<?xml version="1.0" encoding="UTF-8"?>
<!--<!DOCTYPE article PUBLIC "-//NLM//DTD JATS (Z39.96) Journal Publishing DTD v1.0 20120330//EN" "http://jats.nlm.nih.gov/publishing/1.0/JATS-journalpublishing1.dtd">
--><!--<?xml-stylesheet type="text/xsl" href="article.xsl"?>-->
<article article-type="research-article" dtd-version="1.0" xml:lang="en"
   xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink"
   xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance">
   <front>
      <journal-meta>
         <journal-id journal-id-type="DOAJ">15041611</journal-id>
         <journal-title-group>
            <journal-title>Voices: A World Forum for Music Therapy</journal-title>
         </journal-title-group>
         <issn>1504-1611</issn>
         <publisher>
            <publisher-name>Grieg Academy Music Therapy Research Centre, Uni Research
               Health</publisher-name>
         </publisher>
      </journal-meta>
      <article-meta>
         <article-id pub-id-type="doi">10.15845/voices.v18i4.2604</article-id>
         <article-categories>
            <subj-group subj-group-type="heading">
               <subject>Invited Submission - Special Issue</subject>
            </subj-group>
         </article-categories>
         <title-group>
            <article-title>Musical Ripples and Reflections: The Story of Charlie, His Music and His
               New Foster Family</article-title>
         </title-group>
         <contrib-group>
            <contrib contrib-type="author">
               <name>
                  <surname>Stuart</surname>
                  <given-names>Karyn</given-names>
               </name>
               <xref ref-type="aff" rid="K_Stuart"/>
               <address>
                  <email>karynlesley@hotmail.com</email>
               </address>
            </contrib>
         </contrib-group>
         <aff id="K_Stuart"><label>1</label>South Africa</aff>
         <contrib-group>
            <contrib contrib-type="editor">
               <name>
                  <surname>Hadley</surname>
                  <given-names>Susan</given-names>
               </name>
            </contrib>
            <contrib contrib-type="editor">
               <name>
                  <surname>Fairchild.</surname>
                  <given-names>Rebecca</given-names>
               </name>
            </contrib>
         </contrib-group>
         <contrib-group>
            <contrib contrib-type="reviewer">
               <name>
                  <surname>Rickson</surname>
                  <given-names>Daphne</given-names>
               </name>
            </contrib>
         </contrib-group>
         <pub-date pub-type="pub">
            <day>1</day>
            <month>11</month>
            <year>2018</year>
         </pub-date>
         <volume>18</volume>
         <issue>4</issue>
         <history>
            <date date-type="received">
               <day>6</day>
               <month>6</month>
               <year>2018</year>
            </date>
            <date date-type="accepted">
               <day>1</day>
               <month>9</month>
               <year>2018</year>
            </date>
         </history>
         <permissions>
            <copyright-statement>Copyright: 2018 The Author(s)</copyright-statement>
            <copyright-year>2018</copyright-year>
         </permissions>
         <self-uri xlink:href="https://voices.no/index.php/voices/article/view/2604"
            >https://voices.no/index.php/voices/article/view/2604</self-uri>
         <abstract>
            <p>Music therapy is a valuable tool for working with vulnerable children who have
               experienced trauma and neglect, working intimately to draw out their playfulness and
               resilience, and create an experience of a safe and trusting relationship. In South
               Africa, with its overburdened social welfare systems and under-resourced communities
               who remain affected by poverty and unemployment, there is limited access to medical
               and psychological services. The South African foster care system aims to provide
               safety and security for vulnerable and at-risk children and youth, but it is often
               overwhelmed with the extent of the needs. This anecdotal story features professional
               and personal reflections and vignettes on the music therapy journey with a very
               withdrawn and isolated young boy at a place of safety in Cape Town. I, as music
               therapist, and his favourite red drum, accompanied Charlie through four months of
               weekly individual sessions, unlocking his Music Child (<xref ref-type="bibr" rid="NR1977">Nordoff &amp; Robbins, 1977</xref>).
               Sessions shifted from isolated to interactive; from silent to communicative; from
               tentative to confident. Our music therapy journey continued, moving beyond the safe
               music therapy room to the unknown space of a new foster family through a home visit -
               an unusual occurrence in the context of community work in South Africa due to the
               limited psychological services available and the vast number of children in the
               social services systems. Collaborating with the social workers and the foster mother,
               I was able to visit Charlie at his new foster family’s house. The known and safe
               music therapy space expanded to include his foster mother and new foster siblings
               with whom he could share his newfound independence and confidence. The article
               describes music therapy’s role in ‘introducing’ Charlie to his new foster family and
               how it created musical connections, shared enjoyment and a sense of togetherness
               between them. I, as his music therapist, followed where he, the music and the context
               led, as reflected in the notion of community music therapy described by Ansdell
               (<xref ref-type="bibr" rid="A2002">2002</xref>). Although the focus is on the story of Charlie’s music therapy journey, it
               highlights the benefit of the music therapy’s role in all aspects of foster care and
               the need for collaboration with social welfare systems in under-resourced communities
               in South Africa.</p>
         </abstract>
         <kwd-group>
            <kwd>Community Music Therapy</kwd>
            <kwd>marginalised communities</kwd>
            <kwd>Place of Safety</kwd>
            <kwd>vulnerable children</kwd>
         </kwd-group>
      </article-meta>
   </front>
   <body>
      <!-- sec lvl 2 begin -->
      <sec>
         <title>Introduction</title>
         <p>After several years of working in various marginalised communities in Cape Town, South
            Africa, I am constantly reminded of the power and potential of engaging with children in
            music therapy; especially those who have experienced trauma. It was whilst working for
            the organisation MusicWorks<sup>
               <xref ref-type="fn" rid="ftn1">1</xref>
            </sup>, as a newly qualified music therapist, that I first witnessed music therapy’s
            ability to support a child expressing his sadness about losing a parent, offer children
            a distraction from a terminal illness for a brief moment and play vibrantly together in
            a band, and help a child realise he’s not alone in feeling alone as his music therapy
            group writes a song about loneliness.</p>
         <p>I became increasingly aware of how music therapy is shaped by and shapes the communities
            in which I worked: the youth marimba group from the township<sup>
               <xref ref-type="fn" rid="ftn2">2</xref>
            </sup> planning and performing a concert for their friends and families outside the
            run-down block of flats in which they live creates a sense of mastery, belonging and
            pride in their achievements; empowering them to think about the positive impact they can
            have in their community which, in Cape Town, has become synonymous with high levels of
            violence, poverty and unemployment. The nurses at a local children’s hospital, dancing
            and jiving to the lively music made by a small child and me are energised and carry our
            music to the next ward by singing to the babies lying in their cots. The music
            “radiates” as Pavlicevic and Ansdell (<xref ref-type="bibr" rid="A2004">2004</xref>)
            described and flows between the individual and the community. The impact of music
            therapy ripples out (<xref ref-type="bibr" rid="W2004">Wood, 2004</xref>) for an
            isolated person to community, creating community, and bringing the community to the
            isolated person. There always seems to be a transition between music therapy and the
            community – a give and take, each informing the other, ever-shifting between the person
            and the community.</p>
         <p>A story that reflects this, and was particularly meaningful to me, came about in 2011
            while I was working at a Place of Safety in Langa, a township on the Cape Flats<sup>
               <xref ref-type="fn" rid="ftn3">3</xref>
            </sup>. After a history of segregation and dislodging non-white people from their land,
            and subsequently banning them from land ownership, the Apartheid Government’s Group
            Areas Act was passed in 1950 in order to segregate racial groups in South Africa.
            Townships such as Langa, an isiXhosa community, were established. As a result of this
            economic, social, and political disenfranchisement, Langa, and many other townships,
            experiences high levels of crime, unemployment, HIV/AIDS, and has little access to basic
            amenities such as proper housing. Non-profit and non-governmental organisations, such as
            the Place of Safety (POS), play a big role in attempting to meet the social, economic
            and basic needs of the townships. The POS admits children under the age of six years
            from Langa, as well as other surrounding townships, who have been removed from their
            families for various reasons including reports of neglect, abandonment and/or abuse. I
            was introduced to a little 5-year-old boy called Charlie*.</p>
         <p>van der Kolk (<xref ref-type="bibr" rid="K2003">2003</xref>) wrote that it is impossible
            to refer to trauma in children without addressing the parent-child attachment. The
            attachment relationship creates an inner map of the world that helps infants and
            children organize their behaviour (<xref ref-type="bibr" rid="S1985">Stern, 1985</xref>)
            and provides a secure base from which they can explore their world (<xref
               ref-type="bibr" rid="B1988">Bowlby, 1988</xref>). It is a powerful predictor of a
            child’s social and emotional outcomes (<xref ref-type="bibr" rid="B2004">Benoit,
               2004</xref>). van der Kolk (<xref ref-type="bibr" rid="K2003">2003</xref>) noted that
            in the early onset of trauma, where the distress is overwhelming or the parent is the
            cause of the distress, children might have difficulty regulating their arousal,
            processing, and integrating the trauma, hindering in their capacity to regulate their
            internal states. In the case of Charlie, there was not much information available about
            his history or parental relationships, yet he seemed to perceive his world as a scary
            and uncertain place.</p>
      </sec>
      <!-- sec lvl 2 end -->
      <!-- sec lvl 2 begin -->
      <sec>
         <title>Charlie’s Story</title>
         <p>Charlie was brought to the POS by a social worker when after being discharged from a
            local hospital, his parents were judged to be unable to care for him. His family was
            homeless and had been living under a bridge on very busy highway. In South Africa,
            “places of safety” are meant to be temporary placements, and social workers work hard to
            reunite children with the biological families or match children with foster families. It
            was determined that in Charlie’s best interest a foster family be found, and in the
            interim Charlie was to stay at the POS.</p>
         <p>He was referred for music therapy by the POS child care manager as he presented as
            withdrawn, very tentative, and developmentally delayed. Consent was obtained by the POS
            for Charlie to receive music therapy, which he attended weekly for approximately 5
            months. Included in this consent, was the possibility of his story being shared in a
            public forum. Here is his (our) music story.</p>
         <!-- sec lvl 3 begin -->
         <sec>
            <title>Starting small: In the centre of the ripple</title>
            <disp-quote>
               <p>When I first meet Charlie, I invite him to come and play with me. He follows me to
                  the room where I have put a bright orange bag of instruments on the blanket on the
                  floor. He sees it, but makes no move towards it. I sit down and he sits opposite
                  me. I pick up my guitar, strum a chord and start singing a soft, but playful hello
                  song. Although he’s alert and watching me, he sits very still and is silent. When
                  I finish the hello song, I offer him a turn to play on the tambourine which he
                  plays with just the edges of his fingers: tentative and soft. I start unpacking
                  the colourful percussive instruments one at a time with some playful anticipation
                  as he watches closely. The bright red drum catches his attention and I offer it to
                  him. As we play together on the drum, I improvise a song about making music
                  together. While we play together on the drum, I pretended to tickle his fingers.
                  This brings the first (and only) smile to his face.</p>
            </disp-quote>
            <disp-quote>
               <p>The very next week when Charlie saw me walk through the door, he smiled, took my
                  hand, and led me to the music therapy room.</p>
            </disp-quote>
            <p>Charlie’s playfulness seemed overshadowed by a solemn, quiet presence and very little
               sound. He did not vocalise during the first few sessions and held little eye contact.
               It was almost as though he was not trying to reach out to others and to the world:
               perhaps perceiving it as dangerous and uncertain. I wondered at the time whether this
               was because his early attempts to engage were not heard, responded to, or validated,
               and he had given up trying. The small movements, taking up a small space in the room,
               the later emergence of small (soft) sounds - did he feel small… unimportant? It was
               as though he was trying not to be noticed, as though he was not able to trust his
               surroundings. Not unusual, if one refers to the writings of attachment theory
               researchers like Benoit (<xref ref-type="bibr" rid="B2004">2004</xref>), Bowlby
                  (<xref ref-type="bibr" rid="B1988">1988</xref>), and van der Kolk (<xref
                  ref-type="bibr" rid="K2003">2003</xref>) who consider that infants learn to trust
               or distrust the world around them based on their early relationship experiences.
               Perhaps Charlie’s first experiences were of an isolated and unsafe nature, causing
               him to withdraw. Also, removed from his family and daily life under the bridge into
               this new place must have caused much confusion and contributed to unsafe feelings of
               rejection and distrust. The role of music therapy here was to help Charlie in
               developing an intimate and trusting relationship with me as a safe base, through
               inviting him to engage in non-threatening music play.</p>
         </sec>
         <!-- sec lvl 3 end -->
         <!-- sec lvl 3 begin -->
         <sec>
            <title>Radiating outwards: Expanding the ripple</title>
            <p>I offered Charlie many opportunities to explore and expand his sense of self and
               others, as well as provide a safe space for him to experience being in a relationship
               with another. The predictability of the weekly sessions, the familiarity of the hello
               and goodbye songs, and even the regular presence of that red drum contributed to the
               safety of the music therapy space, which I felt was imperative amidst the uncertainty
               of his recent history. Over the next few weeks, although still very quiet and small
               at times, Charlie’s engagement in musical play became more interactive and mutual.
               His playfulness began to emerge.</p>
            <disp-quote>
               <p>Charlie and I are making music very loudly today. I’m playing guitar and he’s
                  playing the red drum. His beating is firm, strong and determined, almost as if
                  he’s trying to go even louder than the fortissimo he’s already playing! It feels
                  like he’s checking whether I will go with him, and I do. I start vocalising and he
                  copies me for a little while. Our playing slows down a little and settles to a
                  medium loudness. I insert a sudden accented double beat and pause, which he
                  notices and immediately we’re off into a turn-taking game complete with vocal
                  sounds. He suddenly stops and I feign surprise. He laughs, having ‘caught’ me out.
                  We play at this ‘stop, start, surprise’ game for a little while. A little later,
                  after our goodbye song, Charlie turns to me and says “bye bye”.</p>
            </disp-quote>
            <p>We played that little red drum very loudly and our music reverberated and radiated
               down the passage. I think Charlie was trying to ensure that everyone could hear his
               drumming! Through attuning to his presence and loudness, he understood that I was
               listening and responding to him, and through doing that, validating him. The
               containing and attuning musical space allowed Charlie to feel heard; to experience
               himself and his musical contributions as accepted and validated - perhaps in contrast
               to the early relational experiences. In this safe space, he started taking initiative
               and even ‘conducted’ our music, laughing and watching my responses. It gave him a
               space to reconnect with his playfulness and draw out the healthy “music child”<sup>
                  <xref ref-type="fn" rid="ftn4">4</xref>
               </sup> that, even though it has been subdued in the midst of his traumatic past,
               remained intact. We made up funny games and engaged in little musical conversations
               on the instruments, which extended in soft vocal play from whispers to audible
               sounds. This also provided a sense of mastery and pleasure, which van der Kolk (<xref
                  ref-type="bibr" rid="K2003">2003</xref>) deemed to be vital to the treatment of
               children who’ve experienced trauma. Towards the end of the therapy process, Charlie
               started verbalising, saying “bye bye” to me after sessions, which I interpreted as
               indicative of his growth in confidence, sense of self and the development of our
               trusting relationship.</p>
            <p>This confidence and communication through sounds and sometimes words, transitioned
               beyond the music therapy sessions. One staff member told me that she had noticed him
               being more confident when, at a fête held at the POS, Charlie had bravely put up his
               hand to have a turn on the proffered Djembe brought by a volunteer and proceeded to
               play it with an air of self-assurance. The staff clapped and cheered his efforts. She
               continued saying that he had surprised her by doing that and that she was so proud of
               him. There was a definite and noticeable shift in Charlie’s communication and
               playfulness in and out of the music therapy space.</p>
         </sec>
         <!-- sec lvl 3 end -->
         <!-- sec lvl 3 begin -->
         <sec>
            <title>Moving beyond isolation towards community</title>
            <p>Five months after our first music therapy session, the time came for Charlie to be
               discharged into foster care as a suitable foster parent had been identified. I felt
               that music therapy could play a valuable role in supporting his move to his new home.
               Following discussions with the POS child care manager, arrangements were made for me
               to do a home visit with Charlie at his new foster home to support his transition –
               the music, the instruments, and I could be recognisable, safe, and known things in
               this new environment. Also, it was hoped that music could be the catalyst for
               developing Charlie’s relationship with his new foster parent and the other children
               in her care.</p>
            <p>I travelled to Delft<sup>
                  <xref ref-type="fn" rid="ftn5">5</xref>
               </sup> to visit Charlie the following week. I had not been to Delft before and
               driving through the community, viewing it through my middle class background, I was
               struck by the level of poverty that was evident even though it’s been 25 years since
               the end of Apartheid. My privileged background means that I have not had to live
               without food or basic amenities, unlike many families in communities such as Delft.
               There was no grass on the verges and only dusty sand surrounded the tiny, pastel
               coloured houses erected by the government post 1994<sup>
                  <xref ref-type="fn" rid="ftn6">6</xref>
               </sup>. The skyline was scattered with hundreds of tall electricity poles with many
               black wires running from them to the small houses. Electricity was only introduced to
               that community in recent years, and many families who cannot afford to pay for it,
               dangerously hook up their own lines to bring life to their appliances. Oddly enough,
               the effect was that of a maypole dance pole with its ribbons flowing out. Makeshift
               wooden fences arbitrarily demarcate properties. Several streets were nameless and
               numbers on houses were sporadic and often hidden by heavy laden washing lines and
               Wendy houses. Delft, and many marginalised communities are home to people called
                  <italic>back yard dwellers:</italic> people and families who erect small wooden
               extensions, innocuously named Wendy houses, in the back or front yards of other brick
               houses. Driving through the narrow, sandy and nameless streets, I found Charlie’s new
               home: a small brick house surrounded by a wooden makeshift fence and with a sandy
               path to the front door. There was no movement in and around the house. I felt
               slightly apprehensive about meeting this new foster parent and what she might think
               or feel about my presence in her house. I was unsure of what to expect. I wondered
               whether these feelings were reflective of what Charlie may have felt, as he drove for
               the first time to his new house. Added to this, perhaps his foster mother would have
               been nervous receiving her new charge and uncertain of what to expect from my visit;
               this complicated by the cultural, societal and economical gap between us and her
               perception of me as a white, middle class woman.</p>
            <p>Mrs. Brent* came out to greet me. She seemed a little nervous but she warmly welcomed
               me into her lounge and disappeared into another room to call Charlie. Left alone, I
               unpacked some instruments, got out my guitar, sat on the edge of the beige couch and
               waited. When he emerged through the door of the lounge and saw me, he smiled and
               immediately ran towards the red drum, which had been his favourite instrument during
               our music therapy sessions. The guitar, the red drum and I seemed to be a welcome and
               familiar sight.</p>
            <disp-quote>
               <p>Charlie and I are sitting on the carpet in the lounge of his new home. His foster
                  mom is seated on the couch near us, nodding along as we sing our familiar hello
                  song. After singing hello to Charlie, his foster mom, and me, I introduce an
                  improvised tambourine game. Suddenly a head pops out from behind the couch.
                  Another one pops up, and another, and another still. It’s Charlie’s new brothers
                  and sisters! They want to see what’s happening. I invite them to come and play
                  with us and all at once we are a band: Mrs. Brent, six children between the ages
                  of two and 12 years, and me. There are lots of oohs and aahs, laughs and smiles as
                  they choose an instrument to play. We sing a song about being in a band and each
                  child gets a turn to play a solo on their chosen instrument. Although some start
                  off a little tentatively, they soon play with confidence and excitement.</p>
            </disp-quote>
            <p>Charlie seemed delighted to share me and his music with his new family. He seemed
               proud to show his drumming skills and to be able to play music. Through sharing the
               music with the other children and offering them turns to play, each one was able to
               contribute their voice - bring something special to the music - and be validated for
               their musical contributions.</p>
            <disp-quote>
               <p>We’re singing our “Join the Band” song, when one of the younger ones looks a
                  little confused and doesn’t shake the maracas he is holding. Charlie notices and
                  leans over to show the younger boy how to play it. He takes the shaker and makes
                  big up and down movements with his hand. In Afrikaans, he explains to him that to
                  make the sound, he should shake it “soos dit” (like that). The little boy watches
                  Charlie’s movements intently, and with the eyes of the other children on him,
                  begins to shake the shaker and starts to grin.</p>
            </disp-quote>
            <p>What a lovely way to introduce Charlie to this new space. Modelling to his new
               younger foster brother how to play the instrument, Charlie was flexing his leadership
               muscles. It was also a meaningful opportunity for Charlie to bring and share
               something of his experiences and life to the new family. It showed his willingness to
               share his music with the others and his kindness of his proffered help to the younger
               boy.</p>
            <disp-quote>
               <p>We are playing and singing a turn-taking tambourine song. As I offer the
                  tambourine to each child I adapt my vocal sounds to match his or her playing on
                  the tambourine. I offer Charlie the chance to take the tambourine and be the
                  leader of the game. I know that he’s done it before in our music therapy sessions.
                  With a big smile, he offers the tambourine to each child in turn, even Mrs. Brent,
                  as he makes vocal sounds and tunes for them to hear.</p>
            </disp-quote>
            <p>Again, Charlie was sharing something of who he is with his new foster family, opening
               the door for helping each other as they all negotiate the new family unit. Each child
               could experience themselves as important contributors to the music and sound and
               experience acceptance and validation in response – possibly in contrast to previous
               life experiences which led to their inclusion in the foster care system. There were
               lots of smiles, laughter, and amusement as Mrs. Brent and the children in her care
               interacted playfully with each other. It felt like an enjoyable, relaxed, playful,
               and uniting experience for the whole group. In this musical space, even the littlest
               child (2-years-old) was offered, and accepted a chance to lead the activity and make
               choices. It is through play that we acquire a sense of subjectivity and agency in our
               world; we experience ourselves and each other in play and “playing implies trust”
                  (<xref ref-type="bibr" rid="W1971">Winnicott, 1971, p. 51</xref>). Music therapy
               afforded Mrs. Brent the opportunity to witness the playfulness of the children in her
               care, and the children could experience her and each other as playful and engaged.
               Through being part of this creative music therapy space, Charlie may have begun to
               understand how he could fit into and be accepted into this new space of Mrs. Brent’s
               home. Perhaps, in playing music together, the possibility of fostering a trusting,
               attachment relationship could be realised.</p>
            <p>We sang a special, final goodbye to everyone and I left with Mrs. Brent and all the
               children hanging over the wooden fence waving and yelling goodbye to me. This seemed
               quite a contrast to the quiet apprehension when I arrived. The energy and excitement
               was contagious.</p>
         </sec>
         <!-- sec lvl 3 end -->
      </sec>
      <!-- sec lvl 2 end -->
      <!-- sec lvl 2 begin -->
      <sec>
         <title>Discussion: Transitioning, rippling and radiating</title>
         <p>There was something special about journeying with Charlie for those few months at the
            POS. It was the first time in my experience as a newly qualified music therapist that I
            had journeyed between physical places with clients and had the capacity (support from
            the POS and MusicWorks) to follow where the needs of the client, context, and music led
               (<xref ref-type="bibr" rid="A2002">Ansdell, 2002</xref>). I experienced firsthand the
            power of music therapy in shifting a child’s experience of his world through tapping
            into the music child that was still present despite his difficult early life
            circumstances: from the initial establishment of safety and security in sessions,
            facilitating his competence and mastery, to supporting his capacity for emotional
            regulation. Knowing and interacting with Charlie’s internal states supported his shift
            from isolation to interaction – perhaps helping him develop a sense of who he is.</p>
         <p>It felt apt that music therapy would make the transition with Charlie and expand its
            space to include his new home, making the boundaries of our interaction more permeable
            and flexible. This resonates with the community music therapy model that encourages
            therapists to follow our clients; recognising that we do not only work with the
            individual beneficiary in a context, but we can work <italic>with</italic> this context
            as highlighted by Stige (<xref ref-type="bibr" rid="S2004">2004</xref>). Orford (<xref
               ref-type="bibr" rid="O1992">1992</xref>) proposed that individuals are part of a
            “state of continuing transaction” (p.14) with the various settings in which they spend
            time as part of their everyday lives. It is these daily transactions in which we, as
            music therapists, become part of the various communities in which we work. As the
            communities themselves shift and change, impacting the individuals within them, we too
            need to shift and change (and improvise) with both the individual and the community so
            that the transaction continues. In a way, re-thinking boundaries of therapy and making
            them meaningful to each individual situation, and less, as Stewart (<xref
               ref-type="bibr" rid="ST2004">2004</xref>) wrote, focused on adherence to therapeutic
            doctrines.</p>
         <p>In the context of South Africa, opportunities to shift with our clients’ contexts are
            rare and often difficult due to limited resources in terms of the small number of music
            therapists, the lack of awareness of music therapy, and the lack of music therapy posts
            in the government and social development sectors. It is in the midst of the overburdened
            South African child welfare system that music therapists could potentially make valuable
            contributions through collaborations with social workers, child-care workers, funders,
            and other role-players in the welfare and foster care systems. In the case of Charlie,
            the collaboration among the POS, the care manager, his foster parent and me, allowed for
            the provision of therapeutic support through his transition. Music was used to bridge
            the gap between therapy and community, which was in the case of Charlie, his new foster
            family. These collaborations may bring about awareness of the psychosocial support that
            music therapists offer not only the children in foster care, but also the
            under-resourced organisations, social workers, and potential foster parents/ individuals
            who attempt to meet the emotional and social needs of children in the foster care
            system.</p>
      </sec>
      <!-- sec lvl 2 end -->
      <!-- sec lvl 2 begin -->
      <sec>
         <title>Conclusion: Final Thoughts and Ripples</title>
         <p>Charlie’s music therapy journey started with just him and me in our safe music therapy
            space. It shifted as he began sharing his new identity and self-assuredness within his
            immediate context of the POS. It then expanded to include his new foster family and a
            new physical home. Charlie was able to share something of his history and growth with
            his new family: the acceptance, strength, agency, and the belonging he felt whilst in
            music therapy. The shift in Charlie’s sense of self and what he could contribute to his
            new family, his confidence in assuming a leader role, the creation of fun and the
            playful communication through the music, helped bring about the feeling of togetherness.
            All of that radiated into his new family through the bringing of his music into the new
            space. <italic>His</italic> music: implying his story and life prior to this new home
            and the musical space that helped move his isolation to connection. Helping Charlie to
            achieve what Amir (<xref ref-type="bibr" rid="AM2004">2004</xref>) referred to as a
            better sense of his belonging and participation in his new community was therefore a
            fitting closing of our music therapy story.</p>
         <p>Wood (<xref ref-type="bibr" rid="W2004">2004</xref>) stated that the “power of music to
            connect people has an impact which can extend far into a participant’s life, like
            ripples in a pond” (p. 61). In Charlie’s story, ripples abound as concentric outward
            circles from tentative to present, rejected to accepted, isolated to connected, from
            traditional music therapy space to community, from alone to being part of a family
            again.</p>
         <p>*names have been changed to ensure privacy</p>
      </sec>
      <!-- sec lvl 2 end -->
   </body>
   <back>
      <fn-group>
         <fn id="ftn1">
            <p> MusicWorks (previously known as The Music Therapy Community Clinic) is a Non-Profit
               organization that provides music therapy services to under-resourced areas and aims
               to use music as a social resource. For more information please see
                  <uri>http://www.musicworks.org.za</uri>
            </p>
         </fn>
         <fn id="ftn2">
            <p> Township refers to an informal settlement or community usually disadvantaged and
               under-resourced.</p>
         </fn>
         <fn id="ftn3">
            <p> During Apartheid (pre-1994), large numbers of people were forcibly displaced to
               out-lying areas under the group areas act. Post-1994, many of these areas, known as
               townships, remain disadvantaged and under-resourced with high levels of poverty,
               unemployment, substance abuse, gang-related violence and crime.</p>
         </fn>
         <fn id="ftn4">
            <p> The music child is a concept created by Paul Nordoff and Clive Robbins (<xref
                  ref-type="bibr" rid="NR1977">1977</xref>). It refers to the belief that even in
               the midst of disability and trauma, there is a healthy aspect or side of the child or
               adult that can be elicited and engaged with in music.</p>
         </fn>
         <fn id="ftn5">
            <p> Delft is a so-called ‘coloured’ community where Afrikaans is the main language.
               ‘Coloured’ is a widely used term in South Africa to denote a culture group and
               amongst general society it is an acceptable term. However, it is not uncontested in
               some literature. For more information on this cultural identity, please read
                  <uri>https://africasacountry.com/2018/06/being-coloured-and-indian-in-south-africa-after-apartheid</uri>
            </p>
         </fn>
         <fn id="ftn6">
            <p> Since 1994 and the ceasing of the Apartheid regime, the South African government
               have begun to address the housing needs in these communities, providing water,
               electricity and sanitation. However, 25 years later and there is a still a vast
               backlog resulting in many such communities becoming increasingly frustrated and
               despondent.</p>
         </fn>
      </fn-group>
      <ref-list>
         <ref id="AM2004">
            <!--Amir, D. (2004). Community music therapy and the challenge of multiculturalism. In M. Pavlicevic, & G. Ansdell (Eds.), <italic>Community music therapy</italic> (pp. 249-266). London, England: Jessica Kingsley Publishers. <uri>https://doi.org/10.1093/mtp/25.1.62</uri>-->
            <element-citation publication-type="book-chapter" publication-format="web">
               <person-group person-group-type="author">
                  <name>
                     <surname>Amir</surname>
                     <given-names>D</given-names>
                  </name>
               </person-group>
               <year>2004</year>
               <chapter-title>Community music therapy and the challenge of
                  multiculturalism</chapter-title>
               <person-group person-group-type="editor">
                  <name>
                     <surname>Pavlicevic</surname>
                     <given-names>M</given-names>
                  </name>
                  <name>
                     <surname>Ansdell</surname>
                     <given-names>G</given-names>
                  </name>
               </person-group>
               <source>Community music therapy</source>
               <fpage>249</fpage>
               <lpage>266</lpage>
               <publisher-loc>London, England</publisher-loc>
               <publisher-name>Jessica Kingsley Publishers</publisher-name>
               <uri>https://doi.org/10.1093/mtp/25.1.62</uri>
            </element-citation>
         </ref>
         <ref id="A2002">
            <!--Ansdell, G. (2002). Community music therapy and the winds of change. <italic>Voices: A world forum for music therapy, 2</italic>(2). <uri>http://dx.doi.org/10.15845/voices.v2i2.83</uri>-->
            <element-citation publication-type="journal" publication-format="web">
               <person-group person-group-type="author">
                  <name>
                     <surname>Ansdell</surname>
                     <given-names>G</given-names>
                  </name>
               </person-group>
               <year>2002</year>
               <article-title>Community music therapy and the winds of change</article-title>
               <source>Voices: A world forum for music therapy</source>
               <volume>2</volume>
               <issue>2</issue>
               <uri>http://dx.doi.org/10.15845/voices.v2i2.83</uri>
            </element-citation>
         </ref>
         <ref id="A2004">
            <!--Ansdell, G. (2004). Rethinking music and community: Theoretical perspectives in support of community music therapy. In M. Pavlicevic, & G. Ansdell (Eds.), <italic>Community music therapy</italic> (pp. 65-90). London, England: Jessica Kingsley Publishers-->
            <element-citation publication-type="book-chapter" publication-format="print">
               <person-group person-group-type="author">
                  <name>
                     <surname>Ansdell</surname>
                     <given-names>G</given-names>
                  </name>
               </person-group>
               <year>2004</year>
               <chapter-title>Rethinking music and community: Theoretical perspectives in support of
                  community music therapy</chapter-title>
               <person-group person-group-type="editor">
                  <name>
                     <surname>Pavlicevic</surname>
                     <given-names>M</given-names>
                  </name>
                  <name>
                     <surname>Ansdell</surname>
                     <given-names>G</given-names>
                  </name>
               </person-group>
               <source>Community music therapy</source>
               <fpage>65</fpage>
               <lpage>90</lpage>
               <publisher-loc>London, England</publisher-loc>
               <publisher-name>Jessica Kingsley Publishers</publisher-name>
            </element-citation>
         </ref>
         <ref id="B2004">
            <!--Benoit, D. (2004). Infant-parent attachment: Definition, types, antecedents, measurement and outcome. <italic>Paediatric Child Health 9(8), </italic>541–545. <uri>https://doi.org/10.1093/pch/9.8.541</uri>-->
            <element-citation publication-type="journal" publication-format="web">
               <person-group person-group-type="author">
                  <name>
                     <surname>Benoit</surname>
                     <given-names>D</given-names>
                  </name>
               </person-group>
               <year>2004</year>
               <article-title>Infant-parent attachment: Definition, types, antecedents, measurement
                  and outcome</article-title>
               <source>Paediatric Child Health</source>
               <volume>9</volume>
               <issue>8</issue>
               <fpage>541</fpage>
               <lpage>545</lpage>
               <uri>https://doi.org/10.1093/pch/9.8.541</uri>
            </element-citation>
         </ref>
         <ref id="B1988">
            <!--Bowlby, J. (1988). <italic>A secure base: Parent-child attachment and healthy human development</italic>. London, England: Routledge.-->
            <element-citation publication-type="book" publication-format="print">
               <person-group person-group-type="author">
                  <name>
                     <surname>Bowlby</surname>
                     <given-names>J</given-names>
                  </name>
               </person-group>
               <year>1988</year>
               <source>A secure base: Parent-child attachment and healthy human development</source>
               <publisher-loc>London, England</publisher-loc>
               <publisher-name>Routledge</publisher-name>
            </element-citation>
         </ref>
         <ref id="___2005">
            <!--Children’s Act 38. (2005). Retrieved from <uri>http://www.hpcsa.co.za/Uploads/editor/UserFiles/downloads/legislations/acts/childrens_act_38_2005.pdf</uri>-->
            <mixed-citation publication-format="web">Children’s Act 38. (2005). Retrieved from
                  <uri>http://www.hpcsa.co.za/Uploads/editor/UserFiles/downloads/legislations/acts/childrens_act_38_2005.pdf</uri>
            </mixed-citation>
         </ref>
         <ref id="NR1977">
            <!--Nordoff, P., & Robbins, C. (1977). <italic>Creative music therapy: Individualized treatment for the Handicapped Child. </italic>New York, NY: John Day.-->
            <element-citation publication-type="book" publication-format="print">
               <person-group person-group-type="author">
                  <name>
                     <surname>Nordoff</surname>
                     <given-names>P</given-names>
                  </name>
                  <name>
                     <surname>Robbins</surname>
                     <given-names>C</given-names>
                  </name>
               </person-group>
               <year>1977</year>
               <source>Creative music therapy: Individualized treatment for the Handicapped
                  Child</source>
               <publisher-loc>New York, NY</publisher-loc>
               <publisher-name>John Day</publisher-name>
            </element-citation>
         </ref>
         <ref id="O1992">
            <!--Orford, J. (1992). <italic>Community psychology: Theory and Practice</italic>. Chichester, England: Wiley.-->
            <element-citation publication-type="book" publication-format="print">
               <person-group person-group-type="author">
                  <name>
                     <surname>Orford</surname>
                     <given-names>J</given-names>
                  </name>
               </person-group>
               <year>1992</year>
               <source>Community psychology: Theory and Practice</source>
               <publisher-loc>Chichester, England</publisher-loc>
               <publisher-name>Wiley</publisher-name>
            </element-citation>
         </ref>
         <ref id="S1985">
            <!--Stern, D.N. (1985)<italic>.The interpersonal world of the infant. </italic>New York: Basic Books-->
            <element-citation publication-type="book" publication-format="print">
               <person-group person-group-type="author">
                  <name>
                     <surname>Stern</surname>
                     <given-names>D N</given-names>
                  </name>
               </person-group>
               <year>1985</year>
               <source>The interpersonal world of the infant</source>
               <publisher-loc>New York</publisher-loc>
               <publisher-name>Basic Books</publisher-name>
            </element-citation>
         </ref>
         <ref id="ST2004">
            <!--Stewart, D. (2004). Transformational contexts in music therapy. In M. Pavlicevic, & G. Ansdell (Eds.), <italic>Community music therapy </italic>(pp. 281-297). London, England: Jessica Kingsley Publishers.-->
            <element-citation publication-type="book-chapter" publication-format="print">
               <person-group person-group-type="author">
                  <name>
                     <surname>Stewart</surname>
                     <given-names>D</given-names>
                  </name>
               </person-group>
               <year>2004</year>
               <chapter-title>Transformational contexts in music therapy</chapter-title>
               <person-group person-group-type="editor">
                  <name>
                     <surname>Pavlicevic</surname>
                     <given-names>M</given-names>
                  </name>
                  <name>
                     <surname>Ansdell</surname>
                     <given-names>G</given-names>
                  </name>
               </person-group>
               <source>Community music therapy</source>
               <fpage>281</fpage>
               <lpage>297</lpage>
               <publisher-loc>London, England</publisher-loc>
               <publisher-name>Jessica Kingsley Publishers</publisher-name>
            </element-citation>
         </ref>
         <ref id="S2002">
            <!--Stige, B. (2002). <italic>Culture-centred music therapy</italic>. Gilsum, NH: Marcelona Publishers.-->
            <element-citation publication-type="book" publication-format="print">
               <person-group person-group-type="author">
                  <name>
                     <surname>Stige</surname>
                     <given-names>B</given-names>
                  </name>
               </person-group>
               <year>2002</year>
               <source>Culture-centred music therapy</source>
               <publisher-loc>Gilsum, NH</publisher-loc>
               <publisher-name>Marcelona Publishers</publisher-name>
            </element-citation>
         </ref>
         <ref id="S2004">
            <!--Stige, B. (2004). Community music therapy: Culture, care and welfare. In Pavlicevic, M. & Ansdell, G, (Eds.), In M. Pavlicevic, & G. Ansdell (Eds). <italic>Community music therapy</italic> (pp. 91-113). London, England: Jessica Kingsley Publishers.-->
            <element-citation publication-type="book-chapter" publication-format="print">
               <person-group person-group-type="author">
                  <name>
                     <surname>Stige</surname>
                     <given-names>B</given-names>
                  </name>
               </person-group>
               <year>2004</year>
               <chapter-title>Community music therapy: Culture, care and welfare</chapter-title>
               <person-group person-group-type="editor">
                  <name>
                     <surname>Pavlicevic</surname>
                     <given-names>M</given-names>
                  </name>
                  <name>
                     <surname>Ansdell</surname>
                     <given-names>G</given-names>
                  </name>
               </person-group>
               <source>Community music therapy</source>
               <fpage>91</fpage>
               <lpage>113</lpage>
               <publisher-loc>London, England</publisher-loc>
               <publisher-name>Jessica Kingsley Publishers</publisher-name>
            </element-citation>
         </ref>
         <ref id="K2003">
            <!--van der Kolk, B A. (2003). The neurology of childhood trauma and abuse. <italic>Child and Adolescent Psychiatry Clinics of North America 12(2)</italic>, 293–317. <uri>https://doi.org/10.1016/S1056-4993(03)00003-8</uri>-->
            <element-citation publication-type="journal" publication-format="web">
               <person-group person-group-type="author">
                  <name>
                     <surname>van der Kolk</surname>
                     <given-names>B A</given-names>
                  </name>
               </person-group>
               <year>2003</year>
               <article-title>The neurology of childhood trauma and abuse</article-title>
               <source>Child and Adolescent Psychiatry Clinics of North America</source>
               <volume>12</volume>
               <issue>2</issue>
               <fpage>293</fpage>
               <lpage>317</lpage>
               <uri>https://doi.org/10.1016/S1056-4993(03)00003-8</uri>
            </element-citation>
         </ref>
         <ref id="W2004">
            <!--Wood, S. et. al. (2004). From therapy to community: Making music in neurological rehabilitation. In M. Pavlicevic, & G. Ansdell (Eds.), <italic>Community music therapy</italic>, (pp. 48-62). London, England: Jessica Kingsley Publishers.-->
            <element-citation publication-type="book-chapter" publication-format="print">
               <person-group person-group-type="author">
                  <name>
                     <surname>Wood</surname>
                     <given-names>S</given-names>
                  </name>
               </person-group>
               <year>2004</year>
               <chapter-title>From therapy to community: Making music in neurological
                  rehabilitation</chapter-title>
               <person-group person-group-type="editor">
                  <name>
                     <surname>Pavlicevic</surname>
                     <given-names>M</given-names>
                  </name>
                  <name>
                     <surname>Ansdell</surname>
                     <given-names>G</given-names>
                  </name>
               </person-group>
               <source>Community music therapy</source>
               <fpage>48</fpage>
               <lpage>62</lpage>
               <publisher-loc>London, England</publisher-loc>
               <publisher-name>Jessica Kingsley Publishers</publisher-name>
            </element-citation>
         </ref>
         <ref id="W1971">
            <!--Winnicott, D. W. (1971). <italic>Playing and reality</italic>. Harmondsworth, England: Penguin-->
            <element-citation publication-type="book" publication-format="print">
               <person-group person-group-type="author">
                  <name>
                     <surname>Winnicott</surname>
                     <given-names>D W</given-names>
                  </name>
               </person-group>
               <year>1971</year>
               <source>Playing and reality</source>
               <publisher-loc>Harmondsworth, England</publisher-loc>
               <publisher-name>Penguin</publisher-name>
            </element-citation>
         </ref>
      </ref-list>
   </back>
</article>
