Professional Documents
Culture Documents
Section 1: Music Therapy Contexts and Populations Across The Lifespan Reviewed By: Terri Coyle and Claire Grant
Section 1: Music Therapy Contexts and Populations Across The Lifespan Reviewed By: Terri Coyle and Claire Grant
109
Jane Edwards (ed.) The Oxford Handbook of Music Therapy. Oxford University Press: Oxford, 2016.
function of eating disorders as a means of feeling in control with a view that ‘refusing food can be a way for a child to refuse
to take in their parent’s pain’ (p. 301). She explores what this means for music therapy approaches, including the fact that
music can often facilitate clients in a more spontaneous and connected expression of themselves. Odell-Miller’s thorough
outline of the personality disorder field describes how music-making in therapy can help clients in the important process
of identifying and understanding their emotions and interactions with others better. A range of approaches are reviewed
with an emphasis on the importance of affect regulation and linking affect with thinking (e.g. Bateman and Fonagy, 2004).
Music therapy with adults with learning disabilities is covered by Watson (chapter 18) who also emphasises the emo-
tional world of her clients. The profound impact of music used as ‘“a means for a person to make contact and be under-
stood” (Wigram, 1988)’ and the importance of helping people take up the challenges of new opportunities are explored.
She also cites, ‘the importance of theories of the grief process being applied to loss for people with learning disabilities’
(p. 344). Her moving vignettes bring the music to the fore, showing how the medium can help people connect with others
or identify, express and name painful feelings in a safe way. Her capacity to share these feelings and respond in musical
form is central to this.
Moving through the lifespan, Clair writes about work with people with Alzheimer’s disease and gives a generous per-
sonal perspective on the client group, which has the effect of bringing theory to life in a poignant way, particularly when
considering that residential care usually occurs ‘after the need for care exceeds the family care giver’s resources and is
therefore an emotionally draining process’ (chapter 20, p. 387). O’Callaghan and Michael follow this up with their work
on grief and mourning (chapter 21).
References to historical, political and social contexts are also important: Edwards and Kennelly remind us of how much
has changed in medical care for children with families having previously been left out of the equation and the inevitable,
often traumatising, impact of such separation. Oldfied describes a range of family approaches to music therapy, again
noting the development in this area. Hayes refers to the field of ‘disability studies’ considering disability as ‘primarily a
socially constructed dimension’ (p. 177). Watson recalls a chilling chapter in history of eugenics and looks at the politics
of the changes in terminology in learning disability services over time. She says, ‘The interaction between the person and
their environment is now considered as important as IQ in assessing disability’ (p. 336). In the field of traumatic brain
injury, Gilbertson calls for the focus to move beyond the individual, such that the ‘context of the injured person forms not
only the frame of understanding, but is the actual phenomenon that requires attention in itself’ (p. 362). Curtis emphasises
the sociopolitical context in her chapter on domestic violence. McCaffrey reflects on paradigm shifts in mental health
from illness to wellness, linking this with recent models such as community music therapy founded on a ‘sociocultural
view of music, health, and illness’ (p. 262). Gfeller highlights cultural issues in relation to auditory impairment: ‘the
variability in the deaf and hard of hearing population with regard to auditory status and cultural values’. She points out
that ‘persons with strong affiliation to Deaf culture are likely to consider oral communication and auditory experiences
(including music) of lesser personal priority’ (p. 234).
Meeting life-limiting circumstances, as described in chapters on oncology care (e.g. Reid, O’Callaghan and Magill:
chapters 4 and 6), makes for painful reading as this goes against the very idea of lifespan, especially when in relation to
children. Similarly, the struggles, losses and challenges facing clients and their networks in other contexts can present the
therapist with profound and demanding emotional material. Despite this, the text can sometimes feel detached in its deliv-
ery of albeit rich material. While it may simply not have always been possible to fit into these complex and informative
chapters’ descriptions of the impact of the clinical material and setting on the therapist, at times we missed this reflection.
UK practice considers that subjective accounts of internal experience are important for their potential to move the other,
allowing the ‘musical’ or ‘feeling’ communication, so important to our understanding of each other on an emotional level.
The examples of this in the text stood out for us. Ahonen, in her chapter on Adult Trauma (chapter 14), emphasises the
emotional impact of the work, highlighting the risk of vicarious trauma in the therapist, and makes one of the few refer-
ences to clinical supervision, personal therapy and specialised training as essential structures supporting the therapist
to process their work effectively. We were also put in mind of the unconscious processes that can impact our work as
described by Menzies-Lyth (1960, 1988) in her seminal texts. She writes of the psychic pain of working within health
care settings and the resulting defensive reactions as staff unconsciously find ways to distance their emotional contact
with patients. She not only understood these processes as coping techniques enabling staff to continue with their primary
tasks of providing care but also emphasised the role of reflective work in order to contain such anxieties more effectively,
making contact with painful material more manageable and improving the patient experience. As Watson says, ‘containing
staff emotions can in turn allow staff to contain the emotions and projections of service users, helping to develop greater
understanding of behavior and emotions and psychological mindedness in their work’ (p. 351).
In summary, this book is an excellent resource. It is a considerable accomplishment to bring together such a diversity
of approaches from pre-structured programmes to client-led free improvisations, from music-listening to music-making,
from hospital bedside to community group and from pre-term infant to end-of-life care. The text was particularly evoca-
tive when case vignettes were shared, bringing us into the vitality of the therapeutic space. We found ourselves following
up many of the extensive references to look into new areas and to revisit familiar contexts with fresh eyes. As Edwards
says, it is ‘a snapshot of activities of practice’ (p. 2), and ‘summing up this breadth in a single text would be impossible
and has not been attempted’ (p. 2).
Book Reviews 111
Section 2: approaches and models of music therapy and Section 3: music therapy
methods
Reviewed by: Leslie Bunt
Section 2 (chapters 22–33) opens with an introduction by Edwards to further chapters outlining seven different models
of music therapy and four approaches, although there appears some overlap of the terms, including ‘perspective’. Many
chapters are written by the founder, contributing to an excellent opportunity to engage with a group of key international
experts and a superb resource.
The focus of chapter 23 by Hadley and Hahna is ‘Feminist Perspectives’, a ‘lens’ that has furthered understanding of
how therapy is defined alongside such issues as inclusivity, power relationships and gender inequalities in the profes-
sion. Links are explored between cultural bias and music and ‘feminist-informed’ approaches to music therapy practice,
supervision, assessment, education and research. The authors chart how other scholars have integrated a feminist per-
spective into their work, for example, Rolvsjord in developing ‘resource-oriented music therapy’ which she elaborates
in chapter 30. Rolvsjord’s focus is on empowering clients to develop their own health-promoting resources in a posi-
tive and equal fashion in contrast to emphasising difficulties and pathology within more medical and intervention-led
perspectives. She builds on a Scandinavian tradition that incorporates Ruud’s links to reflexivity and empowerment
and to Stige’s teachings on a culture-centred approach to music therapy practice, theory and research, as in his chapter
29. Stige focuses ‘on culture as a resource for self and society, music as a situated activity, and music therapy as health
musicking’ (p. 538). He builds on the ecological perspectives of Ruud and Kenny with their emphases on the relation-
ship between culture and personal agency and action. Such themes are also central to the evolution of community music
therapy (CoMT), and Stige joins Ansdell for chapter 32, characterising CoMT not as an approach or model but as a
‘movement’, uniting music therapists from around the world to reflect critically on ‘aspects of the practice, theory and
professional identity of music therapy’ (p. 595). Ecological and sociocultural perspectives alongside the musical poten-
tial for health promotion have contributed to CoMT’s aim for a kind of ‘joined-up music therapy’ (p. 597). Interestingly,
perhaps within the inclusive sprit of CoMT, first names occur on first mentioning in this chapter and uniquely in the
list of references.
The resource-oriented, community and health promotional nature of the work of Rolvsjord, Ansdell, Stige and others
has some historical connections to the pioneering work of figures such as Nordoff, Robbins and Boxhill. The principles
of the Nordoff-Robbins music-centred model (although approach is also used) are described in chapter 26 by Guerrero,
Marcus and Turry, a short chapter and surprisingly without extensive musical examples. What is illuminating is the
unifying theme of the ‘creative now’ and explanation of a teaching diagram devised by Robbins: ‘Poised in the creative
now’.
A review of Boxill’s contribution in the context of a developmental approach (chapter 31 by Edwards and Noone) is
timely, situating her work within more recent references to coping responses to stress (including brain regulation func-
tion), lifespan development, ecological frameworks and stage theories in relation to musical development.
Is this the first time within a book of this range that a separate review on the contributions of Rudolf Steiner to
‘Anthropological Music Therapy’ has been included (chapter 27 by Intveen and Clark)? It is well placed following the
chapter on Nordoff and Robbins, given the historical connections. Chapter 28 on ‘Aesthetic Music Therapy’ is by Lee, a
Nordoff-Robbins trained music therapist. The centrality of music within Lee’s model pervades this chapter and is exem-
plified within his opening ‘Prelude’ with a personal reflection on the importance of Mozart’s Requiem to his practice, the
start of which being incorporated into the following case vignette.
Lee’s initial training was as a concert pianist and Austin’s a jazz singer. Like Lee, Austin went on to bring extensive
musical experiences to inform a unique contribution to music therapy, in her case in the way that clients explore and
discover themselves in processes of ‘Vocal Psychotherapy’ (chapter 33). The way that the breath, song and different
ways of the vocal improvisation are used to release physiological and psychological blockages are illustrated in two
case examples.
Austin’s emphasis on articulating musically unconscious internal processes externally in the interpersonal dynamic
connects to Metzner’s overview of ‘Psychodynamic Music Therapy’ (chapter 24). The evolution of psychoanalytic theory
began to influence music therapy practice and discourse in the late 1960s with its application in the field of mental health
and explorations of object relations, transference and countertransference as manifested in the music therapy transaction.
Today, further theoretical connections need to be made with advances in infant research and neuroscience, expanding the
reach of applications into education and trauma recovery, for example. Metzner’s chapter includes an extensive case study
that reflects on both the changes and difficulties within the therapeutic process.
It feels natural to leave Kenny (chapter 25) and her well-documented model ‘The Field of Play’ to this point, with its
resonance with ‘indigenous ways of knowing’ (p. 474) and ecological nature. As Edwards mentions regarding Kenny’s
model, there are ‘applications for every music therapy practitioner even if they do not employ it as their primary model of
practice’ (p. 419). ‘The ‘Seven Fields’ within Kenny’s model flow out of describing early experiences of creating spaces
and possibilities with patients.
112 British Journal of Music Therapy 31(2)
Edwards begins Section 3, ‘Music Therapy Methods’ (chapters 34–37), with an overview (chapter 34) where she dif-
ferentiates a method as ‘the way the music therapist and client interact musically’ from a specific technique and details of
the procedures used (pp. 639–640).
In chapter 35, Aasgaard and Blichfeldt Ærø explore how songwriting is defined, extending the process to include
rehearsal and performance, before reviewing the history of this relatively new practice and how it is used in different
contexts. The authors introduce ‘Methods Based on Specific Steps or Stages’ before an alternative of ‘Guiding Principles’
resulting from working with individual children or young people in hospital. The chapter continues with practical exam-
ples of different techniques for creating both lyrics and music. Clinical examples are interspersed throughout the more
practical sections of the chapter, with some notated examples indicating harmonic frameworks. Current advances in music
digital technology are outlined. There is discussion on the positive aspects, alongside potential issues of vulnerability and
guaranteeing safety, in sharing materials in more public arenas alongside the life of a song after performance.
A reconsideration of ‘Group Music Therapy’ is the topic of Pavlicevic’s chapter 36, an area that does not feature in the
literature as much as individual practice. She begins with a reflection on how different music therapy practices emerge
from ‘the intellectual, social and political currents of their time’ (p. 671). Music therapists might draw on external, indig-
enous or bridging theoretical constructs. Some recent group-based texts are reviewed in relation to their connections to
theory or practical resources. There is an improvisatory feel to the rest of the chapter as commentary from ‘social-musi-
cal’, ‘music-centred’ and ‘group improvisation’ discourses emerges from three vignettes.
‘Receptive Music Therapy’ is the topic of Grocke’s chapter 37, the last in this section. An introduction to the ubiquitous
use of listening to music today and its effects on mood leads to an exposition of different receptive methods and goals for
therapy. Grocke selects three methods for detailed focus: ‘Music-assisted relaxation for children and adults in different
clinical settings; Music and Imagery and Guided Imagery and Music (Bonny Method)’. Features and principles of each
method are supported by related theory and examples from research. Attention is given to the choice of music and who
makes it, and how this can impact research evidence.
References
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University Press.
Casement P (2002) Learning from our Mistakes: Beyond Dogma in Psychoanalysis and Psychotherapy. New York: Guildford
Press.
Langer SK (1942) Philosophy in a New Key: A Study in the Symbolism of Reason, Rite and Art. Cambridge, MA: Harvard University
Press.
Menzies-Lyth I (1960) Social systems as a defense against anxiety: An empirical study of the nursing service of a general hospital.
Human Relations 13:95–121.
Menzies-Lyth I (1988) Containing Anxiety in Institutions: Selected Essays, vol 1. London: Free Association Books.
Stern DN (2010) Forms of Vitality: Exploring Dynamic Experience in Psychology, the Arts, Psychotherapy, and Development. Oxford:
Oxford University Press.
Wigram T (1988) Music therapy – Developments in mental handicap. Psychology of Music 16(1): 42–51.
114 British Journal of Music Therapy 31(2)
Author biographies
Terri Coyle is a music therapist with many years experience working in the NHS specialising in Forensic mental health and work with
staff groups. Currently between London and Scotland she continues her supervision practice and consultancy to teams on clinical and
employment issues.
Claire Grant is a music therapist with experience of working across a range of adult mental health services and educational settings and
leads a team of arts psychotherapists within a London NHS Trust. She is also a co-ordinator and trainer with the International Centre
for Arts Psychotherapies Training (ICAPT). Claire has an interest in clinical research and the development of the evidence base for arts
psychotherapies.
Dr Leslie Bunt has been practising music therapy for 40 years and teaching students since 1980. Currently he is Professor in Music
Therapy at the University of the West of England, Bristol and a practitioner ad Primary Trainer in GIM. Leslie has recently revised
Music Therapy: an art beyond words with Brynjulf Stige (2014) and is presently revising The Handbook of Music Therapy with Sarah
Hoskyns and Sangeeta Swamy, again for Routledge.
Catherine E Carr is an NIHR Clinical Lecturer and Music Therapist at Queen Mary University and East London NHS Foundation
Trust, Lecturer and Supervisor on the MA in Music Therapy at the Guildhall School of Music and Drama. Previously a Trustee of
BAMT, she conducted a membership survey in 2009. She has been awarded two National Institute for Health Research fellowships and
has expertise in a range of quantitative, qualitative and mixed methods.
Tessa Watson is a music therapy educator, clinician and consultant with over 25 years’ experience in various clinical settings. Head of
Arts and Play Therapies innovation and development, and course leader for the MA Music Therapy at the University of Roehampton,
Tessa has an honorary NHS clinical post working with adults with learning disabilities. She is BJMT Editor, an HCPC Partner, and
holds roles within BAMT. Tessa publishes and presents in the UK and internationally, with current research interests being learning and
teaching in music therapy. She maintains an active musical life, playing cello and singing with local amateur ensembles.