[Reflections on Practice]

A Bigger Picture: Community Music Therapy Groups in Residential Settings for People with Learning Disabilities

By Author

Abstract

This article introduces our development of the concepts of Community Music Therapy and systemic thinking within our music therapy service. The work, which was in a supported living setting for adults with learning disabilities (intellectual disabilities), was set up in response to the challenges of providing a more conventional music therapy service within the London Borough of Sutton Clinical Health Team for people with learning disabilities (Intellectual disabilities). We discovered that collectively our clients, their support workers, and ourselves were being reduced in our human value by not being seen or heard. The Clinical Health Team for people with Learning Disabilities is made up of a variety of health professionals and is part of the London Borough of Sutton's Disability Services. The creative therapy part of the service is music and dramatherapy. Creative therapies look at a wide range of emotional and mental health needs for people with learning disabilities such as depression, anxiety, challenging behaviour, transition, and change.

Keywords: Community music therapy, systemic thinking, ecological music therapy, learning disabilities, intellectual disabilities, support workers



“The idea that music, alone amongst the arts, is a direct expression of archetypal forms places music at the very heart of human experience.” (Paton, 2011).

Music, according to Jung (Paton, 2011) puts us in direct contact with the archetypes. As we reflect on this statement it can be understood as pointing to the universality of music. The theory of archetypes derives from Jung’s expanded model of the unconscious. Is music a universal language? Exploring this question is central to our work. Our approach combines the understanding of archetypal significance, an awareness of psychodynamic theory and a belief in the universal power of music, independent of other theories and explanations, to create opportunities for healing and growth.

As it is constructed in the United Kingdom (UK), music therapy is delivered by a qualified practitioner with a defined set of skills and expected knowledge and competences as governed by the Health Care Professionals Council (HCPC, 2013). Music therapy, as traditionally practised by many in the UK, is a specific space and time which is private and confidential. In this article we are exploring what more music therapy now means in our work.

Music as sound resonates and transmits through buildings and can travel distances; music as form is present across cultures and maybe meaningful to all stages of human existence from birth to death. As part of culture, music sustains communities. Music can also manifest and contain the paradoxes and contradictions of human existence (Hofstadter, 1999).

Is there also a paradox innate in the term music therapy? We feel that there is incongruity between the concept of a universal and shared medium, which somehow conflicts with the personal and the private boundaries of therapy. Both the universal and the personal live together in music therapy. However, the universal quality of music as organised sound, travels beyond physical confines – such as locked psychiatric wards – and travels out of confidential therapy rooms. As therapists we are tied to our responsibilities for confidentiality and as practitioners, can retreat from engaging with the responses of the wider world to the music created in the therapy. Seeing the bigger picture means exploring how music can contain music therapy.

For us, ecological music therapy means the practise of music therapy within an awareness of the whole system (Ansdell, 2002). Moreover, we interpret the term ecological music therapy to mean how music therapy as a discipline and practise can be seen as located within a structure of an organisation and of public policy. Aasgaard (2001) offered an example of this approach in work with dying children. It has become a concept for discussion and thought in the practise of community music therapy (Hiliard, 2006; Pavlicevic & Ansdell, 2004; Stige, 2002; Stige & Aarø, 2012; Stige, Ansdell, Elefant & Pavlicevic, 2010). Community Music Therapy (CoMT) is a group music therapy practice which is a potential medium for social change and for us, is delivered with the intention of befitting wellbeing and being located within an ecological context. [1][2]

In parallel with music therapy, music education, and the arts have also been developing practitioner models. The Faculty for Arts as Well Being at the University of Winchester is researching and developing ideas around the practise of music and other art forms in developing community resilience. This is part of a movement in many universities to offer practise-based doctorates (Boyce-Tillman et al., 2012). Arts as well being are now part of the present community music therapy context. Tsiris (2014) spoke about the changing context of health care and importantly describes the movement from evidence-based practise to practise-based evidence.

Developing an ecological approach to music therapy began for us from a more conventional model of clients being referred and having individual or group sessions in the therapy room. In 2009, we were based in an adult day centre, which was being closed. As music therapists, working with adults with a learning disability had several challenges for us: the reason for referral, the presenting needs of the individuals, and the accessing of the service. This prompted us to reconsider our current approach to practise and contemplate taking an art as wellbeing approach to our work.

Ansdell (2014) reflected on "pragmatic attention" (p.62) and the exploration of how, where, and when music helps and when it can promote not only personal but also community well-being. The current agenda for health in Britain is informed by the UK Care Act of 2014 which has a significant focus on well-being which although it is now a legal requirement for agencies and local authorities to address, remains an elusive and subjective concept (Care Act 2014). Well-being is now a personal and a public health agenda in the UK, Community music therapy is a growing and evolving practise that we feel aligns with this movement towards wellness and well-being. In developing a music as well-being approach we are part of the larger movement of community music therapy which is exploring where therapy and being a therapist starts and ends: the paradox of the universal and the individual in music therapy.

Community Music Therapy (CoMT) is a departure from the conventional models of music therapy and is developing a more real world inclusive approach. Pavlicevic & Ansdell (2004) spoke about offering music therapy approaches in unconventional settings. In our practice, music therapy as a whole community activity was something we started to think about. Could we transcend the boundaries of closed group music therapy and develop a more real-life based approach to our group work? How would it be to work within the clients’ homes with their care staff in the sessions as equal participants?

From the start we had to re-frame the therapy to be much more open and fluid, with people walking in and out of the sessions and the day to day life of the home becoming the context for the music therapy. Pavlicevic and Ansdell (2004) stated that in the practice of community music therapy the boundaries of what is inside or out side and what is before and after are much less defined and the music making is part of a continuum within a community where all participants are equal (Ansdell & Pavlicevic, 2005). This describes what we experienced very well. Our sessions were part of a continuum of the everyday home life with the music evolving out of the happenings in the room. The dynamics of the musical improvisations were continually changing as residents and staff joined the music making or indeed, left the room and became engaged elsewhere. This theme of a musical community is also described in the book Musical Companionship (Ansdell & Pavlicevic, 2005) that is Ansdell’s way of describing the client-therapist relationship where therapy groups are being, in his words, musical communities. Music therapy is a process that values musical communication. Ansdell & Pavlicevic referred to the idea of musical community happening through musical communication. Central to his ideas is the fact that music cannot just be kept in a room (even with sound-proofing), but can be experienced as far as it is heard. The universal aspects of music contain the individual and specific but is not limited by it. It is our belief that music has the potential to hold the important quality of equality where everyone within its embrace is heard. Because of its potentially all-embracing qualities, music can hold the needs of all individuals to relate and communicate.

We began our work in Sutton with a utopian goal of community building and found that indeed, against some odds, musical community happens and that there is the possibility for extending social fulfilment within communities through shared music making.


Our History

Music therapy at Orchard Hill was first developed as part of the Nordoff-Robbins music therapy programme (Nordoff & Robbins, 1977) working with children at the then Queen Mary's Hospital. As the children in this residential hospital grew up, the therapeutic work expanded into working with adults with learning disabilities. The practise of music therapy with adults with learning disabilities in the UK has developed significantly since it began in the 1970s. It has developed from of a model for children to a specific approach to music therapy in which the role of music therapists can co-operatively bring independence and personal autonomy to the adults in their day to day lives (Watson, 2007).

This music therapy service, which came from the service at Orchard Hill, is currently placed within the Clinical Health Team of the London Borough of Sutton. Previously, the service was part of a Primary Care Trust (PCT), a health service that ended when Orchard Hill Hospital closed (Tickle, 2009). Orchard Hill Hospital, the last long-stay hospital for adults with learning disabilities in the UK, closed in 2009 and was part of a new era of care and provision for adults with physical and learning disabilities in Sutton. Services and provision changed to include supported living and the replacement of day centres with individualised community alternatives and the transformation of social care. Maintaining the creative therapy services at the time of closure meant being taken from the PCT to the London Borough of Sutton with ring fenced Health Funding. As a consequence, music therapy remains a free health service for adults with learning disabilities in Sutton. We, the music therapists, have retained our employment. Becoming new members of the Sutton Clinical Health Team for people with learning disabilities brought us many changes: new premises, new organisational structure, and new information technology demands.

We were placed within the People’s Directorate of the London Borough of Sutton. This unusual placement of a music therapy service is one of a handful of pilot projects in England where specialist health teams are placed within a local council. We have to work to the standards of our team and consequently are learning about presenting our work within the terms that the modern care system can understand. We evaluate our work and justify it within the perspective of those such as the Care Quality Commission who regulate the health team. The money for the service comes from the Clinical Commissioning Group and again we need to address their priorities in our service delivery. The history of our work is important because it frames the reason the service exists. Later, as we explore how we remain relevant, we discuss how the needs of those who pay for the service and the end users of the service are becoming integrated through our ecological approach.

Reasons for referral to the music therapy service often include: to improve communication and likes music. Could not these reasons for referral to music therapy be true of much of the human race including music therapists? On assessment, the individuals might show some challenging needs that could require intensive, individual support. However, for many clients the presenting needs are to better their quality of life and well-being; they may have little going on in their week and music therapy is something meaningful to do. Also many were socially isolated because of the change in their home life from a group living setting to their own flat. This was a social and emotional need that again, could be the same for many people. Also, when do you stop therapy for someone who is coming to improve the quality of their life? Moreover, the accessing of our service by these clients was not always consistent. Often they did not attend their sessions at all.

As we waited for clients who often never turned up for their therapy, we sat and reflected on these issues. Although we believed that music therapy was an important part of our clients' lives, we needed to think about the bigger picture.


The Bigger Picture

As we began to work in the service hosted by the London Borough of Sutton, we experienced unexpected difficulties in delivering our service to the adults with learning difficulties we were employed to serve. The model of music therapy we had been offering didn't feel effective in reaching the clients referred to us. Far too often our clients were simply not attending the session offered to them.

Music therapy can happen in a music therapy space which is confidential and that has boundaries. That is what we had always done and what was expected of us by the organisation in which we worked. It is what we were trained to do. Wondering why this wasn’t working led us to question the model within which we were offering music therapy. At a superficial level the group was not happening because the clients were not attending. So why was that? They had little to do in their week. Not attending was leaving our week too empty as well.

Somewhere, we theorised, there was a balance of people who had too much going on. Were these people with too much to do actually the support staff, those who could not get the clients to music therapy? We had many conversations with support staff that told stories about music therapy not being in the diary, about lack of transport, homes being short staffed, and of those responsible being away. These were not comfortable conversations. It left a feeling of music therapy being too much trouble and not a priority for busy and overwhelmed staff. This led us to think about the organisations and structures that contained all of us: music therapists, support staff, and clients.

Parallel processes were becoming evident to us. Parallel processes are when the interactions within a group can mirror the hidden processes within the wider group context. Moreover, these mirrored processes are often those that are denied (Krantz & Gilmore, 1991). The organisation clearly was not functioning in a healthy way for us as music therapists. Using our time to wait for many sessions not to take place was frustrating and felt disempowering.

The concept of transference also came to mind. Transference refers to the tendency of a person to transfer the intense feelings they have experienced in their early relationships with important family members. Transference appears in all sorts of relationships. As music therapists we respond to transference-based expectations and also notice our own responses in relationships. Multiple transference relationships can form in organisations, not only between group members and the management but also between everyone involved with the organisation (Jung, 1966).

So, were others also feeling the same way as us? The support staff was certainly not at ease. The conversations evidenced some frustration at being asked to do something that they clearly felt was not their role or did not have space for – to bring clients to music therapy. Disempowered might also fit as they stated they did not know that the sessions were happening and were unable to support their service users because of a lack of information or resources. Finally, for those referred to music therapy, being disempowered was possibly normal for them. The low expectations evidenced in the sessions they did attend certainly protected them against frustration.

It was possible that our feelings might be shared around all those involved in the music therapy group. Everything could potentially be material for change, transformation and evolution, in reflection and in practice. The parallel processes were, we felt, showing us the denied issues within the organisation, where the ecology of the organisation was stressed and distressed. The conclusion we came to was to explore addressing the organisation.


Ecological Music Therapy

In our experience, music is something that everyone can be engaged by. It is an innate human responsiveness (Gritten & King, 2006). How to transform our practise? Can music as therapy be available to everyone and not only hidden away in our therapy rooms for the specific clients and therapists? The needs of our clients with learning disabilities appeared to be connected to their home lives and their relationships, not only with their peers, but with their carers. We wondered whether the therapy should be moved out of the container of the confidential private therapy room and into the homes that they live in, into their communities. Perhaps any issues that affected their lives would be better manifested in the places where those issues are actually happening. With support from our manager, we moved the sessions from closed groups in a therapy room to open groups for all in the community home. This was the start of our exploration of an approach to community music therapy.

Through running community-based groups we have made the setting more open. By moving away from a therapy room and making the sessions available to anyone in the community building at the time, we can directly address issues at the heart of people’s lives. Issues such as who they relate with and how that communication takes place.

For us, ecological music therapy means doing music therapy in the places where people ordinarily are, rather than in a special and protected music therapy space. This connects the universal power of music and sound with the therapist’s intention to relate and communicate within the art form (Ansdell, 2002). Ansdell (2002) argued for the expansion of the consensus model of music therapy. He describes the evolution of community music therapy from community music making and music therapy. For us, moving from traditional therapy towards a community music therapy approach was innovative because we believed we could make community happen between carers and the adults with learning disabilities they cared for. The relationships between the carers and the adults with learning disabilities clearly left the carers feeling that they were not able to give the opportunity for music therapy to the people they were tasked to look after. Could they accept community music making as a shared opportunity? Could a culture of valuing and being valued grow from the enjoyment of whole group music making? Taking our redundant model of closed group music therapy and moving out of the therapy room and into the real lives of people appeared to be a positive move forward.


"Keeping It Real"

To begin with we had to keep it real and listen to ourselves. As therapists we were left with a lot of complex feelings and ideas. To understand those feelings and ideas we reflected on them using elements of psychodynamic theory. Keeping it real is a phrase that is a useful short hand meaning being honest and up front about what we feel is happening in therapy sessions.

We were frustrated as we could not access our potential as music therapists and so maintain our position within the organisation. The bottom line, the reality for us, was that the quality of life of the clients was not being improved at all by music therapy because it was provoking negative feelings in the care staff, the care providers, and the music therapy service. We also thought about this: 45 minutes of positive experiences in music therapy cannot possibly aim to address the dysfunctional issues of someone’s life when it is the quality of that life that needs addressing. In order for our clients with learning disabilities to have a better quality of life then the quality of their care needs to be good. The quality of care can only be good if the quality of the carer’s life is good. The support staff as a group had a hierarchy that led to obviously unrealistic expectations of the quality of service that could be provided. Helping staff to feel enabled and confident about what they can do became a goal.

The reality for us was that very few of these individuals with a learning disability were a priority for music therapy. That is to say they had no obvious signs of distress and were coping with their lives. Keeping it real meant asking the question: why were we working with them? Because their support staff or social workers had referred them? Again, why did we carry on offering a service? To justify our existence, to keep our jobs and please our managers?


Community Music Therapy

The developing area of community music therapy challenges the preconceptions of the identity of music therapists and explores how music therapy could be delivered in novel settings (Pavlicevic & Ansdell, 2004). We expanded our ideas of who the client was. The focus became the system. To offer any benefit to those we were tasked to support we needed to address the system in which they lived: their community; environment and ecological context. Going back to the referral process we decided to look at the care providers as the focus rather than individual clients. To this end we set up meetings with our manger and then with initially one home manger.

The aim was to set up a community group music therapy pilot project in a new development of supported living flats in Sutton. In setting up the work we needed to redraw our boundaries. The groups would be for residents and staff. Our role as therapists would be to develop communication and relationships between everyone who lived or worked in the block of flats. By valuing the staff we aimed to improve their healthy communication, manifest their resources of understanding, and grow their experience of power and self- esteem. In addition by offering a service in a communal space within the block of flats we could provide a service that the residents could access more independently. Residents could use music therapy as a resource to develop their relationships and communication with their peers and those supporting them. By exploring this model of working we were also empowering ourselves. We could demonstrate to ourselves and to the organisation our resourcefulness as music therapists. In caring for one section of the group we believed we would improve the health of the whole group. If the project worked for any of us it might benefit us all.

In her book on music therapy and social work, Seidel (1992) described taking a strengths-based approach, using music therapy techniques without the conventional boundaries that a sacred music therapy space can offer. In her social-educational model she is working with music in the person’s real world context. This is similar to our aspiration to bring music therapy to the everyday home context of the adults with learning disabilities we work with. The goal for our work was developing the relationships between the carers and the residents and also developing our relationship with the carers. Using shared whole group music making as a medium to build trust and to make community “happen” in the residential homes, to use Ansdell’s (2002) words. Making community “happen” is a way of explaining the phenomena of shared experience evoked by the process of shared group music making. The power of music can evoke a more equal language for communication. Bringing this strength into the real world context of the residential care setting repurposed music therapy for us as a possible tool for culture change.

Brynjulf Stige described a reason for community music therapy existing as an agent for change within a community (Stige & Aarø, 2012). As music therapists we felt a need for change. For us, creating change means daring to be something different. In changing what we did and by addressing our attention to the home life context of our clients, we sought intentionally to develop a model of community music therapy for change in a community.


Setting Up and Running the Service

The idea of working in an open space where we could be observed was frightening. This was new work for us and we did not know if we had the skills and competencies to carry out therapy in such a different format. To contain our anxieties and move forward we needed to re-frame the work: those observing the session had a right to do so as those in the session had a right to comment on it; those in the session had a right to leave; those outside could come in. The session was open to everyone to use in the way they needed to. We had to let go of control over who participated as well as how and when that participation occurred. We respected and processed all the material we witnessed. In this real life setting the manifestations were often raw and challenging, but we found them containable. Therapy is also hard work when it is constructed more formally. The closer to real life context for our exploration into ecological music therapy was only scary because it was new and unfamiliar for us. Our intention to work with the insight from exploring the parallel processes sustained us as we developed the confidence to be vulnerable and human as equal participants in the sessions. Probably having music therapists in the residents’ communal area was a new, unfamiliar, and scary happening for at least some other people too.

Consent to attend was always important in setting up the work. Consent remained an on-going goal each week. Signalling what we were there for and explaining why we do what we do helped us stay focused and takes some of the fear of the unknown out of us being in the setting. It is the basic building block for consent. To support the consent process we used written information, verbal explanations, and worked reflectively within our role as therapists before sessions. Working reflectively with individuals helped to manifest something of the quality of what the group could be about to enable the individual's independent choice. Many of the residents are wheelchair users and could be brought to the session without making any choice. The staff might then leave them saying they had other things to do. Managers told staff to attend but were often “too busy” to attend themselves.

The parallel processes continued to teach us about the suffering and separation and lack of mutuality in the organisation. Trying to be open and available to each person's individual needs, whilst holding the organisational group process, required us to extend the unconditional acceptance to the staff and their manager. Allowing ourselves to conceptualise all of the group dynamics as part of what we needed to listen to – to witness and give attention to – removed some of our fear and enabled us to work as part of this big group and to grow in confidence. This included developing a pre-therapy engagement model that meant the session evolved rather than having always a clear start. We spent time making ourselves available and proposing joining the session to carers and residents in the flats and in the office. This meant people arriving and engaging in the space and indeed leaving and disengaging over the time we were in the building.


The Music

For our groups we chose generous instruments that easily responded to being touched. We also chose instruments that had a variety of sound qualities ranging from the melodic to the percussive and that had different sizes, shapes, and textures. Our role in the sessions was to offer musical context to the sounds, movements and instrumental responses of the group members.

The improvisational aspect of the session dominated most of the groups. However, music did return from week to week as well as individuals’ motifs and sometimes known songs, initiated most frequently by the carers, were also used. Often the groups would build their music slowly as people gathered single tones or beats gradually forming into a more on-going and structured musical expression. Some sessions, particularly where carers were excited and confident in their participation, included energetic drumming, dancing and singing (Trevarthen, Delafield-Butt, & Schögler, 2011).


Evaluation

Fitting into the wider organisation means trying to speak the language of the organisation. This is where the following statements from our evaluation come from. To ignore the organisation, though tempting as an easy way out, would not fulfil the ecological potential of the work. This informed the way we have evaluated the community group for wider understanding by the Clinical Health Team and care managers and the wider organisation of Sutton council.

Speaking the language of the system meant that we needed to express what we were doing clearly and in a way which could be understood. We produced written information for staff, sought structured feedback from staff and residents, and had more meetings. At the meetings we gave and got feedback. The aims of our work were stated:

  • To promote relating and communicating between staff and residents.
  • To reduce social isolation
  • To support a sense of community in the new block of flats.

The outcomes agreed for the project were as follows:

  • Supporting staff and transferring of skills.
  • Improving the music therapy service provision.
  • Developing individual resident's motivation to interact.

Generally, the evaluations indicated that the program was well received by the home management and by the management in Sutton. This was in as much as the project was pleasing to the home and so allowed to continue by our management in the Clinical Health Team. Whether the evaluation genuinely evidenced the purpose of the work was a question that remained for us.


The Purpose of the Community Group

Making music therapy available, through the community music therapy groups, is a resource that has allowed some people to find more of their potential to communicate more creatively. In our work we like to mirror the responses of the group and attune to the mood and energetic qualities of those responses. This is important because it is how we show our non-judgemental acceptance of the group members. Our modelling acceptance has also led to trust in the power of the group and for individuals to become self-aware and therefore, aware of others. Hearing others being listened to can make us feel more real. For those with overt disabilities seeing those tasked to care for them growing in confidence and sharing in the joy of musical mutuality brings them to a level of shared meaning that they might not otherwise have. The giving of feedback through smiles, eye contact, and vocalisations from the residents to the staff can allow the staff to feel that their existence is valued. They then can become more valuing in return. The group music making is more than any of us individually could achieve alone (Vygotsky, 1978). The purpose of this community music therapy group was to foster a space to grow the amount of value and respect shared between members of the system surrounding and supporting adults with learning disabilities. This means that the quality of life and wellbeing of participants in these groups improved because of the shared experiences of mutuality, understanding, and empathic exploration within whole group music making.


The Organisational Pathology

There is a clear argument that unconscious material such as parallel processes, transference, and the psychodynamics of leadership impact on the vitality and effectiveness of organisations. (Krantz & Gilmore, 1991). On reflection, what is it that needed healing? Where was the suffering that music therapy could be a catalyst for change in? To ignore the needs of others makes it easier to objectify and dehumanise them. Indeed to cut across those needs is to attack them. In the group there were three common causes for suffering. The suffering that we have in common is not having our needs met by the organisation.

Firstly, as therapists, we tried to get through the day with little to do except feeling frustrated, left alone not to work. Instead of increasing the burden of frustration, the community group gave us a way of expanding our sense of self as music therapists. We experienced new challenges and acquired new skills.

Secondly, the community group brought us closer to the real, day to day, life experiences of staff and taught us to give attention to their needs for time out and fun, and to address their deep sense of being asked to give without appreciation. They did not get much feedback from the people they were supporting and quite often received negative feedback from those managing them. Within the group they found the residents giving them clearer feedback, as well as their musical culture being enjoyed by others. Their musical culture was not evident or valued as a resource by the system that employed them. Consequently, in music therapy they experienced being valued by their peers, the therapists, and most importantly, by the residents.

Lastly, the group addressed the suffering of the residents. In the community setting, residents were being kept clean and tidy but their emotional needs for choice, honesty, and quality time could be over looked. The group motivated the residents’ independent communication through its focus on emotional needs and expression within a non-judgemental context. This gave them increasing confidence that their ideas would be listened to and responded to.

Being reduced in our human value by not being seen or heard was the common cause of our collective pathology. Giving each other attention addressed this emotional suffering and was the reason for the ecological approach to service. Giving each other attention grew our sense of common humanity, nourished empathy and insight, and so made it harder for us to objectify and attack each other.

The South African concept of Ubuntu expresses this well. Ubuntu, a person becomes a person through another person (Tutu, 1999). Desmond Tutu, amongst others, offers us a definition. Ubuntu describes what we are moving towards in healing for each other and for the ecology of the community. Between the differences in our roles and cultures we are finding a way of rebalancing our relationships with more respect and valuing. We are becoming more human and more self-assured through shared music making. Connecting us, as humans, one to another with equal value, rights and responsibilities, music and therapy brings healing to the suffering of the organisation. We thought about the wounded healer, which is a term first coined by Carl Jung (1966). Jung stated that we are drawn to become therapists to heal our own wounds. The paradox of the wounded healer is central to our practise of therapy, and is also evident in organisations aspiring to serve the adults with learning disabilities. This suggests a contradiction of the able needing the disabled. The care providers need vulnerable and disabled people in order to have a reason to exist. Moreover, the need for validation through helping others is a possible motivation for people entering the caring professions (Theodosius, 2008).


The Future

We have started to learn to communicate in the way that the organisations we work with communicate. We created questionnaires and made graphs. We are writing articles such as this one. We are certainly less easily ignored. Putting an outcome value on our work is part of the more traditional model of health. We are also developing tools for this. We are trying to give attention to the political pressures and the social and cultural contexts that impact on the wider organisation and to respond to that positively. This ecologically-focused music therapy group of therapists, staff and residents, beginning to work together, holds the possibility that the system in which we all exist might be a little healthier as a result. Our ecological approach is part of a wider community music therapy practise happening around the world in a variety of settings. This wider discourse indicates that music therapy has the potential to systematically address emotional life within organisations.

Keeping it real, life is full of contradictions and paradoxes. Working with and through those contradictions, exploring and celebrating the impossible conflicts that modern social care brings is essentially what we find is happening when the communities we join and share time with make music together. In this work, there may also be the opportunity to explicitly promote the goals of adult safeguarding, specifically prevention, and protection from abuse.

Music therapy is an effective tool for communication and can support people with cognitive impairments to express their ideas and feelings (Hopkinson, Killick, Batish, & Simmons, 2015). Many of the stresses in the relationships between people who live or work in residential care and supported living can lead to neglect (Marsland, Oakes, & Bright, 2015). We believe it may be harder to neglect or abuse someone you can relate to, connect with, and who appreciates you. It is possible that simply not seeing the other as fully human could be the cause of the suffering and cruelty we call abuse (Baron-Cohen, 2011). Could it be that this phenomenon is reflected in the abuse that can happen in residential care? Can ecological music therapy improve care and make it a little safer for both carers and those cared for? In the future we intend to explore if and how ecologically-focused group music therapy can play a preventative role in adult safeguarding. Can we create together the environment in which all can experience each other in ways that are valuing and increasing of our self worth?


Notes

[1] Our interest is in the health of a whole community or ecological system which we see ourselves as part of. (Music and the Quality of Life, Even Ruud Nordisk Tidsskrift For Musikkterapi. 6(2), 1997)

[2] In this article we use the terms ecological music therapy and community music therapy interchangeably


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