Music Therapy : A Perspective from the Humanities [1 ed.] 9781891278808, 9781891278549

Citation preview

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MUSIC THERAPY A Perspective from the Humanities

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Other Barcelona Publishers titles by Even Ruud Music Therapy and Its Relationship to Current Treatment Theories (1978) Music Therapy: Improvisation, Communication, and Culture (1998)

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MUSIC THERAPY

A Perspective from the Humanities

Even Ruud

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Copyright © 2010 by Barcelona Publishers All rights reserved. No part of this book may be reproduced in any form whatsoever, or stored for retrieval in any medium, without written permission from Barcelona Publishers. ISBN: 978-1-891278-54-9 10 9 8 7 6 5 4 3 2 1 Distributed throughout the world by: Barcelona Publishers 4 White Brook Road Gilsum, New Hampshire 03448 Telephone: 603-357-0236 • Fax: 603-357-2073 Web site: www.barcelonapublishers.com SAN 298-6299 Cover design © 2009 by Frank McShane Book design and production coordination by Susan Hayes Published with the support of Norsk faglitterær forfatter- og oversetterforening and The Department of Musicology, University of Oslo. ABOUT THE AUTHOR Even Ruud, dr. philos, is professor at the Department of Musicology, University of Oslo, and at the Norwegian Academy of Music.

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Contents Foreword

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Chapter 1 The Tradition from the Humanities

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A Field of Struggle — A Culture of Questioning / 4 Roles and Identities / 5 Cosmologies of Music and Healing / 8 Nonverbal Meanings / 9 History as Legitimation / 12 Basic Principles of a Humanistic Outlook / 15 Caring for the Individual and the Respect for Human Dignity / 16 Empathy / 17 Critical Aspects / 18 Self-determination / 18 Symbols, Metaphors and Meanings / 19

Chapter 2 The Relational Turn

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Basic Needs / 21 Communicative Musicality / 23 The Lullaby as a Communicative Event / 26 Affect Attunement, RIGS, and Lived Stories / 29 “Thirdness” and Improvisation / 32 Recognition as a Philosophical Basis / 34 Further Relational Aspects / 36

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Chapter 3 Musical Identity in a Developmental Perspective Senses of Self-in-Relationship / 39 Competency and Empowerment / 41 Individuality and Autonomy / 42 Values and Authenticities / 45 Consolidation and Regulation / 47 Recollection and Integration / 48 Performing Identity in Music Therapy / 50 Music and Identity in Action / 51 Ethical Responsibility / 51 Self-knowledge / 52 Working with Clients / 53

Chapter 4 Musical Meaning in Music Therapy

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The Concept of Musical Affordance / 59 Embodied Meaning in Music / 61 A Cognitive Perspective / 63 Improvisation and Gestural Communication as Being-in-Time-Together / 66 The Body in Musical Communication / 68

Chapter 5 Dimensions of Aesthetics in Music Therapy Functions of Music in Music Therapy / 75 Aesthetics as Performative Acts / 78 Music Centered? / 79 A Note on Analysis and Music Therapy / 82

Chapter 6 Enabling and Empowerment

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Positive Psychology / 88 Strengths and Resources / 90 Positive Emotions / 92

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Principles of Empowerment / 96 Goals, Needs, and Resources / 97 Looking for Community Support / 97 Corroboration and Recognition / 98 Empowerment as both Approach and Goal / 98 From Empowerment to Citizenship / 98 Disempowering Soundscapes / 99 Silence — an Enabling Condition / 100

Chapter 7 Health and Quality of Life

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Performance of Health, Identity, and Lifestyle / 105 Health, the Eudaimonic Approach and the Good Life / 107 Health as Participation—the Missing Link / 108 Musicking for Life Quality / 110 Health is Relational / 112 Vitality and Self-expression / 112 Competency and Empowerment Through Mindful Practice / 113 Music as Social Capital / 115 Meaning and Coherence in Life / 117

Chapter 8 Systemic Aspects

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A Critical Tradition / 120 Context / 122 Culture / 122 The Concept of Illness and the Definition of Music Therapy / 123 Ecological and Environmental Music Therapy / 124 Performance-based Music Therapy / 125 Toward a Community Music Therapy / 126 Definitions / 128 Four examples / 130

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Communal Musicking / 131 Music Inside and Outside of Prison / 132 Music with Hospitalized Children / 132 Music Therapy in Rehabilitation / 133

Chapter 9 Reflexivity and the Philosophy of Science

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Reflexivity / 140 Empirical Documentation / 141 From Positivism to Phenomenology / 142 The Need for Interpretation / 144 Hermeneutics / 145 The Need for Criticism / 149 Critical Theory / 149 Reflexivity in Language / 152 Postmodern Currents / 152

Chapter 10 Musicking as Self-care

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Music as a Cultural Immunogen — Three Narratives / 161 The Theologian Who Cured His Asthma with Singing / 161 Musicking as a Catalyst for Stress and Anger / 165 Overcoming Depression and Social Phobia / 167 Musical Strategies / 170 Improvisation, Composing/Songwriting, and Performing Music / 171 Performance / 173 Listening as Self-care / 173 Music Affords New Actions / 178 Sources Literature

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Foreword An integrated field of music therapy would perhaps one day be able to synthesize perspectives both from the natural sciences, the social sciences, and the humanities. In this book my effort is to argue for the value of humanities as a basis for the theory and practice of music therapy. With the humanities I include a broad range of academic disciplines, such as taken from the social sciences as well as from philosophy, education, and not least, systematic musicology. Music therapists have lately been met with an increasing demand to deliver evidence-based treatment. This often implies the import of standards of measurement and documentation and models of causality from a natural science-based way of thinking. We know, however, that many of the clients music therapists meet with come to music therapy from a varied and complex set of reasons. Some of their illnesses and ill health cannot be understood only from a linear causal relation between malfunction and structural changes within the body, as many biomedical diseases may prove to be. Other clients may come to music therapy because of mechanisms of social and cultural exclusion. As a discipline, music therapy will need to consider not only biological factors related to illness and treatment, but historical, biographical, sociocultural, and relational aspects of illness and health. As a creative discipline, based within the art therapies, we also ix

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have to keep up our reflexivity about conceptions of music and aesthetics if we really are to offer an important supplement to other health approaches. When we celebrated thirty years of music therapy training in Norway in 2008, I wrote an article trying to define what a music therapy based upon the humanities would imply. I came up with ten defining characteristics that I in this book have expanded into ten chapters. In the process I have borrowed from articles and essays I have published during the last ten years. Some of these have been written in corroboration with other researchers, and I want to particularly thank Hallgjerd Aksnes and Tom Næss for stimulating input and their permission to recycle some of the material. Thanks to Kenneth Bruscia and Lars Ole Bonde for reading the manuscript and their valuable feedback. Thanks to Norsk Faglitterær forfatter-og oversetterforening for financial support in writing this manuscript. Thanks also to the Department of Musicology, University of Oslo for supporting the production of the book and to the Norwegian Council for Research for economic support for translation. Even Ruud June 11, 2009

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MUSIC THERAPHY A Perspective from the Humanities

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Chapter 1

The Tradition from the Humanities What determines our conceptions of and ways of doing music therapy are our basic views on the nature of the individual, or the human being. As I have discussed earlier (Ruud 1998,) a humanistic view of the individual means looking at the individual as a biological, a psychological, and a social being. In this chapter I will look closer at some of the consequences of such an understanding and how this will relate to the practice of doing and researching music therapy. In many ways, this chapter lays the ground for the rest of the book, i.e., the idea of a music therapy based upon the humanities. Music therapy, both as a discipline, a profession, and a practice, is a complex field of knowledge encompassing a whole range of areas of practices, a multitude of professional roles as well as an interdisciplinary theoretical field rooted in different research traditions, philosophies of science, and systems of values. As part of the natural sciences, music therapy depends on knowledge derived from biomedicine, physiology, neuropsychology, or behavioral sciences. Research within this tradition has documented measurable effects that show how music affects our physiology, brain, or leads to observable changes in behavior. A quick search on the Internet in databases and

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journals will convince us that there is a lot of quantitative evidence to document and support much music therapy practice. As a discipline among the humanities, knowledge about music in therapy also includes an understanding of how music may affect our thoughts and actions within a specific historical and cultural situation; it deals with the conditions for interpretations and constitution of meaning in music. Such interpretive music therapy helps us to understand our individual world with its particular intentionality, our ability to create symbols, and the value and role of autonomy and self-determination. This concept of music therapy, in other words, is a perspective founded in a particular view of the individual, a particular view of knowledge as well as the nature of reality, including the nature of music. In the following, where I outline ten basic characteristics of a music therapy based upon the humanities, my proposals can be seen within the context of competing paradigms within the field of music therapy. First of all, the value of the humanities becomes more pregnant when contrasted with models taken from a natural sciencebased music therapy. At a time when health professions are expected to deliver so-called evidence-based treatment, not only the biomedical approach, but also art therapies like music therapy seem to be pushed toward a natural science paradigm. In order to satisfy often rigorous demands set by standards for natural science evidence, researchers are sometimes forced to formulate hypothes and create research designs where a naturalistic view of the individual is favored to the humanistic conception of the individual. This view upon “evidence” presents a certain interpretation of our concept of knowl-

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edge, i.e., what counts as knowledge within a positivist worldview, which has gained a hegemonic position within the health disciplines. The field of music therapy may deliver different kinds of evidence for the value of music in health work and therapy. Both biomedical music research as well as the cognitive-behavioral tradition in music therapy can deliver quantitative results, perhaps not always in the “goldstandard,” i.e., based upon randomized controlled trials, which seems to rank highest in the hierarchy of evidence in evidence-based musical treatment. However, such a rigorous demand about a certain kind of quantification based upon standards from the experimental tradition may create methodological problems, which may be impossible to solve within art-therapy research, unless we violate certain forms of practices and standards of aesthetics. There is a danger, in order to meet the standards of a positivist research paradigm, of excluding research in certain areas of practices, groups of clients, and conditions of suffering as well as neglecting certain discipline questions. Too much emphasis on quantitative research, so-called exact knowledge, may also reduce the ecological validity of research, which is necessary to uphold the link between the production of new knowledge and clinical realities. We also have to remember how the biomedical tradition has lately been challenged from many sides. First of all, we do not want medicine that is only curative; we also need preventative as well as health-promotional medicine. In a broader folk-health perspective, greater emphasis is put on how the individual may promote his or her own health through health-performing behavior. In addition, we also find a movement toward a more humanistic way

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of thinking about health, where supplementary and alternative understandings of health, as well as a more critical and corrective perspectives are being welcomed. We also find interest in new areas of treatment methods, which may be more effective toward our most prevalent, and dominating health problems, i.e., those that concern long-term and chronic illnesses connected with physical conditions as well as depression, burn-out, drugdependency, and social isolation. We should be careful, though, not to polarize the relationship between a natural science perspective and a perspective from the humanities regarding music therapy. Our task will be to argue how a human science perspective can enrich the discipline of music therapy and give directions for a comprehensive and varied practice. Such a human science perspective will help us to develop an identity as a profession with consequences for our professional language, our culture of questions, a certain disposition for how to use music in therapy and health work.

A Field of Struggle — A Culture of Questioning The field of music therapy can in some ways be seen as a field in the sense of the French sociologist Pierre Bourdieu. His field is always “an area of struggle,” where a group of people who has something in common interacts. And at the same time individuals, ideologies, and institutions fight in order to put their own mark on the field, gain and maintain power and positions, and uphold hierarchies of knowledge through their ways of conceptualizing the field. What are music therapists struggling about? Some of the issues under debate concern roles and identities of the

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music therapist, the nature and role of music in therapy, and which ideologies and philosophies of science should prevail in the field. Throughout this book I will elaborate on these themes when discussing the relational turn in music therapy (Chapter 2), how music has different functions in our life within our lifespan (Chapter 3), as well as the concept of music and role of aesthetics in music therapy (Chapters 4 and 5). But we also need to consider different concepts of treatment theories in music therapy and our values concerning health and life quality (Chapters 6 and 7). The role of systemic thinking, as well as the discourse on community music therapy, has challenged traditional roles and created new areas of practice for music therapists, which I will discuss in Chapter 8. Behind the different practices of music therapy there also lies a world of different philosophies of science, which again may help to understand the differences in our field (Chapter 9). In the last chapter I will also bring attention to some of the recent challenges to our discipline and role identities when I discuss the way music has become a new technology for self-care.

Roles and Identities The first area of struggle — identities — focuses on roles assumed by, or conferred on, participants in the process of doing music therapy. In music therapy it is evident that there is a correlation between the ways therapists and their patients identify themselves and interact with each other, and the way they understand the human body and the relationship to the world more generally. Identities are structured within roles, and as we know, roles grant possibilities of action within certain institutional frames.

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Boundaries are set up through socializations, social expectations, and ideological constraints. This is hardly new knowledge for the music therapist, although probably not acknowledged by outsiders (or by all insiders). When the historian Peregrine Horden characterizes music therapy as “their discipline’s nature and purpose have proved remarkably hard to specify” (Horden 2000), I suspect there is an element of fuzzy role identity communicated by the field of music therapy. When Kenneth Bruscia defines music therapy in his last revised edition of Defining Music Therapy (Bruscia 1998), he lists the following areas of practices: didactic, medical, healing, psychotherapeutic, recreational, and ecological. I have myself also described music therapists as social workers, special educators, caregivers, and cultural workers. In sum, this “trickster” identity does not only make it hard for the public to grasp what professional music therapy is really about, it makes the rules of transaction and interaction and the common basis for a contract upon which to establish any intervention difficult. The last development toward increasing community health musicking, new music and health practices as well as certain forms of community music therapy may have added new uncertainty about the border between traditional music therapy and other health musicking or music educational practices. What this argument about identity also makes evident is the problematic therapeutic-ideological situation current professional music therapists have to deal with. Working in all kinds of therapeutic settings, within different institutional and therapeutic regimes, not least within a highly complex music cultural field with all it’s musical codes and blends of musical aesthetics, it seems quite a miracle how any “musical cure” may be offered at

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all. Also, working under the prevailing biomedical model in medicine sometimes gives only marginal space to enact any therapy that claims to influence the body through a musically altered frame of mind. Since music therapists have to negotiate this space of intervention in almost every new situation, much effort has to be spent upon securing boundaries and identities, aiming toward some sort of credibility. This kind of music therapeutic sensibility is “embodied knowledge,” especially among those of us having spent a life as music therapy educators and public negotiators. It is knowledge sometimes hard to articulate for oneself, and it sometimes makes one cautious about what or how much to promise about the role and value of music in health work and therapy. In such a situation, it might well be that other professionals, other identities, occupy the space for “musical cures,” which seems more aligned with the prevailing (musical) healing traditions. We can see this when prominent musicians sometimes move into this space, claiming (more than negotiating) authority through their professional identities, offering supposedly noncontextualized promises of musical healing. We welcome any effort to disentangle this complex mess of multivocality at the present-day scene of musical therapies. We can currently observe some important changes in our field. Music therapists tend to defend their profession from outsiders who claim or prove sufficient musical skills to work within health institutions. For instance, highly trained musicians have increasingly found the hospital as a new concert arena, and this group of “community musicians” is now offering groups of disadvantaged their musical services. We also know how some of the musical interventions developed by music therapists, especially

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those using recorded music, have been taken over by medical staff. Medical doctors and trained nurses will in many cases successfully make use of musical interventions to reduce stress, pain, and anxieties connected with medical situations. Of course, nobody owns music, as one music therapist remarked. Professionals trained in other disciplines may extend their services by using music. Parents, of course, can learn from and take over some of the approaches from music therapy. Musicians may provide aesthetic experiences, enjoyment, and favorable learning experiences to help people connect, as demonstrated by recent research (see Batt-Rawden, Trythall & DeNora 2007). And not least important to the discussion about the role of music as a health practice, people may themselves use music in everyday life to enhance their sense of well-being. Music therapy can meet this situation by empowering these groups through counseling, role modeling, and providing research and knowledge concerning the relationship between musicking and health. Strengthening music therapy as a discipline and as a field of reflection that lookings beyond music therapy as a toolkit of music therapy intervention techniques, will contribute to the growth of music therapy. A broad perspective of the discipline, rather than a technical or instrumental approach is highly necessary. To acknowledge the value of the relationship between the music therapist and the client as a marker of music therapy would also strengthen the professional identity of the music therapist.

Cosmologies of Music and Healing What kinds of mythologies are inherent in our perception of music, various instruments, and musical technologies,

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and how do they interact with the cosmologies forming the backdrop of healing rituals? In an anthology of music therapy edited by Penelope Gouk we find rich documentation of how “music itself and the emotion it arouses are culturally negotiated as well as being mutually interdependent on each other,” as Gouk writes (2002b, p. 13). I have taken the stand of music cultural relativism as an approach to understand how the implicit sharing and construction of common music cultural codes forms a necessary ground for doing musical communication, at least if mutual intentionality is involved. Gouk moves the argument further and points to how music “not only provides a context in which a language of the emotion can come into being, but also gives actual shape and meaning to the emotions themselves, to what it means to be human.” This constructivist attitude is worthy of investigation, and is positively applicable in the process of understanding what is going on in many situations in music therapy. And I would prefer much music therapy writings to be stated in this manner, rather than fuzzy talk about bringing the inborn, natural, real, or whatever emotions and musicality to the surface through common music making.

Nonverbal Meanings How to conceptualize music, musical meaning, and especially the nonverbal, touches the very problem of legitimizing music therapy within a medical-cultural climate infused with positivism. Not to mention being caught between professional struggles among biomedical medicine, psychotherapists, and psychologists. How meaning interacts with cosmologies always becomes important when we are approaching our own

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native as well as other music therapeutic cultures. The use of music in therapy presupposes a cultural situation when the listener is acculturated, that is familiar with a whole matrix of musical structures, melodic and rhythmic codes, which through listening gives rise to a whole iconic world. This point is most explicitly stated in an article by Cheryce Kramer (Kramer 2000) on “Soul Music in German Psychiatry,” where we find an interesting discussion of how a German mental hospital (Illenau) throughout the nineteenth century came to put a major emphasis upon music. Kramer demonstrates the medical ideologies behind this approach, where the Illenau physicians linked the idea of Gemüth to a capacity to mediate sensations by connecting states of body with states of mind. Through musical activities (and other disciplinary techniques!) the idea was to instill the right kind of Gemüth. In concluding remarks, Kramer gives a very articulate statement about how music interacts with culture in forming the backdrop of every treatment effort: The efficacy of music therapy is a result not of the music alone but of its apprehension in experience. Due to this dependency on experience the therapeutic influence of music is necessarily governed by an extant phenomenal framework organizing the musical experience for its participants. That is to say the same cultural conditions, which legitimate certain therapeutic practices also render the target audience susceptible to the influence of those practices. This general feature of healing cures is especially apparent in the case of rituals employing music because the shared assumptions,

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habituated expectations and conditioned emotional responses which uniquely identify a given cultural context are also coded into the music itself. Music does not merely represent a given phenomenal order, it also modifies that order immediately. It is intoned by arousing in its listener a series of discrete emotional states whose cultural significance is variable (ibid., p.146). Anthropologists (and historians) sometimes have the advantage of dealing with cultures far less complex in competing cosmologies compared to our post-modern culture. At the same time well-crafted anthropology and historical cases pinpoint the very essence of the problem of congruency between cosmologies and healing practices. When I teach music therapy students, I use the case of Venda-healing rituals (see Maler 1977) as a point of departure in discussing the problem of bringing one form of healing practice into a totally new cultural context. In this ritual, a woman suffering from infertility is afforded a (drum) ritual based upon a certain rhythmic pattern. After she has gone through the ritual, she has become included once more in the social life of the village, her depression is lessened, and she becomes pregnant. Through the anthropological case I want to discuss how a kind of magical healing practice through music can be understandable seen from the perspective of social psychology and group processes, mechanism of inclusion and exclusion, scapegoating, and other topics from the sociology of deviance, in other words, frames of explanations prevalent and acceptable from the point of view of Western academe. This often immediately leads into a discussion about how boundaries, responsibilities, therapeutic sen-

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sibilities and possibilities affect the discipline of music therapy. This keen understanding of the necessity of complying with the prevailing rules of working in the health care industry, of course, has led music therapists into all kinds of discourses, negotiating a space for music therapy within all shades of psychotherapies, from orthodox Freudian to recent approaches colored by developmental and relational theories, humanistic-existential and cognitive-behavioral, to transpersonal. Not to mention hybrids of theories taken from special education, neuroscience, gerontology, palliative care, neuroimmunology, etc. What is often paradoxically left out in this situation, is theorizing about music itself. There is often a focusing away from the very communicative strength of music, the core phenomena that give rise to the very effect of doing music therapy. But, as we increasingly learn, these two discourses, the musical and the therapeutic, are forever bound together in a dialectics, which is inseparable, almost impossible to articulate, unless locally situated.

History as Legitimation Humanism within history is a common ground for biomedical, critical, and interpretative approaches. A perspective from the humanities upon music therapy, however, does not simply take history as a legitimation for the value of music in health care, but looks critically at the roots of music therapy. When I was researching the Western history of music therapy many years ago, I had the idea of tracing the history of music therapy back to its historical roots. I had found some sources treating various historical periods and events, and was fascinated by the idea of a possible

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continuous historical line from antiquity up to the present day. In many ways I was not disappointed. By combining different sources, I could see a continuous line, although in my presentation it became more a history of ideas of music therapy rather than a detailed continuous narrative. What I soon discovered, however, was that my general historical knowledge was far too incomplete. To do justice to the field would require extensive scholarship in the Arabic, Greek, and Latin languages. And then, Friedrich Kümmel’s monumental work on the history of music in medicine appeared in 1977 with a wealth of details, extensive source reading, and a tremendous knowledge of many intellectual fields (Kümmel 1977). And I left the subject with Kümmel, realizing that in order to become proficient in music therapy theory, one had to renounce some areas of research. Recently, Peregrine Horden (2000), in a sketch of the history of music therapy, makes the point that most historical comments written by music therapists have used history as a tool for the legitimation of current practice. In one of the first lectures I heard about music therapy in Norway, I was met with the argument that Plato had talked positively about the beneficial effects of music. Ergo, music had to be an excellent therapeutic tool it was stated. From then on my empirical mind got suspicious about all kinds of “historical proofs.” Although not totally free from using history as legitimation myself, I was in my own research fascinated by the ongoing rethinking of music as medicine across historical times. As new medical theories were evolving, music seen as therapy always seemed to find a place, a new articulation. Although, as Horden remarks, the idea of music as therapy was upheld by a few basic assumptions probably for a long time. First, we saw the theory of ethos, i.e., that each mode of

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music can induce a specific response in the listener. Further, there were medical theories about the four humors, or that “mental illness” is somatic in origin, and finally that the mind can hinder or generate ill health. Although this last idea, which acknowledges that the psychosomatic traffic is two way, as Horden states it, was not wholly put into practice until the Arabic scholars from the ninth century onward synthesized the ideas and laid the ground for a preventive medicine where music found its place among other so-called nonnatural determinants of health. Horden’s comments on Kümmel also question the idea of a streamless historical continuity. Kümmel’s way of organizing his evidence could easily give us the impression of a “single march past of a huge army,” where in fact we are witnessing “the effect of a smaller number of soldiers coming around again and again” (ibid., p. 26). In other words, much of the “historical evidence” of music in therapy could be a persistent recycling of a few anecdotes, reproduced through the intellectual tradition, which formed part of the training of the medical profession up until the beginning of the nineteenth century. A point, which another historian, Penelope Gouk, makes, is how almost every book on music theory from the Middle Ages on included a passing reference in their introduction to the healing properties of music. This was more a literary convention, following a pattern set by Boethius’s Fundamentals of Music (6th century AD). And as Gouk adds, “in virtually every case the author has nothing substantial to say on the subject” (Gouk 2000b, p. 4). What supports this idea is that much writing on music and medicine has been taken from literary and philosophical traditions. Some of the great systems of medical

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thinking barely mention music, and quite often music seems to be prescribed more for personal reasons by a particular doctor rather than in a systematic fashion.

Basic Principles of a Humanistic Outlook In much contemporary psychology there is a propensity to conceptualize human beings in term of pathology, fault, and dysfunctions. By cultivating a humanities perspective on music therapy, I want to balance a therapy or treatment, which threatens to regard the individual in this manner. This, however, does not mean that music therapy, as a human science does not recognize the body or our biology as important presuppositions in order to understand and work with health and therapy. Music therapy is not an alternative form of therapy in the sense that we reject natural science-based knowledge or a practice based upon such research. Rather, from an institutional perspective, music therapists stress the importance of working as a team with other professionals to supplement rather that substitute other treatment. We should not forget, however, how music is used in private practice at a primary level of intervention, i.e., when the music therapist is the only and primary caregiver. In the hospital everyday, where people often are met with medicines, tests, and diagnoses, music therapists should offer their time and presence, their ability to listen and create trust. Music therapy should direct itself toward expression and experience, play and fantasy, and offer recognition through musical encounters. I want to advance a music therapy that does not only depart from explanations of illness and a treatment based upon the dysfunctions of the clients, but builds upon and cooper-

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ates with the client in broadening his or her resources. With a humanistic critique of natural-science medicine, there is often a wish to offer an alternative to medical treatment. As Danish medical researchers Elsass and Lauritzen (2006) write, we should be careful to put forward such an ideologization of humanistic research, because both biomedicine as well as humanistic medicine are concerned about a “liberating practice.” To counter what is considered as objectifying and reducing means to add value to subjectivity and action, to empower people to take care of their life in the best possible manner. We objectify people when they are reduced to objects that are treated, for instance with medicines or music, leaving out the proper relational context. The opposite of such an objectifying and mechanistic understanding of the individual we will find when we approach people with care, trust, time, and love, when we build relationships and create hope. This takes time and resources. It means that the individual is met with empathy and expectations about mutuality. The relationship becomes focal; the individual is not treated with music, but met by a music therapist in a common musical experience, which forms the basis of the relationship. If we should extract a few basic principles from the humanistic tradition with consequences for our perspective on music therapy, I suggest the following five:

Caring for the Individual and the Respect for Human Dignity To apply humanism as a main perspective on music therapy means to create a link to the original relationship between humanism and the medical practice rooted in the Western tradition in antiquity. As Danish philosopher

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Uffe Juul Jensen (2002) points out, the medical practice in ancient Greece meant a concern for the individual, which we like to associate with the basic humanistic idea. Within humanism the individual is put in the center and human beings are given strong protection, especially within the Christian form of humanism. The idea of human rights is a clear demonstration that all individuals have equal value. In the context of music therapy I would like to stress the idea that musical identities are to be respected as signs of human dignity. It is in the ethics of music therapy to recognize all forms of musical identities. This “philosophy of recognition” (Honneth 2006) also creates a link to critical humanism.

Empathy In order to avoid an unnecessary polarization between a humanities-based and a natural science-based music therapy, it is important to stress that the prevailing medical practice, although it is based upon a natural science ideal, in many ways finds itself within a humanistic tradition. When current medical practice is criticized, it is often based on a view that medical doctors and the medical sciences focus too strongly on illness, i.e., upon components of the body within a mechanistic frame of thinking, and thus forget how the experiencing individual who carries the illness is a historical and cultural being, with an idiosyncratic psychological makeup and presupposition for communication and autonomy. This tension between a holistic humanistic handling of human suffering and a scientific manipulation of delimited unities of illness has been present in the history of medicine since antiquity (Jensen 2002). In mainstream psychology there is also a tendency to

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build theories that are founded on a view of human nature where the human being is regarded more or less as an asocial individualist where self-interest is regarded as the primary and true motivation. As I will discuss later, the new relational turn in psychotherapy, as well as the emerging positive psychology now stress how human nature demonstrates an emphatic “instinct,” or takes as its starting point the individual as a socially and morally motivated being.

Critical Aspects As we know, humanism is a phenomenon that seems to appear in different forms. As a concept from the Renaissance, humanism could be seen as anthropology, a way to understand what the individual could be, what possibilities we as individuals have, and what societal barriers may create hindrances to unfold our nature (Bredsdorff, Larsen & Thyssen 1979). Within such a humanistic anthropology, or what Jensen (2002) characterizes as a critical tradition within humanism, music therapy is a way to “give individuals new possibilities of action through music” (Ruud 1979). In this context, barriers that may stop us from unfolding our characteristic nature will not only concern our body or biology, but just as likely involve psychological, cultural, or material conditions.

Self-determination The view of human nature often prevalent in biomedicine and natural science reflects a reductionist attitude where propositions and facts can be reduced back to less complex and more detailed natural facts. Such a naturalistic

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view of human nature is inherent in the positivist philosophy of science and can appear in the form of a biologism that gives chemical, physiological, and biological causes priority when it comes to explaining experience and behavior. Sometimes materialism, or an understanding that views how the material is basic to all thoughts, ideas, and feelings, comes with this thinking. The individual is compared with a machine, where the body and the mind function after mechanistic laws in correspondence with the laws of physics and chemistry. A pluralistic view upon human nature, where biological factors as well as societal structures act upon us, may be difficult to reconcile with a view of human nature as capable of self-determination and choice. However, as long as the individual has access to knowledge about options and consequences, there is possibility for selfdetermination. Such knowledge may exist within the cultural system surrounding the individual. Responsibility is another keyword here, both to seek knowledge and to act upon the consequences of one’s choices. This means that a humanistic view of human nature postulates that individuals make their own choices, create their own goals, and use their will to fulfill their plans. In this way the individual may overcome barriers to unfold his human potential.

Symbols, Metaphors, and Meanings In the humanist view of the nature of reality, not only the material is real, but language and symbols also may create a reality, which can initiate actions. We create, experience, and respond to myths, language, symbols, and signs. This has consequences for how we come to view

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the nature of music, and how musical experiences are interpreted. This again calls for a science of interpretation, i.e., hermeneutics (see Chapter 9). This also puts meaning at the center of attention.

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Chapter 2

The Relational Turn As we saw in the previous chapter, there is a close connection between humanistic values and concern for the individual. A timely correction of a one-sided focus upon the individual will be to emphasize how we only become human beings through other individuals. In what has now become a “relational turn” in psychotherapy and developmental psychology, it is recognized how mental life is created, comes to expression, and can change only in the context of an interpersonal relation. This relational turn, however, extends beyond the interpersonal. When discussing meanings in music, questions of aesthetics, concepts of health, as well as the systemic nature of our actions, we will throughout the next chapters explore the relational perspective.

Basic Needs In recent developmental psychology we find a new formulation of what seem to be the basic needs and motivating forces in our lives. As we know from much psychology, there have been several attempts to explain the basic drives behind the individual’s action and search

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for meaningful experiences. For instance, Freud reduced these drives to two fundamental needs, sexuality and aggression. Consequently, our interest in art or liking for music had to be seen as a way of expressing these drives; a sublimation, he called it. Abraham Maslow, the prominent humanistic psychologist, created his hierarchy of motivations and he saw self-realization at the top as a basic human motivation. We find now within developmental psychology a reformulation of such thinking. Psychologist Joseph Lichtenstein, after a consideration of empirical research on infants, suggested that we have five basic needs: the need for regulation of physiology, the need for attachment and belonging, the need for exploration and self-affirmation, the need to dislike, and the need for sexual excitement (Hartmann 2000). The motives behind our actions can be understood as systems of motivations developed in relation to these basic needs. Within such a system the basic relational need become important; the individual is regarded fundamentally as a seeker after contact and creator of meaning. This seeking after a response from another individual’s mind, as well as after creativity and playfulness, constitutes our primary drives. These motivations give meaning to our sense of being driven by our bodies (Binder et al. 2006). With reference to Stephen A. Mitchell, the founder of the concept of “relational psychoanalysis,” this orientation toward contact is described as if the individual finds itself within a “relational matrix,” where self-experience becomes possible through interaction with others. We learn about ourselves through a dance where our initiatives and emotional initiatives are met and responded to by others.

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Communicative Musicality There are reasons to believe that sounds constitute an important presupposition when the infant comes to experience both an inner and outer world. This history starts even before birth. We know how the fetus is able to perceive sounds, and there is evidence that this early sonic influence may be able to affect how the child orients itself toward sounds after birth. It is also reasonable to believe that how the newborn masters its new soundscape will strengthen those aspects of cognition, which eventually will take part in the formation of a structure we call “the self.” Infant psychology now emphasizes how the child’s active interaction with the caretakers contributes to the development of a strong self, with its abilities to feel, think and act. Research thus aims to study those means of communication the infant and the caretakers have in order to seek contact, to experience interaction and intentionality. In their brief outline of the history of infant communication studies leading up to our present day understanding, Stephen Malloch and Colwyn Trevarthen found the parameters pulse, quality, and narrative as essential in creating the basis for early communication. Or, to quote: “Pulse” is the regular succession of discrete behavioral events through time, vocal or gestural, the production and perception of these behaviours being the process through which two or more people may coordinate their communications, spend time together, and by which we may anticipate what might happen and when it might happen. “Quality” refers to the modulated contours of expression moving through time. These con-

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tours can consist of psychoacoustic attributes of vocalizations — timbre, pitch, volume — or attributes of direction and intensity of the moving body. These attributes of quality will often cooccur multimodally, such that a wave of the hand will accompany a “swoop” of the voice. Daniel Stern et al. (1985) have written on this in terms of “vitality contours.” Pulse and quality combine to form “narratives” of expression and intention. These “musical” narratives allow adult and infant, and adult and adult, to share a sense of sympathy and situated meaning in a shared sense of passing time (2009b, p. 4). As we see, early communication is founded upon sounds, intonation, rhythmicity and timing, intensity, and small narratives of sounds and melodic fragments. These musical qualities are inherent in the gestural interplay between the infant and the caretaker. This musical communication is embodied in a caring relationship where the child may sense how others share their feelings and expressions. And, of course, we need a concept of “musicality” as Malloch and Trevarthen define it: as expression of our human desire for cultural learning, our innate skill for moving, remembering, and planning in sympathy with others that makes our appreciation and production of an endless variety of dramatic temporal narrative possible — whether those narratives consist of specific cultural forms of music, dance, poetry or ceremony: whether they are the universal narratives of a mother and her baby quietly conversing with one another; whether it is the wordless emotional

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and motivational narrative that sits beneath a conversation between two or more adults or between a teacher and a class (ibid., p. 4–5). There is a link, then, between biologically programmed behavior and the music cultural expression. In other words, we may suppose how music has strong roots in human nature (Trevarthen 2002, p. 21). “Music,” movements, and gestures are the building blocks of human relations. Trevarthen sees this “affective understanding” at the root of identity formation. The infant’s early form of “self-presentation” through musical gestures, as a basis for later formation of identity, is an early sign of the infant’s effort to create a mutual friendship, Trevarthen suggests. There seems to be a lot of empirical support for this early communicative musicality (see Dissanayake 2000; Malloch & Trevarthen 2009a). These findings confirm the presence of the infant’s listening abilities, how the caregivers musicalize their approach. Further, the presence of coordinated interpersonal timing in the exchange of communicative signals, indicates how the caretakers have the ability for “attunement” (Stern), i.e., the ability to pick up expressions and emotions from the child and adjust and reflect these in their own intonations. Such elements create the building bricks in what has been termed “proto-conversations,” which are important preliminary skills in what becomes the experience of “jointattention.” This is the ability for shared attention and common actions crucial to later language development. There is more to add to this narrative about the importance of sounds and gestures in the early life of the child and its importance for the construction of a selfin-relation. One might for instance speculate upon how

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the child uses this information contained in music, how musical gestures and motor actions come together in the making of a sense of a structure we have called “self.”

The Lullaby as a Communicative Event The lullaby may be seen as a paradigmatic example of how the relational experience between the child and the caregiver constitutes a powerful learning situation in order for the child to learn auto-regulation of inner states. The lullaby is not only a song to be purchased or played to the child, it is a communicative event when music with its particular structure is put to work or performed by a caregiver. The lullaby is received by the child within a special situation, at a certain time of the day, at a certain place, embedded in other sensory experiences, smells, visual impressions, bodily movements, and so on. The lullaby thus has become a transitional vehicle, Robyn Brady writes (2005), a technology of bodily regulation effected by the caregivers on the infant. And thus the lullaby becomes an important arena for the training of autoregulative techniques by the infant. Research has identified the presence of five distinct infant states that can be identified by EEG recordings (ibid., p. 193). Refering to the Neonatal Behavioral Assessment Scale, these states are “alert thinking (beta wave 20–40 cycles/second), quiet alertness (alpha wave 10 cycles/ second), agitated/distressed (disorganized high frequency pattern), non-REM sleep, and REM sleep” (loc. cit.) Measurements also show that non-REM sleep has four stages, where the infant progresses through a hypnagogic phase of three to five cycles/second theta waves to slow frequency high-amplitude delta waves. We understand how these states are characterized by

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differences in physical and mental behavior and how we already can recognize a sort of “state regulation in the infant.” We find an increase in respiration and heart rate with agitation and REM sleep and a decrease when the infant is in a state of non-REM sleep and reverie state. Brady also writes that it appears that the alert but quiet alpha wave state is important for establishing accessible long-term memory, and that one of the phases of nonREM sleep is a period for maximal release of hormonal factors connected to growth (loc. cit.). This research shows the importance of developing the ability to learn to self-regulate states. We have all experienced how an infant gets stuck in a hyper-exitable state and must be helped to calm down. Even though we can register such auto-regulation in intrauterine life, it is now increasingly recognized that the infant needs to learn how to regulate itself, that is to move more or less seamlessly between various physiological states. This might be learned through the interactive process of mutual responsivity that might occur between the infant and the attentive caregiver. Parents have knowledge of such body technologies to ease the child, for instance by adapting their movements and body posture in response to microchanges in the behavior of the child. Such affective transactions will create the matrix that organizes this selfregulatory system, and modern techniques of neuroimaging localize these systems to the orbito-limbic areas of the right hemisphere. This means that this evolving ability of emotional transitioning becomes “hard-wired,” i.e., anchored in the brain as the dominant electro-physiological model of response later in life. It would be tempting to speculate how this ability is developed in connection with music listening rituals throughout life, and is a basic mechanism behind our use of music as a self-regulatory

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and self-caring technology, as will be discussed in the last chapter. There is research that tries to identity universal features in lullabies, for instance a certain rhythm or tempo. Some of the findings point toward similarities in musical elements across cultural differences, in the same way as we find similarities in the way caregivers talk to infants. Concerning communication directed toward changing the state of the infant, research has demonstrated how highrising contours are arousing, while low-falling contours settle the child. Bell-shaped contours are approving, and short, low-pitched contours will inhibit the child. This points to how the melody is important — “the melody is the message.” With possible exceptions of certain culture-specific phrases, the most important feature of the lullaby’s function in regulating changes in the physiological and mental states of the infant is the way it is sung in combination with structural elements in the melody. Such elements have to do with increased median pitch, smoother pitch contours, and an increasing percentage of descending intervals in addition to repetition and simplicity. Research shows how parents modify their singing when it is performed as a lullaby. This also takes place when the adult is asked to sing other songs as if they where lullabies. The song performance will show a preference for lower median pitches, less rhythmic emphasis, less pitch variability, and less emotional voice quality than their matching “play tunes.” Such performative modification will make the child disengage with the caretaker and turn within themselves. This turning to and into oneself, Brady writes (ibid., p. 200) “is a settling down, characteristic of state transition, and is an essential aspect of the separation from stimuli which is required for sleep.”

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Physiologically, the coordinated large EEG waves shown in the deep-sleep-phase represent an entry into a coordinated response of neurons in the thalamic area of the brain, which is only possible when cortical input from sensory and other areas is reduced. “The soothing nature of lullaby tunes, especially in the context of the traditional lullaby event, is perfectly designed for this stimulus reduction,” Brady states (loc. cit.). We should add how the rhythm of breathing also plays an important role.

Affect Attunement, RIGS, and Lived Stories Basic to the relational experience seems to be the exchange and mutual regulation of affects between the child and the adult. In Daniel Stern’s terms, what is called affect attunement is rooted in early infant development and can be characterized as a kind of implicit relational knowledge, i.e., a nonverbal, nonsymbolic, and not reflectively conscious way of experiencing or doing things with intimate others (Trondalen & Skårderud 2008, p. 101). Norwegian music therapist Gro Trondalen has focused on such processes in her clinical work with patients suffering from eating disorders and in her dissertation explored and developed a theoretical frame based on recent relational psychotherapy (Trondalen 2004). Basic to this approach is the use of improvisation, which allows for sharing or matching of inner feeling states. This matching is connecting to a cross-modal way of relating, i.e., the matching may occur in another modality than the original one (Trondalen & Skårderud 2008, p.102). “Accordingly,” the authors write: it is not the theme of the interaction or the musical code (e.g., key) that stands out as the most

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important but the quality of the communication. What is at stake is how the interaction moves along. Such a nonverbal emotional experience may be recast as a form of feeling, which may function as a referent for an inner experience of matching and finally facilitate symbolization . . . As we shall see in the chapters on music and musical aesthetics, this argument links to a discussion about the nature of music and how it affects the production of meaning. The authors (loc. cit.) also refer to Pavlicevic’s theory of how it is the “dynamic forms of actions” as they are revealed through musical sounds that are crucial to the musical communication (Pavlicevic 1997). As we also shall see, this supports the argument about how sounds and bodily gestures work together in the making of a musical expression. It is the form, intensity, and timing of the sounding gesture — or, as Trondalen and Skårderud argue, the intensity contour, tempo, rhythm, duration, and form — which seem to match the vitality affects of the subjects. These affects have a regulating function, it is stated, they are connected to body awareness, and continually available for interpersonal coordination through sharing and mutual regulation. Daniel Stern sees attunement as a form of recasting, a restating of a subjective state or a referent and signifier of an inner state. A musical expression, as a mutual and empathic response, as it occurs in moments of musical improvisations, is a possible recasting of a lived experience. Such an expression will serve as an activation of stored memories and expectations of feelings in accordance with Sterns concepts of Representation of Interaction being Generalized (RIG) and Lived Story, which is analogous to RIG, but conceptualized from an assumed

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subjective point of view of the infant in interaction (Trondalen & Skårderud, ibid., p. 108). These two phenomena concern how experiences are represented and how a person may develop a coherent representation of himself. As we will discuss in the next chapter on the development of musical identity, identity itself is dependent upon a coherent self, and not least a sense of felt continuity made possible through memory work. A Lived Story is an emotional narrative that is felt, rather than a cognitive constructed story that is verbalized, according to Stern (Stern 2004, p. 58). On the basis of her improvisation with clients with anorexia nervosa, Trondalen sees sequences of musically Lived Stories as basis for active contact with the nonverbal sense of self during the verbal dialogue finding place after the conversation (Trondalen 2004). In sum, musical improvisations afford a basis for relational experiences that may provide a link between body and mind and thus support a more coherent sense of self. In the following we shall discuss how this may provide a therapeutic experience that leads to change. We might also here speculate if this felt emotional narrativity is involved when we are listening to music and get this sense of how music is able to strongly resonate with our emotions or felt bodily reactions. Especially, in those cases where music seems to hit us very hard the first time we listen, we might speculate if there is some kind of “analogy” between the structure of music and an emotional narrative we may carry within us. Such theories of “analogy” between music and the personal reaction are proposed in music therapy by Henk Smeijsters (2005) and are also present in the understanding of Mary Butterton when she reports about the function of music in psychotherapy (Butterton 2008).

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“Thirdness” and Improvisation We can see how musical improvisation can contain a relational matrix and be understood as a place of mutual transference and countertransference, to speak in an analytical language. The improvisation affords a new form of contact, not least because the freedom offered in the musical dynamics, the symmetrical mode of interaction, and a mutual experience of the other as a subject. This is a form of contact described by the analyst Jessica Benjamin as a kind of “thirdness” that may be experienced in the cocreated rhythm and melody in the parent-child interaction, the emotional dance described by Trevarthen (2002) made possible by the function of mirror neurons in the brain (Stern 2004, p. 79). When we read about how psychotherapists are describing this “thirdness,” with its use of musical metaphors, we understand how a musical improvisation is close to a musical actualization of human interaction and relation with its concomitant possibilities to create a common space for reflection. As underlined by psychologists Veseth and Moltu, this kind of thirdness is an alternative understanding and a metaphor for good ways of being together in a therapeutic meeting (Veseth & Moltu 2006, p. 925). We find this meeting in the music therapy literature described as “golden moments,” “meaningful moments,” “hot moments,” and so on (see Trondalen 2004). When combining such theories with musical improvisations, with a musical interaction that “grooves” and often is experienced in a state of flow, we can say that music therapists have good opportunities to create a state of “thirdness.” I have earlier conceptualized musical improvisation with terms from communication theory, i.e., as symmet-

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rical or complementary (Ruud 1986/1990). If we analyze musical improvisations, it may sometimes appear that the persons involved are stuck in a kind of fixed position, where the freedom of musical response is blocked. Instead of freely moving along, feeding the improvisation with new ideas and responding creatively to the other’s musical initiatives, the persons involved answer stereotypically as if there where no musical options. In verbal therapy, analyst Jessica Benjamin has conceptualized this positioning within her intersubjective or relational theory where the complementary mode of interaction is characterized with the term “doer and done to” — as if “each person feels done to, and not like an agent helping to shape a cocreated reality” (Benjamin 2004, p. 9). The essence of such a complementary relation, Benjamin writes (ibid., p. 10) “is that there appear to be only two choices: either submission or resistance to the other’s demand.” In this complementary mode “our sense of self as subjects is eviscerated when we are with our ‘victim,’ who is also experienced as victimizing object. An important relational idea for resolving impasses is that the recovery of subjectivity requires the recognition of our own participation” (ibid., p. 11). In order to get out of this position, into a symmetrical relationship or improvisation, we need to restore dialogue and start to communicate. From this symmetrical position “emerges a more advanced form of thirdness, based on what we might call the symbolic or interpersonal,” Benjamin writes (loc.cit.). The idea of a “third” seems to be conceptualized in different ways in different theoretical systems. In common seems to be the focus on the intersubjective, the “reciprocal, mutually influencing quality of interaction between subjects,” as Benjamin writes. (ibid., p. 6). Thirdness to Benjamin is a kind of “transitional space” in Winnicot

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terms, a quality of experience of intersubjective relatedness. Or, “. . . third is that to which we surrender, and thirdness is the intersubjective mental space that facilitates or results from surrender” (ibid., p. 8). This is a kind of letting go of the self, which implies the ability to take in the other’s point of view of reality. “Thus,” Benjamin writes, “surrender refers us to recognition — being able to sustain connectedness to the other’s mind while accepting this separateness and difference. Surrender implies freedom from any intent to control or coerce” (loc. cit.). These formulations bring association to the philosophy of I-Thou by Martin Buber. With a long history within existential and humanistic psychology, music therapists have applied the concept of the mutual nonobjectifying relation of I-Thou as a possibility to work through in musical improvisation (see Ruud 1972/1980). Norwegian music therapist, Rudy Garred, has made this relational or “dialogical perspective” the foundation for his whole philosophy of music therapy based upon the philosophy of Martin Buber (Garred 2006). Garred traces this interest in dialogical thinking back to German philosopher Ludwig Feuerbacher, who in 1845 stated that the essence of man was to be found only in community resting upon the difference between “I” and “Thou.”

Recognition as a Philosophical Basis Experiences of self-identity, dignity, and recognition are fundamental to therapy. The concept of “recognition,” as it is emphasized in this relational turn in psychotherapy, has roots in Hegelian philosophy and has been elaborated within critical philosophy, not least by German social philosopher Axel Honneth (2006). In order for a hu-

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manities perspective on music therapy to take care of critical and societal aspects of our work, we need to broaden our understanding of recognition from not only being valid for a two-part relationship, but to operate also at a societal level. Recognition, as we saw, is not only fundamental to the primary relationship between the infant and the caretaker, but can be included in a critical perspective, where social inclusion and human rights play an important role. Honneth maintains how recognition has its root in the dual relationship between the caregiver and the infant. However, in order to fully accept and value ourselves we also need to have our human rights recognized as citizens. If such needs are denied, we will not be able to experience the social solidarity and thus the common norms and values, which have to be shared in order to reach full recognition. On this background we could claim how relational aspects are relevant not only in more individualized forms of music psychotherapy. Within the field of community music therapy, there is a need to elaborate the relevance of concepts such as “participation” (see Stige 2006b) and recognition. In the world today, millions of immigrants and refugees are living under conditions that do not allow for recognition on all three levels discussed above. Working with music among refugees, for example, will need to take into consideration how it is possible to help people not only working through their life experiences and traumas, but also how to reach recognition by society. Learning and performing music are ways of changing one’s identity. Mastering musical skills may increase our sense of self-efficacy, social skills, increase our social capital, and give pride in one’s own cultural history. Being recognized as a performer, as someone who contributes to the cultural expression of a community, may be an important

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step towards (re)gaining a sense of meaning and coherence in life, and therefore hope for the future. The concepts of recognition, as well as participation, thus give legitimation to the health consequences of cultural work.

Further Relational Aspects As we shall see in the next chapters, we have to consider relational aspects in many areas of music therapy theory. As we will see in the next chapter on the development of musical identity, the very concept of self concerns our relation to ourselves: also identity must be seen in relation to a larger context. When we study musical meanings, we will have to consider how musical events are related to other events within the same composition, or relate to past, present, and future musical events. When we discuss questions of musical aesthetics, I will show how aesthetics is a question of how we relate to and frame certain objects within the world. And when we try to understand the complex concept of health, we do not consider only our bodily state, but how we relate to and interpret our bodily perceptions, as well as how we relate to other persons and, not least, relate to our existential needs. All in all, we have to take into consideration how the contingent nature of our relation to the world calls forth an interpretative position, a sort of reflexivity that must not only be built into our theories of music therapy, but also become a part of the everyday practice of music therapists.

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Chapter 3

Musical Identity in a Developmental Perspective Basic to a humanistic concern for the individual stands the respect for individual dignity. Specific to the ethics of music therapy there will be recognition of the idiosyncratic musical identity we encounter in each of our clients. The pairing of music and identity seems to be a fruitful combination for music research as well for the music therapy practitioners. During the last ten years, an increasing amount of books, articles, and dissertations have brought new understanding of how music may come to play an important role in the narrative construction of identity. This has led to an increased sensitivity to how musical communications are culturally dependent and it has given the music therapist some new ways to approach clients. The developmental psychology of music has often been a discourse about how children process and perceive sounds, how they increasingly come to master their sonic environment, and how they control their voices or motor skills in order to perform vocal or instrumental music. Lately, we have seen a turn from this more cognitive approach of musical development to an interest in social psychological aspects of musical behavior (Ruud 1997;

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MacDonald, Hargreaves & Miell 2002; Stålhammar 2004, 2006; Bergman 2009). This new discourse, which sometimes places identity at the core of interest, seems to produce highly relevant knowledge to therapists. At the same time, questions concerning music and identity are reminders of the centrality of music both to developmental psychologists as well as to those dealing with questions concerning the sociology, anthropology, and aesthetics of music. This is knowledge that may come to influence the direction of music therapy, especially in the area of community music therapy. With this I mean that music therapists may become more concerned about the relational aspects of music, that is, how music is a force in creating relations between people, to function as a base for networking, or in serving everyday needs for choosing and articulating values. This, of course, links musical practice to community building, to how music becomes important in the formation of cultural groups, in the expression of norms and values. This again links music therapy to society, to larger questions concerning living in an age of globalization or under the pressure of maintaining a democratic and tolerant form of society. Identity may serve as a bridging concept between music therapy and the role of music in everyday life for the individual. In the following, I will present a theoretical rationale about how music may serve important functions in the narration of identity throughout life. This rationale is to some extent grounded in my own research on musical identity based upon the qualitative research I did on musical biographies written by music therapy students in the early 1990s (see Ruud 1997, also Ruud 1998 for the summary chapter on Music and Identity). I will present my interpretations in a new way, also drawing from recent

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research on music and identity as well as from other areas. I should add to this that my recent training and experience as a psychologist and Bonny Method of Guided Imagery and Music (BMGIM) therapist gives supporting heuristic evidence about the power of musical listening (Ruud 2002, 2003). Although I will be hesitant in presenting a stage theory of the development of musical and personal identity, I will suggest that music serves different developmental needs at different times in life.

Senses of Self-in-Relationship As we saw in the previous chapter, music may come to play a significant role in the development of a “self-inrelationship.” The Lived Story of the child was seen as a felt emotional narrative to be supportive of a coherent sense of self. Developmental psychologist Daniel Stern has also added to our knowledge about the formation of a self by suggesting a series of developmental steps, from the first “emerging” self, through a “subjective” self, and so on. Between fifteen and twenty-one months old, the child seems able to recognize itself (in the mirror) as a clearly separate individual. And through the acquisition of language the child will eventually be able to speak of itself in the first position, as an “I” (see Schaffer 1996, p. 154–159 for the development of a sense of self). Then follows what Stern calls a “narrative self.” Music becomes an important tool in the creation and maintenance of a strong bond between infant and adult, thus serving biological needs of survival, as argued by Ellen Dissanayake. Music may also be helpful for the child, not only to discover other people, and thereby discover itself, but also to come to know its own body, its reactions, and consequential gestural responses. We simply

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have to postulate how such a bodily founded sense of self may lay the foundation for a “self-in-context,” which I regard as fundamental to the definition of identity. Being aware of oneself, and later, being aware of our own stories and narratives about us, is the essence of identity. What is also important in this early stage of life, is how even prelinguistic children may be able to experience meaning in musical expressions. Looking at prelinguistic infants, we will find vast stretches of embodied meaning, Mark Johnson writes (2007, p. 9). This is meaning that is not conceptual and propositional in character. Infants will be able to follow and make sense of musical utterances and narratives within the context of human relations. We might, however, postulate a difference between self and identity. Certainly, the self is in a privileged position in this theorizing, since this ability to reflect upon one’s own thoughts and actions comes before the formation of an identity. This self is not an essential self, as Gary Ansdell observes (2003, p. 156), the self is open to discursive constructions. As we know from the abundant literature about identity, it is not first of all a psychological phenomenon. The study of identity belongs as well to fields such as sociology and anthropology. Reflecting upon oneself involves not only interpersonal relations, but also our orientation to larger groups, to our situatedness in numerous contexts throughout life. Identity, as it is used here, comes to mean how the self reflects upon itself in different contexts. Identity then, might be defined as the self-in-context. As viewed here, identity is constructed through the narratives we will tell about ourselves in relation to musical events and experiences in different contexts. In my research on musical autobiographies, I identified four such main contexts — personal, transpersonal, social —

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and those specifically located in time and place (see also Ruud 1998). The question remains, however, why we choose some narratives and leave others out when our identity is reconsidered. The answer may be that music is crucial concerning our emotional investments in these different contexts. Music, because of its arousing power, its ability to make us feel, is the difference that makes the difference. As Tia DeNora observes, it may be exactly in those small moments, in the everyday events in which we are caught up in a feeling that keep us within the situation, where we construct ourselves as acting subjects (DeNora 2000, 2001).

Competency and Empowerment From early on, the child explores its environment, often through sounds, and makes the experiential basis for developing a concept of itself as a person who can influence and master its environment. Music provides opportunities for the building of skills, for joy and pride in vocal expressions and the handling of instruments. When introduced to musical learning situations, formal or informal, music becomes an arena for the development of selfefficacy. Being able to perform may install an enabling condition, a sense of agency. This empowering force of music becomes clearly evident within the many forms of youth culture, where young performers, often within a short period of time, learn both to play the instrument, compose, play together with a group, and to perform. This instance of “situated learning” also means coming to terms with a whole array of themes and challenges linking the young to culture and society. The social nature of music and situated character of contemporary popular music forces the young musi-

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cian to get involved in issues concerning aesthetics, musical tastes, technology, economics, politics, race, and gender (see Berkaak & Ruud 1994 for a study of a local rock band). Growing up in a band means getting involved in local cultural production of belongings, larger networks of other musicians and audiences, and global orientations as represented through the music industry. Playing in a band seems to be almost an instant way of constructing a cultural and personal platform, which clearly gives a sense of partaking, acting upon, and influencing the environment. Such informal musical learning, as it takes place within a community of practice will eventually come to affect the identity of the person. As Etienne Wenger demonstrates in his theory on situated learning, identity is a negotiated experience where we define who we are by the ways we experience ourselves through participation as well as by the ways we and others reify ourselves (1998, p. 149). Identity follows a learning trajectory were we define who we are by where we have been and where we are going.

Individuality and Autonomy Another crucial developmental task for the young will be to start the process of separation from the family, to initiate new relations with friends and become part of larger groups and communities. The process of becoming an individual starts in infancy, and there is in much contemporary developmental psychology an understanding of the infant as a separate individual, much in contrast to an earlier view upon the infant as more or less living in symbiosis with its mother the whole first year. Observations of children making music in kinder-

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garten also point to how children experience themselves as a group, and how they appropriate songs to create a “children’s culture” as separate from the adults (Bjørkvold 1987). This sometimes teasing and creative appropriation of the use of music may be the initial step toward the first outspoken choice of musical taste, often in response to the reactions from the adult world. Due to the increasing commercialization of children’s musical culture, this process may start long before the onset of adolescence. To choose an artist who is not appreciated by the parents is a strong way to signal individuality. The experience of being able to perform may also give the child an early understanding of being able to withdraw to his own private world that adults can never reach, as one of my informants told me about her first musical experiences (Ruud 1997). Börje Stålhammar, in his research on the experiences of music among young people in Sweden and England has conceptualized this musical navigation between the private and public as moving between individual, internal, and virtual space (Stålhammar 2004). When listening to music in their own rooms at home, the young people screen themselves off, relax, and regain creative resources through the listening rituals, thus maintaining their individual space. Sometimes the young seek together, using music to create a common, internal space, a sort of symbolic community (Cohen 1985), where attitudes are shared and symbols investigated to create and uphold barriers against other “style” communities. In this sense, Stålhammar argues, quoting British sociologist Anthony Giddens, “space” designates the area where experiences from different times and environments come together. At the same time, this “space” is also a fixed “place” where the community actually enfolds (ibid., p. 211).

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In many of the musical autobiographies I collected, it became obvious how the peer group set the taste standard in early adolescence. Revealing one’s musical taste may become an entrance to the social group or can be an effective way of self-delimitation. Some navigate skillfully in this phase of life having both private and social preferences. Close studies of a school class will tell us that taste groups are many and differentiated (Bergman 2009). In this period of life, music becomes an important social resource, a means of conversation, which serves functions of inclusion within the many groups. All the discussions among the young about musical taste and quality become an exercise in social decentering, about how to accept another person’s life world although it may be totally different from one’s own. From a clinical perspective, this intensive relationship to music might offer possibilities for a dialogue on sensitive themes. Maintaining distance and respect for the individual’s own musical choice is critical, however. The musical realm might be the only aspect of life where the young person in difficulty may feel to be in control and out of reach of the adult (Skarpeid 2008). This informs us about the key role of music in relation to the delimitation of cultural and geographical territory, how music becomes a signal of demarcation, as well as a means to connect and synchronize a group through the sharing of a common musical code (Kvifte & Ruud 1987). This sharing, not least, involves powerful synchronous, embodied reactions toward the sound and pulse in music. Social identity theory adds to this story by stressing how “in-groups” and “out-groups” are powerful social forces in maintaining the self-respect of the young (see Tarrant, North & Hargreaves 2002).

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This sense of individuality and autonomy is upheld every time we are able to make our own choices concerning what to listen to (Sloboda & O´Neill 2001) and thus will be necessary to recognize when we are discussing the functions of everyday musicking. On this background it seems natural to expect that music we select ourselves may have a greater and more immediate effect upon our moods, emotions, attention, and energies.

Values and Authenticities In his stage theory of development, psychologist Erik Erikson saw adolescence as the time for identity formation. However, this time of life is not any longer the moratorium he observed in his time of mass cultural innocence. Present day pressure upon the young from media and the fashion and music industries has put the young under a lot of pressure to make choices. This is also seen in a situation described by the German theoretician Thomas Ziehe, where traditions and norms are no longer automatically transferred from one generation to the next, and where the young have to do a sort of identity work in order to keep up with the current expectations concerning individuality. Living in a world where new symbols are steadily produced and offered in the marketplace, forces the young to exercise a sort of necessary symbolic work, as described by Paul Willis (1990), putting great stress on the capacity for interpretation, choice, and the creative appropriation of symbols into an individual style. Music provides raw material in this production of symbols. Music produced and performed in numerous ways, is inscribed in values, linked to beliefs, associated with ethnicities, gender, religion, and politics. Music

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offered to arouse and express a certain sensibility catches the moods and emotions and thus gives expression to how it feels to live in present-day society. Research also point to how music plays an important role in the formation of values and identity among the young. Preferences for music sometimes predict to a large extent nonmusical activities and attitudes, like ways of dressing, media preferences, drug use, and degree of sexual activity (see Sloboda & O’Neill 2001, p. 424). In another study, 81percent of the young reported how music was an important part of their lives and that music had influenced how they think about important themes. Research also shows that young persons’ involvement in music is more important to them than watching television (which was associated with feeling less well, less awake, more passive, and bored) (Sloboda & O’Neill loc. cit.). Research also demonstrates how gender clearly influences how the young are using music. Girls are telling how they use music to regulate their mood, while the boys are using music to create a certain look or image. In this way, boys seem to live up to the cultural stereotypes about male identity, where emotional behavior is not a part of the public self-image. This is true even when the boys prefer to listen to music while they are alone. Macho images seem to be abundant in the rock and hip-hop culture, and there seems to be a steady supply of updated images suggesting how to present oneself as trendy or cool. In this way, musical involvement is a way of “doing gender,” a means to define femininity or masculinity by identifying with or negating artists or genres (Bergman 2009). As Bergman (2009) found in her ethnographic study among teenagers in Gothenburg, negotiating musical taste could become a way of expressing one’s class identity or ethnic background. Musical taste today seems to mean a

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highly personal configuration or conglomeration of artists and genres, a way of showing independence and individuality. In this search for individuality, the question of authenticity may often arise. From my own research, many informants referred to how a certain “voice” or artist evoked the feeling of “coming home,” resulting in a strong sense of identification with artists or groups. It seemed like music was able to mirror some sense of their real or true self, as they often expressed it, borrowing from a romantic notion of the self. Of course, as we know from all strife about genres and musical styles, about musical quality and supposed “aesthetic honesty,” the emotional investment in these discourses points to how existentially important these aesthetic choices may be. It seems that music has become a validity test of authenticity, as if being moved by music is the final proof of an existent “real” and honest way of life.

Consolidation and Regulation There are now many reports about how everyday uses of music are means to regulate emotions (DeNora 2001), escape from the world (Stålhammar 2004), serve existential needs (Ruud 1997), or provide for health (Ruud 2003, 2005a). This points to the need to conceptualize music in a new way, or within a broader psychological theory about how continuity and stability are maintained in life through our engagement with music. It is clearly, as Stålhammar points out, how music may be seen as a “depot of experience” that the young can draw upon when life gets tough, or when there is a need for selfpresentation (Stålhammar 1995). We may also see how, within the so-called object relations theory in psycho-

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analysis, the art object is conceived as a “transitional object” people may turn to in times of crisis, in order to maintain strength, and to explore new personal territories (Butterton 2004). In chapter 10 I suggest how music may be connected with self psychology, defining music as a “selfobject.” The idea of selfobjects points to the function other persons, objects, or events may have in the maintenance of this feeling of being the same and having a meaningful self. In other words, music may serve selfobject functions in our life, when we turn to music to regulate our moods, indulge in memories, or recollect events and persons (see Chapter 10).

Recollection and Integration When psychologist Erik Erikson described what he thought of as the last psychosocial stage in his epigenetic scheme, he emphasized the integration of ego as the main developmental task (Erikson 1968). Order and meaning becomes essential, acceptance of how life had to become what it had been. This identity work seems to include the reconciliation of oneself with the many choices in life, the ability to distance oneself and reflect about one’s own life. From the interviews on musical experiences by British psychotherapist and musician Mary Butterton (2004), we can also see how many of her older informants use music as a metaphor when important themes in life are sorted out. We also learn how music has helped to create a true “home” for some, it has helped to bind feelings and thoughts together with values, it has created a sense of belonging, a way to connect with the larger world. In the retrospective master narrative, which is to become the core identity of the person, music may serve an integrating function pointing to the important themes and events

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in life. From music therapy, we know how this role of music may become a tool in the necessary reminiscence work people have to uphold in order to maintain their identity, especially if dementia is progressing. An Australian qualitative study of the role of music in the lives of older people (60+) confirms the important identity functions of music (Hays & Minichiello 2005). The study, of course, also found how music could be helpful in many ways, which I will discuss further in chapter 10 where the topic is how music may be helpful for people who are not frail or living in residential care. Concerning identity and the understanding of the self, the researchers found how through music the participants came to know and reflect upon their own personhood. The concept of personhood was here used in the sense proposed by Kitwood as the unique life experiences of each person that are infinitely diversified and unique. These life experiences are rich in feeling and emotion and part of a person’s total subjectivity, Hays and Minichiello write (2005, p. 449). Music was found to be used as a symbol for defining their own sense of self and identity; it became a symbolic representation of “who” the participants were and how they liked to be perceived by others. Music was clearly more than entertainment for people participating in this study. It was a way of redefining their self-identity since retiring from work, the researcher writes (ibid., p. 441). They also confirm Butterton’s findings of how people listened to particular kinds of music to recall events and experiences in their lives along with the emotions associated with those experiences. “When people chose to listen, perform, or compose music, it became an expression of their individuality, and as such, a way of defining self,” Hays and Minichiello write (p. 441).

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Performing Identity in Music Therapy In sum, we have seen how our involvement with music throughout life may serve important developmental tasks related to the sense of self and identity. Six such tasks were identified, pointing to how music may play a role in the formation of a sense of self, establishing a sense of agency, help the young when individuality is sought for, supporting the individual to maintain and regulate stability in moods and energies, and serve as a device for symbolizing personhood through recollection and integration of life events. This was all made possible when musical engagement was seen in the service of identity narration and formation. In order for music to serve such functions, we saw how music could be conceptualized as a social resource or social capital, a self object, a memory device, or as a sensitizing agent informing us where to place our emotional investments. Music therapy, then, could be seen as Ansdell writes (2003, p. 157), as the musical performance of the self-in-culture. . . . we see music therapy working not towards verbalconceptual knowledge about some private “self,” but instead as a new way of experiencing, through musicking, a self-in-action, and self-incommunity. I support this argument, although, on the background of my BMGIM training, I also acknowledge how the musicking that goes on through my private listening, and the metaphorical force operating through music in the listening process, is a performance of identity. The musical experience is a virtual performative space where I can

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engage in playful and transformative identity processes, which can later be enacted in real life. This also would involve new verbal-conceptual knowledge about how I can go about performing my identity.

Music and Identity in Action In the training of music therapists, an autobiographical approach to musical identity seems to be a valuable educational tool. For many years, all my students in music therapy theory classes have been assigned the task to write up ten pages about their musical autobiography and hand it in together with a homemade CD of musical examples that had some significance in their life. Then we had a seminar where the students present to each other an example from their musical history. I have also had such music and identity seminars in Canada, Italy, Denmark, Brazil, and Israel, and they seem to be quite well received everywhere. Music is important to us whatever culture we live in, and exploring musical identities is a good way to come to know oneself and others. Why is this important to music therapists? There are a number of reasons why I continue this tradition. Some have to do with the self-knowledge necessary to become a good music therapist, other reasons have to do with possible approaches to work within different areas of practice in music therapy.

Ethical Responsibility When music therapists are dealing with ethical issues, we will find that many of our concerns will be the same as other health workers. Themes like confidentiality, respect for individual dignity, informed consent, maintaining

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professional competence, and so on are familiar to all therapists. Concerning individual dignity, however, we should count musical identity as an integral part of our human dignity. A full respect for other peoples’ musical tastes is of course an absolute requirement for doing music therapy. Music therapists have to balance their likes and dislikes, to see beyond their own cultural taste. This might potentially be a problem, since cultural taste is often built upon the premise that one’s own musical cultural norms, for instance aesthetic preferences, presupposes a dislike for other kinds of aesthetics. But as we argued in a previous chapter, the concept of recognition, to really see and accept the other person, is a prerequisite for therapy.

Self-knowledge To do memory work upon one’s own musical history will teach us that music we today might think of as silly, served important identity functions earlier in our life. We don’t have to appreciate this music today, but there will be no need to disregard our musical past. Instead we should use this knowledge when we need to understand our client’s sometimes idiosyncratic and perhaps exotic musical preferences. To have a broad personal musical background, a varied listening history, would also imply that we have had access to different musical worlds, which also might imply knowledge of different social worlds. If we look at music as narratives from different individual and social realities, broad and intimate experiences with music will prepare the music therapist to meet with all kinds of people — people from different social classes, age groups, and cultural backgrounds.

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Working with Clients Knowledge of how musical identity serves different functions throughout life will also help the music therapist to maintain a good musical focus when meeting with different age groups or working within different areas of practice. To have knowledge of a client’s musical identity will help us to choose the right music, to identify the musical codes and their meanings to the client, and thus prepare the ground for good musical and personal communication. Some areas of practice stand out as quite obvious when it comes to using music and identity as a practical approach. We know how music therapy in dementia care is a unique tool in music as a way to bring out memories, to get access to the past, create self-continuity, and connect people to places and other people. Within mental health care, music and identity groups might serve as a starting point for group therapy, a way to focus on themes of personal relevance to the members. Music may be a strong motivating force to include the client in a psychotherapy group. Doing musical improvisation on one’s own musical history may also be a way to utilize the selfknowledge connected with one’s autobiographic musical memories. This was suggested by Isabelle FrohneHagemann (1998), who in her approach — The “Musical Life Panorama” (MLP) — works with the emotional meaning of experiences, events, and memories that are connected with music in one’s biography. The method is applied as part of the Integrated Music Therapy for psychotherapeutic and sociotherapeutic issues within a verbal form (talking about music) and in an active form (conducting improvisations).

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Chapter 4

Musical Meaning in Music Therapy A music therapy based upon the values from the humanities underlines how we are users and interpreters of signs and symbols. Within this horizon music itself will have to be understood as a sign or symbol, as a narrative text, which may give us access to realities, feelings, and the lifeworld of other individuals. Related to the field of music therapy, such a conception of music will determine how meaning is produced, how it is interpreted and gives rise to action. In other words, the question of musical meaning is a main issue both in this chapter and the next chapter, where broader issues of music and aesthetics are discussed. There are many ways of conceptualizing music in music therapy. Music therapy and musicology are linked through their sharing of some underlying assumptions about the very nature of music, what Philip Bohlman calls the “metaphysical assumptions of music” (Bohlman 1999). Ontologies of music, i.e., what we fundamentally may think music is or is not, are constructed and articulated differently within different music therapy traditions. To the positivist music therapist, music is understood and described as “regular vibrations” effected by energy producing sound waves, while the New Age followers rather

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see music as a reflection of “cosmic vibrations.” To other music therapists the essence of music is linked to sensuality and feelings, while others see processes of cognition at the heart of the musical experience. Recently there has been a move within the field of musicology toward studying music as a sign and in the context of the performance. This means that music is not studied as a work present in a score, but must be studied in the context of a performance, live or recorded, in order to grasp its meaning-producing elements. In summing up some of the recent trends within the field of musicology, British music therapist Gary Ansdell (Ansdell 1997) enumerates some of the views of music he thinks of particular relevance for music therapy, that is music: • as a process rather than a structure • as something intimately tied to human affect and meaning • as participatory and inherently social • as determined by culture and context • as performed, improvised, and lived as well as notated and reproduced • as personal, embodied and deeply human (p. 37) In an article some years later, Ansdell (2003) elaborates further on this theme, and came up with an additional list: • Music is not an autonomous object — it is embedded in sociocultural process. • Music is not a universal (or natural) phenomenon — it is a cultural phenomenon and lives in and through locally defined contexts.

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• Music’s meanings are not “immanent” — they are socially and culturally constructed. • Musicking is not just a mental phenomenon — it happens between bodies. • Music’s meaning is not just in its internal structures — meanings are generated by local sign-systems. • Music is not just a notated artefact — its basic reality is lived performance. • Music does not represent emotion and meaning — it enacts them. • Music’s expressive form is as crucial as its structures. • Music is seldom just a private pleasure — it is always already a social participation. • Musicking can simultaneously reproduce the legacy of another and allow the performance of the self (pp. 155–156). These issues are in many ways part of the everyday concern of the music therapist. At the same time such a focus clearly demands a sort of musicological approach, which goes beyond looking into musical scores as “autonomous organisms.” To the music therapist, the question of musical meaning is not only a question of “aesthetics”; how music affects us is a moral question, a highly pragmatic issue in the sense that we need empirical documentation rather than speculative arguments. To do musical analysis of music therapy products and processes we need to involve the listener and performer in a direct way. What is “aesthetically significant” in music cannot be decided from a disembodied analysis; it must take into account the particular situation, the clinical as well as the cultural, as well as the particulars in the music. I will return to some of the methodological issues involved in analyzing music therapy music in the next chapter.

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As there are many ways to achieve health, there will be many forms of music and musical activities, which can provide resources to experience health. This means that music in this context does not mean certain composers, a specific genre of music, or a specific way to listen to or perform music. How we experience music and how music will affect us will depend on our musical background, the influence of the music we have chosen, and the particular situation in which we experience the music. In other words, in such a contextual understanding, the music, the person, and the situation work together in a relational or mutual relation where changes in any of these components will change the meaning produced. This contextual understanding is an important premise for music therapy and health work through music. In other words, we cannot buy music at the pharmacy that independent of a learning situation and manner of use will have a positive effect. People are in many ways their own experts when it comes to knowing what will affect them in different situations. Music, which may relax one person in a certain situation, may have provocative and destructive effects on the mood of another. When I put forward the value of making one’s own musical choices, I want to refer back to the humanistic values I introduced earlier, where autonomy and self-determination were underscored. But as we also know, within our shared musical culture, most people will experience how music is made for relaxation, to increase tension and drama, or to stimulate us, will be interpreted in the expected way. Many hundreds of years of film music has trained us to decode music after quite specific norms. Slow tempo, steady pulse, few leaps in the melody will be conceived by most of us as calming music. In this way, we can say that certain musical structures, performed in a certain way,

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will afford a certain meaning. If we want to accept and use this music to calm us, we can say that we appropriate this meaning and live it out in practice. In this way, it is a crucial difference between saying that a certain meaning is inherent in music and saying that music affords a certain meaning and use. When we take into consideration the context in which music is chosen, it means that we consider the many factors that may affect the experience of music, i.e., the history of listening and the specific embodied ways of listening that govern our perception, the situation where music is produced and experienced, and, of course, music itself and the way it is performed. This means that we cannot speak about a certain musical meaning or a certain effect of music independent of a certain situation. We have all our idiosyncratic ways of listening to music, we may create our own place in our homes or create certain rituals of listening that will influence and give meaning to the experience of music. This contextual understanding of how music will influence us also makes possible many forms of musical practice. It tells us how difficult it is to predict what meaning people may deduce from different situations. This again means that we cannot explain how music works from a simple cause and effect model. Music therapy cannot deliver a package of music that will affect all people in the same way in a certain situation. To cultivate these kinds of models is a way of adapting to biomedical models. Or, we could say that a certain medical culture enters into our conceptions of how music may affect health. Seen in the perspective of the humanities we will caution that music therapy becomes another discipline that objectifies people’s musical taste and experiences by pre-

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scribing a certain musical culture, and in this way colonizes the individual’s musical lifeworld. To claim how people themselves are experts about which music they prefer and how this music will affect their bodies and minds in different contexts, may leave the choice of music to the listeners themselves. If we as music therapists listen to the stories about how body and emotion are affected by music, we will also discover how people may take care of themselves through musical rituals, bodily practices, and forms of experiences (Ruud 2002, 2005a).

The Concept of Musical Affordance Earlier I introduced the concepts of “affordance” and “appropriation” when speaking about musical meaning. In order to avoid essentialist thinking about music, as if musical meanings where mechanistically transferred from a composer and into the score, and then further disseminated to the listener, we need a model of understanding that sees the process of reception by the listener as necessary for the construction of meaning. Music therapists have traditionally resisted a concept of music as “work” and instead embraced a conception of music where contextual, music structure, as well as individual circumstances influence the interpretation and experience of music. Lately, Christopher Small’s concept of “musicking” (Small 1998), as well as the concepts of “affordance” and “appropriation” (DeNora 2000; Clarke 2005) have been widely embraced by music therapists. Small emphasized how “music” must be understood as a practice and a process, as something we do, rather than as an object. This has implication for our understanding

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of how meanings are produced while engaging in music and led Small to redefine music to “musicking,” that is, to look at the concept of music as a verb. As we have seen, contextual or situational circumstances will play a major role when meanings are negotiated. With the word “affordance” musicologists are referring to James J. Gibsons’s ecological theory of perception (Gibson, 1979), which seeks to throw light upon the interactions between perceiver and environment. Any given environment affords a number of actions and perceptions, according to Gibson. Musicologist Eric Clarke writes that “the affordances of an object are the uses, functions, or values of an object” — the opportunities that it offers to a perceiver (Clarke 2003, p. 117). Clarke emphasizes how perception and action are inextricably linked, and he points to the dialectical relationship between an organism and its environment when he states that it is “neither simply a case of organisms imposing their needs on an indifferent environment, nor a fixed environment determining strictly delimited behavioral possibilities” (ibid. p. 118). This further implies that there will always be a social component affecting the range of possibilities inherent in socially embedded objects like music (Clarke 2005, p. 38), which implies further that the musical affordances offered by a specific piece of music will be appropriated by the listener within the “ecology” of the listening situation in question. This understanding opens a further discussion concerning what possible musical structures may give rise to the experience of meaning. As we shall see in the following, we will have to take into consideration how our bodily schemata, or our embodied way of perceiving the world, may lie at the root of musical perception.

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Embodied Meaning in Music The question of musical meaning is fundamental to music therapy practice. Music therapeutic interventions are based on the musical experiences “and the relationships that develop through them as dynamic forces of change,” as Kenneth Bruscia writes in his definition of music therapy (Bruscia 1998, p. 20). When music therapists consider possible outcomes of a session, in addition to evaluating the situation of the client, they have to rely on their knowledge about the nature of musical communication and their notions of how musical meaning is constituted. The study of musical meaning and how it is perceived, interpreted, and communicated, is of major concern to musicology, and has been subject to inquiry from philosophy, music psychology, and the anthropology and sociology of music. Questions of meaning are debated within the field of musicology as one of several basic problems within the philosophy of music. As Norwegian musicologist Hallgjerd Aksnes has remarked, a new interest in musical meaning and musical expression is based on a rejection of philosophical theories that claim that meaning is dependent upon representational or propositional content, i.e., verbal language (Aksnes 2002). Following Mark Johnson (2007), such conceptual-propositional theories of meaning are “far too narrow and too shallow to capture the way things are meaningful to people” (p. 8). These are theories that state that sentences or utterances with a subject-predicate structure are meaningful to the extent that they express propositions that allow us “to make assertions about the way the world is and to perform other speech acts, such as asking questions, issuing

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commands, pleading, joking, expressing remorse, and so on” (loc. cit.). Such objectivist semantics puts forward a totally disembodied theory on the nature of language and meaning. Contrary to such a view, Johnson proposes that our conceptualizations and reasonings are shaped by the nature of our bodies, our sensory-motor capacities, and our ability to experience feelings and emotions (ibid., p. 9). Looking at prelinguistic infants, we will find vast areas of embodied meaning that are not conceptual and propositional in character, as we remarked in the chapter on musical identities in development. In such an embodied theory of meaning, meaning is relational, it connects to other parts of past, present, and future experiences. Meaning is about how things relate or connect with other things, and verbal meanings are just one selective dimension of “vast, continuous process of immanent meaning that involve structures, patterns, qualities, feelings, and emotions” (ibid., p. 10). In the following I will use the approach from Creative Music Therapy as well as the Bonny Method of Guided Imagery and Music (BMGIM) as paradigmatic examples of meaning-producing situations in music therapy. Many discussions around the role of music in therapy often touch upon the issue of universality. I have chosen here to discuss how our bodies, as embodied in our perceptions, will come to influence our perceptions and experience of meaning in music. As biological creatures we all have some common experiences due to how our bodies perform in the world. Such bodily experiences may be the closest we come to a “universal” way of perceiving the world, and thus lay the ground for the perception of sounds and music.

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A Cognitive Perspective Due to the special circumstances of musical communication within the BMGIM, the transcriptions provide information both about listeners’ experiences and about the ways in which the images and narratives are communicated and transcribed by the therapist as the session unfolds. In a research project, Aksnes and Ruud (2008) designed a new BMGIM program — Soundscapes — in order to study how boy-based schemata may operate through a process of “mapping” onto musical perception. Such “image schemas” can be understood as recurring structures or patterns, although hidden from us in our everyday functioning, they operate to influence our perception of the world. For instance Johnson (2007, p. 21) suggests such typical image schemas of bodily movement to include source-path-goal, up-down, into-out-of, toward-away from, and straight-curved. From early on in our life, we come to know and internalize such structures of experience through our bodily interaction with our environment. When we are listening to music, such image structures are projected onto music, such as we will experience movement in music, i.e., how the music (metaphorically) is moving forward, toward a goal, or away from something, as if to follow a certain path. There are four such basic dimensions of movement, Johnson argues (ibid., pp. 22–24), tension, linearity, amplitude, and projection. When we listen to music, we are aware of tensions as melody rises or harmonic tendencies are blocked; we recognize linearity when melodic curves are jagged or smooth, and amplitude is felt when music fills up spaces in various ways, for instance through changes in volume.

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Through projection I can vary the dynamics of music through the exertion of degree of force. Such qualities of movement in music are felt and experienced and constitute the basis for a meaningful experience. From our BMGIM program, we chose the introductory piece by the Norwegian composer Geirr Tveitt. We then administered nine sessions, took detailed transcripts from all the participant’s narratives, and analyzed and compared the metaphors used in response to the piece in question. We did find a strong tendency among the participants to use metaphors of movement connected to the experience of floating, staying on the water, and being held, which was not surprising compared to the structural idiosyncracities we found in the score of the piece in question (for a detailed report, see Aksnes & Ruud 2008). Music is meaningful, Mark Johnson states (2007, p. 236), because it can “present the flow of human experience, feeling, and thinking in concrete embodied forms.” Music resonates deeply with what Daniel Stern calls our vitality-affect contours, “the patterns or process and flow of our felt experiences, such as the buildup of tension and its release, the sense of drifting, the energetic pursuit of a goal, the anxious anticipation of some coming event, and the starting and stopping of a process” (ibid., p. 238). Fundamental to our experience of music is the way we project movement into music. There is a logic of physical motion that structures our experience and understanding of musical motion. Johnson writes that “part of that logic involves the action of forces that aid or obstruct motion toward some destination” (p. 257). And there seems to be growing research in musicology that demonstrates how image schemas for force dynamics, like compulsion,

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blockage, attraction, enablement, and all of the structural elements of paths, like starting points, paths, steps along the paths, destination, progress towards destination, etc. can be identified in musical pieces and are present in our experience and conceptualization of music. As I remarked earlier, bringing our bodily schemas into the perception of music seems to acknowledge some kind of universalism in musical experiences. However, although as infants we may have an immediate nonconceptual, prelinguistic experience of music, we later learn how to listen as part of our enculturation. Our experience and understanding of music, though, is felt as “woven into the fabric of our existence,” as part of our “way of being in and making sense of our experience” (ibid., p. 256). To avoid any essentialism in the understanding of musical meanings, it is important to underscore what Johnson call “the pluralistic ontology of musical motion.” Although our body-based metaphors constitute of our musical experiences, we will find that there are multiple inconsistent metaphors for any given musical expression. This may be evidence of the richness and complexity of musical experiences, or as Johnsen writes: The fact of multiple inconsistent metaphors for a single concept also sheds light on the important question of cultural difference and variation. The grounding of metaphors in bodily experience suggests possible universal structures (of bodily perception and movement) for understanding music. However, since there are multiple metaphors available, and since there may be differing cultural interpretations of bodily experience, metaphor provides one important avenue for exploring

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cultural and historical variation in significantly different conceptions of musical experience that might arise around the world (ibid., p. 259). Based on this background, it seems reasonable to combine such a theory of embodied meaning in music with the concept of affordance and appropriation stated earlier.

Improvisation and Gestural Communication as Being-in-Time-Together Another important aspect of musical communication and meaning may have to do with the experience of being synchronized within time. Probably one of the worst effects of ill health is the consequential social isolation many people experience. Music therapists have drawn attention to how musical improvisations enable client and therapist to engage in a “mutual tuning-in relationship,” as originally described by the sociologist Alfred Schütz. His concept of “mutual tuning-in” points to how music may create a situation “which originates in the possibility of living together simultaneously in specific dimensions of time (Schütz 1951, p. 78). Time is the keyword here, and phenomenologically speaking, being able to synchronize oneself with another within a musical improvisation, this contact situation may be the first step from social isolation to living in a relationship here and now (see Ruud 1998, p.148). Of course, Schütz was not aware of musical improvisations as they appear in music therapy. However, due to the specific techniques applied in music therapeutic improvisations, this synchronicity may be obtained through the flexible use of adaptive responses by the therapist, and not least through the establishing of a common pulse.

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Ansdell and Pavlicevic (2005) have elaborated the relevance of time in music therapy and improvisation and look at emerging communication as “a mutual coordination of intention and action within concrete events in real time” (ibid., p. 199). They argue how a possibly damaged communicative musicality based upon parameters such as pulse, dynamic quality, and musical narrative (ibid., p. 201) may be “repaired” through the techniques of improvisation developed by music therapists. There are theories that look for internal musical structures as an explanation for how musical meaning arises. As we saw in the previous section, music may be seen as a dynamic field with forces of tensions, rooted in our embodied perception. Because our perception is wired from early on to feel the forces of gravity, due to our early bodily experiences, composers may build in tensions and expectations in the musical structure to create a dynamic behind music listening that we will recognize through our embodied perception. Music therapists will utilize this potential for tension or expectation when they improvise and when they try to engage clients in musical interaction by manipulating the musical parameters. Music therapists use a variety of techniques to get people involved in musical improvisation (see Bruscia 1987). In addition to the foundation of a common pulse, musical interaction may confirm and challenge this common temporality through temporal deviances as experiences when musicians are playing “on the top of” or “behind” the beat (Keil 1994a). Keil suggested the term “participatory discrepancies” (Keil 1994b) for those experiences in the music that lead to involvement and participation that originate from a mutual sense of playing around the beat and out of tune (Ruud 1998, p. 158). Music therapist Ken Aigen has convincingly demonstrated how these

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grooves work in of one of his cases (Aigen 2002). Aigen observes how (ibid., 57) “. . . to groove means to be totally locked into the moment in time, the place, and the individuals with whom one is grooving.”

The Body in Musical Communication Much of the strength of music therapy comes from its unique position in establishing contact and building relations through musical encounters. Musical improvisations based on music cultural sensitivity enable the music therapist to initiate, maintain, and further musical communication. This ability to react to music also seems to be rooted in our common biological nature, in our embodied responses to music. Recent research and theorizing about the gestural nature of music (Gritten & King 2006; Aksnes & Ruud 2008; Ruud 2007a) may help the music therapist to understand how our bodies and our cultural situatedness interact when musical communication comes into play. This connection between music and body seems to be mediated by our gestures, as they are manifested in musical acts and expressions. Following Iazzetta (2000), gesture may be taken in a broad sense, “it does not mean only movement, but a movement that can express something,” Iazzetta writes. And he adds that gesture “is a movement that embodies a special meaning. It is more than a change in space, or a body action, or a mechanic activity: gesture is an expressive movement that becomes actual through temporal and spatial changes” (ibid., p.74). In order to understand how music may come to play such a role in the formation of a relation we have to seek to understand how relations between the child and the adult are established. If we go all the way back to early

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social psychologist Georg Herbert Mead (1863–1931), he maintains in a theory of gesture and communication how the infant’s early “conversation with gestures” creates an orientation toward mutuality. In order to legitimate the use of improvisations in music therapy, theories and arguments have been found in the discourses about the use of music as nonverbal communication, both in relation to clients without language or when words have not been available because of emotional difficulties. Language, though, is of course an important aspect of our social forms of contacts. “Language is a part of social behavior,” Mead writes, at the same time as he adds an important footnote about gestures: What is the basic mechanism whereby the social processes goes on? It is the mechanism of gesture, which makes possible the appropriate responses to one another’s behavior of the different individual organisms involved in the social process. Within any given social act, an adjustment is effected, by means of gestures, of the actions of one organism involved to the actions of another; the gestures are movements of the first organism which act as specific stimuli calling forth the (socially) appropriate responses of the second organism. The field of the operation of gestures is the field within which the rise and development of human intelligence has taken place through the process of the symbolizations of experience with gestures — especially vocal gestures — have made possible. . . . (Mead, 1934, p. 13–14). A gesture originates on a rudimentary level of biological behavior at the same time as it initiates complex social

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acts. Sound and movements from one organism influence the other. Gestures stemming from one organism may be taken as a signal that functions as a stimulus, which initiates a process of adaptation and signification in the other organism. All such responses may develop into mutual gestures toward the opposite organism, which creates a series of interactions, adaptations, and changes in attitude. This is what might be termed a “conversation with gestures,” what is sometimes called protoconversations. Musicologist Wilson Coker builds on Mead when he points to an important aspect of this conversation, namely the immediateness in the response. There is an immediate, almost instinctive adaptation to the other, Coker writes (1972, p.10). We also know today how recent infant research has confirmed Mead’s understanding of how the infant’s ability to adapt its responses is evidence of early empathic activity. We know today how “taking the role of the other,” which was Mead’s formulation of early intersubjectivity, does happen significantly earlier in the infant’s life than earlier thought. So-called primary intersubjectivity originates, according to developmental psychologist Colwyn Trevarthen, from birth on. The immediacy of response means that the musical act happens on a prelinguistic level, in other words, without the selfconscious attention or intentionality. On this level of interaction, the exchange of gestures takes place without the conscious intentionality, which is characteristic of language or rule-governed behavior. In other words, we could say that intentionality in musical response comes after action. By the way of imitation, the person may produce meaningful musical responses only to realize afterward a sort of “intentionality” in retrospect (see Stensæth 2008). In order to explain some of the biological or neu-

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ropsychological background for this conversation with gestures, i.e., protoconversation, researchers have pointed toward how a group of so-called mirror neurons makes early imitation possible. In his book, The Present Moment, Daniel Stern points to how these mirror neurons are active when we try to read other peoples’ intentions, take part in their emotions, experience something that the other is experiencing, and take hold of an observed action in order to imitate it — everything that is about empathy and the establishment of interpersonal contact (Stern, 2004, pp.78–79). We find these mirror neurons beside the motor neurons, and they are activated within an observer who only observes another person executing an action, i.e., playing an instrument. And the particular pattern of firing by the observer is exactly the same as the pattern would have been had the observer himself performed the action (ibid., p. 79). Or, as Stern writes: In brief, the visual information we receive when we watch another act gets mapped onto the equivalent motor representation in our own brain by the activity of these mirror neurons. It permits us to directly participate in another’s action without having to imitate them. We experience the other as if we were executing the same action, feeling the same emotion, making the same vocalization, or being touched as they are being touched. . . . This “participation” in another’s mental life creates a sense of feeling/sharing with/understanding the person, in particular, the person’s intentions and feelings (loc. cit). It seems reasonable to draw from these observations when music therapists want to understand how and why

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musical improvisation often succeeds when other forms of communication have failed. Involvement in musical interplay and interaction, as it grows out of the sensitive recognition and responses from the therapist, may have had its roots in the immediacy of gestural identification, attunement, and interaction. In order to make this conclusion, however, we have to take into account the crossmodal character of perception, how input in one sense modality may be acted upon within another sense modality. Visual information may well be experienced and reacted upon as aural information. Or, as musicologist Rolf Inge Godøy writes in his “triangular model” of motormimetic music cognition: “Any sound can be understood as included in an action-trajectory.” Images of soundproducing actions will have visual and motor components in addition to that of “pure” sound (Godøy 2003, p. 317– 318).

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Chapter 5

Dimensions of Aesthetics in Music Therapy Recently, there has been a debate going on in music therapy concerning the value of music and aesthetics. Too much import of theories from extra-musical fields, such as psychology, seems to hinder the possible construction of a music-based indigenous theory of music therapy. Clearly, within a humanities-based music therapy, music as an art form, as well as aesthetics as a basic humanistic discipline, needs attention. In the following I will link up to the discussion about a music-centered music therapy as well as outline some other perspectives upon the place of aesthetics in music therapy. The current discussion on music and health promotion does not consider that music, i.e., any particular form of music, has health value in itself. The concept of “musicking” (Small 1998) recognizes that the context of performance and our idiosyncratic relationship to each musical situation is crucial to our decoding and interpretation of music, and therefore influences the “effects” of music. This is in line with much contemporary music ethnography, which emphasizes how we make use of music to express symbolic meaning and core values in our culture (Feld 1981, 1990), or how

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music is actively used to create social boundaries (Stokes 1994) or construct identities (Ruud 1997). Music ethnography has demonstrated how music in some form or another exists in all human cultures. It also seems that music always had a regulative role in the culture concerning the individual’s place in cosmology, in healing rituals, educational settings, or in building relations and networks. In contemporary society, although many of the earlier functions of music may have become less obvious, music seems to serve a whole array of functions ranging from social control to ideological maintenance within the institutions of religion, politics, and art. Although music always served everyday needs in our culture, such needs and functions were gradually placed in the background. From the eighteenth century on, we saw the installation of an aesthetics of music, which insisted upon the pure and uncontaminated contemplation of the musical artwork as the paradigmatic relation to music. Music was taken away from everyday life and cultivated in concert halls and conservatories. The result has been a highly elitist art form, ideologically separated from “low culture” through an aesthetic discourse where music is constructed as autonomous and universal, complex and original. At the same time, following the positivist influence upon the natural sciences, music was also left out of the repertoire of healing remedies administered by medical doctors throughout centuries (Kümmel 1977). Music took on an ethos of self-containment; it was through a historical process constructed as having an inherent, benevolent nature. There was no need to give music any instrumental functions, as a means to obtain something. Something was lost, however, when music became an art form within such an aesthetic, where it be-

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came disentangled from everyday life and separated into its own sphere. Music became noninstrumental and not intended to serve any practical purposes in life. This process may have come to its end. Within the current postmodern climate, the process of differentiation and fragmentation, which characterize modernity, are met with a process of integration and a search for wholeness. We are witnessing how the arts are corroborating with the economic spheres, how music is taken into marketing as well as medicine. The postmodern climate has also led to a more inclusive attitude toward the value of popular musical forms. The boundaries between high and low are no longer easily justified.

Functions of Music in Music Therapy In the ongoing debate about working factors in music therapy, one position wants to emphasize the importance of the music therapist with her knowledge about special education or psychotherapy (music in therapy). Other music therapists want to argue how music itself provides the basis for therapeutic change (music as therapy). In the so-called music-centered theories the emphasis is on how music itself is a major therapeutic factor, while the import of music (therapy) external theories is played down when it comes to explain therapeutic change. Instead of placing the two discourses in opposition, I would prefer to explain how we have to illuminate therapeutic change from different theoretical perspectives. In the same way we have to draw on theories from cognition and learning, psychotherap,y or the importance of the therapeutic relationship, we also have to show how musical factors or processes are operating when it comes to create conditions for interaction, dialogue, learning, change, or health.

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As we saw in the previous chapter, such an understanding may build upon theories of music and embodied perception, gestural theories of musical communication and meaning, or phenomenological readings of synchronicities of being-together-in-music. As we also saw in the previous chapter, “music” was understood as “musicking,” as something we do. When we are discussing the concept of music and musical aesthetics in music therapy, it is important to bear in mind the diversity of musical activities we find in use among music therapists. In music therapy, “musicking” means different activities like improvisation, composing, songwriting, dance and movement, listening, and performing. Improvisation means process-oriented activities where the relationship between two or more persons is regulated through a common configuration and exploration of musical elements. Music will here consist of the common musical work that happens in the process. For instance, in Creative Music Therapy, music can be seen as an activity where something is created (relationships, emotions, insights), or as something that carries expression and symbolism (expressive and referential functions). A close look at improvisation in music therapy will tell us how musical improvisations create possibilities for a common unfolding and sharing of time, something that gives experiences of mutuality and commonality, the experience of attachment and participation in common activity. This kind of musicking will provide good opportunities for action and intentionality; musical expectations will arise through musical delays and fulfillments. In other music therapy situations, where play-songs, drama, and movement create a frame for musical interaction, we can see for instance that when music is used as a tool in special education, music becomes a medium to

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promote learning of extra-musical goals. Music can here be seen as a field of learning. Music-internal features that create attention, provide a structure for action, or the transfer of information will create a field of learning useful for therapeutic or educational aims. Another situation in music therapy, which challenges our conception of musical aesthetics, is the performancebased approach where a music therapist and client cooperate in performing a musical product within a public situation. We find this in community music therapy or performance-based music therapy. Music is here understood as an expression, which is tied to competency (emotional, musical, social). When musical performance is at the center, music makes possible how this competency comes through in emotional, social, and musical skills, and mastery. If we take the Bonny Method of Guided Imagery and Music (BMGIM) as paradigmatic for a receptive music therapy, we could say that “the musical” here is located within the relation to different works of art music. Music could be seen as a carrier of expression and symbolism experienced with a metaphoric content, which can be applied to our own life experiences. We can here point to working elements in music as musical structure, form, structural tensions, and narratives in addition to the semantic and associative force, which give music a role as a producer of metaphors idiosyncratic to the BMGIM. In a theory of the role of music in music therapy, it becomes important to relate to research within different areas of systematic musicology. We do not only need theories from sociology, psychology, and anthropology of music, but we also need the discourses from aesthetic theory as a basis for reflection about the aspects of art that defend the use of music in therapy. When we try to

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understand the nature of the aesthetic, what strikes us is the indefinable and unpredictable aspect of music. We should at the same time bear in mind how such features will be hard to reconcile with therapeutic regimes when predictability has been made the norm in order to achieve measurable and reproducible results. In other words, this is an area where the humanities approach will challenge the natural science outlook on music therapy.

Aesthetics as Performative Acts In the debate on the role for the aesthetic in music therapy, as initiated by Kenneth Aigen in the Nordic Journal for Music Therapy (Aigen 2007, 2008), we might trace the traditional Kantian conflict between a position that sees more or less objective aesthetic dimensions as embedded within the work of art and a position that will see such internal musical dimensions as dependent upon contextual circumstances, as I argued in the previous chapter. Aigen (2008) seems to defend the former position when he points to qualities of form (wholeness), unity, and completion (integration) within musical objects as mediators of aesthetic and healing qualities. Brynjulf Stige (2008a) on the other hand, is defending the position of “multiple aesthetics,” and seems to advocate a more pragmatic relativist stance when he discusses aesthetic values. Whatever the nature of the disagreement, it is clearly a problem to postulate a set of criteria like wholeness, unity, and completion as long as we have problems translating the meaning of such terms from one culture to another. As Skårberg (1998) brought into the discussion, Kant himself sought to find a way between dogmatic objectivism and skeptical subjectivism. He found this way in his conception of aesthetics as a form of experience. We

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may discover this position within contemporary ethnographic perspectives on musical aesthetics. Norwegian social anthropologist Odd Are Berkaak (1989) points to how our concept of aesthetic should not be applied to frame or identify a group of phenomena or actions. What we conceive of as “the aesthetic” is a category or mode of perception, which focuses that aspect of a phenomenon that emerges when we regard the phenomenon apart from its ordinary, semantic, and functional relations. Instead of claiming how the work of music creates a certain “aesthetic mood” within us, we might say that we are framing the piece of work in such a way that we relate to it within our own reality. The aesthetic is not within the work of art, it is a performative act by the perceiver, and it is the specific way of relating to the phenomenon in question. Such a performative aesthetic makes it possible to relate to the world in a playful way. Creative musical acts may be seen as a way of exploring realities without considering practical consequences, and the aesthetic mode permits the metaphoric mapping or reading of musical signs in idiosyncratic ways.

Music Centered? Instead of taking this relational mode as a point of departure when studying the aesthetic basis for music therapy, we tend to, as we saw, discuss the actual musical material or content of the music. This is much in line with how we go about judging the world around us. As the social psychologist Kurt Lewin once noted, laypeople misconceive social behavior much in the same way earlier Aristotelian physics was understood exclusively in terms of properties or dispositions of the object: A stone sinks in water because it has the property of heaviness, or

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“gravity” (Ross & Nisbett, 1991, p. 161–62). In modern physics, however, the existence of a physical vector always depends upon the mutual relations of several physical facts, especially upon the relation of the object to its environment. In “laypersonology” people have a tendency to attribute behavior to persons, rather than to situations, or how people construe situations differently. In social psychology this is referred to as the “fundamental or ultimate attributional error.” In much the same way “lay musicology,” in the sense that we all are engaged in the interpretation and classification of music and musical behavior, tends to misinterpret musical behavior by drawing conclusions based upon our own interpretations of the music in question. When it comes to our understanding of how musical meanings are extracted from pieces of music, or how music is performed, we engage in the same game as ancient physics, overlooking contextual or construal factors as different people differently entertain them. It seems to me that musicologists and sometimes music therapists suffer from this sort of “fundamental attribution error,” not making room for allowance of other ways of constructing musical meanings and realities. There is a term for this also in social psychology, “egocentric attribution,” quite often leading to phenomena as “the false consensus effect” and “overconfidence in predictions.” If we look at one of the great controversies within the field of psychology, the so-called person-situation debate, we might gain some understanding of the issues involved when we attribute causes to people’s behavior. In the field of personality theory, or personology, there is a strong tradition of so-called trait psychology that regards personality as composed by certain more or less hereditary traits,

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such as “introversion,” “agreeableness,” “neuroticism,” “openness to experience,” and so on (see Pervin 1996). By means of a battery of tests and measurements, psychologists are aiming to develop a taxonomy of human traits, which may support our common way of predicting human behavior. As within the Aristotelian physics, this particular psychology seeks to understand how and why people behave in certain situations by inferring from their character or traits. People who greet us warmly and openly are seen as “agreeable persons” likely to perform this behavior consistently across situations. However, social psychologists have accumulated a lot of empirical evidence that behavior is not a function of a set of traits. People do not behave consistently across situations. People construe their realities, they interpret situations, and they act according to preferences, plans, or goals. People have different competencies and capacities, different conceptions of themselves and their (musical) identities, it is argued from an alliance between social-cognitive personologists and social psychologists. Behavior is a function of interpretation within a specific situation. Any situation takes place within a larger cultural context, or in Lewin’s terms, within a cultural system of tension of opposing forces. If we look at the field of music therapy, an essentialist or mechanistic approach is in many ways similar to that of Aristotelian trait psychologists, when it looks into the structures of music to find the aesthetically significant traits, totally ignorant of what will happen when this aesthetic reality is interpreted within a specific local situation. The same failure may be seen among those making bold interpretations as if they have been granted a privileged position from some higher authority. In many ways, the field of music therapy is even more complicated than

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the field of social psychology when it comes to the understanding of aesthetic behavior. To understand musical behavior or the experience of music, one cannot only take into account the idiosyncratic interpretation of the person within a particular social, cultural, or historical situation. Music itself is a kind of situation, with is particular materiality, syntax, and semiotics. We need, of course, a music-centered music therapy to focus and describe some of the sonic differences that give rise to our musical cognitions. However, to understand the pragmatics of the situation, i.e., the special effects, or how and why people may change under the influence of music therapy, functions or consequences of music, one has to go beyond the analysis and out into the world, into the specific clinical situation and its concomitant experience. It might be that this is not the agenda of much natural-science music therapy. Seen from the perspective of music therapy based upon the humanities, however, the question of musical meaning and pragmatics is vital. And if we want to understand how music operates in therapy, how music attracts and shapes peoples and cultures, this local and situational knowledge is crucial. In this sense we need an interpretative turn, which aims at making the art objects speak out and communicate. For the music therapists, contextual understandings of musical meaning are vital for any empirical understanding of how music affects our cognitions and behavior.

A Note on Analysis and Music Therapy Music therapy and musicology share a common ground in musical analysis. However, their agendas might be totally different. That is, music therapy will need ways of analyzing music in order to approach the questions of

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“how music works” in therapy. It is openly recognized in the field of music therapy that there has been a neglect of musical analysis. Music therapists often resort to clinical theory and evidence when they are describing the effects of music. Or, they fall back on generalized explanations about the “universal character” of music, the symbolic or metaphoric potential of music, its communicative potentiality, and so on. Only a few music therapists have taken the trouble to probe into detailed analysis of formal characteristics of music as it can be observed, notated, or recorded during the therapeutic process (for an overview, see Bonde 2005). At the same time there is a proliferation of explanations giving general therapeutic potential to certain intervals, scales, tempi, instruments, and so on. There is a danger, however, that we approach the question of musical analysis in analogy with the pharmacological model of thinking about the effects of music. We can see this model of approach in one of the earliest modern academic publications on music therapy, the anthology Music and Medicine edited by Dorothy Schullian and Max Schoen in 1948. As Penelope Gouk observes (Gouk 2000b), those positioned highest in the hierarchy among the contributors, the medical doctors and composers, seemed to reify music as something composed by the expert and then prescribed by the doctor. Such a way of modeling music therapy clearly would direct the analysis in a wrong direction. Inevitably, the process character, the dialog, and relational nature of much contemporary music therapy, and not least the contextual sensitivity, would suffer from such an approach. One of the reasons music therapists have been negligent about analyzing the music may well be that in many instances music making and therapeutic intervention are not separable. It sometimes does not make sense to

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separate the therapeutic intervention from the musical intervention. In many cases, the depth of intervention, or the “level of therapy,” may not qualify for deeper analysis. Music may be solely regarded as a social frame, an activity of doing something together, a means of increasing self-efficacy, a way of reminiscing, a signal for a response, a structure for interaction, and so on. In general, I would advocate situational explanations, rather than broad general explanations, of how music contributes to the therapeutic potential of the situation. It is in those cases where the level of music therapeutic work goes further, where therapeutic changes depend to a large extent on music itself, or the experiences stemming from the interaction with music, that we might be interested in understanding how particular instances of music have effected a significant change in the course of action. In her doctoral dissertation, Lisa Summer (2009) has researched such a possibility for a music-centered approach to BMGIM. In her music-centered GIM, or MCGIM, repeated listening to the same piece within the program, and guiding techniques that direct the clients’ attention to the music itself, proves to be effective especially for those with some previous experience with the BMGIM. Music itself seems to work as a supportive agent. Musical experiences can also lead to new insight into personal issues, i.e., to function as reeducative. The MCGIM can even lead to restructuring or transformative experiences. However, we still have to sort out, if possible, how relational factors between therapist and traveler will influence the therapeutic process. Or how the ritual character of the MCGIM procedure will create an environment conducive to therapeutic change. If we try to specify what

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exactly works within music, we are met with an extremely complicated task of music-ecological research. First of all we need to establish some kind of correlation between the stream of music and the moments of therapeutic significance. How to validate the latter is in itself a major methodological problem that has to be recorded and intersubjectively interpreted by behavioral observation of the client, or given significance as reported verbally by the client him/herself. Given the case that we have selected some instances of music being influential upon the client in some way or another, we have at least somewhere to start. If our choice of departure is a notated transcription of the improvisation, or the score of the music (these of course are not two identical situations), we can set about to analyze the music. But what do we look for? Thematic unity, tempo changes, texture, patterns of dialogue, changes in complexity, melodic or thematic characteristics? I would guess that everything is legitimate, according to the character of the piece in question. A particular problem, however, seems more crucial to this kind of analysis than to the musicologist’s concern: To what extent can we expect a correspondence between the music as heard or notated and the experience as it occurred in the client? Is it possible to translate from the analysis to the experience? Even if it were, is it possible to generalize anything about the effects of music beyond this particular situation? I would think that the problem of overinterpretation is serious. This does not mean that I find this kind of analysis useless, I would rather hesitate to make any general claims about the relations between formal characteristics of music, or changes therein, and possible mental reactions. The very effects of music have to be understood

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within a context when identities of those doing music therapy as well as their instruments and technologies are a vital part of the transaction that gives rise to certain effects. Further, in the process of “conceptualizing the nonverbal” (Gouk 2000a), we have to take into account the nature of the language and metaphors being applied in the analysis. All this together places great demand of the capacity of self-reflexivity. Although the purpose of analysis in music therapy is to make explicit how music or musical processes contribute to therapeutic interventions, we see how this activity may be linked to some of the issues in the “new musicology,” as outlined by Gary Ansdell in the previous chapter. If musicology is concerned about music as something intimately tied to human affect and meaning, or how musical meaning is of a participatory nature and inherently social, cultural, and contextual, music therapy may have a lot to offer musicologists in broadening their understanding of how music is personal, embodied, and deeply human.

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Chapter 6

Enabling and Empowerment A music-therapeutic approach means an inclusive attitude and a low threshold for musical participation. In situations that involve playing and creating music, music and instruments are adapted to give the participants the experience of mastery. In didactic music therapy, when working with severely disabled children, for example, music is offered to utilize client’s resources in terms of attention, ability to respond, create order in sense impressions, explore sounds, and create social bonds. Music therapists build on the possibilities to strengthen the client’s sense of self-efficacy, the belief in one’s own resources for mastery and action. Music therapists should be aware of the powerful tool musicking comprises in its ability to generate well-being and optimism, to foster resilience and agency, to work through positive emotions and the experience of “flow” in order to equip clients with strategies for living a good life. The field of psychology has recently acknowledged its neglect of precisely these factors, which we think the aesthetic curriculum provides. Presently, psychology is moving toward a more “positive psychology” (Snyder & Lopez 2002), where research is focused on sorting out those experiences in life that encourage people to become

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more involved. This is a unique possibility for music therapists to link up with the evolving field of health psychology as well as the new positive psychology. This would resonate well within the longstanding historical tradition of musical thought, that originated in the practice of Pythagoras, as he possibly imagined how musicking was preparing for life. In the following, I will examine some of the theoretical issues in positive psychology to see how music therapy may align with this recent development within psychology.

Positive Psychology The new positive psychology is a formation within the discipline of psychology that seeks to build a science of positive subjective experience, positive individual traits, and positive institutions as a way to improve quality of life and “prevent pathologies that arise when life is barren and meaningless” (Seligman & Csikszentmihalyi 2000, p. 5). Or, as described in more detail: The field of positive psychology at the subjective level is about valued subjective experiences: wellbeing, contentment, and satisfaction (in the past); hope and optimism (for the future); and flow and happiness (in the present). At the individual level, it is about positive individual traits: the capacity for love and vocation, courage, interpersonal skill, aesthetic sensibility, perseverance, forgiveness, originality, future mindedness, spirituality, high talent, and wisdom. At the group level, it is about the civic virtues and the institutions that move individuals towards better citizenship: responsibility,

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nurturance, altruism, civility, moderation, tolerance, and work ethic (loc. cit.). The role of musicking certainly would belong to the list of topics within such a psychology. There are countless examples from everyday musicking of how people reach a state of flow, experience meaning, hope, and happiness from being involved in music. This is an area to be researched and would thus give the discipline of music therapy another important grounding. As we have seen earlier, it is important to have a concept of human nature that acknowledges the relevance of the biological nature of man, our personal and psychological dimensions, as well as sees how society, culture, and social circumstances will influence our life and our concept of music (see also Ruud 1998, chapter 2). This means we have to take into consideration both Darwinian, critical as well as an Artistotelian approach to understand individual and human development. According to Jørgensen and Nafstad (2005), although the Darwinian approach or evolutionary perspective has been represented in positive psychology, some of the core values in positive psychology have roots that can be traced back to ancient Greek Aristotelian traditions, especially when it comes to understanding the individual as a virtuous creature. The Aristotelian model of a virtuous person focuses on those inner traits, dispositions, and motives that qualify the individual to be virtuous, Jørgensen and Nafstad write (ibid., p. 888). And they add: “Moreover, in the Aristotelian model, the virtues of the soul are of two sorts: virtue of thought and virtue of character.” And according to Aristotle the virtue of thought arises and grows from teaching, while virtue of character (i.e., of ethos) results

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from habits. In other words, such virtues are acquiered through education and habituation; they are not inborn. This frame of understanding is “the perspective of a core human nature in which change(s) toward something good, better, or more perfect comprises a fundamental aspect” (ibid., p. 889). A consequence of this is that the individual, according to Aristotle, has possibilities and potentials, and that we should habituate people to realize their positive virtues. Such a realization will, according to the idea of positive psychology, also lead to enjoyment, as the good feeling people experience when they stretch beyond themselves.

Strengths and Resources Positive psychology has focused on people’s strengths, rather than their weaknesses. With the concept of “signature strength,” Martin Seligman introduced how we could perform and build our moral traits, such as integrity, valor, fairness, originality, and kindness (Seligman 2002). Music therapists, perhaps more concerned with talents, resources, or basic competencies, have a long tradition of applying musical performance as a way to discover, assess, and utilize motor, cognitive, emotional, social, and communicative skills implicit in producing music. Although such an optimistic approach toward clients is part of the everyday practice of music therapy, there have been few attempts to formulate a more comprehensive approach to such a positive practice. Norwegian music therapist Randi Rolvsjord, although she does not position herself within positive psychology, took this approach into her work in psychiatry with young female

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clients. Her dissertation on resource-oriented music therapy (Rolvsjord 2007) included elements from salutogenic thinking about health, feminist and empowerment philosophy, positive psychology, and research from psychotherapy about working factors, and she outlined the first general approach to a theory of resource-oriented music therapy. Rolvsjord also formulated some principles in order to sort out essential characteristics of a resourceoriented approach. Among those principles she found unique and essential were: focusing on the clients strengths and potential, recognizing the client’s competence relative to her/his therapeutic process, collaborating with the client concerning goals of therapy and methods of working, and being emotionally involved in music and fostering positive emotions. Priciples that were considered essential but not unique to the therapy process were: engaging the client in musical interplay (such as musical improvisation, creating songs, playing precomposed music, or listening to music), acknowledging and encouraging musical skills and potential, reflecting verbally on music and musical interplay, listening and interacting empathically, tuning into the client’s expressions, and collaborating with the client concerning the length and termination of the therapy process. Rolvsjord also defined some principles acceptable but not necessary: teaching instruments/music, sharing one’s own experiences, presenting/performing music with the client outside the therapy setting, providing therapeutic rationale, having music as the primary goal of therapy, and reflecting verbally and musically on problems. Some principles, however, were considered not acceptable to the resource-oriented approach, such as: neglecting the client’s strengths and potentials, having a strong focus on pathology, avoiding

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emerging problems and negative emotions, and directing in a noncollaborative style (see Rolvsjord, 2007; Rolvsjord, Gold & Stige 2005). Another Norwegian music therapist, Hans Petter Solli, also took positive psychology into his work with acute psychotic patients and demonstrated the value of looking at music therapy through the eyes of a resourceoriented approach (Solli, 2008).

Positive Emotions One of the most promising recent ideas within the tradition of positive psychology is the theory and findings of how positive emotions can optimize health and well-being (Fredrickson 2000). So-called negative emotions, like fear and anxiety seem to narrow a person’s momentary thought-action repertoire, Fredrickson writes (ibid., p. 2). Negative emotions take care of adaptive actions represented by specific actions tendencies. Positive emotions, on the other hand, broaden a person’s momentary thought-action repertoire. The three examples of positive emotions given by Fredrickson are also highly relevant for the appreciation of music, both within a music therapeutic setting as well as in everyday health musicking. To start with “joy,” it has been characterized as “aimless, unasked-for readiness to engage in whatever interaction presents itself and in part readiness to engage in enjoyments” (loc. cit.). Joy creates in us the urge to play, encompassing not only physical and social play, but also intellectual and artistic play. “Play, especially imaginative play, is to a large degree unscripted. It involves exploration, invention, and just plain fooling around” (loc. cit.). There is, of course, lots of evidence in psychology

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about how children benefit from play, both socially and intellectually. In music therapy, especially in the Creative Music Therapy tradition, play and improvisation have been established as main approaches, although theorizing aspects of play is not common (for an exception, see Stensæth 2008). “Interest” is the second positive emotion put forward by Fredrickson: “Interest and related affective states (e.g., curiosity, wonder, excitement, intrinsic motivation, and flow) arise in contexts appraised as safe and as offering novelty, change, a sense of possibility . . . challenge . . . or mystery . . .” (ibid. 3). To be interested involves both effort and attention, often leading to exploration and invention, a wish to expand the self by incorporating new experiences with the person or object that stimulated the interest. Clearly, again we see the relevance of musical activities, i.e., listening and improvising, to stimulate interest and curiosity. In fact, this may be the prime reason why music is so useful in many therapeutic settings. Emotions like serenity, tranquility, and relief — or what Fredrickson groups together as “contentment,” we also know as consequential emotions of partaking in musical activities. Fredrickson relates this category to the Japanese emotion term amae, “which refers to the sense of being accepted and cared for by others in a passive relationship of reciprocal dependence” (loc. cit.). Those familiar with the BMGIM know how some of the titles of music programs have names referring to “contentment,” for instance one of the original programs designed by Helen Bonny — Caring. Everyone who has experienced a BMGIM session, where a deep satisfaction comes from the music and bodily state, reinforced by the therapist intervention: “Permit yourself to be in this state,” know the

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meaning of “contentment.” This emotion “prompts individuals to savor the moment or recent experiences, feel ‘oneness’ with others or the world around them, and integrate current and recent experiences into their overall self-concept and worldview,” Fredrickson writes, and adds: contenment is not simply behavioral passivity but rather a reflective broadening of a person’s selfviews and worldviews. Contentment, according to this analysis, is a mindful emotion. It involves full awareness of, and openness to momentary experiences; it carries the urge to savor and integrate those experiences, which in turn creates a new sense of self and a new worldview. These links to mindfulness, receptivity, integration, selfcomplexity, and insight characterize contentment as an emotion that broadens individual’s momentary thought-action repertoires, and builds their personal resources (ibid., p. 4). These emotions do not only share the feature of broadening the individual’s momentary thought-action repertoire, but they also share the feature of building the indivual’s personal resources, ranging from physical and intellectual resources to social resources, Fredrickson writes (loc. cit.). These resources are more durable than the transient emotional states that led to their acquisition, and thus positive emotions can mean an increment in enduring personal resources that can be drawn on later. This is why Fredrickson states this as the broaden-and-build model of positive emotions. Positive emotions also seem to have an undoing effect of negative emotions:

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Broadening may turn out to be the operative mechanism. By broadening the momentary thought-action repertoire, positive emotions may loosen the hold that (no longer relevant) negative emotions gain on an individual’s mind and body by dismantling or undoing the narrowed psychological and physiological preparation for specific action. I propose then, that the broadened thought-action repertoire of positive emotions is psychologically incompatible with the narrowed thought-action repertoire of negative emotions. In addition, to the extent that a negative emotion’s narrowed thought-action repertoire (i.e., specific action tendency) evokes physiological changes to support the indicated action . . . a counteracting positive emotion — with its broadened thoughtaction repertoire — should quell or undo this physiological preparation for specific action. By returning the body to baseline levels of physiological activation, positive emotions create physiological support for pursuing the wider array of thoughts and actions called forth (ibid., p. 5). Positive emotions not only undo the physiological effects of negative emotions, like undoing cardiovascular damage, but they also may undo the psychological or cognitive narrowing engendered by negative emotions. We can see how this theory has vast implications for our understanding of the effects of everyday musicking — it is as well highly relevant for some of the intervention and change strategies we find in music therapy. Fredrickson mentions a variety of techniques related to relaxation, imagery exercises, muscle exercises, meditation exercises, and relaxation therapies. From the field of BMGIM we know how

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all these are integrated in the approach, which clearly puts this approach as highly relevant when it comes to not only treating and preventing problems, but in the realm of building personal strength, resilience, and wellness.

Principles of Empowerment Within treatment, counseling and education principles of “empowerment” have evolved from perspectives and theories developed within both individual and systemstheory related discourses. Generally, adhering to the principles of “empowerment,” means developing strategies to strengthen those who seek help through emphasizing experiences of mastery and competence. In practice, this involves a resource-oriented approach, i.e., to focus on what is possible and what gives meaning for the client. In the literature concerning empowerment theory, we are met with studies of resilience, as well as the influences from salutogenic thinking. The study of what factors may promote the healthy development of a child, despite adverse conditions like poverty, lack of schooling or parental support because of addiction and so on, is of course valuable for those who create compensatory programs within music and art. Antonovsky’s (1987) basic understanding of the health-promoting or salutogenic factors, such as the experience of comprehensibility, manageability, and meaningfulness in life are evidently transferable to the practice of musicking. Research with families and within early intervention have identified some principles and themes that help clients to release their own strengths (Lassen 2002, pp. 117–120). Elaborating on these themes, we could postulate how our approach to music therapy should be concerned about the following themes.

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Goals, Needs, and Resources Goals for music therapy are based on the client’s own needs. When someone turns to the music therapist for help, it is important to develop a musical approach based on the needs of the clients, assuming that such needs are resources or support necessary to attain the goals set. This means, for instance, that sometimes music therapists will support the client in developing musical skills in order to regain or reclaim proficiency in the client’s own musicking as an entry to participation in musical life (see Rolvsjord 2007). This approach presupposes a belief that every human being, along with external systems, has existent resources to increase competencies. For instance, musicality is a natural capacity among all humans. As Rolvsjord also underscores, cultural and music educational traditions and norms and market values are sometimes undermining our sense of musicality. To the vulnerable person, to regain a natural felt way of musical expression is an important acknowledgment of his own resources, and perhaps a good starting point for belief in manageability in life.

Looking for Community Support In accordance with contemporary community music therapy, the music therapist will look for possible support and cooperation with both formal and informal groups or institutions. While therapists and counselors look for support in the network of the family, neighborhood, voluntary organizations, and the community, music therapists will seek contact with the local music and cultural school and local bands and choirs.

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Corroboration and Recognition As we saw earlier, mutual recognition is basic to the relational approach in music therapy. Within the empowerment approach, cooperation and corroboration with the client is just as important as what kind of resources are mobilized. Empathy is necessary to ensure that we get to know the client as a unique individual, learn about his or her resources, and recognize the client as a person.

Empowerment as both Approach and Goal The process of empowerment includes giving enabling experiences and ensuring empowering consequences. This last means that the client can make use of these experiences later in life. Lassen (ibid.) states that there is no opposition between treatment and prevention. To ensure that empowerment really takes place, it is suggested that the client will need systematic support in trying out new strategies and making choices. Further, a strengthening of socioecological network and personal recognition is needed. And thirdly, the above focus on mastery, strength, and resources must be felt by the client to be dependent upon his or her own actions. These principles should be possible in music therapy situations. Music therapists, for instance, should never forget that the client in many cases is an expert on music. The client knows what kind of musical genre, which pieces or under what circumstances music will be enjoyable, give energy, relax, or be boring.

From Empowerment to Citizenship There is a connection between empowerment, participation, and recognition. As I wrote in an earlier chapter

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about relational aspects of music therapy, and as we will see later when I discuss community music therapy, being recognized as a musician is an important step toward a sense of being socially included. Especially among people stigmatized with a handicap or medical diagnosis, or those who are marginalized for economic, political, or other reasons, gaining citizenship through obtaining equal formal rights is a powerful way of empowerment. Music therapists should strive to give marginalized people a sense of providing valuable cultural input into society.

Disempowering Soundscapes Related to the issue of “soundscape” there are a number of themes possibly relevant to our state of presence and awareness in our immediate surroundings, not to mention how noise directly influences our mental and physical well-being, as documented by health authorities. A noise-polluted environment is adverse to children’s concentration and learning. Noise disturbs our sleeping patterns and provokes people into aggression, depression, and eventually, despair. Blood pressure may rise, and even death may result from living in a noisy environment. Music therapists should not forget how music, unwarranted sounds, and noise are part of a contemporary soundscape that in some cases leads to ill health. Inappropriate background music in public spaces, music that is out of context and felt to mismatch our musical identities, or sounds that carry information we don’t need or are unable to decode, threatens our agency and lead to bodily stress. Our modern soundscapes with noise coming from traffic, airplanes, machines, kitchen equipment, radios, and music we don’t like or is being played too loud, create a “lo-fi” sound environment, masking

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almost every distinct sound. From the perspective of music therapy, the topic of institutions and sound environment, seen from the perspective of “the captive audience” (Kittay 2008), is a great challenge. Music therapists should take the responsibility for the total sound environment of the wards or institutions they work in, not only the musical environment, but also the soundscape of the institution (Stedje 2009). Music therapy, as a discipline involved in the relationship between man and sound within a health perspective, should take an interest in designing soundscapes that provide for silence as well as for mindful presence in a hi-fi soundscape. This is a soundscape where musical landmarks as well as distinct sonic signals are audible signs that can be interpreted as meaningful information.

Silence — an Enabling Condition It seems to be an inherent paradox in the use of sound and music as self-caring technologies, that we have reached a point of saturation when it comes to sound pollution in our environment. The ecology of sound and silence, the need for quiescence faced with the overstimulating soundscape we move around in, has created a longing for silence and withdrawal to quiet places. Quiet rooms — quiet places such as on trains and in airports — give witness to a search for inwardness. Of course, silence is a relative term. As John Cage remarked, there is no such thing as absolute silence. We never can expect a total silence, rather we could define silence as the ability to perceive “the tiny sounds.” The quest for silence has become a metaphor for a life in search of the possibility of creativity and spirituality. Silence may have to do with a state of mind rather than

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the level of sound or noise. Silence has come to signify contemplation, a state when we can reach into ourselves. Silence affords the unforeseen, what is not programmed, Ursula Franklin writes. Silence is a state that enables us to relate to ourselves and the world in a certain way. Silence is an “enabling condition,” Franklin writes (Franklin 2000).

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Chapter 7

Health and Quality of Life Within many definitions of music therapy, achieving or promoting health has become a main objective. When we visit the literature on the concept of health, however, we may soon witness that there are many and different views upon the nature of health (Blaxter 2004). On the one hand, we find an objectivist position on health, where health is seen as a fact that can be subject to empirical investigation. On the other hand, we may take an stance where what is meant by health is subject to interpretation (see Duncan 2007). Within the objectivist tradition, health is sometimes regarded as a state with absence of any disease, in other words, a kind of vacuum. However, there are variants of what we call such biomedical theories of health. Some will emphasize how health is something we have when all parts of the body function normally — biologically or statistically. Such theories may rely on a basic thought that the body is a kind of mechanical system and that lifeconditioning functions are to be understood as a kind of machinery. This is called a mechanistic understanding (Medin & Alexanderson 2000). Health researchers as well as most people, however, conceive of health to be more than a kind of medical state

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of normality. Social medicine as well as emerging health psychology also give a more empirical exposure of how most of us experience how health has more to do with a sense of balance and harmony in life that gives us the energy we need to perform whatever we like to do with a sense of enjoyment. When people are asked, health is often regarded pragmatically, as a relative phenomenon and seen in relation to what people expect in the context of age, burden of illness, and social situation. Health is regarded as an individual and personal phenomenon, and the road to health is seen differently from person to person. If we ask people about what they think is good health, they might answer that health is well-being, function, nature, good spirit, mastery, and surplus of energy (Fugelli 1998). Blaxter (2004) also refers to research that shows how people’s views of health are also dependent upon their profession and social class. Health can be seen as a state, an experience, a resource, and a process (Medin & Alexandersson 2000). When health is seen as a state, we know this from a discourse where health and disease are regarded as opposite poles within a continuum, and when our state of health varies according to where we find ourselves in the continuum. Health is then something we have, we are either well or ill, and these two states do not exist simultaneously. If we look at the concept of health from an interpretative perspective, health is seen more as an experience, which means that health is to experience well-being and meaning in life. Within our perspective we conceive of health as a resource and a means to achieve goals we have set in our lives. Such a goal may be to achieve well-being. Health is then a resource in the same way as education,

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work, and housing. Health becomes a reserve of energy, a force we can rely upon to resist illness or restore ourselves faster. Such a concept of health does not allow health to be regarded as a fixed state, but something in change, something that can be influenced. Health is something created through a process. Health is developed in the relationship between the individual, action, and environment (Medin & Alexandersson, ibid., p. 70). As we saw in the fist chapter, our humanistic conception of human nature regards the individual as active, with possibilities to determine its own life, lifestyle, and health habits to adapt to the demands of life. As we know, music therapy taken as a broad field may respond to or serve different positions within the health discourse. We may make use of music to change behavior or sometimes alleviate or cure ill health. We may use music to regulate mood and emotions or maintain a preferred state. We turn to music to work through pain and sorrow. In all these cases different conceptions of health may be operating. Musicking may be curative, palliative, preventative, or health promoting. All these different views upon the concept of health tell us that health makes us reflect upon the quality of our physical, emotional, and social life. Instead of looking for an objective definition of health, we see how health can be seen as a category of experience, which reveals some of our unspoken suppositions about human and social realities. When we speak about health we give expression to our culture’s view of what is meant by well-being and life quality. Health is in this sense a keyword, a productive or generating concept, and a value that is added to other values important to us.

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Performance of Health, Identity, and Lifestyle As we saw in the chapter on music and identity, musical identities have become an important part of our autobiographies, as significant markers of who we are and where we belong in the social landscape. As David Aldridge observes (2004) our health in the same way has become a part of our identity. Health is no longer connected to being sick, but “individuals are choosing to become healthy and, in some cases, declare themselves as pursuing the activity of being well,” Aldridge writes (ibid., p. 37), and continues: This change, from attributing the status “being sick” to engaging in the activity of “becoming well,” is a reflection of a modern trend whereby individuals are taking the definition of themselves into their own hands rather than relying on an identity being imposed by another. Being recognized as a “healthy person” is, for some, an important feature of a modern identity. While personal active involvement has always been present in health care maintenance and prevention, in that people have strategies of distress management . . . a new development appears to be that being a “healthy,” “creative,” “musical,” or “spiritual” person is considered to be significant in the composition of an individual’s “lifestyle.” Rather than strategies of personal health management in response to sickness, we see an assemblage of activities designed to promote health and prevent sickness. These activities are incorporated under the rubric of “lifesyle” and sometimes refer to the

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pursuit of “emotional well-being” . . . Furthermore, such a lifestyle is intimately bound up with how a person chooses to define him or herself. In this way, becoming healthy is a creative performance (Aldridge 1996, p. 20), sometimes also an aesthetic practice where lifestyle and self-construction are linked to personal values and cultural norms. In this way, health in our modern society also becomes a commodity, something that is offered and bought in order to serve as social representation of our values, aesthetic preferences, existential principles, etc. In this context, we have seen already how music is marketed through slogans as “the Mozart effect,” or how selections from the classical Western musical canon are promoted as music for relaxation, sleep, concentration, and so on. At the same time people keep listening to music (of their own choice) for its pleasurable effects, also aware of its possible health-regulating side effects. We have also seen how music sometimes is taken into a moral discourse, where a specific genre is connected to an ethical value, claiming how certain “low” forms of music or art have dubious moral value. This kind of cultural struggle can be seen in the light of an effort to uphold “high art” as a “pure” pursuit in the service of art for arts sake, and thus let art serve as a social marker, as French sociologist Pierre Bourdieu has shown us. We will certainly have to face this discussion when music is placed within a health discourse. The challenge for the field of music therapy will be to keep alive a critical reflection on the commodity nature of much music offered as health promotion and support people’s own musical expertise and choice, as opposed to pharmacological models imposed on music consumers . We have to

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counterbalance the claim for an aesthetic ideology of music for the sake of music with people’s inclination to tap all possible affordances of music, aesthetic as well as self-regulative. As we will discuss in the last chapter, it might be possible to pursue several discourses on music and health at the same time; music listened to for pleasure might sometimes also be applied as a way to care for ourselves in stressful situations.

Health, the Eudaimonic Approach and the Good Life As we saw in the previous chapter, positive psychology could be seen in the Aristotelian tradition, where the concept of “eudaimonia” as “the state of being well and doing well is being well” (cf. Jørgensen & Nafstad 2005, p. 890). This was linked to the idea of optimal functioning and associated with the concept of the good life, well-being, or happiness. For Aristotle, what constitutes this good life is said to be a complete human life lived at its best, a life where we can exercise our virtues. Positive psychologists differ, however, between hedonic and eudamonic approaches when it comes to understanding what is meant by a good life. Seligman, for instance, has put forward how a good life cannot be seen as a permanent state, but is a continuous development and growth when the individual is using his or her signature strengths to obtain gratification. He then proposes four forms of a good life — a pleasant life, a good life, a meaningful life, and a full life. A pleasant life is “a life that successfully pursues the positive emotions about the present, past, and future” (Seligman 2002, p. 262). We have no difficulties in seeing how music might be a valuable tool in pursuing such goals in life. Music gives immediate pleasure; enjoyment in

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music is a highly valued form of aesthetic activitiy. The triggering of nostalgic emotions, the memory-stimulating function of music puts it at the center of attention when we perform a memory work upon our autobiography. A good life means using our signature strength to obtain gratification. As I will argue later, art and especially musical abilities give us rich possibilities to explore and develop our skills toward perfection. Musical skills, both as general and universal communicative abilities will be part of most peoples “signature strengths” and deserve and need to be exercised. As highly developed skills among those with special talents or motivations, they may provide an opportunity to richer forms of a good life. A meaningful life, as Seligman describes, means an affiliation to something larger than yourself, as defined by the individual herself. The full life for Seligman means to build on all three previous forms of the good life and he defines it as follows: “A full life consists in experiencing positive emotions about the past and future, savoring positive feelings from pleasures, deriving abundant gratifications from your signature strengths, and using these strengths in the service of something larger to obtain meaning” (ibid., p. 263). We should bear in mind, however, how such a conception of a good life, as well as the whole notion of optimal functioning, is a culture-bounded concept tied to Western values, i.e., the modernism’s ideal of a constantly greater progression toward more ordered, complex, articulated, and consistent developmental systems, as Jørgens and Nafstad remind us (op. cit., p. 891).

Health as Participation — The Missing Link When we are discussing the nature of health we should not forget how certain conditions of illness will help us to

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identify and concentrate on important areas of health musicking. As I discussed in the first chapter, we have seen a diffusion of role identities within the field of music therapy. New areas of practice are opening, and new groups of professionals are entering the territories of musical health work. In an article on the subject of health musicking as cultural inclusion, Kari Batt-Rawden, Susan Trythall, and Tia DeNora (2007) remind us how illness is disruptive not only when it hinders us to complete ordinary routines: . . . illness is often estranging: it partitions friends and loved ones and sequesters the sick from their everyday life worlds and social networks. This sequestering is spatial but it is also temporal; it divides the “sick” individual from the ongoing social times and thus from the opportunity of sharing and shaping those times in the flux of here-and-now. Illness imperils our ability to make, communicate and share meaning, pleasure, and emotion. To speak of this matter points in turn to critical questions about cultural participation and the way in which illness acts as a barrier to continued participation. Participating in culture — whether through consumption or production is, we believe, the means through which we connect with others, the way we tell each other that we are not alone but together. As Brynjulf Stige (2006b) has written, the role of participation plays an important part when it comes to meeting the needs of people who have become marginalized because of illness and handicap. To Stige, the concept of

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participation implies a lot more than an individual activity of “being there” or “joining” in. Stige defines participation as follows: Participation is a process of communal experience and mutual recognition, where individuals collaborate in a socially and culturally organized structure (a community), create goods indigenous to this structure, develop relationships to the activities, artefacts, agents, arenas, and agendas involved, and negotiate on values they may reproduce and transform the community (p. 134). In this definition, we find many of the values and concepts celebrated throughout this text, for instance, “collaboration,” “recognition,” and “relationships.” In the complex discussion about the value of cultural activities for the promotion of health, “participation” may be the missing link between culture and health when it comes to understanding the value of music as health promoter.

Musicking for Life Quality From a constructivist or interpretative view on health we may equate health with quality of life, which is also a rather unclearly defined concept within the field of medicine and health psychology. (For a discussion, see Ogden, 2000, chapter 14). As I have argued elsewhere (Ruud, 1998, chapter 4; Ruud, 2001), our perception of quality of life has many subjective dimensions and is open to values projected from various professions. Traditionally, life quality has been discoursed within the social sciences, the medical or health-related professions, and within the field of psychology. The ethical orientation of each profession is

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based on different sets of fundamental values, and it is these values that are stressed when confronted with issues concerning life qualities. Medical doctors value and protect the body and life, social workers are concerned about democratic distribution of welfare goods, and psychologists are fundamentally concerned about human rights and dignity. Within these traditions, different sets of criteria have been developed to measure and evaluate standards of life quality. For instance, psychologists would focus on subjective factors, as measured through the individual’s conscious positive or negative cognitive or emotional experiences. What seems important to the field of music therapy is to develop a new tradition for evaluating life quality as related to the field of art, music, or cultural activities. Such a tradition should be concerned both about the more objective economic and organizational frames of such activities, as well as the subjective experiences stemming from participation in cultural life. Within the context of music therapy, life quality could for instance be related to the state of our emotional life, self-efficacy skills, our social relations as well as our experience of meaning in life (Ruud 1998, 2001, 2006). This has to do with musicking as: • A provider of vitality, i.e., emotional stimulation, regulation, and expression. • A tool for developing agency and empowerment. • A resource or social capital in building social networks. • A way of providing meaning and coherence in life. To the extent that musicking is taking care of some of these needs, we may argue that musicking is providing a better quality of life, that is, better health. However, when

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we are aligning health with life quality, we have left off important physical aspects of health, which may be seen as narrowing the concept of health too much.

Health is Relational Instead of making health an individual phenomenon, we could postulate how health is always relational. Being in a state of health means having a good relation to yourself, to others, and to important existential values. Swedish scholar Ola Sigurdson (2008) discusses the concept of health within our Christian tradition, where spiritual healing always has been added to physical health in order to restore the whole person. This spiritual healing does not only mean restoring our relationship to God or a higher value, but also to our fellow human beings and to ourselves. In this theological and cultural tradition, we are relational beings, which means that being healthy is not only a physical state, but involves our relationship with existential values.

Vitality and Self-expression Having a good relationship with oneself might imply our sense of our body and our feelings, i.e., our self-value. Music may be used as a technology of the self, as Tia DeNora observes. There are now many reports about how everyday uses of music are means to regulate emotions (DeNora 2001), serve existential needs (Ruud 1997), or provide for health (Ruud 2002, 2005a). This points to the need to conceptualize music in a new way, or within a broader psychological theory about how continuity and stability are maintained in life through our engagement with music. It is clearly, as Stålhammar points out, how

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music may be seen as a “depot of experience,” which we can draw upon when life gets tough, or when there is a need for self-preservation (Stålhammar 1995). We may also see how, within the so-called object-relation theory in psychoanalysis, the art object is conceived as a “transitional object” people may turn to in times of crisis, in order to maintain strength, and to explore new personal territories (Butterton 2004). In the last chapter I will suggest how music may be connected with self psychology, defining music as a “selfobject.”

Competency and Empowerment through Mindful Practice Another aspect of our relationship to ourselves concerns not our self-value, but our self-confidence, or self-efficacy. There is a focus in music therapy on adapting instruments and musical challenges in order to promote the feeling of success and mastery in musical performance. The aesthetic quality and standard of composition and instrumentation will secure how even the disabled child will experience a sense of fulfillment and mastery. If we add the process character and improvisational mode of music therapy approaches, music therapists take care of the sense of self-expectation, or feeling of self-efficacy toward musical mastery. We also saw in chapter three, about the development and function of music identity, how music from early on, and not least through playing in bands throughout adolescence, could provide opportunities for empowerment. If we want to discuss the role of musical skills, performance, and mastery within a discipline approach, music therapy also must consider musical achievements among amateurs or professional musicians, to ask if mu-

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sical mastery can provide health in a more general sense. This is an area that seems to belong to the field of music education. On the other hand, there sometimes seems to be little effort among music educators to consider musicking as a health performing practice, especially among those who are infused with an ideology of music as a noninstrumental activity, i.e., those who regard music as an autonomous object. As we know, the hard way of becoming a proficient performer may be contrary to what we regard as healthy. The rigorous self-discipline, and not least its asocial aspect, in which it is necessary to spend so many hours in solitude with the instrument, as well as the highly tense situation of performance, sometimes may spoil the career and life quality of a performer. Add to this the many physical problems that may haunt a performer due to bodily tensions and weird bodily postures. However, we know how learning to play an instrument also gives opportunities for exercising positive characters and virtues and how it affords an important area for many people’s self-realization. In fact, musical institutions, like conservatories and musical academies, are some of the few places within the industrialized society that can provide for concentration and careful preoccupation with details, with repetition, and with search for perfection. As many traditional craftspeople and artisans have disappeared from society, it seems to be left to artists to explore detail and perfection. The idea of “practice” seems to be threatened by ideas of process and creativity, which is sometimes misunderstood to be independent of knowledge, skills, and practice (Ruud 1983). German existential philosopher Otto Friedrich Bollnow has in his book about “the spirit of practice” (Vom Geist des Üben) compared the musician’s repeated work with details with

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the Zen attitude of a mindful relation to the world. In repeated practice you not only work toward perfection and realization of musical ideas, you also take part in the realization of your own potential, to go into a state, a relationship with the world and the music that is a powerful way to exercise your virtues. Clearly, the connection to eudomonian ideals is present in such a philosophy. This links to positive psychology’s ideas about the value of enjoyment over pleasure. While most people seek pleasure from music, that is, the good feeling that comes from satisfying homeostatic needs such as bodily comfort, enjoyment refers to the feeling people experience when they break through the limits of homeostatis — “when they do something that stretches them beyond what they where — in an athletic event, an artistic performance, a good deed, a stimulating conversation. Enjoyment, rather than pleasure, is what leads to personal growth and long-term happiness . . .” (Seligman & Csikszentmihalyi 2000, p. 12).

Music as Social Capital Our relationship with other people will always be an important source in defining our state of health. One of the single most important factors contributing to health has to do with our social capital, i.e., how well we are integrated into the community — our social connectedness. According to Putnam, many studies have established beyond reasonable doubt how social connectedness is one of the most powerful determinants to our well-being (Putnam, 2000, p. 326). It is important to see the discussion about health in a larger perspective than illness and hospitals. Social medicine has long since tried to show how we have to take

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into consideration important health conditions when this is debated. This means work, education, housing, nutrition, environment, self-respect, power, and belonging. In this debate we find how differences in health are conditioned by economic and societal factors. Differences in states of health are not only a matter of poverty, but must be seen in light of structural conditions in society and related to degree of social cohesion and integration. We have knowledge about how some of the greatest health problems in Western societies have to do with social isolation and living without a social network, which naturally arises from neighbors, work, and cultural activities. When people get ill or unemployed, they often loose their social bonds, which makes it even more difficult to regain their health. People are driven into a “space between,” a critical phase of life between illness and ordinary life, between work and employment, between having mental problems and the sense of belonging and living in good relation to others. In fact, this is seen as the most important factor that contributes to a loss of well-being. Putnam has shown how a society where there is a decrease in community creating activities, in a short time will have poorer statistics of health. Our abilities to create relationships and to support each other will prevent social isolation, which is seen as the worst enemy to health (Putnam 2000). Social science can present empirical data that show how participation and social integration is health promoting. The sociologist Emile Durkheim, more than a hundred years ago, demonstrated a connection between the prevalence of suicide and social integration. Later investigations confirm this general connection between health and social contact.

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What we call social capital will originate in the network of local communities from the work of volunteering organizations, places that give possibilities for interaction and social support. Through the development of social networks, coherence and integration is created within a society. When Robert Putman writes about social capital, he refers to what holds a society together, about mutuality and social networks. Individuals without a social network have two to five times the likelihood of dying from all kinds of causes compared to individuals who live within tight bonds to family, friends, and local community. Social capital, then, has to do with belonging and connectedness, about mutuality and trust between individuals, neighborhoods, common activities in the local community, influence and participation in local democracy, and not least the feeling of being included. We can see how many of these factors are clearly present when we deal with participation in cultural life. Music groups are meeting places where people are bonding. Although music groups may vary with regard to how inclusive they are, they will afford both tight communality as well as possibilities for looser bridging and openings for social contact.

Meaning and Coherence in Life In his research on salutogenic factors influencing our health, Antonovsky outlined how the sense of coherence in life made a crucial difference (Antonovsky 1987). One aspect of this was how meaningful life was felt; other factors had to do with predictability and our ability to handle our life. As we saw in the chapter on music and

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identity, when psychologist Erik Erikson described what he thought of as the last psychosocial stage in his epigenetic scheme, he emphasized the integration of ego as the main developmental task (Erikson 1968). Order and meaning became essential, acceptance of how life had to become what it had been. This identity work seemed to include the reconciliation of oneself with the many choices in life, the ability to distance oneself and reflect about one’s own life. From the interviews on musical experiences by British psychotherapist and musician Mary Butterton (2004), we can also see how many of her older informants use music as a metaphor when important themes in life are sorted out. We also learn how music has helped to create a true “home” for some, it has helped to bind feelings and thoughts together with values, it has created a sense of belonging, a way to connect with the larger world. In the retrospective master narrative, which is to become the core identity of the person, music may serve an integrating function pointing to the important themes and events in life, a sense of coherence. From music therapy, we know how this role of music may become a tool in the necessary reminiscence work people have to uphold in order to maintain their identity, especially if dementia is progressing. We saw earlier how there was a danger in a medical practice that separated biology and culture as we have seen in our times of modernity. People have come to equate physical health with the meaning of life, and thus existential health has been mistaken for a healthy body. Accordingly, medical science has in many ways taken the role of theology. As we know from studies of strong musical experiences (Gabrielsson 2008) as well from the literature on

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BMGIM, transpersonal or transcendental experiences are common in our musical culture. To the extent that musicking is taking care of some of these needs, we may argue that musicking is providing a better quality of life, that is, better health. How different people approach these areas of life quality, however, is highly individual.

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Chapter 8

Systemic Aspects As we saw in the first chapter about humanism, we could already see in Greek antiquity a critical tendency when the individual sometimes had to be protected against forces in society that could hinder him in reaching his potential. Such a critical humanism is developed within a philosophy that takes care of and develops liberating interests, which we can find within critical theory or philosophy. This agenda is a reminder of how we will always be dependent on what is happening at a macro level in society. The values we share, our belief systems, and how we communicate through language are all part of the ideologies or the ideas and thoughts we hold. Although, as we saw in the last chapter, health is related to subjective experiences and the realization of personal virtues, we always have to include how societal forces and structures will influence our potentials and goals.

A Critical Tradition Brynjulf Stige makes a distinction between three currents in contemporary music therapy. First, we find the technical instrumental-functional music therapy, as we may meet in parts of medical music therapy. Next, the

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hermeneutic or dialogical music therapy we will find within the relational or analytical music therapy. The third current is the critical, which is developed within socalled community music therapy (Stige 2008b). Before we discuss this emerging community music therapy, we should outline some of the major concepts of a music therapy based upon the humanities, which also involves systemic aspects. When music therapy was reinvented as a modern profession in the middle of last century, it became affiliated with established institutions and ideologies. Music therapy was incorporated into university programs, and research was initiated within a natural science paradigm. Music therapy was constructed as a treatment profession where the individual relationship between a client and a therapist was most important. Therapy was performed within medical or special educational frames and music became a means to establish and regulate the basic therapeutic relationship. For many years, music therapy seemed less preoccupied with larger social forces or cultural contexts. Music therapists insisted upon the boundaries between their discipline and others such as music education, community musical practices, or alternative healing medicines. Thus, music therapy was performed inside the institution, in the music therapy room. There were few links to the world outside; sometimes even other children, parents, and siblings were not involved in the therapy. The biomedical model of illness disallowed a challenge to how social and material conditions, social networks, or cultural contexts could be taken into consideration when therapeutic measures were taken. Systemic thinking was still not developed within music therapy.

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Context It is a major concern for music therapy to be context sensitive. This means that as music therapists we do not go about applying only one method, one theory, or one kind of music in every music therapy situation, regardless of age, level of functioning, culture, or institution. We might, however, outside of the field of music therapy, find examples of the use of music or a music therapy that is not especially sensitive to contextual factors. One example would be if the same music were played to a group of people expecting to have the same reaction. As we saw in the chapter on the concept of music in music therapy, a contextual view of music claims that musical meaning is a result of a transaction between a listener and the music in a certain situation. In this relation, musical meaning will change according to the listening history of the listener, her strategies of listening, and so on. This kind of context sensitivity is overcome in the situation where improvisational music is used and adapted to the cultural needs of the client.

Culture There have been lay theories about universalism in music therapy; the romantic version often presented is how music is a universal language that reaches into the innermost mind of people. If you add this to a notion of musical archetypes, you may end up with a dogmatic approach to musical communication about how certain musical formulas may serve as building blocks in making contact. There seems to be more sense in departing from in the musical culture, the musical codes we acquired during our musical development or socialization. These codes may

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be global, in the sense that we are all exposed to an international entertainment industry through movies, television, and computer games. And the codes will certainly be local as they are colored by national and regional culture as well as idiosyncratic ways of interacting with music in the family and upbringing. When we meet with a new client, we need to make a musical assessment to map the personal soundscape, or rather soundtrack, behind musical identity. This means coming to know children’s tunes, television music, rock groups, favorite music from earlier times in life, and so on. Culture in this sense means a sort of knowledge, a way of organizing sounds into meaningful musical structures. Such codes also include the organization of musical references, the many layers of musical meaning we only can come to know through what anthropologists call “thick description.” Culture will be an aspect of all understanding of human action. Music therapists will, for instance, always operate within a certain treatment culture, or an institutional culture with its unspoken assumption about how to do therapy. Within the current multicultural situation, music therapists also face demands, not only to deal with sometimes exotic musical cultures, but also cosmologies, values, and conceptions of illness and treatment that challenge prevailing treatment ideologies (see also Stige 2002).

The Concept of Illness and the Definition of Music Therapy A systemic approach to music therapy, which takes both culture and context into consideration, will clearly demonstrate how it is problematic to export music therapy from one culture to another. A successful introduction

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of music therapy will depend upon theories of treatment, economy, and material resources; local backup and understanding will determine the outcome of music therapy. One element is the definition of illness, which often is handled as a biological phenomenon and thus does not see how material conditions surrounding the client will influence his or her life. This has to do with poverty or with how society does not adapt architecture and communication to secure full participation in society. Illness can thus be defined as a condition that is caused both by biological and societal factors, and therapy thus has to aim at changing the material and structural conditions that keep the individual away from full participation in society. Music therapy — as a description of professional activity — could be defined as “the use of music to give new possibilities of action” (Ruud 1979, 2007b). This is particularly important when it comes to participation in cultural life. With the sharpened focus on culture and health, we need to remember that those who will be in most need of participation in cultural activities are those falling in the “space between” and thus threatened to be isolated.

Ecological and Environmental Music Therapy An important aspect of music therapy is looking at the work in a larger perspective. This means looking beyond the classroom or therapy room to see how we can make a bridge from the client to the larger society, to the family and friends of the client, to neighborhood and local culture. A systemic approach presupposes how many aspects of therapy are interwoven. This also means that processes of change can be initiated and maintained outside of traditional therapeutic arenas.

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We have had several suggestions about how music therapy can be viewed within a larger context. Norwegian music therapist Trygve Aasgaard labeled his work “environmental music therapy” (Aasgaard 2002). He saw the need to work with the whole institution, to change some of the local contexts (see later in this chapter). In his book Defining Music Therapy, Kenneth Bruscia labeled this systemic approach “ecological practice” (Bruscia 1998). Bruscia writes that the primary focus here is on “promoting health within and between various layers of the sociocultural community and/or physical environment” (Bruscia 1998, p. 229). Bruscia underscores how so-called systems theory is an influential philosophy in this area of practice. In the twentieth century, as a result of influences from information and communication theory, it was gradually realized how phenomena in the world, or in a field of study, are interrelated. What has emerged under the label of systems theory is an approach within science that is concerned with how we are interacting with the world. Systems theory suggests an alternative to the traditional cause and effect model within science, i.e., a circular model of understanding how phenomena are interacting. Systems theory was influenced by cybernetics, which is concerned with the regulation and control (feedback) of movements within different types of systems. Influential scientists were Norbert Wiener and Ludwig von Bertalanffy (see Kenny 1989).

Performance-based Music Therapy Within many traditions of music therapy there is a somewhat ambivalent attitude toward the use of performance in a more or less public situation. Music therapy is often

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centered on the process, not the product; the client is protected from public exposure, and the therapeutic process is considered private. This model of therapy may sometimes be counterproductive when it is used to present the musical work of therapy, not only to challenge oneself but also to present to other staff, family members, and larger community another picture of one’s capacities. Performance thus can be seen as a part of what Gary Ansdell calls an “individual-community continuum” (Ansdell 2006).

Toward a Community Music Therapy At present, a new discourse labeled “community music therapy” is gradually evolving in the field of music therapy. Community music therapy is a way of doing and thinking about music therapy where the larger cultural, institutional, and social context is taken into consideration. The approach involves an awareness of the systems music therapists are working within. It means that music therapy is not only directed toward the individual, but often aimed at changing the systems that are part of the situation of the client. Music therapists have come to realize that ill health and handicaps have to be seen within a totality, as part of social systems and embedded in material processes. People become ill, sometimes not because of physical processes, but because they become disempowered by ignorance and lack of social understanding. Music therapists have come to see how their tool — music — may be a unique tool to involve other persons, to empower and make visible persons who because of their ill-health and handicap have lost access to symbols and expressive means so important in every culture. Music therapists are

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now on the way to use music to bridge the gap between individuals and communities, to create a space for common musicking and sharing of artistic and human values. Some music therapists may then look for what is new in this development, and perhaps only see the links to traditional practice of music therapy. Others may notice how this community-oriented approach is changing not only the goals, vocabulary, or language of doing music therapy, but also the actual practice. An approach to the use of music in therapy, which is sensitive to cultures and contexts, speaks more of acts of solidarity and social change. It tells stories of music as building identities, as a means to empower and install agency. A community music therapy talks about how to humanize communities and institutions; it is concerned with health promotion and mutual caring. Music therapists are increasingly more often working with whole communities. They do not only work with individual problems, but also focus on systemic interventions, how music can build networks, provide symbolic means for underprivileged individuals, or use music to empower subordinated groups. Music has again become a social resource, a way to heal and strengthen communities as well as individuals. In other words, this new discourse enables a new way of reading and understanding music therapy (Pavlicevic & Ansdell 2004; Ruud, 2004a; Stige 2004). To do music therapy within the paradigm of community music therapy means a responsibility toward the relationship between client and society, a particular sensibility toward this borderland, where many of our clients find themselves. This may involve a new language for music therapy where words like “action,” “participation,” “recognition,” “network,” “empower,” “marginalized,” “solidarity,” “resources,” “identity,” “health,”

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and so on are substituted for words like “motor development,” “attention,” “behavior,” “conflict,” “handicap,” and “illness,” etc. (Ruud 2004a). Or put in other words, in a perspective of discourse theory, we could understand community music therapy as a discursive field, a theoretical space where one discusses the significance of looking at music therapy in a larger societal perspective, applying an anthropological concept of music, expanding the arena of music therapy, finding new identities for the music therapist, and recognizing performance as a valid approach. To work with community music therapy will mean to practice, explain, and understand one’s own work by referring to discourses within this field (see also Ansdell 2004).

Definitions Although we have seen some earlier practice of community music therapy, for instance German music therapist Christoph Schwabe is an important European forerunner (Schwabe 2005), Norwegian music therapist Brynjulf Stige was the first to give this approach a comprehensive academic presentation (Stige 2003). Stige also defines community music therapy as a practice where its goals are related both to the individual and to society, where the participants govern the process, arenas are inclusive, and the use of music is ecological (see also Stige 2004, 2006a; Ruud 2004b). Some defining characteristics of this approach to music therapy have been its awareness of culture and context when music therapy procedures are chosen and put into action. Stige also emphasizes how community music therapy is ecological, music centered, and value driven (Stige 2004b). To me, an awareness of systemic or eco-

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logical aspects of therapy also seems to be the distinctive feature of community music therapy. Further, a variety of music therapy methods or approaches such as playing, singing, or improvisingare valid, but they need to be taken into a context of performance in order to be negotiated with the larger social context. This is because the essence of community music therapy lies in the use of music to negotiate the space between private and public, the client and the institution/other staff, or the client and the community. Therefore, I stress the emphasis on performance as an essential part of community music therapy. To give a brief definition: “Community music therapy is the reflexive use of performance-based music therapy within a systemic perspective.” (Ruud 2004b). The word reflexive is important. It covers both the awareness of culture/context as well as considering ethical aspects when therapists and clients are lining up for performance in the public, as Alan Turry has written about (Turry 2004). Concerning the concept of performance it must be understood in a broad sense, i.e., musicking in a public space within or outside of institutions. Researching the history of music therapy may reveal that this idea is not totally new. In many countries, there has been a tradition of therapists working within community mental health systems, especially from the 1970s on in the United States and many European countries. In Great Britain, there has also been a tradition among musicians to take their art back to the community and give performances as a sort of social service. This has been labeled “community music” (see Ansdell 2002). In Norway, conventional ways of performing music therapy, i.e., those based on the so-called consensus model taken from psychotherapy, have not been prevailing. Instead of the private, process character of (clinical music) therapy,

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music therapy in Norway has always been more concerned with special educational processes and their activities seen within a larger cultural or communal process. Stige traces some of the historical roots of music therapy, and as he remarks, it may happen that this idea of a more communal practice is not new at all (Stige 2003, p. 124). Examining the tradition of music therapy with a focus on musical healing in indigenous cultures will reveal that the whole community may often be involved in the musical rituals connected with healing (see Gouk 2000).

Four Examples In order to exemplify some of the recent trends within a community-oriented approach to music therapy, I will give four examples from Norway. First of all, it is to be noted that music therapy in Norway, since the start of the 1970s, was alwaysconcerned with larger cultural issues. This meant in the way concepts of health, illness, and therapy were conceived, as well as how music was understood as a cultural concept (Ruud 1990; Jensen and Jensen 1976). First of all, music therapy was defined as “the use of music to give people new possibilities for action.” It was thought that illness not only concerned the biological status of the individual, but also had to be seen as a condition where the person’s situatedness in society was considered. And it became important for music therapists in Norway to build their practices upon the prevailing musical codes in society. They felt that basic to music communication was the need to use music that resonated with the cultural group music therapists were involved with.

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This meant, for instance, that amateur music activity, rock bands, or children’s music often was the point of departure for common musicking.

Communal Musicking The first example, taken from Stige (2002, 2003), will illustrate how music therapists may involve the larger community in their planning for music therapy. In the 1980s, Stige and his colleagues initiated a music therapy project that aimed at integrating persons with learning disabilities into society. Stige noticed how individuals with such handicaps were segregated from communal music life. They were not included in local band activity and thus not able to share the symbolic resources inherent in musical life, which may give membership to the local community. In addition to providing these handicapped persons with the musical resources necessary to take part in communal musical activity, Stige also had to address the attitudes and practices prevailing in local music life. By setting up short-term performance projects, which involved all groups, he managed to break down some of the boundaries that kept the person isolated or segregated from mainstream local life. In this case, working through the idiom of local brass band music became of central importance. Here we can clearly see how systemic thinking and the performance-based approach operate together. Not only did the music therapy approach empowered the persons musically, but it also changed some of the attitudes and actual practices within the local community. This example, as well as the next, opens discussion about the borders between music therapy and music ed-

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ucation, as musical learning, both formal and informal, are focal concerns for this community music therapy practice.

Music Inside and Outside of Prison The second example involves music therapist Venja Ruud Nilsen, who for a number of years has been working with female inmates. Nilsen has offered weekly band rehearsals with the inmates. This has throughout the years led to a culture of rock bands within this group, which means that many of these ladies now have become quite proficient as musicians. Nilsen also offers participation in groups or rock bands after the women are released from prison. As we know from the politics of criminal care, these kinds of supportive activities are crucial to survival and staying away from drugs, as well as staying out of prisons for these individuals. Working both within the institution and out in the community, the music therapist creates a bridge between the prison and society. Not only can the therapist prepare the client for partaking in a musical group outside of the institution, she can also be there for the client when she is released. In this way, Venja Ruud Nilsen creates a safe place to be, provides friends, a social network, and a drug-free environment.

Music with Hospitalized Children The third example is taken from the work of Trygve Aasgaard (Aasgaard 2000, 2002, 2004), who in his doctoral research showed how music may be applied within the medical hospital among children with severe diseases to install a culture of creativity. Aasgaard gave music therapy in the form of song creation to children hospitalized

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with severe diseases such as cancer. He then studied how the life of these songs composed by a child and the therapist together, affected not only the life and situation of the child, but his whole relationship to the nursing staff, the child’s families, and friends at home. By arranging the songs for the staff’s choir and band, medical staff could interact with the children in another modality. Children did not stay in the role of being sick, but instead saw themselves as small composers, being able to express and communicate their situation through artistic means. In working directly with the institutional system, Aasgaard enforced new values and roles for the children as well as for the staff. In this way he changed the ward environment through engaging the whole staff in common musicking with the children.

Music Therapy in Rehabilitation The last example is taken from a work by the music therapist Tom Næss, who worked with an elderly woman diagnosed with a psychiatric disorder, who had been hospitalized for almost thirty years, and was finally given the opportunity to start living a life outside of the institution (see Næss and Ruud 2007) Næss, originally trained in the Nordoff-Robbins tradition of clinical improvisation brought this method into new domains and managed to form a practice that established a link between the individualized improvisations and the everyday life of the woman. I will elaborate on this example in more detail, trying to show how some of the traditional individualized methods of music therapy, for instance clinical improvisation, may be combined with new theoretical perspectives. Clinical improvisation, or Creative Music Therapy

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(CMT) has come a long way since its original conception in the 1960s by Paul Nordoff and Clive Robbins, both in terms of expanded musical and instrumental resources, new areas of practice including adult mental health, and new theoretical perspectives. Originally, a piano-drumcymbal improvisational-based approach directed toward children with special needs, the approach has today widened its musical resources as well as extended its areas of practice to include adult clients with mental health problems. More instruments are taken into the music therapy session, and musically, creative music therapists not only utilize the slightly modern, neoclassical style of Paul Nordoff, but also seem to thrive in contemporary jazz-pop-rock styles well adapted to the cultural background of the clients. Theoretically, CMT now draws from a whole range of discourses, from those inspired by recent approaches within relational psychotherapy, to performance theory, and resource-oriented thinking as well as from the field of community music therapy. A multidimensional perspective upon the improvisational approach also seems to fit well with the recent development within community mental health thinking about psychiatric rehabilitation. These multidimensional approaches within this field now require several theoretical perspectives, ranging from empowerment theory to social-cognitive approaches. In his work with an elderly woman, Tom Næss used a variety of approaches. Listening to live music, improvisation, and teaching keyboard skills were the basic music therapeutic approaches chosen over a period of nearly three years with almost weekly sessions. Within this improvisational approach, four theoretical perspectives were taken into considerationto explain the changes that occurred in behavior: relational music therapy, resource-

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oriented music therapy, performance-oriented music therapy, and community music therapy. Through the music therapy sessions, the woman gradually became more secure and took her own initiatives. She asked for new songs, tried to improvise, asked for lessons in piano, and took pleasure and interest in learning. As has been argued in the evolving resource-oriented music therapy, and as I have been arguing in an earlier chapter, it is of supreme concern to take care of client’s strengths and resources, in other words to broaden and build upon the positive initiatives coming from the client. Within this perspective, as we saw, some of the essential and acceptable principles are also to recognize the client’s competence, to engage the client in musical interplay, to acknowledge musical skills and potential, to listen and interact empathically, to tune into the client’s musical expression, and to teach instruments (ibid.). Looking at the woman from this perspective, her resources became evident in her listening abilities and interest in new songs, her attempts at improvisation, her ability to master the keyboard, willingness to learn to play new songs, and not least her musical and verbal initiatives, all in all a lot of resources to be used in building up a new self-image and competencies related to mastery of social skills. In this sense, as her “musical capital” increased throughout her music therapy, music became a resource that could be transformed and valued at a social arena outside the music therapy room and thus enable and empower her (cf. Procter 2002). An important aspect of this is how the woman decided to end the music therapy and instead go back to an “ordinary school.” By recognizing this need to make her own decisions and corroborate with her, the music therapist also contributed to an important principle related to a resource-oriented music therapy.

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As the woman developed her musical skills, she was also able to perform. Being able to perform music enables one to prove to others new roles, skills, or behavior, which are quite distinct from the “sick” role. As Ansdell (2005) suggests, “giving a performance” can have positive, healthy connotations that relate to a fundamental and natural mode of musicking, and to a fundamental psychological and social reality — that “performing” ourselves in the world is natural and necessary” (ibid.). The woman, however, did not want to perform music for other patients or staff. She would only play together with the music therapy students and eventually also perform for her family. The music therapist, however, was permitted to make digital video recordings of most of the sessions. These recordings became instrumental in keeping her within the educational program, and thus demonstrate how this technology can be seen in the perspective of a performance-based approach. The woman’s initial lack of attention and motivation for educational work made the staff seriously consider withdrawing her from the school. This process was ended when the music therapist managed to show a video from one of the session to the head of the staff. This video made such an impact upon the decision makers that the client was allowed to continue the following school year and continue her music sessions. One of the most important contributions from the evolving discourse on community music therapy has been the increasing understanding of how music therapy may come to bridge the gap between much individualized music therapy practice and the need for the client of social participation (see Ansdell 2006). As we can see from this case, music therapy was helpful, not only in estab-

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lishing interactive rituals necessary to proceed with learning experiences, but music became as well a social resource she could draw upon in her private life at the sheltered home. The following story should illustrate some of her progress: One day, when she was taken to the record store to buy some music, she bought some conventional CDs. Suddenly, on her way out of the store, she turned around and asked to buy a CD with The Rolling Stones. This CD became a topic of conversation between the woman and other clients in the halfway house. She had in fact, through this musical initiative, acquired a form of social capital that could be integrated into new social relations. In this abbreviated case study (see Næss & Ruud 2007 for the whole case) I have tried to use systemic thinking to demonstrate how music therapy could help an elderly woman diagnosed with paranoid schizophrenia to find her way back to a more meaningful life, to reestablish her relations with her family, and to take up a new interest in playing on her synthesizer. Through her music therapy sessions she became much more focused, she made her own decisions, and clearly set some new goals for herself in life. At the same time, we demonstrated how the method originally conceptualized as “clinical improvisation” by Paul Nordoff and Clive Robbins in the 1960s, has come to include not only new areas of practice, but expanded its musical and technological resources to include popular musical forms and audio and visual digital recording technologies that may be edited and transformed into performance-oriented objects. At the same time, our theoretical understanding of what takes place through the improvisations has come to include theories from relational psychotherapy, resource-oriented, and performance-based music therapy, as well as musi-

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cological research on musical gestures. Lastly, the individually oriented work of music therapy improvisation has been placed within a group context, and has been influenced by theories from community music therapy where the music therapist, in close collaboration with institutions and other professionals, cooperate to make possible the reintegration of the client into society (cf. Stige 2003). In all these examples we may witness how the music therapists are not only approaching the individual in isolation, but look for how the larger societal or institutional context may be involved in their work. They all utilized musical forms well established and known within the culture of the persons they were working with. Their work also involves other persons in the system of the clients — doctors, nurses, neighbors, parents, or friends. Their clients are not only the individuals involved, but extend to larger units, such as local communities or hospital wards. Community music therapy does not stop at the music room, but concrete measures are taken to build links to other persons in the systems where the clients participate.

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Chapter 9

Reflexivity and the Philosophy of Science Contemporary research in music therapy is based upon attitudes, principles, and approaches prevailing in the humanities as well as in the natural sciences. The nature of such scientific practice is a result of a long historical development shared among scientific disciplines. This history reflects a changing landscape in relation to basic philosophical questions, and some of these questions have particular relevance concerning research. Contemporary approaches to music therapy are informed by various philosophies of science, as is demonstrated in the different quantitative and qualitative approaches to research. The music therapist, as both health worker and musician, will have to accept the multidimensionality of the field. Music therapy will have to recognize both quantitative and qualitative research (see for instance Daly et al. 2007). Evidence-based treatment should recognize not only empirical quantitative research, but also recognize modes of understanding and results obtained through the qualitative investigation of the life world of individuals about connections between health and musicking. Below, I will outline some of the most important underlying

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philosophies as they make up the foundations of our scientific activity.

Reflexivity What we can learn from the study of the theory of science is to be more critical, aware, and reflexive concerning our own theorizing and understanding of our work. We may also learn to appreciate the many possibilities for doing research or to learn from the many perspectives and interpretative possibilities given us. One could also claim that the many perspectives reflect our conditions as individuals, as a guarantee for not being locked into a one-dimensional existence. Such reflexivity is a major characteristic of a music therapy informed by the humanities. Reflexivity is based upon four strategies (see Alvesson & Sköldberg 2000). First of all, empirical detail and closeness is essential to good research. Whether music therapy research uses positivist or phenomenological methods, analysis and interpretations of practice, effect studies and theory building will depend upon solid data gathered through controlled and systematic routines. Data will secure the basis for replication or make it possible to trace back to the origin of the interpretation, thus making it possible to follow the argumentation. Secondly, reflexivity is also dependant upon an understanding of the role of interpretation, both when it comes to seeing how our own preunderstanding will affect our statement of problems, focus, choice of theory, and through our explicit use of theory and theoretical creativity. Thirdly, I have also earlier underscored the importance of a critical approach to music therapy. This means

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to be aware of one’s own historical situation, to see the consequences of music therapy both for the individual client and for the wider cultural practice within society. Such a critical perspective, we will see, means that music therapy will have to draw from theoretical traditions like critical theory, gender studies, and so on. Finally, we also saw how language, signs, symbols, and metaphors became crucial when defining human nature within a humanistic approach. When realities are defined, we need to understand the role of how language and discourse take part in the construction of reality. We need to take an analytical approach to the choice of theoretical terms, concepts, and metaphors. We need to reveal what positions we invest in, where we take a subject position, and so on. This takes an understanding of how power is described in the discourses. Reflexivity will have to secure how we make transparent the relationship between language, power, and reality.

Empirical Documentation Music therapy research should be concerned with empirical grounding and detail. Music therapists are familiar with an understanding of science that emphasizes knowledge based upon objectivity in procedures and measurements, controlled experiments, and studies that can be replicated. These are ideals grounded in a philosophy of science called positivism. I will not discuss the positivist approach here (see Ruud 2005b), as it is sometimes contrary to the epistemology advanced by the humanities. For instance, in the positivist paradigm the concept of truth considers data to be in correspondence with reality in what is called the correspondence theory of truth. Another concept of truth found in much research upon the

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effects of treatment is the pragmatic point of view, which is concerned with the practical consequences and the usefulness of what is being measured.

From Positivism to Phenomenology As we saw in the first chapter, positivism is not always compatible with the humanist conception of the individual, with its primary assumptions underlying the reductionistic epistemology of the experimental approach in science. However, taken as a strategic approach to secure valid data, it will have its place among other ways of doing research. Positivism should, however, never have a hegemonic positition within a humanities approach to research. This is illustrated in the debate between positive and humanist psychology. From this debate we know how leading positive psychologists, like Seligman, have attacked humanistic psychologists for not being concerned about empirical evidence. This is refuted by scholars in humanistic and existential psychology (see Taylor 2001; Held 2004). The objection against positive psychology has been that it contains no reflexive elements; their theory is still “in its infant stages,” Taylor writes (2001, p. 24). And he continues: To be able to influence the core of experimental psychology, positive psychology could take a page from existential humanist’s study of the phenomenology of the scientific method. Phenomenology could become the new standard on which research is conducted (loc. cit.). It is sometimes felt that positivism has drained all substance and color from the observed reality, leaving behind

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only abstract formal structures. One may easily understand why phenomenology appeals to musicologists and music therapists, who want to reclaim the immediate and sensuous in musical expressions and interactions with clients. Phenomenology then, has inspired music therapists to study experiences as they emerge from musical meetings with clients. Phenomenology shares with positivism its close attention to the empirical material. This is also the case with other qualitative methods like grounded theory and ethnomethodology that may rely on a phenomenological approach. In this sense, phenomenology takes a position both as a methodology and a philosophy. In the phenomenological approach, the experience becomes the point of departure. This implies disregarding the question of whether or not the experience has an objective counterpart. One is interested in the phenomenal world, which means that the researcher sets aside all preconceived experiences, as far as humanly possible. In other words, the real world is cut out or bracketed off. This is called the phenomenological reduction, which means that we abstract from real existing objects, confining ourselves to the world of ideas. In other words, the experience involves all active processes that include and form the different ideas and content that become present to awareness. It is claimed that the intentional objects of interest cannot be reduced to either the sphere of the mental or the sphere of the physical. Following such a methodology, one is supposed to perform various descriptions of the essence, to differentiate the unessential and particular from the essential elements and their relationships. Within such a phenomenological reduction comes an eidetic reduction. In this process there is a kind of comparative analysis of the elements in our thought process trying to reach something

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common, or an invariance to a whole group of phenomena. A final reduction is reached through a process of transcendental reduction in order to investigate how these invariances are constructed. There is a certain tension between phenomenology and more interpretative approaches that are based upon epistemologies that claim we only can gain access to our experiences as they are mediated by our language and placed within a larger cultural and political context. Approaches that adhere to the correspondence theory of truth may be criticized for sometimes making naive assumptions about the possibility of defining essences and seeing things “as they really are” as if it were possible to define the world without a language. The historical character of language, as it has been transformed and infused by ideologies and cultural values, may make any effort to define the essence of something no more than a good representation, a good story. This problem may be met by establishing a broader interpretative approach, as within some hermeneutic traditions. The phenomenological approach has opened the possibilities for a close examination of feelings, memories, expressions, and imaginations as they evolve in the hereand-now. A phenomenological approach to the analysis of music will allow experiences to be in the foreground of study, rather than musical structures as they may be examined in the scores. Examples of phenomenological research are to be found in dissertations by Skewes (2001) and Trondalen (2004).

The Need for Interpretation Music therapists are often met with problems of understanding and interpreting creative musical processes, per-

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sonal narratives, or cultural contexts framing the therapeutic processes. In this sense, the discipline of music therapy is more similar to the humanities than to the natural sciences.

Hermeneutics The duality between these traditions was emphasized by the emerging hermeneutic tradition dating back to the Renaissance in European history. Originally, hermeneutics was applied in Protestant analyses of the Bible and in humanistic studies of the antique Greek texts. A main theme in this research was how the meaning of a part could only be understood when seen in connection with the whole. For instance, on the one hand, you can only understand a certain fragment of the Bible if you look at it in the context of the whole text. On the other hand, you can put it the other way around: Since the whole text is a composite of parts, you can only understand the whole through its parts. This led to the formulation of what is called the hermeneutic circle. This apparent contradiction was solved in transforming the circle into a spiral. This means that one has to begin in some part of the text and tentatively try to connect the part with the whole text, which may give new meaning to the original part, and so on. Gradually we will arrive at a deeper understanding of both the parts and the whole. In the first form of hermeneutics mentioned by Alvesson and Sköldberg (2000), objectivist hermeneutics, the autonomy of the object of study is underscored. This means that what is to be understood must be understood in its own terms, from its own immanent standards and criteria or from the original intentions behind the object. It is also held that in any phenomena under investigation,

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there is a coherent totality of meanings that is reflected in each part, as we saw in the description of the hermeneutic circle. Interpretation is also regarded as a creative, reproducing act. A researcher always produces meaning; it is not to be seen as a mechanical reflection. This is the reason an interpretation will always be relatively objective, never absolute. This position is elaborated by what is called “alethic hermeneutics,” in which our preunderstanding of phenomena will always inform our research. Another development was seen in the idea of empathy as a necessary prerequisite for the interpretation and understanding of a text. This meant that the researcher had to take the position of the agent behind the text and try to relive or imagine how the situation was felt. The second form of hermeneutics takes its name from the Greek aletheia, which means uncoveredness, the revelation of something hidden. These hermeneuticians broke with the problem of the subject-object as well as with the split between understanding and explanation. To the alethic hermeneutic, understanding is a basic way of existing for every human being, a precondition that orients us in the world. Both natural and cultural sciences are irrevocably marked by interpretations all the way down to the level of data. On this basis, a second hermeneutic circle emerged with its special relationship between preunderstanding and understanding. In the concept of preunderstanding lies the formulation that our knowledge, language, or historical situatedness will always inform our perception of the world. According to existential hermeneutics, one form of alethic hermeneutics is what is to be revealed constitutes an original structure of properties buried at the roots of our existence. In order to reveal the hidden meaning, we

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have to make our interpretation as informed by our conceptions of this structure. This may be our basic situatedness in the world, as outlined for example in Heidegger’s major work, Being and Time, and Sartre’s concept of how we are “condemned to freedom.” Poetic hermeneutics, another form of alethic hermeneutics, is concerned with the role of language in our structuring of the world. What are important are not the logical and formal aspects of language, but its rhetorical figures, metaphors, and narratives. To explore metaphors may help us to understand how meaning is transferred from one area of reality to another. For instance, to speak about music as a language is to create an identity between two different phenomena. In this way, we tend to search for characteristics in the music that intend to reflect language-like traits. What has remained hidden and is sought to be revealed by the hermeneutics of suspicion, the final form of alethic hermeneutics, can be regarded as something shameful and thereby suppressed. To put it simply, Marxists often tend to see economic interests as the motive of human agency. Nietzsche saw the will to power at the root of our struggles, and Freud postulated sexuality as a force in development and behavior. In the positivist paradigm, we saw how the concept of truth considers data as being in correspondence with the reality in what is called the correspondence theory of truth. Opposed to this, data in hermeneutic research are considered to be constructed. There is no way to know the reality directly, only through language and perception, which means that the hermeneutic effort aims to reveal some kind of meaning or significance in the data. This is in accord with the broader interpretative background, the hermeneutic concept of truth, or what is sometimes called

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the coherence theory of truth. The coherence criterion refers to the unity, consistency, and internal logic of a statement. A hermeneutic approach may be taken when we are confronted with a question like, “Which meaning is conveyed?” We may say that interpretations can be made from different perspectives. In music therapy, these perspectives may in turn be informed, for example, by a particular philosophical position, a psychological theory, theories concerning metaphors and narratives, analytical theories in musicology, and indigenous conceptions of the nature of music therapy processes. For example, music therapists may meet concepts from existential hermeneutics as their interpretations are informed by perspectives from existential psychotherapy (Medard Boss, Rollo May, and Irvin Yalom). Further, metaphors are unavoidable when we try to characterize music. In analyzing transcripts from clients, for instance from a GIM session, poetic hermeneutics and the identification of metaphors may help to reveal significant meanings behind the images of the client. The hermeneutics of suspicion are relevant for the psychodynamic music therapists when Freud’s metaphorical universe with its topographic and dynamic concepts inform their interpretation of the meaning behind musical and verbal expressions as well as interpersonal behavior. Analytic therapy does not necessarily deal with facts, but with clients’ recollections and reinterpretations of their life stories. In revealing hidden meanings, possibilities arise to construct a new life narrative in cooperation with the therapist. For research in the psychodynamic tradition, see Bruscia (1998b) and Eschen (2002). See Bonde (2002) for the use of theories from poetic hermeneutics.

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The Need for Criticism As we have seen in the chapter on systems theory, music therapy will always need to understand itself within a larger cultural or social context. Music therapists work under different ideological circumstances, with material conditions as well as theoretical constructs informing their work. Critical theory may inform music therapists about the wider social and cultural contexts in which they are working. It may point to social issues behind the problems of clients, thus leading the focus of music therapy in a new direction.

Critical Theory According to Alvesson and Sköldberg (2000), critical theory is characterized by an interpretive approach with a pronounced interest in critically disputing actual social realities and ideologies. Critical theorists see the aim of social science as serving an emancipatory project. They held that social phenomena always have to be viewed in their historical context. Societal conditions are not natural and inevitable, but rather created and influenced by power and special interests. Thus they can be subjected to radical change. The task of critical social theory is to distinguish what is socially and psychologically invariant from what can be changed. Habermas, one of the more outstanding critical theorists, has compared various views of knowledge in terms of what he calls cognitive or human interests (Alvesson & Sköldberg 2000). He differentiates between a technical, a historical-hermeneutic, and an emancipatory interest. Within a field such as music therapy, we will find that research may pursue all these kinds of interests. The first,

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technical interest, concerns the acquisition of knowledge used to develop resources for survival and is found in activities like the production and distribution of food and clothing, the treatment of disease, and so forth. This is an activity that presupposes that nature can be manipulated in a predictable way. This motivates research geared to the development of knowledge and methods for maintaining control over objective or objectified processes. We see this in research when objects are isolated and divided into dependent and independent variables in order to ascertain regularities and causalities. As we know from the ideas behind positivism, the prediction and establishment of reliable procedures for the confirmation or falsification of hypotheses are of pivotal importance (Alvesson & Sköldberg 2000). Nevertheless, we also need research based upon the second type of interest, historical-hermeneutic, which is concerned with language, communication, and culture. The focus of this research lies in interhuman understanding within and between cultures as well as between different historical periods. As we saw in the hermeneutics section, actions, events, statements, texts, and gestures are interpreted and the primary interest thus concerns significations and meanings. The third knowledge interest is emancipatory, which is a sort of liberating activity aiming to negate pseudonatural constraints. Focus is directed toward attempts to identify sources of misunderstandings and ideological notions. Critical theory looks at both structural and unconscious sources of social and psychological phenomena. Habermas cites Marx and Freud as examples of those working in emanicipatory modes. One of the basic tenets of the critical school in the philosophy of science is that there is a correspondence be-

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tween values and interests and how we perceive the world and act. The ideals of a value-free science have been met with a critique from the hermeneutically inspired critical tradition. In the positivist conception of science, objectivity is held as one of the basic conditions of a scientific approach. According to this tradition, scientific results have to do with reducing possible sources of error or being systematically open to critique in advance by trying to reduce some of the most characteristic sources of errors. Critical theorists would claim, however, that there are different types of errors. Our observations and theories may be influenced by personality or cultural and social or political background. In addition, they may be influenced by the particular scientific tradition to which we belong. Objectivity addresses the possibility of dealing with such sources of errors. Scientific activity has developed procedures and methods in order to secure objective access to the phenomena we are studying. We call this type of objectivity intersubjectivity. There is a type of error that we cannot handle in this manner. Different interests or values that will influence their research activity will always inform researchers. This preunderstanding concerns not only what we experience and describe as researchers, but also what we search for. As we can understand, there is a close relationship between the three types of interests: technical, historicalhermeneutic, and emancipatory. In music therapy, we need knowledge about the human body and physiological functioning to develop procedures to handle the effects of music. We also need to understand culture and communication in order to understand how music is interpreted in a meaningful way. In addition, it is important to include the mode of explanatory understanding that helps us to look behind the categories of illness and

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disability to elucidate social structures or forces that maintain the individual in a limited role. In this way, critical theory may serve an important function in the development of music therapy as a complex discipline.

Reflexivity in Language In a postmodern climate there is room for a variety of values and approaches. Postmodern theory has put earlier philosophies of science in a new perspective. In the perspective advanced in this book we are allowed to see how music therapy will need the pragmatic evaluation of the effects of music in therapy and efforts at making good essential descriptions of musical behavior, as well as a broader contextual interpretation of our symbolic interaction with music. There is no easy way out of a world seen as a single reality, where truth is reached through better measurements, more exact definitions, or deeper interpretations. As we will see, the postmodern approach asks for a greater concern about reflexivity, that is, a need to be more aware of the role of language in the construction of reality.

Postmodern Currents During the last decades, the term postmodernism has become increasingly more common. Within this broad field of ideas, not only are structuralism negated but also the metaphysical inheritance of ideas that pervades all Western tradition from Plato onward. The idea that there are definite rational global solutions and explanations, some general principles that guarantee progress in the development of knowledge, has been challenged. Rather, postmodern thinkers see these principles as grand narratives

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and have thought to replace them by microhistories, “local, always provisory and limited stories,” as Alvesson and Sköldberg write (2000, p.148). The different schools of science we have met so far all seem to rely on the value and possibility of doing empirical research. We have seen, however, that researchers may disagree on how to approach the real world. However, they all assume an independent outer reality that can be perceived and accounted for. It is exactly this faith in data and empirical inquiry seen as a cornerstone in the development of knowledge that is being challenged by the many thinkers within the postmodern movement. The interpretive perspective presents an example of this skeptical attitude. According to Alvesson (2002) this perspective emphasizes how our preunderstanding, paradigm, and metaphor prestructure our basic conceptualization of what we want to study. Also, our approach to, perceptions of, and interpretations of our experiences are filtered through a web of assumptions, expectations, and vocabularies. Within the postmodern movement, feminism occupies an important position. Feminism encompasses ideas ranging from liberal feminism striving for gender equality and neopositivists’ concerns for not taking gender as a variable seriously enough, to approaches that take a radical epistemological stand. Concerning the above problem of perception of reality, feminist advocates have pointed to how male domination and masculine standards influence dominant epistemology and methodology of science. As Alvesson writes, “male domination has produced a masculine social science built around ideals such as objectivity, neutrality, distance, control, rationality, and abstraction. Alternative ideals, such as commitment, empathy, closeness, cooperation, intuition, and specificity,

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have been marginalized” (2002, p. 3). It may be easily imagined, particularly in a field like music therapy, how research might have been radically different within a paradigm that allowed the latter values to come into the foreground (see Hadley 2006). Within the group of constructivist thinkers it is held that science does not provide privileged access to the objective truth about the social worlds outside of language and the use of language. The language constructs rather than mirrors phenomena. It is argued that both outer reality, such as behavior, and inner reality, such as feelings or motives, are complex and ambiguous phenomena. They can never simply be captured, but given the perspective, the vocabulary, and the chosen representation, reality emerges in a particular way. This means that any claim of truth says as much or more about the researcher’s convictions and use of language as about the objects of study (Alvesson 2002, p. 4). A last approach to be mentioned under the heading of postmodernism stems from the French philosopher Michel Foucault, who has been the leading name in research on social power and the relationship between power and knowledge. In his archeological or genealogical method, Foucault tried to map out the overarching rule systems in the thought system of whole epochs. He wanted to track down the ordered fields of knowledge, which he called episteme, that are common to discourses of a whole epoch. Foucault uses the word discourse in a different sense than it is used above. To Foucault, discourse is more of a framework and logic of analysis that, through its penetration of social practice systematically forms its objects (Alvesson & Sköldberg 2000, p. 224). Foucault used the genealogical research program in many studies, for instance when dealing with the phenomenon

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and institutionalization of mental illness. Foucault is not interested in who exercises power over others due to office, knowledge, or a power base. Rather, power exists in relationships and when it is expressed in action. The postmodern turn in the philosophy of science has been criticized for its endless theoretical argument and for being too pessimistic about the possibility for doing actual research. However, postmodern ideas have opened new possibilities for reflexivity as well as providing new theoretical insights, which have then opened new possibilities for interpreting data. If we accept the idea that we live in different subjective realities, differently informed by language, values, and cultural realities, there can be no general objective theories in music therapy. This means that it is impossible to make statements about music therapy or music that can be generalized to all patient populations or methodological approaches. Truth is local, and the best we can do is to give good interpretations and descriptions of what happened there and then. Our interpretations and descriptions are always communicated through language. This means a choice of metaphors and a narrative structure that is enforced upon our descriptions of reality. If music is seen either as communication, reward, symbol, sign, interaction, or whatever, our choice of metaphor is sought from other fields of language, other theoretical models. Of course, sometimes our choice of metaphors or our ways of enacting the music therapy situation may prove rhetorically efficient, particularly when our choice of narrative comes from an established theory in another field. We should be aware that our ways of describing, interpreting, or performing, “proving the effects of” music therapy is a kind of discourse that has the effect of creating the reality we believe in and which we want other

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people to believe in. In therapy, this discourse must be felt to be true, otherwise we will meet with serious ethical and practical problems in dealing with clients. Scientific activity means a high degree of reflexivity. This aspect may create a conflict between the music therapist as a researcher and as a clinician. As researchers, we always have to deal with the underlying values of our activity and our ways of conceptualizing and narrating our perceptions. This, in the end, will reveal the relativity of our ways of telling the story of our work, the arbitrary nature of our choice of communicative form.

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Chapter 10

Musicking as Self-care When music therapy is defined as a profession, most often the role of the music therapist is underscored. There is no questioning the necessity of the music therapist in music therapy, and her musical skills, knowledge, and the responsibility for assessment, evaluation, and documentation of the therapeutic process. However, music therapy, viewed as a discipline, and not only as a professional practice, encompasses the whole interdisciplinary field of study of the individual-health relationship. As we have seen, music sociologists and music psychologists are also now discovering how people are using music to regulate and control their emotional behavior (DeNora 2000) and take care of their health needs through music (Ruud 2002; Batt-Rawden 2007). Music is used for identity building (Ruud 1997), relaxation, to cope with stress, to release pain, or to regulate sleep patterns. People bring their own soundtracks and personal stereo into the urban landscapes to regulate their moods, attentions, and emotional investments (Bull 2000; Skånland 2007). As a discipline, music therapy should provide knowledge and reflection about how music can also serve therapeutic functions in the everyday life of people. Music therapy, as a laboratory of the study of musical effects, may pro-

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vide theories and practical guidelines for how help people to take care of themselves through everyday musicking. This means that music therapy, taken as a discipline, does not only restrict itself to the professional practice of “doing therapy.” Music therapy also has to study the way music is put to work in everyday life in order to regulate what we may label “health.” When recognizing how listening rituals are shaped through the functional use of the new music technologies in everyday life, we find how a new area of music as an “immunogen practice” emerges (Ruud 2002), where music is used as a health technology in order to regulate emotions, moods, energies, to alleviate pain and sleeping disturbances, or change negative emotions. If we take this use of music as a regulator (and definer) of health, as a medium for self-care, and recontextualize it within the new-media technologies, such as MP3, iPod, and the new generations of smart phones, we are entering a future where the old Pythagorean ideal of music as a regulating device has become an ever-present reality. We could say that music plays a role in our healthperforming behavior much like other behavior or habits prescribed by health authorities and media in order to regulate our lives toward improved health. Of course, when it comes to health-promoting behavior, most attention is directed toward physical exercise, food, drug, alcohol habits, or sexual behavior (Taylor 1995; Ogden 2000). Within the emerging field of health psychology, the study of health behavior sometimes focuses upon behaviors that may protect health, called “behavioral immunogens” (Matarazzo 1984, in Ogden 2000, p. 13). Music might be seen as a form of behavioral or cultural immunogen along with other behavioral immunogens, or health promotion activities, like brushing our teeth, the

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use of seat belts, good sleeping habits, and so on. There is emerging interview research that shows how people may use music to regulate bodily and psychological imbalance (see Bergland 2006; Batt-Rawden 2007; BattRawden, DeNora & Ruud 2005). I think this research should be incorporated into the information music therapists give to society along with information about possible harmful effects of sound, such as environmental noise pollution and the damaging effects of excessively high volume. We have seen throughout this book how a humanitiesbased health science could position itself in relation to a natural science approach to medicine. Danish humanistic medical researchers Peter Elsass and Peter Lauritzen write that what is common to humanistic health research is the wish to make their ideologies scientific on conditions from areas of science other than the natural sciences. Such conditions may be understood within the humanistic view of human nature where thinking and acting subjects are objects of study, not physical matter (Elsass & Lauritzen 2006, p. 34). It is important, however, as Elsass and Lauritzen remark, that such an orientation in health science emphasizes the difference between a scientific practice and everyday practice. This can mean establishing new “objects” and concepts that refer to new aspects of health performance. When humanistic health researchers take interest in such a “folk practice” it is an effort to create counterbalance to medical research, which places the individual as an object of research and not an acting subject with possibilities for greater responsibility for own health. Historically, this use of music as a “self-care technology” probably goes back to the roots of our Western culture. The philosophy of Pythagoras may have been more

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pragmatic in its intent than we think today. Although we know very little about the life and practice of Pythagoras himself (West 2000), it is suggested that, as a religious leader, he practiced a sort of musicking in the evening in order to cleanse his mind from everyday noise and purify his thought to restore balance or harmony before going to sleep. Additionally, he used music in the morning to prepare himself for the coming day (Schumacher 1958). In other words, Pythagoras seems to have practiced a very well-known functional use of music, musicking as a technology to regulate a body-mind relationship. What we today might label a musical home pharmacy, is exactly the new use of music technology to take care of one’s energies, bodily states, emotions, cognitive orientations, memories, and moods. This is what I call “musical self-care” when music is a part of the technologies of self we use to define and perform health. I will later discuss how we give music a selfobject function, as a source of safety and continuity, to evoke memories, comfort ourselves, and to provide good experiences and feelings. Music is used to distract us from negative thoughts, and subdue anxieties by providing a cognitive reorientation. Or we learn to know how people use music to forget chronic pain or create rituals, which prepare us for good sleeping habits. When music therapy moves into such areas, it also becomes important in the ongoing debate about the role and function of music in society. It may sound trivial to claim that music is a kind of technology, a means of achieving something beyond itself — in this case, improved health. In what has been named “the bourgeoisie art religion,” music has been construed as one of the purest art forms since the Enlightenment. Based on the idea that aesthetic pleasure has been cleansed from practical concern, that

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involvement in music is a way to trance and transcendence, music therapists do not object to the idea that we have a right to enjoy music as a form of aesthetic enjoyment. However, it might be argued that such a practice is just another instrumental way of using music, i.e., to regulate our existential needs.

Music as a Cultural Immunogen — Three Narratives As far as I know, the relevant literature contains no studies focusing on the use of music in everyday life as a type of behavioral immunogen. I could not find any systematic studies on the use of music in our contemporary culture to maintain, improve, or change health status administered in a nonprofessional setting, in other words, musicking as a sort of “folk-medical practice.” In the following, I will present three narratives about how music is given a regulatory device in life.

The Theologian Who Cured His Asthma with Singing The idea of initiating a study of everyday health musicking occurred to me one day after I gave a presentation on music therapy before the Norwegian Academy of Science. Although I have given quite a number of lectures about music therapy before, I was a bit worried about presenting before such a scholarly audience. Since this is a rather interdisciplinary subject, there is a risk of inadvertent slipups on historical or medical details. In the discussion that came after my presentation, I was surprised to find that some of the elderly participants were more interested in giving a personal account of their own everyday use of

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music rather than disputing any of the historical or medical facts in my presentation. In particular, a retired professor, a well-known theologian, spoke of how he sang the song “Amazing Grace” every night to a disabled friend over the telephone. I had no trouble recognizing this as a story about music providing comfort and hope, and maintaining friendship and relationships. A few weeks later the retired professor called me. He wished to elaborate on his narrative, and asked permission to sing me the song over the telephone. Despite his considerable age, he had a very strong, expressive voice, and I assured him that I found his song and singing ritual both beautiful and meaningful. As the conversation continued, he also revealed that he had used singing all his life, both to combat his own asthma and in various other personal and professional situations. I became curious about his musical biography and he allowed me to record both his narratives and songs the next week. As it turned out, my informant had, as a small child, been victim to a serious lung disease that had developed into asthma. When his family moved to a colder climate in Norway during the 1920s, he often suffered from asthma attacks. He told me how he had been deeply involved in singing from early on. Influenced by his father, who entertained him in a rich baritone voice while he was bedridden with bronchitis, he discovered how his mood changed positively when he sang himself. He was, of course, unable to sing during an acute asthma attack, when his ability to inhale was restricted. However, he got the idea early on that he could do something to strengthen his lung capacity and he started to practice singing and breathing exercises systematically: “. . . singing, and it was quite a lot, became a major part of my everyday life.

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I learned to sing and to do breathing exercises and how to use my lungs all the way down,” he told me, demonstrating how his breath could move the lower part of his stomach. “I can still be pretty flexible there, so I think this had a great impact,” the eighty-five-year-old theologian said. He added that his asthma disappeared at the age of eighteen. Many years later, when he had a chest X-ray, the medical examiner confirmed that not many would keep up with him when he was walking in the forest despite the traces of lung disease that could still be seen. When I checked for “asthma and music” on the Internet I found more than ten research articles, encompassing the use of treble and brass instruments in the treatment of asthma. I became aware that this was an area pretty well covered in the music therapy and medical literature. It was interesting to note, however, that this knowledge was known or discovered among people outside medical circles. In other words, this chronicled the emergence of music as a cultural immunogen, a way to practice better health habits. My informant told me he had further cultivated his voice when he became a student. So, his singing had become greatly integrated in his adult life. When we discussed his vocal abilities and how his gift of absolute pitch sometimes made him uneasy when he did not hit the right pitch, he suddenly exclaimed: “It was enormously joyful, life-confirming, encouraging . . . I don’t know how to express it. But my singing had a lot to do with my quality of life.” Then he spontaneously performed Bach’s “Jesu bleibet meine Freude,” before he assured me that he also had a lot of popular tunes in his repertoire. This turn of the conversation led to reflections about how music is able to change our mood, to calm, to

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brighten our state of mind, to comfort us, and bring us hope. Not surprisingly, the theologian had an impressive repertoire of hymns, which he could utilize to regulate his mood. He had suffered from several serious diseases, even a heart attack, and the awareness of a potentially sudden death created a need for music as a supportive and nurturing object. When I asked him if his singing did something to his thoughts, if he felt that music changed anything, he said yes. This opened the way for a narrative where my informant told me how the Gestapo had visited him during World War II, under suspicion of keeping weapons in the house. This was, in his word, a “life-threatening” experience, which revisited him in his dreams for many years. During these nightmares, he was too disturbed to be able to sing. “But I am able to sing while in bed. I do that from time to time, with great pleasure,” he added. I asked him if he did this in a conscious attempt to change his mood. “Yes, definitely. But I have to wait for a while. After a nightmare I have terrible heart palpitations and my pulse is irregular. Sometimes even my ears are throbbing.” Once his body has returned to its normal state he is able to sing. “Yes, I use the singing. I lie in the bed and sing. Usually I keep my hymnal in the bed next to me. I nearly always keep the hymnal beside me.” As this story illustrates, music is clearly used as a means of expanding and strengthening lung capacity literally, as well as a means of regulating mood in order to prevent anxiety or to return to a state of normal physiological function after a nightmare. In both instances, music serves as a type of cultural or immunological technology in the service of promoting or retaining health. In this sense, music is a cultural immunogen, a type of aesthetic behavior, a way of musicking in the service of promoting health, or even directly preventing ill health.

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Musicking as a Catalyst for Stress and Anger A woman told me how she took up a song-dance ritual after she no longer could do her regular physical exercises, i.e., running, which she had used as a way to regulate her level of stress. I asked her how she actually felt when she was in a state of stress and if she could describe her bodily state before and after singing. “Are you as conscious about this as you seem?” I asked her. Yes. Music gives you a sort of release. You are in a state of everyday stress because of your work or because you demand something of yourself. . . . First, I have to listen to some fast music and then some more quiet music. I sing and dance at home alone by myself to the fast music. I prefer to use the headset in order not to disturb the neighbors too much. And then, it seems, the adrenaline comes and gives you a kick. And you get a sort of release and then a sense in the body when the stress has somewhat left the body and you can put on some more quiet music. Sometimes I actually sing so loud that I can feel in my vocal chords afterward that now I have really been shouting. I then asked her if she could tell me more about this self-absorbing feeling, “where” she is when she enters into this state. “I enter the music totally. I forget everything. And it is a very good feeling. Even though the headphones may harm my ears.” I asked her if she feels the stress in her head or in her body. No, it is more in the body I feel the stress, for me it is usually the stomach. But I get a fairly instant

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bodily relaxation. I don’t get a headache; I’m not that kind of person. But I have too many thoughts and it feels good to get out of the thoughts. Music takes control and it is such a good feeling because you tend to forget everything you have been thinking about. I tried to get a better understanding of the situation and asked her to tell me more about her feelings. I do actually listen when I am angry. Then I also need the loud music to balance my anger. Even though I have lost my anger during the last years, it used to be a problem earlier. So, I do not need that kind of music as much as I used to. Because earlier, I had a real need to get it out, as a counterweight to the anger I felt within. But it has become less, though it is still there when I want to relax. Earlier it was more anger, now I do it because I am stressed and it makes me feel good. This is a good example of a strict procedure, a musical ritual in the service of health-performing behavior. A state of stress is identified; music is selected and programmed according to a fast-slow/loud-quiet format. The whole procedure is similar to a sort of mini “rite de passage” (Ruud 1995, 1998). Headphones are used to provide seclusion and high volume-stimulation, dancing and bodily movement are combined with music to get into a state of void and flow. This creates a sort of liminal state, a space where the head is emptied and she is ready to enter a new state of well-being. There has even been an element of self-administered musico-psychotherapeutic work on anger. She has learned to sort out anger and to

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handle it. Nowadays, anger is differentiated from more general stress, and the adrenaline-stimulating music is directed more toward the stomach, the body.

Overcoming Depression and Social Phobia Sometimes music may also be of help to a person with serious social and personal problems. My third informant was brought to my attention by a music therapist colleague who for many years has been working with the rock band format with female inmates, both inside the prison and in the community after their release. This project inspired one of these women to start her own band. Now in her forties, with serious social problems and emotional difficulties, she was able to realize her adolescent dreams about playing in a band, writing lyrics, putting music to the text, performing in public, and recording the product. When I called her to make an appointment, she mentioned to me that she saw music as something, which gave her “health.” I repeated this to her in our conversation, and she continued: That’s right, because of my emotional problems; it’s really affecting my health, especially when you are feeling down. Sometimes it gets so bad I have to pull down the curtains and go to bed or lay down on the sofa with the blanket over me. You don’t want to see anyone or talk to anyone or do anything. The only thing that can get me up from bed is if I can imagine the music. So for me, this is a real help psychologically. Because then I can manage. Sometimes it is a real pain to get off of the sofa, to stand up, dress, and leave the house. But when I finally have managed to get to the

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rehearsal, even if it has been very hard sometimes, I have managed because I have comforted myself, telling myself I will feel much better when I have left the house. Even my son has told me: “Mom, get down to the rehearsal. You will feel much better when you have been there.” At the time I feel this as nagging, but he has actually encouraged me to go — even if I didn’t have the energy. And I have never regretted it, I have always been happy I did go anyway. It feels like a personal victory . . . and I was in a much brighter mood when I got back home. And I also became more active; I did not go back to the sofa. I can do a lot of housework when I come home, just because I have been away. Music has become the only means that sometimes can get her up off the sofa and give her courage and energy to go to the band rehearsal. This must have been a major step to overcome for a person who was feeling confused and depressed, who shut herself up inside her apartment behind closed curtains. With the band, performing her own tunes, she manages to forget her own problems, to overcome her social phobias, enjoy the friendship of other musicians, and to share some positive things in her life with her teenaged son. “If it hadn’t been for music I would have been even more depressed,” she added. I asked her if she forgets her problems when she is rehearsing with the band. I am not worrying about problems; I am just concentrating on the music. I concentrate on my own texts, getting really involved because I am really eager to find out how to construct the tune, how

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to perform, and things like that. You tend to get so involved in music that you forget your problems. And to forget your problems for a couple of hours, on a Monday, I felt wonderful. And I did not worry anymore when I came home at night. During the day, problems could lie there and grow, but never after the rehearsal. Besides the social and mood-enhancing effect of the band rehearsal, she also emphasized how the act of composing music and writing lyrics helped her to straighten out her confusing thoughts. She told me she has emotional problems, or is “confused” as she puts it. I asked her what happens to her confusion when she is focused on the music. “Does the confusion disappear?” Yes, when I have got things down on paper, I feel like I have lost ten pounds. I have many thoughts spinning around in my head, and it helps me on the psychological level to write these thoughts down. Because I get to write down how I really feel about things. It really helps me psychologically. So does going to the rehearsal and playing the music. It appears that music gives her a context in which to be precise and honest about how she actually feels. She is able to sort out what is important from among her whirling and confusing thoughts. Further, she is able to tolerate what she has become aware of, and to express this through her writing. Going to the rehearsal enables her to elaborate, express, and communicate her thoughts. Composing music to the lyrics and performing the piece of music transforms the text into a message. She has

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created something to share with others, something that others can recognize and identify with, she told me. I also asked her if she sometimes listens to music consciously to change her mood. Yes . . . it helps me a lot to listen to music. Because, mentally, if you are able to get up from the sofa and put on some music . . . with something . . . I have consciously chosen music with lyrics I listen to and which can remind me of my situation. And then I start to cry in order to really cry. Other times I can put on some music, which puts me in a better mood, music with real force, in order to change my thoughts into something else, and to forget about a lot of problems. This because I actually manage to get involved in the music I am listening to. So I am somewhat conscious about what I actually listen to. Again we can see how music is used to refocus attention, to address and align troubling memories in order to create an emotional catharsis. Or, music is used to switch mood, to forget about worries.

Musical Strategies The field of music therapy can be seen as a laboratory, studying how people may change under the influence of music. Up until now, in order to understand and explain how such changes are possible, music therapists have turned to the social sciences, the natural sciences, and the humanities. The import of theories from medicine, psychology, sociology, or musicology have aimed at understanding how we may use music to effect an influence

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upon our life. However, music therapy, itself becoming a new interdisciplinary study of how we may use music to promote health and well-being, has during the course of its history gathered idiosyncratic examples and experiences about how music is appropriated to effect changes. Perhaps it is time to question music therapy itself about how it would explain the possible influence of music upon our lives. In other words: What can we learn from music therapy about the way music influences our actions?

Improvisation, Composing/Songwriting, and Performing Music Music therapists have a tradition of using musical improvisation when approaching their clients. Within improvisation, music therapists have had the freedom to meet and adapt to client’s idiosyncratic music cultural cognition. Improvised music therapy thus lies at the core of activities within the field, and thus may demonstrate some of the operating principles behind the application of music in human interaction. Studying improvisation, we may learn how music affords social bonding through listening to and playing music. More common to everyday musicking, we find activities related to composing and performing music. We know how music in music therapy is used as a means to explore personal issues, to transform autobiographic experiences into symbolic expressions, and to perform and share with a larger audience. This musical practice is widespread among music amateurs and musicians within the field of popular music. Not least through songwriting, we are given the opportunity to transform the raw material of our life into an artistic object, a symbol that

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allows us to look at ourselves from some distance. Music therapists have always recognized songs and singing as one of their main approaches within their work. Along with improvisation, listening, composing, and performing, songs have had their natural place in the music therapist’s toolbox as a way of expressing and performing aspects of oneself as part of a process on the way toward better health. In music therapy, songwriting provides opportunities to deal with traumas and conflicts, to give poetic form to life experiences and thus create something, which is possible to accept and share with others. The same function of songwriting is also well known outside the therapy room. From childhood on, we all relate to songs and songwriting in a personal way. Children improvise with their voices, create mock versions of familiar songs, and engage in a host of changing forms of identification with songs and singers along their way to adulthood. The song text often represents an early experience of how to symbolically represent the world, and of how we can use the metaphor to understand the meaning of what is happening to us. Music therapists have become skilled in appropriating popular culture in order to help clients formulate, ventilate, express, and communicate some of their deepest wishes and thoughts. It seems like the song gives the client a new context, a freedom and strength to bypass their own vulnerability. The song form not only affords a range of possibilities for self-expression, but it equally allows one to touch on and warm to themes and relationships that have been deeply frozen for a long time. Songwriting provides an aesthetic context inviting the client to explore, within a new play-frame, their own life, their pos-

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sibilities — their losses, and their aspirations (Ruud 2005; Baker & Wigram, 2005).

Performance Music therapists view music as a social capital (Procter 2002), as a resource for networking and community building. Performing is a way to gain access to symbolic resources often highly regarded within society. To perform is a possible way to enhance the feeling of pride in one’s self, to develop strategies of agency and self-efficacy. A performance may give opportunities to listen to the voices of disadvantaged people, to make the invisible visible. Performing music has consequences for a person in terms of becoming recognized and thus a possible member of a community

Listening as Self-care As we saw above, interviews with people demonstrate how there is a reflexive use of music in the everyday aimed at regulating both physical and mental balance (Ruud 2002; Bergland 2006; Bratt-Rawden 2007). What we could term “musical self-medication,” sometimes based upon the new music technologies with personal and portable soundtracks in MP3 players and smart phones, involves taking care of one’s energies, bodily states, emotions, cognitive orientations, memories, moods, in short our physical and emotional well-being. In this is a new form of musical self-caring; music is a part of the technology of self (DeNora 2000) directed toward defining and performing health. Concerning the psychological states, this musical

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practice could be a way of giving music what psychologists call selfobject functions. Here, music represents a source of safety and continuity; it brings back memories of important events and persons in our life. As other selfobjects, music comforts and gives us access to positive emotions and experiences. Music also allows dissociations from difficult emotions and thoughts, thereby subduing anxieties by a cognitive reorientation. This may result in bodily relaxation, the initiation of a new bodily felt harmony. Music is also used to reduce pain, either by redirecting thoughts, blocking the pain impulses, or producing endorphins, which give us sensations of pleasure. Our music libraries then become much like a personal pharmacy when used to reduce anxieties or prepare us for sleep. Within music therapy there is growing research on receptive music therapy, or how we may use listening to music to further self-insight and/or bodily well-being. There is a tradition of music psychotherapy based upon music listening to a special selection of music “programs.” The Bonny Method of Guided Imagery and Music (BMGIM) is a much-researched approach (Bruscia & Grocke 2002). I understand this method according to Bruscia (2002), as “a modality of therapy involving spontaneous imaging, expanded states of consciousness, predesigned classical music programs, ongoing dialogues during the music-imaging, and nondirective guiding techniques” (p. 59). The core of the BMGIM lies in the ability to create images under the context and conditions that are maintained during the listening. These images, as we know, emerge at different levels, as sensorial experiences, visual

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scenes, or language and thought figures. As we know from the literature, images may be placed in a number of different categories. In order to understand how listening to music under such conditions may have affective, cognitive, as well as physiological consequences, we may turn to the tradition of self psychology and recent research concerning affect consciousness. For a long time, much clinical and developmental psychology did not acknowledge the idea of a “self,” and instead used the concept of an “ego.” Psychologist Heinz Kohut founded a self psychology that was based upon the idea that it is something within us, a self, which we experience as a structure and that keeps things together in our life. Within the theory of self psychology, music may be understood as a selfobject, which may have important self-sustaining functions for the individual. Kohut termed any dimension of an object that had the function of supporting ourselves as “selfobject.” Such selfobjetcs had to do with the subjective aspects of anything that could maintain, support, restore, or confirm the self. This sort of a relational experience toward an object may awaken and maintain the self or give us the sensation of having a self. Not only could other persons serve such selfobject functions, but also cultural objects, such as music. This self thus contributes to the experience of being whole and continuous in time and space. Such an experience of a self is related to the sense of having a center for action, emotions, intentions, and plans. This self is both a way of organizing our experiences as well as a structure that makes it possible to experience. The idea of selfobjects points to the function other persons, objects, or events may have in the maintenance of this feeling of being the same and having a meaningful self. In other

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words, music may serve selfobject functions in our life, when we turn to music to regulate our moods, indulge in memories, or recollect events and persons. In this music therapy approach images are the outcome of a multidimensional process where music, image, client, therapist, and the state of consciousness mutually influence one another. Images may be followed by the release of an affect, as well as affect may influence the production and content of an image. There is no linear or causal relationship between any components of the BMGIM experience. To understand the role of music, we could, in accordance with the concept of affordance say that music has a phenomenological profile (Ruud 2003), which affords affect to emerge. This again may be due to the release of associations or external references made by music or our experiencing structural expectations within music itself. We know these affective responses in the form of more or less delimited or categorical emotions, vague states of feelings (vitality affects), or more lasting moods. Listening to music may then give rise to an affect consciousness, which is beneficial to psychological health. Kohut held the view that the integration of affective states is central to the development of self-regulatory capacities and to the structuralization of self-experience (Monsen & Monsen 1999). Within the theory of affect consciousness, it is basic to allow clients to experience and tolerate their emotions fully, which is also important to the BMGIM or MCGIM experience. In their work on affect theory, Monsen and Monsen present a model of affect consciousness and how it can serve the understanding of therapeutic processes. The authors describe the concept of affect consciousness (AC) as “the mutual relationship between activation of basic affects and the individual’s ca-

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pacity to consciously perceive, reflect on, and express these affect experiences. AC is defined and operationalized as degrees of awareness, tolerance, nonverbal expression, and conceptual expression of . . . nine specific affects . . . (p. 288). These affects are listed as interest/ excitement, enjoyment/joy, fear/panic, anger/rage, humiliation/shame, sadness/despair, envy/jealousy, guilt/ remorse, and tenderness/devotion. Possible forms of imaging while listening to music, then, concern visual images, associations released through listening, and the emotions and bodily processes going on at the same time. While “images” may be seen as “scenes” within this proposed theory, emotions released may inform us about a possible “script” that is idiosyncratic to the person experiencing the music. A script can be understood as a sort of underlying principle, or as a set of rules utilized by the person in handling various situations. A script is an underlying narrative that informs the person how to act in a certain situation. Such prescriptive narratives may sometimes be dysfunctional and need correction. We could postulate then, that when scripts are activated or “heated” during the BMGIM or the listening process, possibilities arise to get to know some of the underlying dynamics of the person. The person then may gain some new information about herself. Musical experiences may thus be more than supportive, that is, sometimes teach the person something about himself, what we earlier spoke of as reeducative experiences. If music really would change the person, or give a strong transformative experience, we could say that the scripts or narrative has changed. This may again open some other possibilities to work in the verbal modality. In short, self psychology, script theory, and the theory of affectconsciousness, may offer a theoretical approach in order

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to understand what is happening when we are listening to music. As we know from the study of imagery, autobiographical imagery is only one among several ways to react to music. Often images come to us in symbolic and metaphorical form. In the reflective conversation the client is given the opportunity to express and reflect upon their images and scripts. An important skill for the therapist is also to help individuals recognize how images may be important metaphoric expressions about important issues in their lives. Metaphorical integration leading to a new understanding of a life narrative may be of primary concern. In this sense, self psychology as a theoretical approach to the understanding of the process of music listening, allows for transformation to happen through the music listening experience itself. When music is understood as a selfobject, self-sustaining as well as transformative needs may be taken care of. As we have seen, the function of a selfobject is to maintain, support, and confirm the individual. In this sense, this self-psychological frame allows for music and images to shape the sustaining and transformational process.

Music Affords New Actions Although music always served everyday needs in our culture, such needs and functions were gradually placed in the background. From the eighteenth century on we saw the installation of an aesthetic of music that insisted upon the pure and uncontaminated contemplation of the musical artwork as the paradigmatic relation to music. Music was taken away from everyday life, and moved into concert halls and conservatories through an aesthetic dis-

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course where music was constructed as autonomous and universal, complex and original. Something was lost when music became an art form within an aesthetic, which became disentangled from everyday life and separated into its own sphere. Music became noninstrumental and not intended to serve any practical purposes in life. Music therapy contained the idea of how music might become an important factor in social change. Music therapy can be seen as an orientation toward life, as a social movement, in addition to a treatment profession. Today we are witnessing how music therapists are crossing the boundaries between “therapy” and “community music making.” We can see how music therapy takes part in reclaiming some of the original functions of music in our culture. Maybe a new sociology of music could observe how music therapy is now leaving its marginal site to take on a more central role in society. Music therapy may come to play the same spatial politics as other groups, like new social movements, youth subcultures, and identifications associated with New Age that have come to articulate alternative futures for society (Hetherington 1998). It could be that music therapy, in aligning with other practices of music making, may vitalize the healing, empowering, self-regulatory functions of music. Thus, music therapy could reclaim music back to everyday life as central forces in humanizing the culture.

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Sources Text and arguments in this book were previously presented at conferences or printed in proceedings or journals during the last ten years. All the texts have been modified and completely rewritten for the context of this book. For readers who might wish to follow the arguments in more details, I will refer to the following: All chapters Even Ruud 2008. “Et humanistisk perspektiv på musikkterapi.” In: Trondalen, G. and Ruud, E. (Eds.) Perspektiver på musikk og helse. 30 år med norsk musikkterapi. Skriftserie fra Senter for musikk og helse. NMH-publikasjoner 2008:3. Chapter 1 Even Ruud 2002. “Music Therapy — History and Cultural Contexts.” In: Stige, B. and Kenny C. (Eds.) Contemporary Voices in Music Therapy. Communiction, Culture and Community. Oslo: Unipub forlag. Chapter 2 Even Ruud 2004. “Musikkopplevelsen i selvpsykologisk lys.” In: Johansen, G., Kalsnes, S. & Varkøy, Ø. (Eds.) Musikkpedagogiske utfordringer. Oslo: Cappelen Akademiske Forlag.

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Chapter 3 Even Ruud 2006. “The Role of Music in the Development of Identity.” Paper presented at the research symposium Music and Human Beings October 46, 2004 at the School of Music, Örebro University. Reprinted in Stålhammar, B. (Ed.). Music and Human Beings. Music and Identity. Örebro University. Chapter 4 Hallgjerd Aksnes & Even Ruud 2006. “Metonymic Associations of Nature and Culture in a BMGIM Program.” Nordic Journal of Music Therapy, 15 (1) 2006. Hallgjerd Aksnes and Even Ruud 2008. “Body-Based Schemata in Receptive Music Therapy.” Musicae Scientiae, Spring 2008, Vol XII. No. 1, p. 49–74. Even Ruud 2007. “Kropp og gester i musikalske samhandlinger.” Psyke og logos no 1, Bonde, L.O. (Ed.) Chapter 5 Even Ruud 2002. “’New Musicology’, Music Education and Music Therapy.” Keynote paper at the 13th Nordic Musicological Congress, Aarhus 2000. Reprinted in Hansen, T. H. (Ed.) 13th Nordic Musicological Congress Aarhus 2000 — Papers and Abstracts. Studies & Publications from The Department of Musicology, University of Aarhus, 2002. Chapter 6 Even Ruud (2005). Lydlandskap. Om bruk og misbruk av musikk. (Soundscape. On the use and misuse of music). Bergen: Fagbokforlaget. Chapter 7 Even Ruud 2006 “Musikk gir helse.” In: Aasgaard, T. (Ed.) Musikk og helse. Oslo: Cappelen Akademiske Forlag. Chapter 8 Even Ruud 2004. “Reclaiming Music.” Forward. In:

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Pavlicvic, M. & G. Ansdell (Eds.) Community Music Therapy. London: Jessica Kingsley Publishers. Even Ruud 2005. “Community Music Therapy.” In: Björnberg, A., Hallin, M., Lilliestam, L., and Stockfelt, O. (Eds.). Frispel. Festskrift til Olle Edström. Skrifter från Institutionen för musikvetenskap, Göteborgs universitet nr. 80. Even Ruud 2005. “Music: A salutogenic way to health promotion?” In: Tellnes, G. (Ed.) Urbanisation and Health. New Challenges in Health Promotion and Prevention. Oslo: Unipub 2005. Tom Næss and Even Ruud 2007. “Audible Gestures: From Clinical improvisation to Community Music Therapy.” Nordic Journal of Music Therapy, 16 (2), pp. 160–172. Chapter 9 Even Ruud 2005. “Philosophy and Theory of Science.” In: B. Wheeler (Ed.) Music Therapy Research. Second Edition. Gilsum, NH: Barcelona Publishers. Chapter 10 Even Ruud 2002. “Music as a Cultural Immunogen — three narratives on the use of music as a technology of health.” In: Hanken, I. M., Nielsen, Graabræk, S. and Nerland, M. (Eds.) 2002. Research in and for Higher Music Education. Festschrift for Harald Jørgensen. NMH-publik- asjoner 2002:2, Oslo. Even Ruud 2003. “‘Burning Scripts.’ Self Psychology, Affect Consciousness, Script Theory and the BMGIM.” Nordic Journal of Music Therapy 12 (2), 2003. Even Ruud 2008. “Music in therapy — increasing possibilities for action.” Music and Arts in Action, Vol. 1, no. 1, May 2008. Even Ruud 2008. “Hvorfor musikk?” In: Bjursell, G. & L. Vahlne Westerhäll (Eds). Kulturan och hälsan. Essäer om sambandet mellan kulturens yttringar och hälsans tillstånd. Stockholm: Santérus förlag.

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Index Aasgaard, T. 125, 132–133 acculturation 10, 65 aesthetics, 21, 36, 42, 47, 56, 73–86, 88, 107, 108, 113, 160–161, 172, 178 see also musical aesthetics performative 79 affect consciousness 175–178 affordance 58, 59–60, 66,107, 171, 176 agency 41, 50, 87, 99, 111, 127, 147 Aigen, K. 67–68, 78 Aksnes, H. 61, 63–64, 68 Alexanderson, K. 102, 103, 104 Aldridge, D. 105–106 Alvesson, M. 140, 145, 149, 150, 153, 154 analytical music therapy 121 anorexia nervosa 31 Ansdell, G. 40, 50, 55, 67, 86, 126, 127, 128, 129, 136 Antonovsky, A. 96, 117 anxiety 167ff 174 Aristotle 79, 81, 89, 90, 107 art 22, 73–75, 78, 82, 96, 106, 108, 111, 179

music 77 therapy research, 3 asthma 161–163 attunement 25, 29, 30, 72 authenticity 47 Bach, J. S. 163 Baker, F. 173 basic needs 21–22 Batt-Rawden, K. 8, 109, 157, 159, 173 behavioral 12 Benjamin, J. 32, 33 Bergland, R. 159, 173 Bergman, Å. 38, 44, 46 Berkaak, O. A. 42, 79 Bertalanffy, L. von 125 Binder, S. E. 22 biologism 19 biomedical 3, 7, 9, 12, 16, 18, 58, 102, 121 Bjørkvold, J.-R. 42 Blaxter, J. 102, 103 body 10, 15, 18, 19, 23, 24, 26, 27, 30, 31, 36, 39, 59, 62–72, 102, 112, 159, 166, 174, 177 schemata 60, 63–65

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technology 27, 160 Boethius 14 Bollnow, O. 114 Bonde, L. O. 83, 148 Bonny, H. 93 Bonny Method of Guided Imagery and Music (BMGIM) 39, 50, 62–64, 77, 84, 93, 95, 119, 174, 176, 177 Boss, M. 148 Bourdieu, P. 4, 106 Brady, R. 26, 28, 29 brain 27, 29, 32, 71 breathing 162–163 Bredsdorff, T. 18 Bruscia, K. 6, 61, 67, 125, 148, 174 Buber, M. 34 Bull, M. 154 Butterton, M. 31, 48, 49, 113, 118 Cage, J. 100 catharsis 170 citizenship 98–99 Clarke, E. 59, 60 Coker, W. 70 cognitive 12 communication 23, 24, 28, 30, 53, 66f, 109, 151 communicative event 26 theory 32, 125 communicative musicality 23, 25, 67 community music therapy 6, 35, 38, 77, 97, 99, 121,

126–130, 132, 135, 136, 138 community musicians 7, 129 composing 76, 133, 169, 171– 172 constructivism 9 contextual understanding 57, 78, 80, 122, 152 countertransference 32 Creative Music Therapy 62, 76, 93, 133–134 creativity 22 critical 18, 35, 89, 106, 120–121, 140, 141, 149–152 humanism 17 philosophy 34, 120, 149–152 cross-modal 29, 72 Csikzentmihalyi, M. 88, 115 culture 18, 19, 25, 28, 51, 65, 68, 73–74, 78, 82, 97, 104, 122–123, 126, 128, 130, 149, 151, 171, 178 children’s 42 context 127, 144 inclusion 109 indigenous 130 low 74 mass 45 multi 123 rock 132 struggle 106 youth 41 Daly, J. 139 dance 76, 165

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Darwin 89 dementia care, 53, 118 DeNora, T. 8, 41, 47, 59, 109, 112, 157, 159, 174, 178 depression 167f development 29 developmental needs 39 developmental psychology 21, 22, 42 dialogical 34 dignity 34, 37, 51, 111 Dissanayake, E. 25, 39 Duncan, P. 102 Durkheim, E. 117

113, 126, 127, 131, 134, 179 enable 41, 87–101 enjoyment 115 environmental music therapy 124–125 Erikson, E. 45, 48, 118 Eschen J. 148 ethics 37, 51–52, 106, 111, 129, 156 ethnography 73–74, 79 ethnomethodology 143 evidence based treatment 1, 2, 139

early intervention 96 ecological music therapy 124–125 ecological validity 3 Elsass, P. 16,159 embodied perception 63–72, 76 emotion 9, 11, 22, 25, 27, 30, 31, 45, 46, 47, 49, 62, 71, 76, 104, 111, 157, 174, 177 emotional dance 32 emotional investment 40, 50 emotional narrative 31, 39 negative emotions 95–96 positive emotions 87, 91, 92–96, 107, 108, 174 empathy 17, 18, 28, 70–71, 91, 98, 135, 146, 153 empower, empowerment 8, 16, 41, 87–101, 111,

Feld, S. 73 feminism 91, 153 Feuerbacher, L. 34 flow 32, 87, 88, 89, 93, 166 Foucault, M. 155 Franklin, U. 101 Fredrickson, B. 92–96 Freud, S. 22, 147, 150 Frohne-Hagemann, I. 53 Fugelli, P.103 Gabrielsson, A. 118 Garred, R. 34 gender 42, 45, 46, 141 gesture 25, 26, 30, 39, 68–72, 76, 138, 150 Gibson, J. 60 Giddens, A. 43 globalization, global 38, 42, 123 Godøy, R. I. 72 Gold, C. 92

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Gouk, P. 9, 14, 83, 84, 130 Gritten, A. 68 Grocke, D. 174 groove 32 grounded theory 143

82, 104, 120, 139, 140, 141, 145, 159, 170 humanistic-existential 12, 34, 142 human rights 35

Habermas, J. 150 Hadley, S. 154 Hargreaves, D. 38, 44 Hartmann, E. 22 Hays, T. 49 health 14, 21, 36, 47, 57, 58, 73, 75, 96, 99–100, 102–119, 120, 124, 130, 157f folk 3, 159 ill health 66, 99, 126 musicking 6, 109, 139 performance 3, 158, 159–160, 166 promotion 3, 158 health psychology 88, 103, 110, 158 Held, B. 142 Hegel 34 Heidegger, M. 147 hermeneutics 20, 121, 144f, 150, 151 Hetherington, K. 179 history of music therapy 13 Honneth, A. 17, 34, 35 hope 88, 89 Horden, P. 6, 13, 14 humanities, humanism 2, 4, 12, 15, 16, 17, 18, 34, 37, 54, 57, 58, 73, 78,

Iazzetta, F. 68 identity 25, 31, 35, 37–53, 105, 127 see also musical identity illness long-term 4 image 175–178 image schemes 63, 64 immunogen 158, 161, 163 improvisation 29, 30, 31, 32, 33, 34, 53, 66–72, 76, 85, 91, 93, 113, 122, 129, 133f, 171–172 intentionality 70, 76 interpretative, interpretation 12, 20, 36, 45, 65, 81, 82, 102,103, 110, 140, 144f, 149, 153 intersubjectivity 33, 70 iPod 158 I-Thou 34 Jensen, H. S. 130 Jensen, U. J. 17, 18 Johnson, M. 40, 61–66, Jørgensen, I. 89, 107, 109 Kant 78 Keil, C. 67 Kenny, C. 125 King, E. 68

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index Kittay, J. 100 Kohut, H. 175 Kramer, C. 10 Kümmel, F. 13, 14, 74 Kvifte, T. 44 Larsen, M. 18 Lassen, L. 96–99 Lauritzen, P. 16, 159 learning disability 131 Lewin, K. 79, 81 Lichtenstein, J. 22 lifestyle 105–106 liminality 166 lived story 30, 31, 39 Lopez, S. 87 MacDonald, R. 38 Maler, T. 11 Malloch, S. 23, 24, 25 Marx, K. 147, 150 Maslow, A., 22 Matarazzo, J. 158 materialism 19 May, R. 148 MCGIM 84, 176 Mead, G. H. 69–70 meaning 19, 22, 36, 48, 61, 89, 103, 108, 109, 111–112, 117–119, 147, 148, 150 see also musical meaning meaningful moments 32 medical music therapy 121 medical staff 8 Medin, J. 102, 103, 104 melody 28, 57, 63, 85

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mental health 134 metaphor 19, 48, 63, 64, 65, 77, 79, 86, 100, 141, 147, 148, 153, 155, 172, 178 see also music metaphor Miell, D. 38 mindful 94, 113, 115 Minichiello, V. 49 mirror neurons 32, 71 Mitchell, S. A. 22 Moltu, C. 32 Monsen, J. 176–177 Monsen, K. 176–177 Mozart effect 106 MP3 158, 173 music, musical 12, 23 aesthetics 5, 8, 30, 36, 38 analysis 56, 82–86, 144 background 99 education 114, 121, 132 capital 135 centered 84 classical 106, 174 code 29, 44, 53, 122–123, 130 communication 24, 30, 37, 61, 63, 66–72, 76, 83, 122, 155 competency 41, 77 cosmologies 8, 9 culture 6, 9, 10, 11, 35, 37, 44, 55, 57, 59, 122–123 cure, 7 development 37 healing 7, 10, 11, 14 identity 36, 37–53, 62, 81,

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99,105, 113, 118, 123, 157 interventions 8 listening 27, 31, 39, 43, 45, 46, 49, 50, 58, 63, 84, 91, 106, 122, 134, 170, 174f meaning 9, 21, 30, 36, 40, 53, 54–72, 76, 80, 82, 122, 123 meeting 32, 143 metaphor 32, 50, 83, 118 narratives 24, 67, 77 ontology 54, 65 sign 55, 56 taste 42, 44, 46, 52, 58 teaching 134 universality 62, 65, 83, 122 musicality 24, 97, 105 see also communicative musicality musicking 8, 44, 59–60, 73, 76, 87, 88, 89, 95, 96, 97, 104, 131, 136 health 92, 114, 133, 157f musicology 54–56, 61, 64, 70, 77, 80, 85–86, 138, 143, 148, 170 music therapist identity 5, 6, 7, 8, 109, 128 role 5,6, 138 Nafstad, H. 89, 107, 109 natural science 1, 2, 4, 15, 16, 17, 18, 74, 78, 82, 121, 139, 146, 159, 170 network 42, 74, 97, 98, 109,

112, 115–117, 127, 132, 173 neuroimmunology 12 neuroscience 12 New Age 54 Nietzsche, F. 147 Nilsen, V. 32 Nisbett, R. 80 noise 99–100, 159, 160 Nordoff, P. 133, 134, 137 North, A. C. 44 Næss, T. 133ff object relation theory 113 Ogden, J. 158 O’Neill, S. 46 palliative care 12 paradigm 1, 3 participation 35, 67, 71, 76, 98, 109–110, 124, 127, 136 Pavlicevic, M. 30, 67, 127 performance, performative 28, 35, 49, 50, 55, 58, 77, 79, 90, 91, 113, 125–126, 129, 131, 134, 136, 137, 171–173 health 106 personhood 49 Pervin. L. 81 phenomenology 66, 142, 142f, 176 Plato,13, 152 play 92–93 play-songs 76 pleasure 115

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index popular music 41, 46, 75, 131, 132, 134, 137 positive psychology 18, 87f, 107, 142 positivism, positivist 3, 9, 19, 54, 74, 140, 141, 142, 147, 150, 151 postmodern 11, 75, 152f Procter, S. 135, 173 protoconversation 25, 70–71 psychotherapy 12, 17, 21, 29, 31, 32, 34, 35, 53, 75, 91, 129, 134, 148 music 174 Putnam, R. 115–117 Pythagoras 88, 158, 159–160 qualitative research 139, 143 quality of life 102 –119 quantitative research 139 receptive music therapy 77 recognition 17, 34, 98, 110, 127, 173 reflexivity 139ff rehabilitation 133ff relation, relational 16, 18, 21, 26, 33, 34, 35, 36, 38, 62, 68, 74, 76, 84, 98, 112f, 134, 175 knowledge 29 relativism 78 resilience 87, 96 resource 87, 90f, 94, 97, 98, 103, 127, 131, 135, 137 symbolic 131, 173 resource-oriented 90–92, 96,

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134, 135 RIG 30 ritual 11, 27, 43, 58, 59, 84, 137, 160, 165 Robbins, C. 133, 134, 137 Rolvsjord, R. 90–92, 97 Rolling Stones 137 Ross, L. 80 Ruud, E. 18, 33, 34, 37, 38, 39, 41, 42, 43, 44, 47, 59, 63–64, 66–67, 68, 74, 89, 110, 112, 113, 114, 124, 127, 128, 129, 130, 133, 141, 154, 155, 159, 166, 173, 176 salutogenic 91, 96, 117–118 Sartre, J. P. 147 Schwabe, C. 128 Schaffer, H.R. 39 Schoen, M. 83 Schullian, D. 83 Schumacher, J. 160 Schütz, A. 66 script 177–178 self 23, 25, 26, 27, 31, 33, 36, 39ff, 47, 48, 49, 50, 93, 175f self-confidence 113 efficacy 35, 41, 84, 111, 113, 173 narrative self 39 performance of self 56 realization 114 self-identity 34 self-image 135 self-in-context 40

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self-in-culture 50 self-in-relationship 39 value 112 self-care 157179 technology 100, 112, 159, 160, 174 self-determination 18–19 selfobject, music as 48, 50, 113, 174–178 self-reflexivity 86, 129 self psychology 175f Seligman, M. 88, 90, 107–108, 115, 142 semantics 62, 77, 79 Sigurdson, O. 112 silence 100–101 singing 28, 129, 162–164, 172 situated learning 41–42 Skarpeid, G. 44 Skewes, K. 144 Skånland, M. 154 Skårberg, O. 78 Skårderud, F. 29, 30, 31 Skölberg, K. 140, 145, 149, 150, 153 Sloboda, J. 45, 46 Small, C. 59, 73 Smeijsters, H. 31 Snyder, C. 87 social capital 35, 44, 50, 112, 115–117, 137, 173 Solli, H. P. 92 songwriting 76, 91, 132–133, 171–172 soundscape 99–100, 123 special education 12, 75, 76, 121

spiritual healing 112 Stedje, K. 100 Stensæth, K. 70, 93 Stern, D. 24, 25, 29, 30, 32, 39, 64, 71 Stige, B. 35, 78, 92, 109, 120–121, 123, 127, 128, 130, 131, 138 Stokes, M. 74 stress 165–167 Stålhammar, B. 38, 43, 47, 113 Summer, L. 84 symbol, symbolization 19, 29, 30, 33, 45, 49, 54, 73, 76, 77, 127, 141, 171, 178 symbolic community 43 symbolic work 45 systems, systemic 21, 96, 98, 120–138 Tarrant, M. 44 Taylor, E. 142 Taylor, S. 158 theology 112, 119 thirdness 32f Thyssen, O. 18 time 66–67, 76 transference 32 transpersonal 40, 119 Trevarthen, C. 23, 24, 25, 32, 70 Trondalen, G. 29, 30, 31, 32, 144 Trythall, S. 8, 109 Turry, A. 129

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index Tveitt, Geirr 64 Veseth, M. 32 vitality. vitality affects 30, 64, 176 contours 24 Wenger, E. 42 West, M. 160

Wiener, N. 125 Wigram, T. 173 Willis, P. 45 Winnicot, D. W. 33 Yalom, I. 148 Zen 115 Ziehe, T. 45

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