valid, it becomes easier to see that each context, ecological and systemic, will provide the criteria for the usefulness of how music improvisation contributes in and as therapy. The framework thus helps to provide an answer to the question of how people or things are related. Importantly, this is not an anonymous process that exists somewhere out there in the dark global nothingness; it is a process that is located in the situated and social negotiation of the perception and determination of meaning between two or more people or things—or, more simply put, in the relation between them.

The Quality of Relationship in Improvisational Music Therapy with Children With Autism (Karin Mössler’s and Wolfgang Schmid’s symposium contribution)

Improvisational music therapy with children with autism is an established practice (Nordoff & Robbins, 1971, 1977/2007; Schumacher, 1999; Wigram, 1999) and it has shown promising effects concerning the development of social interaction skills in this population (Gold, Wigram, & Elefant, 2006; Kim, Wigram, & Gold; 2009; Gattino et al., 2011).

In music therapy, the interaction with the child is initiated and developed through music. Musical features form and define the therapeutic way of relating with the child and open up the potential for a variety of interactions that are crucial for social and cognitive development.

It is interaction between people, that enables development and growth. The individual gets to know herself/himself by experiencing resonance from others. This is no longer only a philosophical theory stated by Martin Buber, who wrote in the 1920’s that human development happens between the I and Thou (Buber, 1970). More recently infant-researchers like Daniel Stern have shown how the interaction between infants and their caregivers influences the development of the child (Stern, 1985/2000).

Stern’s developmental theory has been especially influential in music therapy, because it supports the importance of music within human development. The resonance a human being experiences through affect attunement in its first years is based on musical features including rhythm, sound, shape, and dynamic. The caregiver’s response to the child’s expressions and needs is musical as her/his voice is among other qualities much more melodious and dynamic. These qualities can regulate the infant’s vitality affects. In contrast to categorical affects, such as anger, sadness or joy, vitality affects represent more the dynamic quality and the kinetic energy of categorical affects (Stern 1985/2000).

This experience of non-verbal resonance, togetherness, or mutual understanding is based on the human ability that Malloch and Trevarthen (2010) define as “communicative musicality.” Musical features serve as a kind of proto-communication in moments where parents and their infants share their attention and their intentions, as well as emotional experiences. In these shared moments in which the mother emotionally attunes into the infant’s world, intersubjective exchange happens. As a result of the mother’s attuning, the child is allowed the experience of being with another person. The child starts learning to interpret intentions, needs, feelings of her/himself as well as others. At this point an understanding of the child’s own inner world, which can be shared with, as well as distinguished from, the outer world, is developing and leads to a growing ability to mentalize (Fonagy, Gergely, Jurist, & Target, 2002).

In autism, skills concerning social communication and interaction, described as core symptoms, are crucially affected (American Psychiatric Association, 2000). Unlike normal development, children with autism show severe difficulties in coordinating sensory perceptions and processing them meaningfully, which is described as precondition for being able to relate to oneself and others (Stern, 1985/2000; Stern 2010). Children with autism show difficulties in experiencing intersubjectivity as they might not take eye-contact, might not show imitating behavior, and might have difficulties to interpret and reflect on emotional contents. The autistic child does not necessarily sense another person as a possibility to grow and learn because the meaning of being in relation might be hard to be perceived emotionally.

Yet, the experience of shared emotions or inter-affectivity, as Stern (1985/2000) calls it, represents the basis for all further cognitive-emotional development. Shared moments of synchronized experiences support the emotional regulation and the development of empathy but, above all, they create motivation to learn (Schumacher & Calvet-Kruppa, 1999; Schumacher & Calvet 2008). In this aspect, the autistic child needs extensive support through early interventions.

Music therapy might be an especially important intervention as it operates with principles of resonance, responsiveness, and affect attunement within the frame of musical structures. The music therapist relates to the child musically by the use of imitation, mirroring, reinforcement, complementation (of a musical line), holding or confrontation – in the sense that the music therapist might gently provoke the child, for example, by violating expectations or jointly developed patterns (Geretsegger, Holck, & Gold, 2012). Following the referents of the child by improvising music, structure is created with and through the child. To comprehend the structure, music therapists need to ensure that the child and the therapist share a common understanding of the situation as well as the musical structure in joint improvisations. In this regard it is important that the music is negotiated between the players rather than being predetermined by the therapist. It is dictated not by musical structural conventions, but rather by emotional and relational dictates (Pavlicevic, 1997). These emotional and relational dictates can be seen as reference points that are expressed non-verbally, musically, in some cases verbally by the child.

Case Reflection: Music Therapy With Marc

To illustrate improvisational music therapy with children with autism, we introduce a case study with three vignettes from music therapy with a 6-year old boy with infantile autism, whom we will call Marc. From the very beginning, Marc was interested in directing the music therapist’s musical activities. He took the therapist’s hands and put them on the instrument when he wanted her to play, and took away her hands when he wanted the music to stop. When Marc wanted her to sing, he touched the therapist’s chest to open her mouth, and touched it again when he wanted her to stop singing. This way of using the therapist as a type of “music-box,” turning her on and off, was one central theme of the therapy process. The therapist had to accept and understand that Marc was, on the one hand, used to this way of using music, similar to how he does it with his CD-player at home; and on the other hand, that he could control the situation as well as the level and complexity of the acoustic input in this way.

First Vignette: Getting Into Contact

The first vignette is from the 3rd session. Marc showed a high level of affect in this session. He was very aggressive and tried several times to attack the music therapist, directly and physically. She had to react immediately to protect herself. Later on the therapist took over the level and quality of Marc’s high affect, and attuned to it. She did this mainly in a mixture of dramatic screaming and singing his name, with glissandos. Marc became interested in this singing, laughed, and looked at the movements of the therapist’s mouth. In the following, both came into a more playful interaction, included their voices.

This vignette illustrates that it was important to meet Marc’s affective expression as closely as possible without trying to stop him. By reflecting his energy level in her voice, the therapist made a game out of it and reframed it. She created a playful and meaningful context, including and containing his affective state. This helped Marc to realize that his inner world and needs could be communicated to another person. The therapist’s role at this point of the therapy course was to be used or functionalized by the child in terms of matching and sharing his high affective state, and simultaneously acting it out.

The affective quality of these confrontations functioned as a ritual in almost all of the subsequent sessions. It seemed that Marc wanted to repeat these interactions again and again. After some weeks, Marc became more able to regulate himself through these shared moments of high affect.

Second Vignette: Exploring His Voice

Some sessions later, after a similar confrontation described in vignette one, Marc managed to regulate himself, calmed down, and became interested in the therapist’s hands and fingers. For the very first time in the therapy process, he took over musical initiative by singing the syllables "Ko-ka-ka-ka-di-ze-ze-ze." The music therapist imitated Marc’s idea vocally, and he immediately looked at her with an expression of surprise and interest. Both continued with his idea in a mutual, but still random, manner, with long pauses in between the activities. After a while the therapist played Marc’s melodic idea on the piano, reinforcing it through a harmonic accompaniment, as well as extending it through melodic and rhythmic variations. After a while, Marc joined the therapist at the piano and showed interest in a more coherent continuation of his idea.

This second vignette illustrates how Marc, after calming down, became able to focus his attention first on the fingers and hands of the therapist, almost exploring them. It also illustrates how he was able to introduce a musical idea for the very first time, not using the therapist as a “music box”, but singing on his own. Marc explored his voice as a personal medium of expression. He discovered himself as the owner of an idea, and got in contact with himself and his own abilities. He found confirmation by the therapist taking over this idea and extending and varying it. In this way, Marc experienced the idea of ownership and self-efficacy.

As therapy continued, he became more and more able to initiate on his own, especially with his voice. The next vignette, from a session three months later, illustrates this.

Third Vignette: Singing Our Song

This vignette is from the beginning of session 22. Marc and the therapist sat next to each other at the piano. The greeting song referred to Marc’s own idea, introduced by him in a former session with the syllables “”. Both Marc and the music therapist created the music in an improvised setting — the therapist repeatedly singing “Marc is here,” and Marc singing some single words from this line. Marc used his voice in an explorative, playful way, having fun and making eye-contact with the music therapist. He watched himself in a mirror installed in the room while moving his body to the music. He spontaneously imitated the word "Hurra“ for the first time, and playful turn-taking was established.

The three vignettes are representative examples from the music therapy course with Marc. They show the importance of matching a child’s affective state even on high levels of arousal and aggression. It is important to help the child to avoid becoming overwhelmed with these feelings, and to support and contain the handling of it. In this way the child can find self-confidence and trust in another person. This self-confidence forms the basis for further exploration and expression of musical ideas. After having experienced this, Marc could better initiate and interact. He explored his vocal capacities in manifold ways, finally sharing varying affects of joy and togetherness with the music therapist. He extended his repertoire of actions, and showed increasing interest in language use and language development.

Shared Moments: Some Closing Thoughts

The three vignettes from improvisational music therapy with Marc illustrate how music therapy can support an autistic child in developing the capacity for interpersonal relating. It is crucial that the music therapist is aware of the current developmental state of a child and of her/his ability to tolerate offers of contact by others, and to build up relationship. These ways of relating must be flexible and variable in their quality, as portrayed in the three vignettes. Building up relationship includes ways in which the music therapist can be functionalized by the autistic child. He or she might use the therapist like an instrument or a tool for getting her/his own needs regulated or fulfilled, as described in the first vignette. In such phases, the music therapist might experience feelings of being neglected, ignored, or not recognized as a person. However, it is important for the establishment of relationship not to insist on a more explicit interaction in these situations, but to show acceptance towards the child’s current needs in handling the affect. Based on previous research closely related to developmental psychology, Schumacher, Calvet and Reimer (2011) describe the developing interaction process between the autistic child and the therapist through 7 contact modi. It starts with modus 0 “lack of contact” and approaches towards modi 6 “joint experience/ interaffectivity”. Within these different modi, the quality of relationship depends on the occurrence of synchronized moments in which the child and the therapist can share their experience. This can be a shared atmosphere, a shared sound, a shared rhythm, a shared attention, a shared intention, or a shared emotion. The aims within the musical therapeutic process are to support the child in her/his ability to build up contact to herself/himself, to objects (e.g. music instruments), and to others (e.g. music therapist). It is the experience “I am hearing what I am feeling” that should be made reachable for the child (Schumacher, 1994). Specific musical and relational opportunities will support the experience of shared moments or inter-affectivity, as Stern (1985/2000) calls it, providing the basis for all further cognitive-emotional development.

Music Therapy, Adolescents and Children’s Rights (Viggo Krüger’s symposium contribution)

If I don’t like myself, and I don’t even care
How can anybody else like me when I don’t even like myself?
When nothing goes my way and everything turns grey
I need some kind of push to get me out of here
(Excerpt taken from the song “Is there somebody there for me”, composed by a client)

The uses of child welfare services in Norway are increasing in frequency and complexity (Backe-Hansen & Bakketeig, 2008). Increasing use of child welfare services does not imply that conditions are becoming better. As Clausen and Kristofersen (2008) have highlighted, adolescents that have lived in the care of child welfare services may risk ending up with poorer life-conditions compared to those living at home with their biological parents.

Challenges in Norway can be seen in relation to the rights of children as defined by the UN Child Convention (CRC). The ideological foundation of the UN Child Convention is complex and should be treated as such. The CRC was established in 1989 and includes 54 articles ranging from civil, cultural, economic, political, and social rights. The convention articulates basic human rights adapted to children and adolescents (UN Committee on the Rights of the Child, 2005). Child welfare practice in Norway is based on values from the CRC, in particular with regard to the concepts of provision, protection, and participation (Cantwell, 1993; Strandbu, 2011; UN Committee on the Rights of the Child, 2003).

Recently there has been an increase in interest in music therapy and child welfare particularly within discussions of community music therapy (Krüger, 2012; Stige & Aarø, 2012). There are available accounts on how music therapy offers certain possibilities in relation to child welfare work. As argued, music can be a multifaceted and complex resource useable for the promotion of different forms of participation. Music may be used to facilitate the voice of the child as well as give individual and social support (Krüger, 2009, 2012; Stige & Aarø, 2012). The concept of participation can be used to consider participation from different perspectives following Stige’s (2006) notion:

Participation is a process of communal experience and mutual recognition, where individuals collaborate in a socially and culturally organized structure, create goods indigenous to this structure, develop relationships to the activities, artifacts, agents, arenas, and agendas involved, and negotiate on values that may reproduce or transform the social and cultural structure (Stige, 2006, p. 134).

Following Stige’s (2006) definition of participation, the concept may have several meanings that are not necessarily exclusive and may be seen as mutually constitutive. Participation, as defined this way, may function as a conceptual bridge needed to implement the different meanings of participation inherit in the CRC.

Case Reflection: Music Therapy With David

The lyric excerpt above is taken from the song called "Somebody out there." The song is written by one of the adolescents participating in music workshop organized through a child welfare organization in Norway. The work with the music workshop may be regarded as a form of community music therapy (Stige & Aarø, 2012). The lyric is quoted to give an example of how songwriting can be used in music therapy with adolescents in the context of Norwegian child welfare. The lyric highlights the importance of listening to young people’s voices in order to make good enough practices in context of child welfare work (Skivenes & Strandbu, 2006). The argument of listening to the voices of adolescents to decide content of practice is taken from the UN Child Convention, especially regarding articles concerning children’s rights to be heard and to be empowered. The author of the lyric is an adolescent who I will call David. David participated in a music workshop for four years. During that period, David lived at a child welfare institution. Through these years David learned how to play instruments, he learned how to use music technologies such as recording equipment and he developed skills in songwriting and performing. At the time the above lyric was written, David felt confident in using musical instruments and he liked to perform. Through participation in music making processes, David gradually developed confidence in the art of storytelling and hence for the construction of important stories. Through songwriting, David found a language for his experiences, thoughts and feelings. He thus became able to tell stories about aspects of his life situation he otherwise did not feel very confident about, namely being labelled as a child welfare child or being called a trouble child at school. Through various music activities, David found ways to communicate his experiences to a listening audience. David’s music hence became a tool for managing potential difficulties in his life situation. Through demonstrating his abilities and capabilities in music, David could stand up for what was especially challenging; being a troubled adolescent living under difficult conditions. Through the music, David was enabled to use his skills as a musician and songwriter to tell a different story about being alone and having low self-esteem. Because family members, social workers, and teachers from school were invited as audiences to a concert where the song was performed, important people in David’s life could take part in his storytelling. The story about David can teach us how individual and social resources can be used strategically in child welfare work. As the story with David informs us, music can become an important resource for the forming, expressing, and communicating different personal views. Hence, the use of music may facilitate possibilities in working with confidence, mastery, identity, and thus may give voice to the individual child or adolescent. Given conditions like these, music therapy can be used in order to promote the intentions inherent in the UN Child Convention (2005).

What Can We Learn From the Adolescent’s Voices?

The theme of music and children’s rights are explored and elaborated in Krüger’s (2012) doctoral thesis, a qualitative study consisting of interview material from adolescents living under institutional care. Based on qualitative analysis of interviews with 15 adolescents, Krüger found the following findings described as constructed themes:

First, the study indicates that the adolescents have experienced serious challenges related to life and upbringing in the child protection institution. The adolescents tell about problems with moving and unstable social relations. Furthermore, they tell about issues related to missing or poor quality of dialogue with adults. They also tell about negative identity formation related to stigma from others, as well as the lack of or poor quality of recreational activities. The interviews reports reveal paradoxical situations in relation to the UN Child Convention, especially due to young people's rights to participation, safety and individual freedom.

Second, the adolescents expressed that music can be an important resource in the way they organize and make meanings in everyday life situations. These findings show that music is an important part of the way young people process thoughts, feelings, and experiences of social participation. The adolescents’ descriptions show that some music can be used in order to create personal reflection and engage in individual self-care.

Third, the adolescents expressed that music – as offered in the context of community music therapy workshops – can function as a structuring resource related to participation. This focus has led to the development of perspectives on how music affords resources for contact with adults and support from peer group communities. Although not all stories are equally positive, most of the stories generally indicate that participation has led to positive changes.

Fourth, the young people's narratives indicate that music makes it possible to establish meeting places where music can be used as a resource to communicate an important message to others, as well as challenge established positions of power. By letting young people speak through music, acceptable protest actions are formed and expressed, such as sending the message of an alternative child welfare identity (Krüger, 2012).

The Need for Multiple Music Therapy Strategies in Context of Child Welfare: Some Closing Thoughts

Music may be regarded as giving structure to a complex set of participatory practices (Sinclair, 2004). The role of the music therapist and related music therapy strategies need to be multifaceted. First, there is need for an individual approach to music therapy in child welfare. This strategy includes person-oriented activities such as conversation, songwriting, and the use of music technology. Second, there is need for a community-oriented strategy wherein activities such as playing in a band or doing songwriting collectively are in focus. This strategy facilitate peer group relations, and contact with family members or adults from child welfare institutions. The third strategy can be described as a form of citizen participation. This strategy involves working with community-related aspects such as values, rights, and attitudes (Stige & Aarø, 2012).

The music therapy strategies outlined above provide opportunities to work in the tension between the individual and the community, and between dependence and independence, all dimensions that are relevant in relation to the rights of the child according to the UN publication (2005). These strategies provide multiple perspectives, where work with the individual can be seen in relation to the community and thus in relation to collaboration with other people and social environments. While working methods may vary, the goal can be the same — namely, to enhance the individual's ability to succeed in relation to society's opportunities and limitations. Music's role in the socialization process is complex; it can be used for a variety of purposes where the use may change in relation to contextual factors. Music's potential as a structuring resource spans an unlimited number of combinations. And as we saw in the vignette with David, music can function as a resource that, when used in the right way, may change social realities and alter power relations.

For the development of nuanced practices, nuanced theoretical perspectives are needed. According to the sociocultural perspective, music (and other available cultural resources) can be used in order to create and transform experiences of action related to various contexts of human agency (Stige & Aarø, 2012). Music may be regarded a form of resource that children and adolescents use in order to create and transform identity as well as possibilities for action (Ruud, 1997). Because music is an important part of young people’s lives, it represents a variety of possibilities in implementing the values of the CRC. As described above, music may be used to facilitate the voice of the child as well as give individual and social support. These ways of working with participation is in line with the CRC.


As a team of scholars who have been collaborating at GAMUT during the past few years, the symposium offered an opportunity to become better acquainted with each other’s practical work. Having different theoretical backgrounds originating from psychodynamic and humanistic traditions, our practice is framed using different rationales and terminology. These theoretical backgrounds were not predominantly of interest while sharing our case material and discussing it. Moreover, discussing practical examples revealed common strategies in responding to our clients´ needs as well as challenges in building up a relationship with them. It was fairly unsurprising that a relational perspective of music therapy emerged as our common basis, and that there was agreement about how the active involvement of the client is crucial for building up a relationship between therapist and client. Listening to our clients’ needs and emphasizing their resources provides the basis for all further phases of the therapeutic process. This further implies that a relationship does not only exist when communicating directly with each other, but begins to emerge when we, as therapists, are able to relate our responses to our clients’ needs. Minimal vegetative responses expressed through changes in breath or pulse might inform our music when working with non-verbal clients in early neurorehabilitation. A child with autism who is not engaging in contact can be provided with a relational context by offering music which creates an accepting atmosphere and acknowledges the child being alone. Adolescents in child welfare might in a different way deny contact by showing difficulties in communicating their needs verbally. However, they might be interested in making music, and songwriting becomes an opportunity for personal expression as well as performance and social participation.

These examples can be based theoretically on developmental and relational theories as well as human rights perspectives. In other words they are oscillating between an intra-psychic, inter-psychic as well as a social role performance dimension (Hill & Lambert, 2004). Focusing, for example, on an emerging awareness of ones own body might be central when working with children with autism or traumatic brain injury; whereas giving voice to adolescents to support their active participation within society might be of central interest when working in child welfare. Even though social role performance dimensions might differ when working with different group of clients, all three dimensions might be present all the time. Involving children with autism in processes of participation can be reflected in the light of basic human rights defined by the UN Child Convention emphasizing a social role performance dimension. Likewise, intra- and inter-psychic dimensions become visible when reflecting dynamic processes in the work with adolescents at risk in terms of developmental theories. To oscillate between these dimensions opens up the possibility to maintain a distinct theoretical perspective while simultaneously being able to change the perspective. Using these dimensions as a reference point might facilitate communication processes when discussing music therapy within teams, including professionals from different music therapy cultures. Finally, to focus on our direct work with clients helps us in creating a reflexive openness for each others working modes and backgrounds. Like in the actual therapy situation, in the collaborative process, our clients provided a crucial basis for understanding music therapeutic work. Taking our clients as a starting point was a fruitful experience in our intra-disciplinary process in establishing a mutual understanding for our various ways of understanding music therapy.


Altenmüller, E., Marco-Pallares, J., Münte, T. F., & Schneider, S. (2009). Neural reorganization underlies improvement in stroke-induced motor dysfunction by music-supported therapy. Annals of the New York Academy of Sciences. 1169, 395-405.

American Psychiatric Association (2000). Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR) (Vol. 4th edition, text version). Washington, CD: American Psychiatric Association.

Backe-Hansen E., & Bakketeig, E. (Eds.) (2008). Forskningskunnskap om ettervern [Research based knowledge about aftercare]. Norsk Institutt for forskning om oppvekst, velferd og aldring. Rapport nr. 17, Oslo: NOVA.

Baker, F., & Tamplin, J. (2006). Music therapy methods in neurorehabilitation: A clinician’s manual. London: Jessica Kingsley Publishers.

Buber, M. (1970). I and Thou. A new translation, with a prologue and notes by Walter Kaufmann. New York, NY: Touchstone.)

Cantwell, N. (1993). Monitoring the convention through the Idea of the 3 P`s. Eurosocial Rapport, 45, 121-30.

Clausen, S.E. & Kristofersen, L. B. (2008). Barnevernsklienter i Norge 1990 - 2005, en longitudinell studie [Child welfare users in Norway 1990 – 2005, a longitudinal study]. Norsk institutt for forskning om oppvekst, atferd og aldring, Rapport nr. 3, Oslo: NOVA.

Fonagy, P., Gergely, G., Jurist, E., & Target, M. (2002). Affect regulation, mentalization and the development of the self. New York: Other Press.

Gattino, G., Riesgo, R., Longo, D., Leite, J., & Faccini, L. (2011). Effects of relational music therapy on communication of children with autism: a randomized controlled trial. Nordic Journal of Music Therapy, 20(2), 142-154.

Geretsegger, M., Holck, U., & Gold, C. (2012). Randomised controlled trial of improvisational music therapy's effectiveness for children with autism spectrum disorders (TIME-A): study protocol. BMC Pediatrics, 12 (2), doi:10.1186/1471-2431-12-2

Gilbertson, S. (2005). Music therapy in early neurorehabilitation with people who have experienced traumatic brain injury. Unpublished doctoral thesis. Witten: Faculty of Medicine, University of Witten/Herdecke.

Gilbertson, S. (2008). The silent epidemic of road traffic injury: What can music therapists do about it? Voices: A World Forum for Music Therapy, 8(1). Retrieved from:

Gilbertson, S., & Aldridge, D. (2008). Music therapy and traumatic brain injury: A light on a dark night. London: Jessica Kingsley Publishers.

Gold, C., Wigram, T., & Elefant, C. (2006). Music therapy for autitstic spectrum disorder (Review). Cochrane Database of Systematic Reviews, 2.

Kim, J., Wigram, T., & Gold, C. (2009). Emotional, motivational and interpersonal responsiveness of children with autism in improvisational music therapy. Autism,13(4), 389-409.

Koelsch, S. (2009). A neuroscientific perspective on music therapy. The neurosciences and music 3 – Disorders and plasticity: Annals of the New York Academy of the Sciences, 1196, 374-384.

Krüger, V. (2009). Musikkterapi som hjelp til selvhjelp [Music therapy as assisted self-help]. In Ruud, E. (Eds.), Musikk i psykisk helsearbeid med barn og unge [Music in mental health work with young people] (pp. 171-186). Oslo: The Norwegian Academy of Music.

Krüger, V. (2012). Musikk – fortelling – fellesskap, en kvalitativ undersøkelse av ungdommer sperspektiver på deltagelse i samfunnsmusikkterapeutisk praksis i barnevernsarbeid [Music – narrative – community, a qualitative investigation of young people’s perspectives on participation in community music therapy in the context of children’s welfare]. Unpublished doctoral thesis, Bergen: The Grieg Academy, University of Bergen.

Hill, C. E., & Lambert, M. J. (2004). Methodological issues in studying psychotherapy process and outcomes (5th ed). In M. J. Lambert (Ed.), Bergin and Garfield's handbook of psychotherapy and behavior change. New York: John Wiley & Sons.

Lee, C. (2003). The architecture of aesthetic music therapy. Gilsum: Barcelona Publishers.

Limb, C., & Braun, A.R. (2008). Neural substrates of spontaneous musical performance: An fMRI study of jazz improvisation. PLoS ONE, 3(2): e1679, doi:10.1371/journal.pone.0001679

Malloch, S., & Trevarthen, C. (2010). Communicative musicality. Exploring the basis of human companionship. Oxford: Oxford University Press.

Nordoff, P., & Robbins, C. (1971). Therapy in music for handicapped children. London: Victor Goolancz, Ltd.

Nordoff, P., & Robbins, C. (1977/2007). Creative music therapy. New York, NY: Harper and Row.

Pavlicevic, M. (1997). Music therapy in context: Music, meaning and relationship. London: Jessica Kingsley Publishers.

Ruud, E. (1997). Musikk og identitet [Music and identity]. Oslo: Universitetsforlaget.

Schumacher, K. (1994). Musiktherapie mit autistischen Kindern [Music therapy with children with autism]. Stuttgart, Jena, New York Gustav Fischer Verlag.

Schumacher, K., & Calvet, C. (2008). The "AQR-instrument" (Assessment of the Quality of Relationship). An observation instrument to assess the quality of a relationship. In T. Wosch, & T. Wigram (Eds.), Microanalysis in music therapy: methods, techniques and applications for clinicians, researchers, educators and students. London, UK/Philadelphia, PA: Jessica Kingsley Publishers.

Schumacher, K., & Calvet-Kruppa, C. (1999). The "AQR" - an analysis system to evaluate the quality of relationship during music therapy. Nordic Journal of Music Therapy, 8(2), 199-191.

Schumacher, K., Calvet, C. and Reimer, S. (2011). Das EBQ-Instrument und seine entwicklungspsychologischen Grundlagen. Göttingen: Vandenhoeck & Ruprecht.

Sinclair, R. (2004). Participation in practice: Making it meaningful, effective and sustainable. Children and Society, 18(2), 106-118.

Skivenes, M., & Strandbu, A. (2006). A child perspective and children's participation. Children, youth and environments, 16, 10-27.

Soanes, C., & Stevenson, A. (Eds.). (2003). Oxford dictionary of English. Oxford: Oxford University Press.

Stern, D. (2010). Forms of vitality: Exploring dynamic experience in psychology, the arts, psychotherapy, and development. Oxford: Oxford University Press.

Stern, D. (1985/2000). The interpersonal world of the infant. New York, NY: Basic Books.

Stige, B. (2006). On a notion of participation in music therapy. Nordic Journal of Music Therapy, 15(2), 121-138.

Stige, B., & Aarø, L. E. (2012). Invitation to community music therapy. New York: Routledge.

Strandbu, A. (2011). Barnets deltakelse, hverdagslige og vanskelige beslutninger [Children`s participation, decisions in everyday life and in difficult situations]. Oslo: Universitetsforlaget.

Thaut, M. H. (2005). Rhythm, music, and the brain: Scientific foundations and clinical applications. New York: Routledge.

Twyford, K. and Watson, T. (2008). Integrated team working. Music therapy as part of transdisciplinary and collaborative approaches. London: Jessica Kingsley Publishers.

UN Committee on the Rights of the Child (CRC) (2005). CRC General Comment No. 7 Implementing Child Rights in Early Childhood, 20 September 2006. Retrieved from:

Wigram, T. (1999). Contact in music: The analysis of musical behaviour in children with communication disorder and pervasive developmental disability for differential diagnosis. In T. Wigram, & J. De Backer (Eds.), Clinical applications of music therapy in developmental disability, paediatrics and neurology (pp. 69-92). London, UK: Jessica Kingsley Publishers.

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