[Position Papers]

Representing People in Music Therapy Research and Practice: A Balancing Act

By Rebecca Fairchild &, Jennifer Bibb

Abstract

The process of representing people in academic writing and discussion is paradoxical. Drawing on our experiences of research in areas of child welfare and adult mental health, we consider whether the predominantly problem-focused language often used to describe and represent people in music therapy research and practice is congruent with the strengths-based way in which music therapists work. This article describes a call to action for music therapists to reflect on the language we use to represent the people we work and research with. We argue the need for a better balance in representing people in music therapy case studies, presentations and articles, by focusing on their strengths and resilience along with their challenges.

Keywords: representation, language, resource-oriented, music therapy



Introduction

As early career researchers of a young and developing profession, we, like many others in the field tend to embody the need to prove, promote, and advance the music therapy profession through research. As music therapists, we strive to walk alongside our allied, education and medical colleagues and make a contribution to publishing the latest knowledge and to prove that our work is worthwhile. We see people in a unique way that often other professionals do not, and we are proud and excited to share stories of hope, health, and development. However since embarking on our PhD studies, we have noticed a tendency in academic writing to privilege descriptions of the challenges and negative aspects of people’s lives, as a way of demonstrating the important role music therapy can play in improving them. Throughout this position paper, we have attempted to use the word we in a purposeful way to represent the music therapy profession as a whole, as well as our individual perspectives. We argue that a critical discussion is needed about how music therapy participants are represented through the ways we write about them, and suggest that a better balance is needed in representing people’s strengths alongside their weaknesses.

Representing People in Research and Practice

Contemporary approaches to music therapy emphasise user participation, equality, and promote agency through music therapy practice. Resource-oriented and community music therapy approaches nurture the strengths and resources of participants while encouraging people to be active agents in their own health experiences (Rolvsjord, 2006; 2010; 2014; Solli & Rolvsjord, 2015; Stige, Ansdell, Elefant, & Pavlicevic, 2010). As such, emphasis is placed on equal relationships between the therapist and participant where power is transferred from the expert therapist to the person with the ability to empower themselves (Rolvsjord, 2006; 2014). Stige (2002) described this collaboration as a shared responsibility between therapist and client. A resource-oriented approach to music therapy not only implies the acknowledgment of people’s skills and resources, but also embodies an attitude towards the person, as a “resource-person” (Rolvsjord, 2006, p. 7). Recognising people’s strengths in music therapy, acknowledges the way they can use music and music therapy to improve their own quality of life (Rolvsjord, 2003; 2006).

The consensus model of music therapy focuses on improvement of deficits and reduction of symptoms (Ansdell, 2002). As such, there has been a tendency within music therapy practice and research to talk and write about people with illness or disadvantage at the expense of strengths and resilience (Procter, 2001; Rolvsjord, 2010). Language is often used that represents the therapist as a powerful expert, and the person they work with as weak and powerless (Duncan & Miller, 2000; Rolvsjord, 2010). We construct meaning through the ways we represent people and their experiences, and this subsequently showcases our values and identity through what we choose to focus on. The representation of people involves selecting certain words to describe them, sharing their stories and detailing our emotional responses associated with these experiences (Donnelly, 2002). The meaning we make from these representations contributes to the development of norms and rules for how people will be viewed by others (Hall, 1997).

How we talk and write about music therapy practice influences the way participants and the therapy process is perceived (Rolvsjord, 2006). The stories we tell about music therapy and the people we work with can be about “victors or about victims” (p. 11). If we assume the role of a storyteller then the people who share in music therapy processes will no longer be viewed as subjects, but as participants and active contributors to the therapy and research (Polkinghorne, 1997). We can choose to emphasise people’s weaknesses and pathologies or strengths and resources (Duncan & Miller, 2000; Rolvsjord, 2006). Facilitating empowerment through music therapy practice suggests acknowledging people’s resources in our representations of them outside of therapy, as well as during the music therapy process itself (Rolvsjord, 2006).

Within the feminist discourse, the representation of participants has been challenged (Charmaz, 2014) and the potential dangers of appropriating participants’ voices and experiences to meet academic standards have been acknowledged (Ellingson, 2011). This has resulted in a shift away from objective and generalised descriptions, and a step towards subjective and individualised representations of people within their own contexts (Charmaz, 2014). We need to consider how the authors’ own values and identity affiliations such as gender, race, age, and social status impact the ways in which knowledge is shared and understood (Roof, 2012). Due to implicit power imbalances that exist within therapeutic relationships, the music therapist ultimately holds the authority for how people will be described and represented.

Within the field of mental health, the development of person-first language aimed to significantly change the way people are described and represented (Granello & Gibbs, 2016). The American Psychological Association developed guidelines for representing people by striving to “maintain the integrity of all individuals as human beings” and to “avoid language that objectifies a person by her or his condition” and to avoid using “excessive or negative labels” (APA, 2010, p. 76). This acknowledges the need to see the whole person first, and their illness or adverse experience as only one aspect of their life.

There are many people in society who are the subject of discrimination, stigma, and exclusion from people in positions of power or within the dominant majority group (Lago, 2011). Anti-oppressive practice recognises the power imbalances that exist in our society and music therapy is one way to facilitate and represent the strengths and potential of its participants (Baines, 2013). However by emphasising people’s challenges in the way we write about them, we consider whether it is possible that we are inadvertently contributing to the oppressive nature of how these people will be viewed by others. As suggested by Hadley (2014), our deep connection to music therapy and the people we work with makes it uncomfortable to consider that we might be a part of the oppressive structure through the way we describe and represent people. The following section will provide some personal reflections of our own experiences and research regarding the representation of people within the child welfare and adult mental health context.


Rebecca’s Reflections On Representing Children Within The Child Welfare Context

I have been working with children who are accompanying their families through the homelessness and family violence system in Australia since graduating in 2009. As a graduate music therapist in a new program, I grappled with finding my place amongst case managers who focused primarily on crisis intervention and supporting families with basic needs such as food, safety, shelter, and education. As children were referred to my programs, I heard their painful stories of violence, transience, family disruption, and intergenerational poverty. But in meeting these children, what I saw was their resilience, strength, and interest in music despite their experiences of adversity. I noticed that the ways that family members, schools, and professionals described children, was often not the way they presented when engaging in music therapy and in talking about what was important to them.

I started my PhD with a critical interpretive synthesis, which involves asking critical questions of the literature (Fairchild, McFerran, & Thompson, in press). I was interested in exploring the different programs that were described for children in the homelessness and family violence context, which included perspectives from art therapy, social work, play therapy, counselling, and music therapy. Very early on as I was reading and analysing these articles, I started to notice a sense of discomfort and anger each time children were described in the early stages of the articles. The beginning of the articles included lengthy descriptions of the problems and challenges that children in this system face, with a substantial focus on family deficits and the bleak statistics for children’s futures. On the other hand, there was little discussion of children’s personal resources and capacities in times of adversity. Through my music therapy work with children in this context, I was very aware of the challenges that some children experience when faced with adversities such as violence and transience. However, the ways they were being described and represented in the literature was incongruent with my experience of working musically with these children.

As I started to look more broadly at the field of child welfare now focusing purely on music therapy, I noticed some similarities in the ways participants were being described and represented. It seems as though when music therapists write up their work, they feel obliged to express the dire need for services in this context, by emphasising the statistics and possible physical, social, and psychological impacts of these experiences. Children are often described using powerful language such as having psychological, psychosocial, and behavioural problems (Kim, 2015; Zanders, 2012), being emotionally disturbed (Layman, Hussey, & Laing, 2002), and being invisible (Strehlow, 2009). However, what is often missing is the acknowledgement of the resources that children draw upon within themselves in the face of adversity.

Influenced by academic guidelines and previous publications in similar contexts, I acknowledge that I was also compelled to include similar strong descriptions of children within my own Masters thesis about the experience of a performance for pre-adolescent children and families in the homelessness and family violence context (Fairchild, 2014). In the early stages of the thesis, I felt it was necessary to emphasise the statistics and incidences of homelessness and family violence, the multitude of possible risks for children, and the children’s experiences of living in these challenging circumstances. At the time, this seemed like an appropriate and powerful way to demonstrate the possible needs of children in the system and to describe the importance of the music therapy research. However in an attempt to balance my discomfort in focusing mainly on the risks for children, I also (somewhat imperfectly) incorporated discussions of resilience in the early stages of the thesis, privileged children’s voices, and provided idiographic descriptions of their experiences in the results.

While I was completing the critical interpretive synthesis for my PhD, I attended the Pathways to Resilience Conference in Halifax, Canada. One of the keynote presenters Bruce Ellis (2015) discussed his rejection of the deficit model, which assumes that children who have experienced trauma are somehow broken and in need of being fixed. Throughout my engagement in this conference, it became clear to me that the deficit model is not enough. The resilience approach is about focusing on what is going right for children and building upon their existing resources, rather than merely identifying the challenges that they may be experiencing (Liebenberg & Ungar, 2009). Creative arts therapies are typically built upon the premise of strengths-based approaches, however it became increasingly clear that the way we write does not always represent the collaborative and mutually empowering ways that many music therapists work.

An example of a piece of writing that shows congruence between its descriptions of the participants and the subsequent outcomes of the program was written by Scott MacDonald and Michael Viega in the edited book Therapeutic Uses of Rap and Hip Hop (2012). MacDonald and Viega (2012) described the Hear Our Voices program for children described as at risk, which focuses on providing opportunities for children to express themselves and explore the issues that surround their lives through songwriting in the styles of rap and hip-hop. In the early stages of the book chapter, the authors provided a brief overview of the statistics related to the levels of crime, poverty, and violence in the community and how this impacts the children’s access to education and social activities. However they also acknowledge the challenges associated with using the term at risk to represent these children, describing how the people living in the community do not see themselves in this way and are doing everything they can to prevent intergenerational experiences of violence. Similarly, the at risk label has been debated in the literature, as this places an emphasis on their assumed individual deficits rather than challenging the systemic issues that contribute to children’s exposure to this adversity in the first place (te Riele, 2006). When describing the participants in the program, MacDonald and Viega (2012) primarily focused on the musical interests of the children and personal experiences of the children were later shared through the song lyrics created. The authors acknowledged that the children understandably displayed behaviours such as teasing and fighting at times throughout the songwriting process, but they highlighted that the music and lyrics they created demonstrated their inner beliefs concerning humanity and social justice. The inclusion of the song lyrics throughout the discussion provided a child-centered representation of the children’s experiences and values.

Child welfare is a system fraught with multiple oppressions and often-negative attitudes surrounding experiences such as poverty, violence, disadvantaged, and disrupted family relationships. Therefore the language that authors choose to use is likely to influence the ways that children will be perceived. I am not naïve in thinking that we must only write about the strengths and resources of the children that we work with, without acknowledging what they have experienced and how that impacts the way they present and the subsequent ways that we engage with them. However, it is also clear that we need to consider how we can better represent the whole picture in our descriptions of these children’s experiences and participation in music therapy. This new understanding influenced my motivations to conduct a PhD project that focuses on changing perceptions of children within the context of homelessness and family violence, by providing opportunities to showcase their strengths and capacities during times of crisis.


Jennifer’s Reflections On Representing People Within Contemporary Mental Health Care

The field of adult mental health care has traditionally been based around illness and medicine. Mental health care has changed direction in the last 10 years, embedding recovery-oriented philosophy into policy, research, and practice (Commonwealth of Australia, 2013). Recovery literature emphasises empowerment, lived experience, and looks beyond the limitations of illness, for health (Banfield et al., 2014; Slade, 2009). Music therapy authors have previously noted the congruence between music therapy in mental health care and its emphasis on empowerment and consumer led processes within recovery philosophy (Baines, 2003; Procter, 2001; Rolvsjord, 2010; Solli et al., 2013). Like recovery-oriented practice, music therapy practice promotes empowerment and self-determination by collaborating with people and focusing on their strengths and resources (Rolvsjord, 2010).

Although recovery-oriented theory encourages the use of positive and hopeful language (Slade, 2012), strengths-based language is not always used in practice. When recently conducting a review of academic journal articles of group music therapy studies in mental health care as part of my PhD studies, I found that many of the articles followed a similar structure in the way they introduced mental health consumers. First, they introduced the statistics and literature around illness or disadvantage, and then they described how music therapy could improve this illness or disadvantage. There is little mention of consumers’ strengths or resources until music therapy is introduced. One example of this is in an article describing a randomised mixed methods study using group music therapy for people with severe mental illness (Grocke et al., 2013). Grocke and colleagues used the first paragraph of the article to describe the challenges people with severe mental illness (SMI) face, using words like “stigma,” “discrimination,” “uncertain future,” “isolation” and “suicide” (p. 145). Of course, these descriptors may well be a reality for many people with SMI and the references cited in the article support these claims. However, it is concerning that people with SMI are only represented by the negative aspects of their lives. The next paragraph of the article introduces music therapy as an “effective intervention” (p. 145) for treating mental illness, and literature is used to support the claim that music therapy can solve or help with the problems described in the previous paragraph. After noticing the way consumers were represented in articles describing music therapy programs in mental health settings, I was prompted to reflect on my own writing within academic reports and case studies. I noticed that I too used language that emphasised the negative aspects of consumers’ lives in an attempt prove that my clinical work was worthwhile.

In academic discourse, consumers are often represented as weak and ill prior to attending music therapy, which is incongruent with the way music therapists work in contemporary mental health care. Indeed, when Grocke and colleagues (2013) reported on the music therapy sessions conducted with participants in their research study, they describe working “collaboratively” with participants, focusing on their strengths and resources and offering choice in the song writing process (p. 148). It is clear that in practice the music therapy program was strengths-based and consumer-focused. But when representing participants in an academic setting, there is a tendency to ignore “all that makes [a] person human,” their strengths and weaknesses (Slade, 2012, p. 83). Grocke and colleagues (2013) may well have experienced pressure from the journal where the article was published, to write in a way that emphasised the negative aspects of mental illness, to support the clinical work detailed in the article. Acta Psychiatrica Scandinavica is a prestigious journal in the area of mental health with an impact factor of 5.6, publishing “high-quality, scientific articles in English, representing clinical and experimental work in psychiatry.” The journal clearly prioritises a medically-oriented perspective on mental illness, which has a strong focus on pathology and tends to ignore subjective experience (Slade, 2009).

We believe we can offer a balanced representation of the people we work with by consciously prioritising their strengths and resources over their illness. The following example from my PhD study (Bibb, in progress; see Table 1), attempts to represent participants through their individual difference, rather than group membership (clinical labels of diagnosis). When presenting the people who participated in this research, I felt it was important to include information and labels that the participants themselves identified as representing their own recovery experience. The information was gathered during conversations with participants, which is reflected through the use of their own words describing their illness or health experience. This is defined by Slade (2012) as “self-knowledge” and is included in an attempt to value the lived experience that participants bring to research (p. 87).

Table 1. Participants' representations of their own experiences of mental health recovery.
Participant name (self-selected pseudonym) Identified self-knowledge
Lola Student and animal-lover with complex physical and mental health problems
Ellie Librarian with depression and anxiety
Kate Mother with bipolar disorder
Hannah Nurse with major depressive disorder
Sam Ex-music theatre artist with chronic mental illness
Violet Retiree with an “active life” and a mood disorder
Greg Teacher and ex-surfer with depression
Hurdler Aged care worker and ex-sportsman with a chronic mental illness
Milly Creative arts student with bipolar disorder
Margaret Sales assistant with a mental health disability
Dan Drug dependent person with OCD
James “Bloke in a wheelchair” with depression
Lindy Singer with mental illness on a disability support pension
Sarah Person with depression who had a stroke

A Call to Action

As we have identified, the language used to represent people when writing about music therapy does not always fully represent the ways that we actually work. We write this article as a call to action, in a hope that music therapists will become aware of the way they represent the people they work with, and will consciously and purposefully talk about their strengths and resilience alongside their illness and weaknesses.

Music therapists have spent so long trying to demonstrate the significance and need for music therapy services through research and writing, that we have started to lose sight of what makes our practice so unique. In 2001, Simon Procter cautioned music therapists against the potential risks of becoming so preoccupied with professionalisation that we are no longer writing about our work in the same way that we actually do our work. Regardless of how well intentioned we are in the ways we work with people, we as music therapists ultimately hold a sense of power and responsibility about how we choose to represent people in the ways we write about them. Therefore, we argue that what is needed is a better balance in the ways we represent the people that we work and research with.

We believe it is our responsibility as therapists to tell stories about strength and coping that give credit to the people who participate in music therapy. Although challenging “the status quo can frighten us and make us feel uncomfortable, it can also be exciting, challenging, and empowering because it is about having expectations for a better future” (Hadley, 2012, p. 28). Within our own PhD studies we continue to grapple with finding a better balance in the ways we represent the people who we encounter through our work and research. In doing so, we reflect on how these people will continue to inspire and drive us to be fairer and more intentional with our use of language, so that we can more fully represent their strengths and capacities in spite of their adverse experiences.


Acknowledgements

We would like to thank our supervisor Professor Katrina Skewes McFerran for her ongoing mentorship in our critical thinking and research development. We also acknowledge the contribution through discussion and debate on this topic from the graduate researchers and staff within the National Music Therapy Research Unit (NaMTRU) at The University of Melbourne.


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