Community Music Therapy

Gary Ansdell, Mercedes Pavlicevic

• Publisher: Jessica Kingsley Publishers
• Year: 2004
• Print ISBN: 9781849851329
• eBook ISBN: 9781846420498
• Topic: Psychology
• Subtopic: Music
• Index: Psychology

Music therapists from around the world working in conventional and unconventional settings have offered their contributions to this exciting new book, presenting spirited discussion and practical examples of the ways music therapy can reflect and encourage social change. From working with traumatized refugees in Berlin, care-workers and HIV/AIDS orphans in South Africa, to adults with neurological disabilities in south-east England and children in paediatric hospitals in Norway, the contributors present their global perspectives on finding new ways forward in music therapy.

Reflecting on traditional approaches in addition to these newer practices, the writers offer fresh perceptions on their identity and role as music therapists, their assumptions and attitudes about how music, people and context interact, the sites and boundaries to their work, and the new possibilities for music therapy in the 21st century. As the first book on the emerging area of Community Music Therapy, this book should be an essential and exciting read for music therapists, specialists and community musicians.

PART I

New Name, Old Game?

CHAPTER 1

Learning from Thembalethu: Towards
Responsive and Responsible Practice
in Community Music Therapy

Mercédès Pavlicevic

This chapter describes work over a period of three days at Thembalethu¹ in South Africa. Thembalethu is a non-governmental organization (NGO), that is, not for profit and relies on donations, and is based in Mpumalanga, which is the South African province that borders Mozambique on the east, and the kingdom of Swaziland in the south. Traditionally, this corner of the country is poor, unemployment is rife, and the HIV/AIDS statistics horrifying. Thembalethu trains home-based care-workers and also oversees home-based care for hundreds of persons who are ill at home, as well as HIV/AIDS orphans who often need help in managing their households. The work was part of a community arts project set up by the Dedel’ingoma Theatre Company, which is committed to developing a community arts model in disadvantaged communities across South Africa.

We arrive at Thembalethu hot and thirsty, nauseous from the anti-malaria medication, and late. We are taken to the case conference in the pre-fab building, in which are seated around 70 women, in rows behind tables. We sit on the chairs set out to face the women, and listen. There is a song to welcome us, and then we are formally addressed, through an interpreter, and thanked for coming all the way from the city to be here, in this tiny forgotten rural corner of the country. Each of the women then introduces herself, and we take this as a cue to introduce ourselves: Kirsten is the drama therapist, Lauren the clinical psychologist, Hayley is the art therapist, Maria is to do massage, and I am the music therapist. For the following hours, the five of us listen to various stories from the women, to do with their work as home-based care-workers, caring for people dying of HIV/AIDS. After the ‘case conference’ we are taken to surrounding villages, accompanying the care-workers as they visit their ‘patients’. In small dark huts we see and smell thin bodies, some blind, some coughing, some covered with sores, and we witness the care-workers talking, holding a hand, washing a wound and, simply, being there, with the dying person. After the visit, we five drive to the lodge, where we will spend the evening discussing how, as arts therapists, we can contribute something to Thembalethu’s work.

This may sound melodramatic and sensationalist. It is a tiny window into the days that follow.

During the next three days, we hear constant sawing, drilling and hammering in the wood workshop across the small parking area. Occasionally, a coffin is carried out of the workshop and loaded onto a waiting van: another HIV/AIDS statistic in South Africa.

This vignette suggests unfamiliar territory in terms of conventional² contexts for music therapy practice. The unfamiliarity is to do with regional and physical space, the large group number, language, ethnicity and discomfort (the temperatures are searing). In thinking about Community Music Therapy practice, the assumption might be that it is this unfamiliarity that invites a re-considering of music therapy practice and a critique of the consensus model. That would be too easy, and also imply that music therapy practice that is embedded in more familiar socio-cultural and work contexts need not concern itself with re-visiting conventional norms, theory and intentions. While other chapters in this book describe Community Music Therapy within established – if not always traditional – working contexts, this chapter uses a context where at first nothing about the territory feels familiar or adaptable. My experience, here, was that the basic tenets of music therapy needed constant re-thinking and re-assessing, and it was this experience of having my professional ground profoundly shaken that I use in this chapter, to re-visit some assumptions and norms in all music therapy practice: those of skills, health, roles and timing.

Coding the cultural contexts

Traditional music therapy practice has, by and large, managed to ignore the socio-cultural territories surrounding the music therapy sessions and, more critically perhaps, kept these ‘outside’ music therapy practice. Inside the existing and received canon of music therapy theory and techniques, a culturally neutral stance has preserved a comfortable seal between ‘inside’ and ‘outside’. Within ‘neutral’ practice, clients are invited to enter the ‘therapeutic space’ (which is private and confidential) within which the client and therapist enter into a therapeutic relationship. Surrounding this entry are a complex set of social conventions: beginning with the setting (let’s say an institution of sorts), the referral system (activated either as a result of the client’s request for music therapy, or the carer/professional’s suggestion or request), the music therapy room (generally closed, physically and figuratively, after the client enters it), the music therapy technique or approach used by the therapist (which enables the therapist to work, and to understand the work and the client in a particular way), and the duration and frequency of sessions (generally negotiated between therapist and the client/carer according to a set of conventions). Once these conventions are more or less in place, there is ‘the music therapy session’, in which the roles of client and therapist are activated. The ‘session’ is followed by another set of conventions, this time to do with reporting, evaluating, assessing, reflecting, and theorizing about the session. In this model, music therapy skills are equally neutral: we can apparently transport ourselves from one working/regional/ socio-cultural/professional context to another, confident that our skills apply everywhere.

At the beginning and end of each session, the women sing with depth and fervour, often shifting into spontaneous dancing, and the energy in the group and in the room changes palpably as a result. At the beginning of our work together, when we negotiate the group’s expectations, and what/how we can provide these, they say that they want to ‘sing and dance to de-stress’. I hardly know where to begin and how – there is already so much music in the group, and do they really ‘need’ music therapy? In the few days that follow our arrival at Thembalethu, I feel increasingly de-skilled and un-useful.

Who am I, here

Thembalethu appears to operate within the medical model. The care-workers identify with nurses, look after ‘patients’, who have a medical condition called HIV/AIDS. Thembalethu also offers psycho-social support in the form of counselling: the women speak of patients and themselves as ‘having problems’, and they have regular ‘case conferences’. At the same time, the women make clear their stance against traditional African healers, whose methods appear to be unwelcome. All of this prompts conventional work – as part of the therapy team, I am there to do music therapy, apparently in the culturally neutral sense. This confusing state of affairs is presented in this chapter, in that I retain Thembalethu’s vocabulary – which is, after all, part of the culture of the organization, and remove the quotation marks for the remainder of the chapter. This symbolizes the continuing ambiguities and their destabilizing effects on my professional presence.

My experience of feeling de-skilled lasts the duration of this three-day workshop. Within my conventional music therapist’s mind, there are several insurmountable issues: the size of the group (now reduced from 70 to 32); the women’s musical energy (why am I needed, they already know how to use music to shift their own energy); the complicated expectations and needs (we are here to offer experiences in various modalities, both for the women’s own experience, and also as a model for work that they might do with their patients).

I then try to think about this situation not so much as music therapy, but rather, an experience of cultural induction. In other words, listening to the care-workers’ singing, to their songs, learning the songs, singing and dancing with them. Here I experience my self and my body in a way that is different from my more usual sense of self, and gradually realize that the context is beginning to permeate my music therapist’s listening, musicking and thinking.

I begin to listen to, and hear, the group’s shifts in tension, harmony and exhaustion in the group’s singing and dancing – in which our therapy team becomes increasingly familiar and comfortable, even though the language eludes us. The contents of the songs tend to be quasi-gospel, hymn-like, and, as a team, we find ourselves wondering whether this choosing to sing ‘religious’ rather than secular songs, is part of the Thembalethu culture, or whether this is for our benefit, since some of the songs have English refrains. We then learn that these songs are part of the group’s daily repertoire – whether or not anyone else is present. Although none of us in the team is especially religious (and two are non-Christian) we find ourselves singing Jesus is Great, The Lord brings Joy, Hallelujah, and so on. Here is a sense of the Thembalethu women presenting their group music, in which we are included. There is no invitation or request that, as visitors, we join in. Rather, there is an assumption that we will become part of this music. The music is, apparently, non-negotiable, i.e. the women will not especially sing songs for our language or religious, ethnic sensitivities. This feels a clear statement about the group’s identity being comfortable, inclusive, and at the same time, fixed: you’re either part of it or...not. There seems to be no choice about singing other songs.

The way that the women begin (and end) songs adds to my questioning of my role and my professional skills. As a music therapist, I am not ‘needed’ for musicking to happen. Anyone begins a song – and within microseconds, it is taken up by all. The person who starts the song remains the ‘soloist’ or leader, responsible for how the song is sung, and when it ends. Also, over the three days, I begin to recognize the beginning of the song’s ending – there is a minute shift in intensity, and a gradual winding down. This is not always as obvious as a decrescendo or diminuendo, but rather, is to do with the beginning of a quietening even if, paradoxically, the song seems to continue at the same dynamic and tempo.

How am I here

Does my listening, tracking, witnessing, and becoming ‘part of ‘ use music therapy skills? Or is it a ‘purely musical’ experience? My understanding, with hindsight, is that, in fact, my music therapy skills are activated almost automatically, in spite of myself. In the group I listen not just to the music, but to the group as music: in other words, music is the vehicle through which I ‘read’ the group in terms of coherence, agitation, fluidity and tension. I ‘read’ the life of the group, its breath, expanding and shrinking, tightening and ‘grooving’.

Here, a question emerges – one that is culturally loaded: why ‘read’ the group at all? Is this not an imposition of conventional music therapy meaning and thinking frameworks onto a context which does not invite – nor seem to want – this reading, while at the same time apparently operating within a frame that sees me as ‘the therapist’? Another question is this: if I am to ‘read’ the group, then how? In other words, what meaning can we – the women and the therapy team – possibly create and share, given the diversity of norms and contexts? My understanding, which is embedded in conventional music therapy culture, is that through singing, the whole group creates itself and shifts itself into a different musical, emotional, and group space. The women themselves say: ‘music makes us feel different’, in other words, different from how they feel before singing, and possibly closer to how they would like to feel. Also, the women say that they need to sing because it ‘de-stresses’ them; musicking seems to be about more than just singing, and seems to be related to health: ‘de-stressing’. They seem self-sufficient, knowing music’s time and power. How, then, am I to be with them?

Shall I take them through a group improvisation, using musical instruments, and then invite them to reflect on this event? This feels inappropriate, and in any case, musical instruments are not part of the women’s reality; although by being ‘in role’, so to speak, this might be congruent with the apparent framework of psycho-social support for the women. Intuitively, my decision was to become part of the larger group, not negating my music therapy identity, but extending this to become a listener, musician, thinker, group participant, singer, and to reflect on events as they happen.

There are other moments in the three days when our more familiar, traditional (and comfortable) therapeutic skills are called for. For example, one morning one person (whom I shall call Lindiwe) says that her patient died overnight, and she remained with the body and the patient’s children, who have now become orphans. She has not been home to see her children but has come directly to our workshop. She feels worried because a gang of older children (also orphaned) have been ‘hanging around’ her home, and, it turns out, no husband/father/adult takes care of her children while she is working. Lindiwe looks distressed and exhausted and we (the therapy team) are on high alert. The entire group listens attentively. The women next to her put an arm around her shoulders, and other members of the group ask her questions, are receptive, supportive and highly empathic.

Again, as therapists, we might have had a sense of not being needed. Except that this is brought into our large group time. It could have been talked about before – and indeed, on some mornings the women have work meetings before we begin working together as a larger group.

Why, we might then ask, is this information shared with us – why is it not dealt with outside our sessions? One of our tasks, which begins to emerge after hours of team discussion and reflection, is to be there in order to listen to, and share what the women live through every day (and night); to receive and to witness their lives. One of our tasks, also, is to ‘become part of ‘ the group in their sense of hopelessness and despair as they share their troubled lives with us. At the same time, we represent a bridge, a link with another world: the noisy, cluttered, and possibly gl...

Table of contents

• Cover
• Half Title
• Of Related Interest
• Title page
• Copyright
• Dedication
• Contents
• Acknowledgements
• Foreword: Reclaiming Music
• Introduction: ‘The Ripple Effect’
• PART I: New Name, Old Game?
• PART II: What has Theory got to do with it?
• PART III: Is Community Music Therapy a Challenge to the Consensus Model?
• PART IV: But is it Music Therapy?
• PART V: What has Culture got to do with it?
• PART VI: What has Context got to do with it?
• Afterword
• Concluding Remark
• List of Contributors
• Subject Index
• Author Index