A Reflexive Music Therapy Clinical Introspection in Working with Foster Care Youth

Introduction

Introspection was first developed as a research technique by Wilhelm Wundt (McLeod, 2008). The idea was for the psychological researcher to observe their inner thoughts, feelings, and emotions as it related to a phenomenon. It would seem that music therapists would be introspective in their own work– meaning, practicing self-awareness and reflection on the therapeutic processes. As part of the purpose of this paper, we wanted to take a clinical introspective of the published literature on music therapy with foster care youth. What initially transpired seemed more related to a heuristic approach.

A heuristic approach is an adaptation of phenomenological inquiry, but explicitly acknowledges the involvement of the researcher, to the extent that the lived experience of the researcher becomes the main focus of the research. The focus of the approach is the transformative effect of the inquiry on the researcher's own experience (Douglass & Moustakas, 1985). Also, like clinical introspection, a heuristic approach “requires a subjective process of reflecting, exploring, sifting, and elucidating the nature of [a] phenomenon” (p. 42). Since the beginning of this article process, the reflections have involved self-search, self-dialogue, and hopefully self-discovery. The process continued as a group search, dialogue and discovery “to receive it, accept it, support, and dwell inside it” (Moustakas, 2001, p. 263). Although this paper is not a research study, qualitative research methodology such as heuristicism and clinical introspection is embedded in the paper.

It is a challenge to write about the experiences of individuals in music therapy, while also honoring their experiences as co-participants of the process. There is also a challenge and struggle to research and write about child welfare populations as the therapist is many times the “voice” of the youth. In this context, the term youth is used to represent young children through adolescence. As there is an imbalance in therapy at times, there is an imbalance in the youth’s experiences, not only in music therapy but in their everyday lives. However, the focus and intent of the therapeutic process with foster care youth is about “being in relationship” (Abrams, 2012) and not about doing. At the time, around 2004, when the first author started practicing and researching with foster care youth, there were very few clinical writings in music therapy and no research studies that specifically focused on the musical characteristics of foster care youth. It would seem that although the youth’s experiences would be different than youth not in foster care, the connection to their own music experiences would be similar. In fact, with one youth who was abruptly moved from a foster home, “he compared the loss of his iPod as being similar to the loss he felt when he had been separated from his biological parents” (Zanders, 2012, p. 72).

This special issue on child welfare promotes the idea of understanding the resources that youth need, providing a space for professionals and youth to have a voice and collaboration between those who have involvement in the child welfare system. It would then seem essential to promote the critical thought of professionals and music therapy students who have personally encountered the child welfare system as it relates to foster care and adoption. As part of this approach, three other authors, two pre-professionals (one undergraduate and one graduate) and a professional, have provided their perspectives, their voices, on the experiences within the child welfare system and also the music therapy literature on foster care youth. Two articles- one theory and one research; and one chapter-practice based- were chosen (Zanders, 2012; Zanders, 2013; Zanders 2015). Additional music therapy literature related to foster care, as applicable, was used as a foundation to the dialogues and introspection, i.e Kruger and Stige (2014).

In analyzing the literature and describing their own experiences to the first author, further discussion revolved around: How are the youth perceived in the literature? How do the music experiences relate to their own experiences? What are the roles of the music therapist and the youth? Are the youth reflexively and appropriately discussed within the literature? What seems to be the nature of the music therapy relationship? How would music therapy have related to your life, or not? Initially, through navigating the literature and experiences of foster care through their lenses, although not receiving music therapy as youth, their voices were representative of the themes presented in the literature. However, what emerged was a critical reflection on power and privilege and how both the youth and the music therapists represent and strive for both authenticity and genuineness.

Privilege and Power: Reflexivity in Practice

In Midach’s first placement, the foster couple immediately began reporting that she was a blue baby, which is a baby with a blue complexion from lack of oxygen, due to a congenital defect of the heart or major blood vessels. Neither her case worker nor medical staff ever saw evidence of the condition. However, she does remember frequent visits to the doctor and being restrained while they drew blood for constant monitoring. Eventually her case worker determined the foster parents were attempting to turn her in to a “special needs” infant so she could remain in their home. Unfortunately, their strategy was partially successful in that they did usurp her chances for an adoptive placement. This idea of foster parents “forcing” a medical or psychological diagnosis is not uncommon. Zanders has compared this to an emotional type of Munchausen by Proxy syndrome. Foster parents receive more money and attention with foster youth who have medical and psychiatric concerns. There is no research to ‘prove’ this syndrome, although there is sufficient information in noting the systematic marginalization of pathology that occurs within foster care (Zanders, 2013, 2015). Particularly, as each of the authors are from and experienced foster care in the United States, the focus on the medical model within mental health lacks a salutogenic approach in viewing health on a continuum which situates the youth in their own personal, ecological, and emotional context.

For Waldmeier, growing up in predominately white Portland, Oregon, on the beautiful West Coast, as an adopted child from Bogotá, Columbia was very complex for her at times in terms of understanding or struggling with identity. In the city that she lived in (suburb of Portland) which is a predominately upper middle-class demographic, she was the only South American child (besides one other Peruvian family) in the community. Growing up, she was frequently asked "what are you?” Her adoptive mother, a sweet white Swedish Scandinavian woman who grew up in North Hollywood, California, studied Latin American economics/ history and Spanish in college, traveled abroad for her master’s education, and then lived in Bogotá Colombia in the early 1970s. After Lindy’s birth, she lived in Bogotá for a few months before returning to California when she was about eight months old. Waldmeier believes that for the nine and half months that she was in her biological mother's womb and experiencing much of her first year of life in South America, the music, the culture and the language was embedded in her. Due to being only a few hours old, she has no recollection of being in “the system.” She was born, rushed to the adoption agency, and within a few hours of life, adopted. She supposes a part of her adoption story is a testament to how the more privileged and affluent citizens have easier access to obtaining what they want and in a timely fashion.

Fairchild and Bibb (2016) provided a “call to action” for music therapists to reflect on how people are discussed in published practice and research in our work. The authors remarked, “we have noticed a tendency in academic writing to privilege descriptions of the challenges and negative aspects of people’s lives, as a way of demonstrating the important role music therapy can play in improving them” (para. 1). A critique was opined that music therapists working in child welfare, including Zanders, miss the acknowledgement of the resources or resilience of youth and focus on the “dire” need. We do not disagree, and as part of the introspection and reflexivity¹

that is important for practice, we have discussed language related to social justice concerns.

There is still an ordered structure inherent in the publishing world in using wording and language that the field as whole can understand and agreeably, may be oppressive. Thus, terms like diagnoses or problems are still unfortunately used to be representative of clinical concepts. Further critique of the overall literature does note the “potential risks of appropriating participants’ voices to meet academic standards” (Fairchild, McFerran, & Thompson, 2017, p. 18). Gross (2018) cited Oliver and Barnes’ The new politics of disablement in discussing a social model of disability. [Individuals with mental illness] “were subject to control and exclusion by this newly emerging group of professionals who readily seized the opportunity to increase their power and influence by classifying people in relation to the labour market and by facilitating their segregation” (p. 83). Fairchild and Mraz remarked that youth “are often described in the literature through the lens of risk, focusing on the perceived ‘problems’ and ‘challenges’ associated with their experiences” (p. 2). Zanders (2013) stated, “Foster care youth are at times viewed as an at-risk population. The term at-risk, however, has no consistent definition and can be viewed as stigmatizing certain groups” (p. 206). Fortunately, there is a force in academic writing that recognizes axiology, epistemology, and ontology (Fairchild, McFerran, & Thompson, 2017, p. 19) in representing the inherent privilege and power structures.

Bruscia (2014) stated, “Power is ubiquitous and necessary; without it, we could achieve nothing. Yet, power can be perceived and applied in both positive and negative ways—to enhance or abuse or to liberate or oppress” (p. 291). As noted above, critiques of the literature on child welfare seem to take a post-modernistic stance on the abuse of power and the inherent structures of systematic oppression and privilege. Notwithstanding, whatever conditions or constraints, an existential perspective would note that “every individual has the free will and power…to respond in different ways” (Bruscia, p. 276). Existentialists view genuineness and authenticity as essential to the therapeutic relationship. Authenticity is the primary characteristic of existentialism, even more relevant than freedom. Viega (2016) remarked “authenticity is grounded in one’s journey toward self-knowledge, commitment to self-improvement, and recognizing the plight of people who are oppressed and marginalized” (p. 143). Within the givens of existence then, empowerment would be the liberating axis on the continuum with oppression. The individual is ultimately not the communal and can exercise free will and power within their own unique conditions and ecological contexts. Sprague and Hayes (2000) stated, “Empowerment becomes a potential characteristic of a social relationship, one that facilitates the development of someone's self. The most empowering relationships are mutual, recognizing and building on the diverse contributions and needs of participants in ways that seek to minimize inequalities over time” (p. 671). Being reflexive allows then for the youth to describe and transform their experiences authentically. Similarly, if oppression and power are related to hierarchies, then the constructs and language used to describe the individuals worked with take on different perceptions.

In regards to the potential hierarchies and perceptions in the language used in the literature, each of the authors viewed the youth as “troubled” but not as a result of their own doing. For example, Bruscia (2014) promoted a co-construction of music therapy. He noted that in being “socioculturally or linguistically constructed our conceptualization of music therapy can be based on our direct personal experiences” (p. 275). Furthermore, the music therapists’ experience and the youths’ unique experiences imply that “the comparison and integration of different constructs is not only possible but ongoing- it is the method we use every day to create individual and collective knowledge” (p. 275). The directness of the question of “how the youth are perceived?” builds a narrative of their value and starts to show them how their biography is a symbol for their triumph over significant odds. Odds, when put in perspective, many adults could not overcome. As two of the authors are therapists in training, their experiences resonated with the experiences of youth in the music therapy literature. However difficult, each author had an emotional response.

Yet, not all hierarchies are oppressive. “Even when the therapist’s help is hierarchical to some degree, it does not mean that as a helper, the therapist is necessarily at the top of the hierarchy, and that the client as the person being helped is necessarily at the bottom” (Bruscia, 2014, p. 97). As a field, working with child welfare populations, we have to understand our own paradoxical connection to hierarchical structures. Of course, it is important that the professionals writing about individuals are sensitive to sociocultural contexts, but isn’t there an important, albeit vertical or horizontal hierarchy, in the training and education that we as professionals receive? When music therapists focus on the idea of help or how we talk about those we work with, perceptions and language that includes both positive and negative connotations, may create false equalities that inevitably demand reflexivity.

If, we as music therapists are going to be reflexive, then the nature of our descriptions of how we describe the individuals we work with, also needs reflexivity. For example, terms and models, such as resilience, recovery, and resource oriented, are essentially representative of a humanistic orientation. Zanders (2013) even remarked, “Music therapy is invaluable to this population due to its unthreatening and creative nature. According to humanistic principles of therapy, there is an innate goodness and potential for growth for foster care youth” (p. 210). However, if self-inquiry is a key component to being reflexive then the music therapists working within child welfare need to self-inquire on the inherent philosophies and theories related to practice in music therapy. The need to use language that is related to social psychology positivism, such as strengths-based, is a well-intended perspective. However, even a Rogerian perspective of positive regard and seeing people as inherently good or healthy, may lack genuineness and authenticity in regards to real clinical concerns. Zanders (2015) suggested, “suffering and pain are part of living, and integrating these experiences brings about more meaningful, cogent ways of being in the world…integrating the past into the present and making meaning of past experiences” provides a fulfilling and resilient present, and hope for the future (p. 106). Viega (2016) noted in talking about Hip Hop and music therapy, that music therapists take an empowerment perspective which includes, “increasing self-efficacy, developing group consciousness, reducing self-blame, and assuming personal responsibility” (p. 143).

In taking a reflexive stance in the literature, it would be also paradoxical that a description, discussion, etc., of any foster care youth is marginalized if their voice is not heard. In this vein, the challenge in working with foster care youth is not about language or strengths but the inauthenticity of not fully representing them. It is in the discourse that power and privilege can be exposed or illuminated; dismissed or understood. Of course, the intent is not to pathologize or ‘label’ and to avoid the injustices that “render people passive and dependent” (Brusica, 2014, p. 302). For example, Bruscia stated in discussing the word ‘client’ as part of deconstructing his original definition of music therapy, “By not calling a person a ‘client,’ am I not denying the existence of the very health needs or goals that a person presents? Isn’t denial of a health need itself a way of unconsciously stigmatizing disparities between those who do and do not have such needs?” (p. 302).

Conclusion

Allow me (Zanders) to go back to first person and state that I am honored and privileged to have been a part of the lives of the youth I worked with, spent time with, and will continually cherish the time together. Similarly, I am honored to be a part of a clinical reflection and introspection with these authors that encourages me to promote and fight for the need to provide therapeutic affordances, opportunities, and relationships with foster care and adoptive youth (Abrams, 2012). From a Jungian perspective, my warrior archetype or perhaps my own “Hero’s Journey” (Viega, 2016) has led me to feel the anger when children and youth can be treated in such harsh ways. Perhaps Midach noted it best in our conversations when she said that being a child in foster care for the first 10 years of her life led to several developmental irregularities. As an adult, she spent years searching for the source of these anomalies or as her favorite poet, John O’Donohue mused, trying to “draw alongside the mystery as it was emerging and somehow bring it into presence and into birth.” Midach believes the mystery and beauty of music therapy is that it does draw alongside the grief and trauma these foster children have witnessed, while simultaneously awakening in them the imagination to weave a new a musical “cloak to mind their lives;” “To Bless the Space Between Us” (O’Donohue, 2008). This musical cloak, is the bedrock of the universally human psychic annuities we all crave… comfort and companionship. We, each of us, can think of no greater gift to help foster care and adoptive youth to mend and mind their lives.