By Emily Rose Mahoney
This paper examines multicultural issues that currently exist within the field of music therapy. Music therapists often find themselves working with clients who come from very different cultural backgrounds than themselves. Before music therapists can understand and work with clients from other cultures, they must first have an understanding of their own background and culture, and how their values and beliefs have shaped them as therapists. This paper highlights the value of multicultural awareness, and explores issues of disability, gender/sexuality, feminism, and race, as they relate to music therapy.
Keywords: multicultural music therapy, culture, disability, race, sexual orientation
Music therapy is inherently multicultural, because it deals with people, and people exist within cultures. Furthermore, the function of music is often dependent on one’s culture. Culture influences how people think, what they value, how they communicate, and how they envision themselves in the world. By bringing a multicultural focus to music therapy, we seek to understand the cultures with which our clients identify. Individuals are products of their environments, so in order to understand a person, we must first understand the environments and the contexts that define them. This holistic perspective can then help us understand how individuals function in society, and how society views them. A multicultural approach asks that music therapists strive to better understand both the cultures of our clients and the ways in which our own cultures define and shape ourselves. Through this practice, we may approach music therapy with greater empathy, self-awareness, and acceptance.
Music therapy training involves a vast amount of self-examination, yet this is not always achieved from a cultural perspective. While it seems that music therapy curricula are increasingly requiring students to demonstrate knowledge, respect, and skill in working with culturally diverse populations, programs may not always provide students with the tools they need to examine their own cultural backgrounds and challenge the biases that accompany them. Becoming a multicultural music therapist begins with increasing one’s self knowledge and acquiring an understanding of the socio-economic background and the cultures with which one identifies. We must understand who we are, how we view ourselves in the world, and how society views us. We must understand how our cultures shape our values and beliefs, and how these factors influence our identities as therapists. Then we must gain cultural knowledge of other groups, including the music from other cultures and the function that music has in these cultures.
Therapists must be able to form culturally-informed relationships with their clients. If the therapist comes from a very different cultural background than the client, that client may experience a lack of trust or disconnect. It is likely that a client’s values and beliefs will differ from those of the therapist, and the therapist should not expect otherwise. From an ethical standpoint, we need to know our limitations as therapists, and to become more aware of biases and values that influence our responses within our work. Knowing that our services may be compromised because of our biases and values, it is our ethical responsibility to seek supervision or to refer clients elsewhere when necessary. It is our responsibility to respect our clients; and in doing so we must not let our own values and beliefs, informed from our cultural perspectives, lead us to unwittingly disregard those who identify with other culture groups.
Greater awareness can come not only from examining the cultures of which we are a part, but also by immersing ourselves in relationships with others from cultures that are different from our own. By surrounding ourselves and forming relationships with those who are different from us—be it by nationality, race, religion, gender, sexuality, ability, or class—we begin to approach our understanding from experience and not just from a conceptual level. In building knowledge of ourselves and others, we have opportunities to strengthen our ability to empathize and relate, which greatly affects our work as music therapists.
Susan Hadley (2013a) discusses how individuals, groups, and societies create narratives as a means of interpreting our own and others’ experiences. Over time, dominant narratives are formed, as those that do not fit perfectly are filtered out as less significant, and these dominant narratives become our truths. These narratives can be oppressive in how they limit perceptions. Hadley writes, “I became somewhat disillusioned with therapy and the focus on ‘changing’ individuals or helping individuals to function more adequately in a system/world not wired for them...It became obvious to me that it was dominant systems/dominant narratives which were limiting what it was to be fully human” (Hadley, 2013a, p. 347). These dominant narratives, and thus many aspects of our culture, influence and are influenced by the many systems of which we are a part. They determine the ways in which individuals, groups, and societies are oppressed and the ways in which they are granted unearned privilege, most often but not limited to the areas of ability, sexuality, gender, and race.
Perhaps some of the most common groups music therapists work with are clients with disabilities, be it physical, sensory, cognitive, or emotional. While therapists may assume they are helping and have the client’s best interests in mind, they (along with other health professionals) have done these populations a disservice by not fully understanding their cultures and by not confronting their own ingrained assumptions about these cultures. Liz Crow, in the Disabled Arts Forum (1992), states that, “There is a joke amongst Disabled people that non-Disabled people listen to music, do the gardening, hold down jobs, but Disabled people do music therapy, horticultural therapy, occupational therapy. Where Disabled people are involved, almost every activity of life seems to have to be justified in terms of its medical and therapeutic benefits” (Crow, 1992, p. 1). She continues by explaining how we stereotype individuals with disabilities as a “body or mind gone ‘wrong’”, a personal tragedy which they “would gladly escape given the opportunity” (p. 1).
The stigma that comes with having a disability can cause more psychological damage than the disability itself. Those with unseen disabilities may opt to “pass” as non-disabled, but risk not having their needs met by those around them. Those who do not seem “disabled enough” risk “taking advantage of the system” or not being welcomed by supportive communities. Those with more severe (or more visible) impairments constantly deal with the stigma of being sick or broken, and impairment becomes the defining feature by which others see them. Furthermore, it doesn’t help that disabled people are in the hands of non-disabled people. Because most of the people that make decisions regarding the conditions and treatment of disabled people are nondisabled, disabled people have little voice.
Our current society is organized in a way that continuously excludes those with disabilities. Crow states, “We are Dis-abled not by impairment but by a range of discriminatory practices which remove or restrict our abilities and limit our opportunities” (Crow, 1992, p. 2). As the dominant culture, non-disabled people must work towards facilitating equality, and adapting our environments to be more inclusive and less limiting, in addition to eliminating stereotypes and assumptions that those with impairments are lesser than us.
Disability activist, Simi Linton (1998) discusses how disability has long been hidden from public view and covered up through “special” schools and institutions. She writes that people with disabilities are only recently beginning to have their voices heard, as they have joined as a community demanding to be heard. They have created a cultural narrative that provides “an account of the world negotiated from the vantage point of the atypical”, in comparison with the dominant group’s perception of disability as deficit and loss (Linton, 1998, p. 5). Linton argues in favor of dismissing the medical model of disability, which pathologizes impairment. Instead, we must look at each individual as whole--disability being just one aspect of their identity. In trying to cover up the wrongness and brokenness of those with disabilities, we have created “nice words” like “challenged” and “special”, which Linton argues is a collective defense mechanism in which “an individual adopts attitudes and behaviors that are opposite to his or her own true feelings, in order to protect the ego from the anxiety felt from experiencing the real feelings” (Linton, 1998, p. 16). Furthermore, when we adopt an attitude that is “colorblind” or “impairment-unaware” and try to hide a person’s disabilities, we are hiding something that may be a significant part of their identity. The implication, when we do not acknowledge this significant aspect of the person’s identity, is that disability is shameful. This is one way that non-disabled people invalidate the experiences of those who are disabled.
Adrienne Asch (2004) argues for adopting the human variation model of disability, which states that disability should be viewed as an extension of “normal” variation in human functioning. The problems people with disabilities experience are a consequence of social institutions failing to provide inclusive services, and limiting their services to a more narrow range of variation than actually exists. On the topic of becoming a more inclusive society, she states, “If the social norm becomes one of trying to achieve an adaptive environment that can easily respond to a broad range of talents and needs, then we may be able to accept the occasional institution or setting with fixed standards of performance” (Asch, 2004, p. 21).
Often “therapy” focuses on alleviating medical conditions, but a client with a disability may not see their condition as needing to be alleviated. Bruscia’s definition of music therapy stresses the terms wellness, change, helping, and the relationship between client and therapist (Bruscia, 1998). As music therapists, we must decide what kind of help we are offering, and what kind of change we are trying to address. This decision must be made in consideration with the client’s perception of health and change; we must gain the client’s perspective of what is healthy and what kinds of change they want to make. The relationship should be one of equality--the therapist must be able to see past the client’s diagnosis and be motivated by understanding the client and working together on goals. The first steps in doing this, after confronting one’s own assumptions, involve actually listening to clients and hearing clients’ perspective on goals they want to address, while understanding their relationship to their environment, and how they view their disability. The factors that determine one’s quality of life and concept of wellness may be vastly different from someone else’s. A multicultural music therapist does not depend on the medical model of health, and is careful not to pathologize disability; the therapist does not assume that a disabled person is in any way limited in their ability to live a healthy, fulfilling life. While we are far from achieving this goal of inclusivity, we have made strides of progress. We must continue to change by adapting our environments so that integration and equality are possible. Asch states, “I am not ready to abandon the quest for a society in which human beings are appreciated for abilities and talents; assisted based upon their needs; and where differences in skin color, gender, sexual orientation, and health status are not occasions for exclusionary or pejorative treatment” (Asch, 2004, p. 10).
Sexuality is another aspect of identity and culture that defines individuals and determines how they will be privileged or oppressed by the systems that govern our socio-economic world. The LGBTQ population is a historically marginalized group of subcultures that most music therapists will encounter, and it is important that therapists are sensitized to the issues that individuals from this population face, as well as be aware of their own sexual identity, beliefs surrounding it, and how it influences their practice and identity as a music therapist.
Annette Whitehead-Pleaux (2012) notes how LGBTQ individuals regularly experience discrimination in forms of workplace harassment, loss of employment, refusal of housing, denial of medical care, and homelessness, which affect them in many detrimental ways, including suicidal ideation, high risk behavior, mental health problems, substance abuse, and compromised physical health, as well as lack of acceptance by family and society (Whitehead-Pleaux, 2012). Many medical facilities still maintain heterosexist policies, such as limiting patient visits to immediate family, making it impossible for many LGBTQ individuals to visit or make decisions regarding their loved ones, and are often not allowed to properly grieve the deaths of loved ones. Frequently, heterosexism manifests itself in misdiagnosis or failure to identify serious problems (Chase, 2003). Chase (2003) also discusses survey research showing that lesbian and gay people often choose a therapist with the same sexual orientation and gender. Perhaps, if therapists were more educated on and sensitive to the issues LGBTQ clients face, these clients would not feel as though their options for therapists were limited.
It is important that therapists do not make assumptions about gender identity or expression, or sexual orientation. Therapist need to be aware of the many issues LGBTQ individuals may face due to discrimination and marginalization, not require self-identification for gender, and be open to using a preferred pronoun. Overall, when working with individuals from these cultural groups, therapists should continue to engage in self-reflection, to learn more about issues impacting LGBTQ individuals, and to adapt their clinical practice to fit the needs of the clients.
Feminist thought and issues regarding oppression toward women have been gaining more interest and voice within music therapy. Music therapists have coined the term feminist music therapy to describe an anti-oppressive practice that focuses on women, equality, and social justice. Feminist music therapy is rooted in the principal that the personal is political, practiced on an individual and societal level. “Its purpose is not to enable women to adjust to a dysfunctional culture, but to seek social change for all women in order to improve the situation, while at the same time seeking personal change for individual women who have been harmed by the current situation” (Curtis, 2006, p. 228). Feminist music therapy holds that interpersonal relationships must be egalitarian, empowering clients as equals. Additionally, feminist music therapists believe that a woman’s perspective should be valued, and as Sandra Curtis states, this applies not only to the client, and the client-therapist relationship, but also to the therapist’s life. “Feminist therapists are to enable their clients to understand and value women’s perspectives; they must also enable their clients to value themselves. In order to do so, feminist therapists must also value themselves, their clients, and other women, both in attitude and action” (Curtis, 2006, p. 229). Feminists in a more general sense understand that the historical and problematic system of patriarchy is in need of change, and how aspects of social life relate to gender and women’s subordination (Hadley, 2012). Hadley advises feminists to continue to raise awareness about the ways in which “the patriarchal system continues to restrict ways of being ‘human’ and continue to support oppressive practices” (Hadley, 2012, p. 3).
Like patriarchy, Eurocentrism is a system that “permeates our theories, our musical practices, our research practices, our educational practices” (Hadley, 2013b, p. 8). In a field that is primarily white, it is important for music therapists to be aware of the “ways in which racialization gets performed in various situations, it is politically and morally imperative that white music therapists do this so that they can work to reduce the harmful effects that can result from the invisibility of whiteness and find ways of rethinking and reperforming whiteness in ways that don’t reinscribe the hegemony of whiteness” (Hadley, 2013b, p. 8). Hadley calls for music therapists to look inward at how their own race affects the therapeutic relationship, witnessing their own whiteness and unearned privilege before thinking about how to work with the “other”. Race, as well as the other topics mentioned above can create and strongly influence the power differential in the therapeutic relationship, thus in addition to being educated about other cultures, it is so important to be aware of one’s own, especially when it comes to race. Aaron Lightstone comments, “I have learned that one needs to be very careful when trying to be of assistance to a group that has been marginalized. You have to do whatever work is required to get past the Othering and to know them as individuals and as people with really individual circumstances and histories, to get past the idea that this Other group is interesting and exotic because they are different” (Lightstone & Hadley, 2013, p. 37). A major theme across personal narratives in Hadley’s (2013), Experiencing Race as a Music Therapist, is how music therapists were forced to confront their own assumptions while working with individuals from another race. They grappled with addressing the power dynamic that was present because of race, and tried to empower their clients by inviting them to take the lead within the group or therapeutic relationship. Getano Bann confronts the common inner monologue of the therapist thinking they need to “fix” a client. “I think once you are in that mode, what kicks in is your belief system. And then that becomes dangerous because you are imposing your own belief system, things you’ve learned early on in life to be right” (Bann & Hadley, 2013, p. 67). Michael Viega discusses coming to terms with the term “at risk” which is commonly used by therapists. He highlights his experience with needing to use this term in order to get funding, regardless of the racial undertones that accompany it. “You know, I am calling everybody here ‘at risk’ just because they live in a poorer neighborhood and are from African-American and Latino communities. But who am I to say that they are at risk?’(Viega & Hadley, 2013, p. 169). Many respond to race with a colorblind or transcendent mentality, which essentially denies a history and culture of oppression. Shelly Tochluk (2010) calls a need for “witnesses who can help sound the bells of alarm and raise a voice in the interest of improving our ability to create healthier, more successful, and more productive relationships and institutions” (p. 3).
Music therapy has adopted a very Eurocentric approach, especially with the majority of the field consisting of white women. This may be part of the reason feminist music therapy is growing, however the Eurocentricity and whiteness of music therapy still has a long way to go in terms of inclusivity. A therapist from any dominant culture working with clients from a marginalized culture has many issues to confront. Already, the therapist is in a position of power by being of a dominant culture; being a therapist can easily exacerbate the position of power, and contribute to oppression. Unless an anti-oppressive approach is adopted, the therapist runs the risk of perpetuating oppression. Further marginalization can occur when the therapist aims to “change” the client, depending on the therapist’s beliefs and values regarding change and health. Thus, the therapist must continually engage in thorough self-examination regarding concepts of health and change, as well as the therapist’s own cultural identities.
In my opinion, “multicultural music therapy” should be a redundant term. In any health profession or social service, “multicultural” should be implied, and one’s training should be multicultural in nature. Many leaders in the field are moving in a progressive and anti-oppressive direction, especially with the emergence of feminist music therapy. However, feminism is only one part of the umbrella of critical theories that must be addressed and understood by music therapists. I believe it is necessary for multicultural topics to be implemented throughout one’s entire music therapy training, as becoming aware of these topics implies the beginning a lifelong journey of responding to them. Multicultural music therapy involves understanding the wide breadth of cultures that exist in the world. It involves understanding how individuals and societies are affected by these cultural systems, and how dominant groups are favored while others are oppressed. It involves undertaking thorough self-examination and awareness of how one fits into these systems and how one can respond to them, while realizing that there will always be more to learn. Becoming a multicultural music therapist is a lifelong journey of continuous self-reflection, cultural learning (musical and non), and adapting to fit the needs of others. However, I believe the most important of these obligations is to promote the ethical, equitable, and equal treatment of all individuals. As Asch states, “The goal is to create a society where it is irrelevant to be blind or Black” (Asch, 2004, p. 32). Lastly, we must realize the privilege we experience as therapists, and approach our field with humility. Colin Lee states, “As therapists, we gain more than we can ever hope to give our clients. We are allowed to be with them at times of great uncertainty and distress. The privilege they give is to allow us to be with them at these crossroads in their lives. We should never take this honor lightly” (Lee, 2008).
 This paper is a revision of a paper written for a Multicultural Music Therapy course I completed at Temple University in 2013.
Asch, A. (2004). Critical race theory, feminism, and disability: Reflections on social justice and personal identity. In B.G. Smith & B. Hutchison (Eds.), Gendering disability. New Brunswick, NJ: Rutgers University Press.
Bann, G & Hadley, S. (2013). The view from the floor. In S. Hadley (Ed.), Experiencing race as a music therapist: Personal narratives. Gilsum, NH: Barcelona Publishers.
Bruscia, K. (1998). Defining music therapy. Gilsum, NH: Barcelona Publishers.
Chase, K. (2003). Multicultural music therapy: A review of the literature. Music Therapy Perspectives, 21, 83–87. doi: 10.1093/mtp/21.2.84
Crow, Liz. (1992 July/August). On Our Terms. Women’s Art Magazine, 47. Retrieved from http://www.roaring-girl.com/work/on-our-terms/
Curtis, S. (2006). Feminist music therapy: transforming theory, transforming lives. In S. Hadley (Ed.), Feminist perspectives in music therapy (pp. 227-244). Gilsum, NH: Barcelona Publishers.
Hadley, S. (2013a). Dominant narratives: Complicity and the need for vigilance in the Creative Arts Therapies. The Arts in Psychotherapy, 4, 373-381. doi: 10.1016/j.aip.2013.05.007
Hadley, S. (2013b). Experiencing race as a music therapist: Personal narratives. Gilsum, NH: Barcelona.
Hadley, S. (2012). Embracing feminisms in music therapy In K. Bruscia, (Ed.), Readings on music therapy theory. Gilsum, NH: Barcelona Publishers.
Lee, C. (2008). Reflections on being a music therapist and a gay man. Voices: A World Forum for Music Therapy, 8(3). doi: 10.15845/voices.v8i3.415
Lightstone, A. & Hadley, S. (2013). Reflections on the complexities and paradoxes of identity. In S. Hadley, Experiencing race as a music therapist: Personal narratives. Gilsum, NH: Barcelona Publishers.
Linton, S. (1998). Claiming disability: Knowledge and identity. New York: NYU Press.
Tochluk, S. (2010). Witnessing whiteness: The need to talk about race and how to do it. Lanham, MD: Rowman & Littlefield.
Viega, M. & Hadley, S. (2013). Direct encounters: Challenging my sense of self as a good, moral person. In S. Hadley (Ed.), Experiencing race as a music therapist: Personal narratives. Gilsum, NH: Barcelona Publishers.
Whitehead-Pleaux, A., Donnenwerth, A., Robinson, B., Hardy, S., Oswanski, L., Forinash, M., Hearns, M., Anderson, N., & York, E. (2012). Lesbian, gay, bisexual, transgender, and questioning: Best practices in music therapy. Music Therapy Perspectives, 30(2), 158- 166. doi: 10.1093/mtp/30.2.158