Advanced Clinical Training in Music Therapy BARBARA HESSER Vol. 5. No

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66-73 Advanced Clinical Training in Music Therapy 66 NEW YORK BARBARA HESSER UNlVERSlTY Music therapists are beginning to seek graduate training in music therapy that provides skills and

This article presents one concept of graduate level clinical training in music therapy and describesthe twelve yearevolution, the philosophy and practical application of this approach.

The paper is based on the belief that training is a dynamic rather than static process; always changing to reflect and initiate changes in the profession of music therapy.

As I developed my understanding of the potential depth and power of the music therapy processand its uniquecontribution to the lives ofclients with whom I work, the need for advanced

Before addressing this level of training, however, it was first important to define the entry-level competencies necessaryfor the practice of music therapy (Bruscia, Hesser, and Boxill,

1 Music Therapy Vol. 5. No Advanced Clinical Training in Music Therapy 66 NEW YORK BARBARA HESSER UNlVERSlTY Music therapists are beginning to seek graduate training in music therapy that provides skills and competencies beyond the entry-level training which they received in their undergraduate programs. This paper focuses on one approach to advanced clinical training on the graduate level. This article presents one concept of graduate level clinical training in music therapy and describesthe twelve yearevolution, the philosophy and practical application of this approach. It is offered in the hope of stimulating more awarenessand discussion of the needand possibilities for advanced music therapy training. The paper is based on the belief that training is a dynamic rather than static process; always changing to reflect and initiate changes in the profession of music therapy. Therefore, any model of training must constantly evolve to meetthe needsof the field and to create newdirections for the work. As I developed my understanding of the potential depth and power of the music therapy processand its uniquecontribution to the lives ofclients with whom I work, the need for advanced clinical training of music therapists became clear. Before addressing this level of training, however, it was first important to define the entry-level competencies necessaryfor the practice of music therapy (Bruscia, Hesser, and Boxill, 1981). In the United States today, entry-level training leads to certification (CMT) or registration (RMT) by the two national associations of music therapy and allows a person to begin his/her clinical work. This entry-level training is done predominantly in baccalaureate programs, although some master s degree programs offer this training as the first part of a program which provides advanced competencies. As a practicing clinician who believed that entry-level training was only a beginning, I began to explore advanced training in music therapy. In reviewing the few existing master sprograms in the United States, I found that they provided research skills to entry-level therapists. Although training in research is certainly important for therapists, I was surprised to find

Advanced Clinical Training 61 no program which stressedother advanced-level clinical skills.

choice. Since music therapists were not offered opportunities to continue their clinical training beyond the entry level, they were unprepared to practice in-depth.

education, psychology and social work. It would seemthat the research-oriented master s programs available in our field at that time were not meeting the needs of music therapists.

I also observed that the useof music therapy in the treatment of in-depth emotional problems was far less understood and accepted than comparable work with cognitive, physical, and behavioral

Work with nonverbal patients and those with severedisturbances such as pervasive developmental disorders, mental retardation, and chronic schizophrenia was more recognized than music therapy s

2 Advanced Clinical Training 61 no program which stressedother advanced-level clinical skills. The status of music therapy as an adjunctive therapy seemedto limit its potential to serveas at least an integral and equal treatment to other forms of therapy and sometimes as the treatment of choice. Since music therapists were not offered opportunities to continue their clinical training beyond the entry level, they were unprepared to practice in-depth. I discovered through an unpublished national survey in 1979, that music therapists who did continue their training on the master s level studied predominantly in other professions such as special education, psychology and social work. It would seemthat the research-oriented master s programs available in our field at that time were not meeting the needs of music therapists. I wanted to offer an alternative that would encourage more students to continue their training in music therapy beyond the entry level. I also observed that the useof music therapy in the treatment of in-depth emotional problems was far less understood and accepted than comparable work with cognitive, physical, and behavioral problems. Work with nonverbal patients and those with severedisturbances such as pervasive developmental disorders, mental retardation, and chronic schizophrenia was more recognized than music therapy s ability to treat higher-functioning populations. These attitudes seemedat least partially reflective of the lack of advanced clinical training in our field. My impressions about the state of music therapy were some of the important motivations for focusing on the development of an advanced level clinical training program. PHILOSOPHY OF TRAINING The essential attitudes communicated to students during training are fundamental to the effectiveness of any course work or clinical training. These attitudes must be considered the core of the program. The environment in which training takes place is a key factor to its success.therefore, I aim at establishing a community composed of myself, all adjunct faculty, clinical supervisors and students. This entire community works together to be a reflection of the basic attitudes and values which are fundamental to our work. Staff and supervisors must be carefully chosen to exemplify theseattitudes. The diversity among staff in their practice of music therapy brings richness to the program, but their basic values and attitudes are the same. The community is dedicated to the belief that being a music therapist is an in-depth, lifelong process, not begun or completed with a degree. Training for the two or more years is just a part of an exciting journey. Ending the master s degreesimply allows the student to take on adifferent function in the professional community, but growth and study continue. The staff reflects this attitude of ongoing training by personal involvement in doctoral programs, advanced private supervision, and institute training.

68 Hesser Their involvement in writing, research, and music therapy organization work is ongoing. Music plays a vital role in the life of our community.

Music making alone and together is therefore an essential part of the training. Our interpersonal relationships include music as an essential ingredient just as do our relationships with our clients.

Music is used for personal growth and exploration in our weekly music therapy groups.

There is a strong emphasis on improvising together in the here and now, and clinical improvisation as a tool in treatment.

Our community believes that continued growth - psychological, physical, mental, and spiritual - is essential for a good therapist.

3 68 Hesser Their involvement in writing, research, and music therapy organization work is ongoing. Music plays a vital role in the life of our community. We are brought together from diverse backgrounds and cultures by our love for music and a belief that music contributes to the wellness of individuals and society, and is a unique therapeutic tool. Music making alone and together is therefore an essential part of the training. Our interpersonal relationships include music as an essential ingredient just as do our relationships with our clients. Music is used for beginnings and endings of gatherings, meetings, and classes.we usemusic for our celebrations, asan important way to share feelings, and to give of ourselves to others. Music is used for personal growth and exploration in our weekly music therapy groups. We individually continue to deepenour technical and improvisational skills on a variety of instruments in order to be more expressiveand usemusic more effectively with our clients. There is a strong emphasis on improvising together in the here and now, and clinical improvisation as a tool in treatment. The more we understand and explore music together and individually, the better we can bring it to our clients. Our community believes that continued growth - psychological, physical, mental, and spiritual - is essential for a good therapist. We see our lives asjournies of personal growth and changeand believe that only in this way can we help others in their journies and with their problems. The program provides students with many opportunities to explore themselves through music, words, and the other arts. For this to be successful, an atmosphere where the student feels safe and supported is essential. This therapeutic environment is not easyto create in an academicsetting, but is possible with careful attention and the cooperation of staff and supervisors. A non-competitive attitude must exist among staff and be conveyed to students. We are working together for the well-being of our clients and if this is kept in mind asthe foremost purpose of the work, each individual s contribution can be seenas interesting and unique, This in no way implies the lessening of professional standards nor total acceptanceof all aspects of another s work, but a respect and openness to each other. This attitude of openness is communicated to students. Each individual admitted to the program is encouraged to identify her/his own unique skills and interests and to integrate these into music therapy. Grades are not emphasized; each student is motivated instead to work as hard as possible, given her/his life situation and goals. Grades imply a tneasurement against ultimate standards or a comparison with each other s performance. Though in a university grades are unavoidable, we try to use them to measure each student s individual progress as s/he develops. Another factor which createsa proper environment for growth is that the staff gives quite unselfishly of its time and expertise to help students. We regard our knowledge, talent, and skill as gifts that we do not own and which are expanded through giving. We understand that both teacher and student are learning together, paralleling the relationship between client and music therapist.

Advanced Clinical Training 69 During training, students are supported asthey struggle to identify their strengths and work through the weaknessesrelevant to the work they plan to undertake.

Many students are surprised and pleasedto have the opportunity to be open and honest in a university setting. I view the training of music therapists as an art.

SELECTION OFSTUDENTS We have learned that accepting the students who can most benefit from the type of training we offer is essential to our approach.

Once admitted a great deal of energy and time is invested by the staff in each student s successfulcompletion of the program; therefore a wise choice of candidate is important.

Certified and registered music therapists are accepted as well as students who have not yet completed music therapy training, but show that they have gained many entry-level competencies through

4 Advanced Clinical Training 69 During training, students are supported asthey struggle to identify their strengths and work through the weaknessesrelevant to the work they plan to undertake. The full range of their emotions during this processmay be shared freely with staff and supervisors without judgement. This openness is modeled by staff and encouraged from the beginning. Many students are surprised and pleasedto have the opportunity to be open and honest in a university setting. I view the training of music therapists as an art. Building the type of community described in this section is time-consuming, but tremendously creative, rewarding work. The interpersonal bonds create a lifelong network of support. SELECTION OFSTUDENTS We have learned that accepting the students who can most benefit from the type of training we offer is essential to our approach. We explore the students readiness and suitability for our approach just as carefully as a student should investigate a potential program in all its aspects. Once admitted a great deal of energy and time is invested by the staff in each student s successfulcompletion of the program; therefore a wise choice of candidate is important. We seek individuals who demonstrate readiness for this program based on their previous educational, work, and life experiences. Certified and registered music therapists are accepted as well as students who have not yet completed music therapy training, but show that they have gained many entry-level competencies through alternative educational paths and life experiences. We have found that just as having a CMT or RMT does not automatically make someone suitable for advanced training, not having such certification or registration does not make someone necessarily unsuitable. Interestingly enough, there is quite a bit of commonality in the advanced clinical training needs of CMT s, RMTs, and other previously uncertified students. We select students who demonstrate personal maturity, sensitivity to others, and an opennessto in-depth self-examination. In addition to technical music skills on several instruments, we want a student who can freely express him/herself through music and interact musically with others. Previous work experience with clinical populations, whether or not specifically in music therapy, helps a candidate understand the realities of health and mental health work. We have found that examining a candidate s motivations for this work is very revealing. We would like to train students who will remain in the field and contribute to the profession, and through time have carefully developed music therapy interview procedures which effectively identify the candidate who will most benefit by the advanced clinical training available.

70 Hesser STAGES OF TRAINING The existing master s degree program at New York University is presented as one possible approach to advanced clinical training.

these three components are integrated throughout all stages, though the relative emphasesvaries from stage to stage.

During advanced training a student should specialize with one population and synthesize all skills and knowledge into a personal approach to treatment.

There are very few comprehensive approaches available as models in our field today.

therapy treatment method based on this framework.

Programs are individually tailored for each student; the amount of coursework required to complete advanced training varies.

5 70 Hesser STAGES OF TRAINING The existing master s degree program at New York University is presented as one possible approach to advanced clinical training. The academic, clinical, and personal growth experiences have been divided into three training stages.these three components are integrated throughout all stages, though the relative emphasesvaries from stage to stage. Entry-level training in music therapy is a time to gather broad knowledgeand skills for the practice of music therapy with many different client populations. During advanced training a student should specialize with one population and synthesize all skills and knowledge into a personal approach to treatment. The main goal of the New York University model is to help each student develop his/ her own personal and comprehensive approach to the practice of music therapy. There are very few comprehensive approaches available as models in our field today. Each student s approach focuses on one specific client group (though some approaches have possibilities for broader application) and consists of a fully evolved theoretical framework and a music therapy treatment method based on this framework. Stage I Students enter Stage I of the training at different levels of competence, This has not proven to be a difficulty, but seemsto enhance everyone s education. Programs are individually tailored for each student; the amount of coursework required to complete advanced training varies. Stage I of the training involves all students and concentrates on either gaining entry-level competencies or, for already certified/registered therapists, expanding any weak areas. Musical foundations are emphasized and students strengthen their skills on many harmonic and melodic instruments. Clinical improvision is taught in small groups and practiced clinically. Developing a freedom from musical or creative blocks is emphasized and playing, singing, and moving together is encouraged. Most people in Stage I have great joy in discovering new dimensions of their musicality and creativity. In-depth study of all national and international music therapy literature is seen as a prerequisite to the development of one s own personal approach. The few available approaches in our field are studied with clinicians who have specialized training in theseareas.adjunct faculty and clinical supervisors demonstrate and share their own music therapy approaches in hospitals, clinics, and special schools around New York City. Faculty is selectedto demonstrate the type of personal music therapy approach the students are seeking to develop. Experience has shown that most students who enter the program seemto needwork in the musical and music therapy foundations areas. Psychological and clinical foundations are stressedin psychology and music therapy coursework, fieldwork, and clinic-taught courses. Though students enter the program with a variety of levels of competence, many

Advanced Clinical Training 71 students seemable to pass immediately to Stage II in this particular area.

Each student meets once a week for two years in a small music therapy group led by a trained music therapist. This is often a student s first personal experience as a client in music therapy.

Students development during this stage is followed closely through individual advisement.

A student s program is reviewed carefully at the end of this Stage and may be changed any time deemed necessary.

This decision is made carefully since the remainder of the training is based upon it.

In personal growth groups and supervision a student s unconscious motivations that might impede such work are identified and worked through, and her/his readiness to cope with the problems and needs

6 Advanced Clinical Training 71 students seemable to pass immediately to Stage II in this particular area. It is during Stage I that students begin to deeply understand the importance of self-growth for a therapist and the value of music therapy asa tool for their own growth. Each student meets once a week for two years in a small music therapy group led by a trained music therapist. This is often a student s first personal experience as a client in music therapy. (A future article will explore this important training experience.) Music therapy groups can significantly change a student s insights into the process and power of music therapy. Students development during this stage is followed closely through individual advisement. If a student has not had individual or group therapy before entering the program, it is strongly encouraged as an additional support and growth experience. A student s program is reviewed carefully at the end of this Stage and may be changed any time deemed necessary. Stage II The second stage of training begins when the student, in consultation with staff, identifies the population in which s/he would like to specialize. This decision is made carefully since the remainder of the training is based upon it. The student s potential for work with this special population is explored with supervision in a nearby clinical facility. In personal growth groups and supervision a student s unconscious motivations that might impede such work are identified and worked through, and her/his readiness to cope with the problems and needs of this population is carefully explored. With staff help, the student examines his/her musicalskills to ascertain if they are best suited for this particular type of work. All further coursework and clinical experience will then be built on identification of the problems and needs of this particular client group and the development of a music therapy approach to meet these needs. It is during this stagethat the student begins to build his/her theoretical framework of music therapy. This is an exciting process and is done in seminars where the students emerging frameworks are shared verbally and in writing. Students examine what their basic assumptions are in the areas of music, therapy, and music therapy. They now ask and answer such questions as: What is it about the experience of music that makes it an important tool in my evolving therapy approach?, What does therapy mean to me?, What are the major psychological, philosophical, scientific, and spiritual principles that influence my work?, and What music therapy principles motivate my work? These questions and many others are explored. No longer is the student simply reading and learning about others approaches, but s/he now has enough background and clinical experience to begin to identify his/her own. There is much creativeenergy at this stage of training. Since music therapy group continues during this very important Stage, the student begins to understand the process of music therapy in a much more meaningful way becauseof his/her own personal experience.

72 Hesser Stage III The final stage of training involves the application of the student s new and continually growing approach to music therapy under the guidance of experienced music therapy

The music therapy supervision done at this time is not oriented to the communication of the supervisor s approach (which is so necessary at earlier stages of training) hut to the fullest development

The student is guided in the application of his/her framework and music therapy method, but at this level the supervisor also encouragesa relationship in which the student can deeply explore personal

At the beginning of the NYU training program, few music therapists had the experience and therapy skills to do this type of supervision, but over the years we have more fully developed this concept

7 72 Hesser Stage III The final stage of training involves the application of the student s new and continually growing approach to music therapy under the guidance of experienced music therapy supervisors. The music therapy supervision done at this time is not oriented to the communication of the supervisor s approach (which is so necessary at earlier stages of training) hut to the fullest development of the student s personal style. This advanced supervision is a delicate balance between teaching and therapy. The student is guided in the application of his/her framework and music therapy method, but at this level the supervisor also encouragesa relationship in which the student can deeply explore personal issueswhich arise in the clinical work. At the beginning of the NYU training program, few music therapists had the experience and therapy skills to do this type of supervision, but over the years we have more fully developed this concept of advanced music therapy supervision. The last step of training is the completion of a master sthesis, representing the culmination of a student s work in the program and involving a thorough theoretical or practical examination of some area of clinical music therapy. Students are individually guided throughout this process. Before completion of the program, students arecounseled regardingjob development, grants, future professional and personal growth needs,and avenues through which additional training can be obtained. Talents for writing, research, teaching, and supervision are discussed. Students leave the program with a personally developed approach and an understanding of the role they can play in our growing field. ONLY A BEGINNING This article discusses one approach to advanced training in music therapy. There should be no final position on training in a world and profession that is changing asrapidly as ours. Maslow (1971) writes of the need to make ourselves into people who no longer need to staticicizeand freezethe world and who can confidently face the future with the ability to improvise in situations which have never existed before. It is my belief that properly trained music therapists can be such people and will therefore help our world survive and prosper by finding new and creative ways in which music can be used for wellness, healing, and therapy. REFERENCES Bruscia,K., Hesser, B., &Boxill, E. H. (1981). Essential competencies for the practice of music therapy. Music Therapy, I, Maslow, A. H. (1971). the further reaches of human nature. New York: Penguin Books. I wish to thank all the people who have unselfishly given their creativity, talents, and time to

Advanced Clinical Training 73 the New York University program as adjunctive faculty, music therapy supervisors, and professional colleagues.

8 Advanced Clinical Training 73 the New York University program as adjunctive faculty, music therapy supervisors, and professional colleagues. I would also like to thank the hundreds of students who have opened themselves to music therapy training and taught me so very much about myself and my teaching. Barbara Hesser, CMT, is Associate Professor of Music Therapy at New York University and is also the Coordinator of Master s and Doctoral training at N.Y.U. She has been a president of the AAMT and edited the first issue of Music Therapy. Currently, she is one of eight members on the planning committee for the World Federation of Music Therapy.

Essential Competencies for the Practice of Music Therapy

Kenneth E. Bruscia Barbara Hesser Edith H. Boxill Essential Competencies for the Practice of Music Therapy Establishing competency requirements for music professionals goes back as far as the Middle Ages.