Music-Centered Dimensions of Nordoff-Robbins Music Therapy

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1 Music-Centered Dimensions of Nordoff-Robbins Music Therapy KENNETH AIGEN New York University ABSTRACT: The present article has a dual focus: it illustrates aspects of music-centered thinking in music therapy with examples from Nordoff- Robbins music therapy while at the same time providing insight into Nordoff-Robbins practice by explaining the music-centered rationales that support it. A brief introduction to the origins and defining characteristics of music-centered thinking is offered that utilizes David Elliott s notion of musicing and John Dewey s aesthetic theory and its differentiation of means from media. Some of the more central practices and precepts of music-centered thinking are elaborated upon including the convergence of musical and personal processes, the intrinsic value of musical experience, and the use of music as an autonomous clinical force. Central notions of Nordoff-Robbins music therapy such as the music child, the concept of quickening, the idea of establishing a musical world for a client, and the relationship between music and personal identity are reviewed. The article concludes with a brief exploration into the implications of Nordoff-Robbins practice and music-centered thinking for the future of music therapy. There is a mutually constitutive relationship between Nordoff-Robbins music therapy (NRMT) and music-centered music therapy. 1 The former term designates an overall approach to music therapy with specific theories, intervention strategies, techniques, modes of research, forms of assessment and evaluation, and values; the latter term designates a stance that one can take (much like being client-centered or directive) that can be implemented within a variety of clinical approaches. The present article draws connections between the clinical model of NRMT and the particular perspective represented by music-centered thinking. The article begins with a brief introduction to the philosophical foundations underlying music-centered thinking, expanding on ideas from the philosopher John Dewey and the music philosopher, David Elliott. The first of two main sections that follow includes a more detailed look at some of the central aspects of music-centered music therapy and shows how particular components of NRMT reflect these elements of musiccentered thinking. The second main section reverses this analytical strategy and analyzes a few of the core notions of NRMT to show how music-centered precepts are present within them. 1 Portions of the present article have appeared in the book Music-Centered Music Therapy (Aigen, 2005). This material is reprinted here with permission of the publisher. Readers are directed to the original publication for an elaboration of the arguments and topics discussed here. Kenneth Aigen, DA, MT-BC, LCAT, is an Associate Professor of Music Therapy at New York University. His clinical specialties include work with children and adolescents with emotional and developmental delays, and adults in mental health. Aigen was the research director and then co-director of the Nordoff-Robbins Center for Music Therapy at NYU for 15 years. From 2006 until returning to Steinhardt in 2013, Aigen was an associate professor in music therapy at Temple University where he received the Lindback Award for Distinguished Teaching. kenaigen@aol.com the American Music Therapy Association All rights reserved. For permissions, please journals.permissions@oup.com doi: /mtp/miu006 Advance Access publication June 23, 2014 Music Therapy Perspectives, 32(1), 2014, Music-centered ideas were implicit in the origins of NRMT in 1958 when its two developers, Paul Nordoff and Clive Robbins, first met. A music-centered perspective was reflected in the phrase they employed to describe their work as the art of music as therapy. 2 The first published appearance of the term music-centered as a descriptor of music therapy was in the mid-1980s in the name of the The Bonny Foundation: An Institute for Music-Centered Therapies, founded by Helen Bonny, Barbara Hesser, and Carolyn Kenny. Subsequent uses of the term were made almost exclusively by authors writing about guided imagery and music (GIM) or NRMT, although this is not to say that the approach is limited to those models. While music-centered thinking informed the origins of NRMT, the detailed clinical explorations and reports of scores of NR therapists working since 1959 offer a unique contribution to the general theory of music-centered music therapy. Hence, the focus of the present article is to detail some of the ways that the theory and practice of NRMT reflect underlying music-centered principles. There is a wide spectrum of practice under the umbrella of NRMT. While the overall perspective of the model is musiccentered, there is a diversity of opinion regarding issues such as whether or not music-centered precepts complement or contradict psychodynamic considerations. However, even those practitioners such as Alan Turry (1998) who comfortably integrate psychodynamic practices within NRMT do so in a way that acknowledges the music-centeredness that provides the foundation for the model. And just as music-centered thinking is not restricted to practitioners of NRMT, these practitioners are not restricted to thinking only in music-centered ways. Given these caveats, all of the discussions regarding the connections between music-centered thinking and NRMT should be understood as tendencies rather than as strict delineations. Moreover, NRMT is not a uniform practice. In the material that follows, general statements about what NRMT consists of should be understood primarily as referring to the form of practice that characterized its originators rather than to the model as a whole, which includes some contemporary variations. Origins and Definition of Music-Centered Music Therapy A number of factors are driving the contemporary development of music-centered thinking in music therapy. Personal dimension. The music-centered perspective in music therapy is deeply rooted in one s personal experience in music. Consequently, it is relevant to detail some of my own reasons for developing this perspective. My motivation 2 See Aigen (2005, pp ) for a discussion of the differences between the concepts of music-centeredness and music as therapy.

2 Nordoff-Robbins Music Therapy 19 to do music therapy stems from musical experiences that have enriched my life immeasurably. Soon after becoming a music therapist I began to realize how much they influenced my conceptualization of clinical work. I increasingly became aware of how the needs of clients reflected deficits in the areas of experience that my nonclinical musical experiences provided to me. For example, while music allowed me to experience and create beauty, my clients did not have such opportunities. My relationship to music played a vital role in adding a sense of purpose and meaning in my life, and yet my clients had few opportunities to engage in activities that contributed to a meaningful life. I soon came to the realization that the best thing I could do for clients in music therapy was to provide opportunities to gain from music what I was gaining from it outside of music therapy. This recognition of the essential continuity between clinical and nonclinical musical experiences is a core aspect of music-centered thinking, and one that is shared with other contemporary frameworks such as community music therapy (Pavlicevic & Ansdell, 2004) and resource-oriented music therapy (Rolvsjord, 2010). Theoretical dimension. Music therapy theory has traditionally been draw from nonmusical domains such as psychology (psychoanalysis, behavioral learning theory), neurology, education, and sociology. Each of these systems of thought has fundamental assumptions unrelated to music. Because none of them were created to explain music and musical experience and are therefore not accountable to the nature of music, they can distort or pay insufficient attention to the specifically musical aspects of music therapy. The use of nonmusically-based concepts to explain music therapy has a number of negative consequences: (a) the uniqueness of music therapy as a discipline is obscured because what music specifically contributes to the clinical process is hidden. When the musical aspects of music therapy are minimized, people without clinical-musical training feel entitled to apply musical therapeutically. (b) The maturation of the discipline is impeded because if existing theory directs us away from an essential aspect of the process, our ability to explain how and why music therapy works is impaired. (c) Because a large percentage of clients in music therapy are motivated primarily by a desire to make music, when rationales for treatment and the formulation of legitimate goals do not reference music, client perspectives and interests are marginalized. (d) The exclusive use of nonmusical concepts leads to a situation where theory becomes disability-based rather than health- or wellness-based. Music is conceptualized as an intervention to remediate deficits rather than as a medium of engagement that mobilizes strengths and resources. Music-centered thinking was developed to counter these trends. 3 Grounding music therapy practice in ideas about music is a developmentally necessary step for music therapy to take and stronger theory will be developed when that theory is adequate to the nature of music and musical experience. 3 In addition to the text from which portions of the present article were drawn, other publications that manifest aspects of music-centered thinking include Ansdell (1995), Epp (2001), Garred (2006), Lee (1996, 2003), and Verney & Ansdell (2010). An autonomous foundation for practice. Psychotherapy practice is based on a theory of personality regarding how the human psyche operates. The different models of psychotherapy are based upon different models of the psyche. In the music-centered perspective there is no rationale for taking on any particular personality theory as a basis for music therapy practice because music therapy is considered to be an autonomous discipline, not a form of psychotherapy, rehabilitation, or special education. The music-centered conception of music therapy is closer to that of a specialized application of music rather than a specialized form of therapy. Theory for music therapy as an autonomous discipline requires a foundation in music. A conception of music is necessary for the foundation of music therapy just as a personality theory is necessary for psychotherapy. Developments in the profession of music therapy. Musiccentered theory was developed to provide a theoretical framework for what many music therapists were already doing. Prior to the articulation of music-centered principles, significant numbers of practitioners were using approaches with clients that resembled nonclinical uses of music. Some focused on creating music in rock or jazz bands, some focused on composing and recording songs with clients, and others were utilizing the idea of performance in a clinical way. The framework of music-centered music therapy combines with likeminded frameworks such as community music therapy and resource-oriented music therapy to accommodate these ways of working with clients and provide a conceptual support for them. In his exploration of the application of NRMT with adult clients, Gary Ansdell wrote that music therapy works in the way music itself works (Ansdell, 1995, p. 5). In defining music-centered music therapy I have extended Ansdell s statement to the notion that in music-centered music therapy, the mechanisms of music therapy process are located in the forces, experiences, processes, and structures of music. Each of these four dimensions or levels of analysis has a corresponding discipline of inquiry that has traditionally focused upon it: In identifying the forces of music as a potential explanatory mechanism of music therapy, one can draw upon the ideas of philosophers of music, who discuss its ontology or the nature of the tonal, harmonic, rhythmic, and timbral material that constitutes music; in identifying the experiences of music, one gains access to the material from psychological and social science research that studies musical experience and the cognitive operations involved in performing, composing, and listening to music; in identifying the processes of music, one gains access to all of the ideas from the disciplines of ethnomusicology, sociology, and anthropology, that discuss the social processes involved in the creation of music and the social contexts in which it is used; and in identifying the structures and forms of music, one can draw from music theory and musicology studies of how music is constructed and what this tells us about its clinical value. Music-centered theory and practice advances the development of music therapy in a number of ways. First, it broadens the number of domains music therapists draw from and interact with to include areas such as musicology, music philosophy, and music theory. Because the music-centered position

3 20 seeks to explain the efficacy of music therapy within specific musical structures and processes, it allows greater specificity in musical interventions. For example, consider the analysis in Aigen (2009) that shows how the management of verticality in tonal space (high and low pitch relationships), melodic direction and spacing, and cadences, in music therapy improvisation helps to facilitate the ability of a physically-impaired client to move in physical space. In this way, music-centered theory can explain the rationale for the tonal, rhythmic, harmonic, and stylistic components of clinical music. As will be subsequently discussed, the music-centered approach honors client experience and desires because it can account for the value of music therapy when the client s motivation is primarily to make music rather than to achieve a nonmusical goal. Music-centered thinking establishes continuity between nonclinical and clinical musical experiences, emphasizing that some music therapists are musicians who work in therapeutic contexts to bring the inherent benefits of musical and musically based experiences, rather than therapists who use music as a tool to achieve goals that are not specific or unique to music. There are two different ways that the term music-centered can be employed. For some therapists, the term is an allencompassing label that summarizes central components of their work. Being music-centered is something that they are it is part of their identity. It is reflected in a clinical practice characterized by a great deal of musical specificity in interventions and theory. For other therapists, the term accurately describes aspects of their practice and thinking, although they may have other beliefs that are equally if not more important that contrast with or complement music-centered thinking. Being musiccentered is something that they do it is a stance that one can move in and out of. It can be reflected in a clinical practice that places music in a central role or that holds music and musical experience in great esteem, but it may be implemented without the same degree of musical specificity as would characterize the first group. As a stance that one can choose to employ in particular circumstances with particular clients, it is no different from being directive or client-centered. The bottom line is that music therapists should decide for themselves how and when to make use of this way of thinking based upon client needs and treatment contexts. Foundations of Music Centered Thinking Music as a Medium of Experience Many music therapists define music therapy as the use of music to achieve nonmusical goals, thus distinguishing it from music education, music appreciation, or music performance. There are a myriad of possible goals that vary according to the treatment milieu. Typical goals include increasing impulse control, enhancing social skills, increasing emotional expressiveness, resolving psychological conflicts, improving cognitive functions such as increasing attention span, and any number of goals in the social, emotional, cognitive, physiological, neurological, or motor areas. The rationale is that the clinical must be distinguishable from the musical for a particular use of music to be considered music therapy. Music Therapy Perspectives (2014), Vol. 32 However, this approach renders the actual musical experience dispensable. The music becomes merely a tool to achieve some nonmusical end, goal, or experience. The musical experience is dispensable because if a better tool can be found to achieve the nonmusical goal, then there is no rationale for the music therapy intervention. In contrast to this position, the goal of music-centered work is the achievement of experiences and expression specific and unique to music. In this view, the clinical and the musical are not separable. What is achieved through the music cannot be approached in any other way because musical experience and expression are the goals of therapy. Implicit in this idea is that musical experience and expression are inherently beneficial human activities that are legitimate ways to address the reasons for which people come to therapy. There is no denial that capacities such as impulse control, expressiveness, and social skills can increase from the musical engagement; it is just that these are considered to be secondary effects, not the primary locus of intervention. Therefore, music is not necessarily a tool for achieving something else. What Elliot (1995) calls musicing (see next section) is the goal of music therapy. The idea that musical goals are a legitimate focus of music therapy involves conflating the means and ends of music therapy. In this way of thinking, musical experience is framed as a medium of experience in the sense that John Dewey uses the term in his aesthetic theory (Dewey, 1934). In discussing the common substance of the arts, Dewey makes a detailed examination of the role and significance of the medium of particular art forms. Dewey observes that the word medium implies the presence of an intermediary, as does the word means. Both words indicate the presence of an intervening process, activity, or substance through which something occurs. But there is a crucial distinction between the two concepts: Not all means are media. There are two kinds of means. One kind is external to that which is accomplished; the other kind is taken up into the consequences produced and remains immanent in them.... External or mere means, as we properly term them, are usually of a sort that others can be substituted for them.... But the moment we say media, we refer to means that are incorporated in the outcome. (Dewey, p. 197) Human activities can be separated into those that are media and those that are mere means. A medium is an experience sought for what is inherent in it; a mere means is a tool to an external end. Dewey uses the example of a student studying merely to pass an examination compared to another student for whom learning has a meaning apart from its instrumental value. We can also think about the difference between traveling to get somewhere, such as getting on the train to go to work, and traveling for the pleasure of it, such as hiking in the mountains. In the former example, our travel is a means to an end, getting to work, and we would gladly do without the means if we could be instantly transported to our workplace. In the hiking example, it would not make sense to say that we would gladly do without the travel to get to the end of the hike, because the travel itself is our motivation and our goal. In music-centered thought, music is a medium of experience. It is indispensable. In this way of thinking, musical experiences are more akin to the travel involved in hiking in the

4 Nordoff-Robbins Music Therapy 21 mountains than to the travel involved in getting to work. Just as one would not do without the travel in the hiking example because the trip itself is the focus, in music-centered work one would not do without the musical experience because it also is the focus. Hence, there is a unity of means and ends as regards the music in music-centered theory. This is similar to what is the case in aesthetic experience in general Dewey believes it is a defining feature of the aesthetic and helps to explain the relevance of aesthetic concerns in music-centered theory. 4 Strictly speaking, means and media are not dichotomies. Dewey s presentation of the concepts does not preclude something from functioning both as a means and as a medium. A medium is a medium for something. It is an entity, process, or substance through which something occurs, and in this way it is similar to a means. Identifying something as a medium does not formally dissolve the notion of a means; it just locates what is usually considered the external goal of the means to an internal position within the means itself. So, for example, the student who embraces learning for the love of it may also have a wish to earn high grades. The hiker may also be pleased by the fact that the walk in the mountains will have positive cardiovascular health benefits. But the reason why these activities can be considered media of experience is that these secondary benefits are just that; they are not the sole or even the primary reasons for which the activity is undertaken. In the same way, music-centered music therapy can lead to many areas of benefit that are either nonmusical in nature or not connected in a singular way to the musical experience. This observation, however, does not invalidate the fundamental notion of music as a medium of experience in music therapy, any more than it does in the hiking or educational examples. The Concept of Musicing A primary focus of music-centered approaches is to bring a client into a state of musicing as Elliot (1995) defines the term: To act is not merely to move or exhibit behavior. To act is to move deliberately, with control, to achieve intended ends.... Musicing in the sense of musical performing is a particular form of intentional human action.... To perform music is to act thoughtfully and knowingly. (p. 50) Music is not just something we know. It is something we do, and this is an informed doing, embodying a specific form of knowledge. In this view, music is clearly not behavior in the sense of actions devoid of consciousness. Hence a true music therapy is incompatible with behaviorism because if it is behavior that is being conditioned, then it is not musicing that is the object of the behavioral contingencies. Musicing implies the activation of knowledge, but it is knowledge that is implicit it is knowledge-in-action (Schön, 1983). The act of musicing implies an informed doing. Therefore, making the judgment that a client is musicing and not just interacting in a motoric or sensory way with a musical instrument means that cognitive capacities are present that may not be evidenced in any other way. 4 See Aigen (1995) for a detailed application of Dewey s aesthetic theory to music therapy theory. Musicing is not just an informed doing on the client s part but on the therapist s as well. This explains why the more music-centered one s practice is, the less important is extrinsic theory in guiding clinical-musical actions. In music-centered practice, the therapist follows the dictates of music-making because of a belief that the creation of music is itself the product of informed thought that is embodied in it. The music-centered position is not anti-intellectual or anti-theoretical, but locates the activity of intellectual processes within the musical ones. And just as the therapist s therapeutic thinking takes place musically, for the client the therapeutic locus is still within the musical (Ansdell, 1995, p. 4). 5 One of the implications for music therapy is that making music is never just making music in the sense of being engaged in rote behavior. The judgment that musicing is occurring implies that there is intelligence, intention, and consciousness present, although these qualities may not be verbally expressed. This is because musicing is a unique way of knowing based on its own epistemology, not reducible to verbal formalizations. In Elliot s view, musicing is a most valuable human experience. He believes that self-growth, self-knowledge, and enjoyment are the primary reasons for making music. They underlie all others. Musicing consists of activities that order and strengthen the self, and our goal as human beings is to engage in activities that reflect this desire. We find as enjoyable and meaningful those activities that are congruent with our fundamental drive toward self-development. The development of self comes primarily from activities without biological necessity. And flow experiences (Csikszentmihalyi, 1990), in particular, lead to more complex self-organization. Flow experiences arise when we apply our conscious powers and knowledge in goal-directed activity; musicing can be an exemplary flow experience. The construct of musicing supports a music-centered notion of clinical practice where the essentially musical experience is a legitimate clinical goal because music exists primarily as a medium for the development of the self. Elliot s ideas on the value of music-making are relevant for music therapy because in some applications clinical skills are used to create a context where a client can be musicing. What is clinical about this is not the addressing of a nonmusical skill, but the way that particular obstacles are circumvented in order to give the same musicing experience to a client that musicians in nonclinical situations obtain. It is music therapy not because the goal is different this is still to produce and/or experience music but because of what is done to help the person achieve a state of musicing, a point that will be further elaborated in the following section. Aspects of Music-Centered Theory in Nordoff-Robbins Music Therapy A number of rationales and practices characterize musiccentered thinking. In the present section, each of these aspects of music-centeredness will be briefly explained along with a description of how each one is specifically manifest within NRMT. 5 There has been some debate in the literature regarding these tenets of musiccentered thinking. For an argument critical of these views see Streeter (1999). Responses to Streeter s critiques include Aigen (1999), Ansdell (1999), Brown (1999), and Pavlicevic (1999).

5 22 Musical Goals as Clinical Goals: Musical Development as Self-Development Many music therapy clients are motivated primarily by a desire to make music. This recognition is a central point of departure for music-centered approaches. Whether we are considering a child with autism with an affinity for playing the piano, a group of adolescents with behavioral problems creating a rap song, or an elderly woman with Alzheimer s disease singing a song from her youth, in each case the client s primary motivation is to participate in music, not to achieve some nonmusical clinical goal. For such individuals the motivation behind the music-making is no different from the motivations of people who make music in the nonclinical domain. Of course, there are many other clients for whom the primary benefits of music therapy may not be in the musical domain. No one would reasonably argue otherwise. However, for clients whose desire in music therapy is primarily to participate in music, a music-centered stance can be the most appropriate one to adopt. The use of purely musical clinical goals is legitimate when this dovetails with the client s agenda, whether this is stated explicitly by the client or is conveyed implicitly by the client s actions, affect, or expression. This does nothing more than reflect a profound respect for the client s perspective on the clinical experience, and it also makes room for situations where the client is not able to state a preference but communicates it in other ways. For clients who cannot communicate their preferences directly, it is important for the music therapist to use individual judgment in deciding when the client s motivation is primarily toward musical participation. In the music-centered perspective, there is license to express clinical goals in purely musical terms. This is not to deny that changes in nonmusical areas can occur, or even that these nonmusical changes can be the music therapist s primary focus at times. It is merely to say that when one is practicing in relatively pure music-centered fashion, one is seeking to develop and enhance capacities for musical expression and experience. Changes in other areas frequently occur as secondary consequents of the primary locus of intervention, the client s ability to music. Yet, these changes, as welcome as they are, are seen as things that accompany the primary process and are not what justify it. The starting point for this way of thinking is that music enriches human lives in a unique and necessary way. Music therapy consists of providing opportunities for musicing to people for whom special adaptations are necessary. The functions of music for disabled individuals or for those in need of therapy are the same as for other people. It is the means for achieving the musical state that comprise the music therapist s craft and that differentiate music therapy from music performance or music education. In this view, music therapy involves the creating of special conditions where musicing can happen for people who cannot create the conditions on their own, whether this is due to physical, cognitive, social, or emotional reasons. The therapist s primary responsibility is to effect the deepest possible involvement in music by the client. This stance reflects a belief in the convergence of personal and musical development. The therapist formulates strategies to deepen and differentiate the client s musical experience and the Music Therapy Perspectives (2014), Vol. 32 therapy lies in the variety, complexity, depth, and beauty of the musical expression thereby achieved. These experiences of oneself in music contribute to a fuller sense of self. 6 The convergence of musical and personal process is reflected in a number of ways in NRMT. First and foremost is the primary clinical focus of working through music to effect change in a client s capacity for musical experience and expression. The fundamental notion is that client limitations are fully reflected in the client s capacity for expressive, responsive, and engaged musicing. If a person can only play in one tempo or dynamic level, that person cannot have musical-emotional experiences that require other levels of tempo or dynamics, or that require the use of a ritard, accelerando, diminuendo, or crescendo. The therapist works to expand the client s musical range of expression in order to help the client be able to experience all aspects of human emotional life. This is why ongoing assessment and evaluation in NRMT examine the development of things like tempo mobility, dynamic flexibility, and melodic and rhythmic complexity, items of assessment in Scale III: Musicing: Forms of Activity, Stages and Qualities of Engagement (Nordoff & Robbins, 2007). These aspects of one s musical functioning are understood broadly as reflections of one s overall cognitive and affective relationship to the world and to oneself. Emotions sometimes build inside people like a crescendo or accelerando, or they can come on us suddenly as in accented cymbal crash. When clients in music therapy develop these skills relevant to the expressive dimensions of music they are simultaneously developing the capacity to first tolerate and then enjoy the full realm of human emotional experience. Instead of being imprisoned by a paucity of emotional experience, they become liberated by the ability to fully experience their humanity as represented in emotional experience. Working on music is working on one s inner life as clients order their being as they order their beating, realizing order and purpose in themselves as they find these qualities in the music (Nordoff & Robbins, 2004, p. 53). However, while musical behavior is what is assessed in NRMT, the approach is not congruent with behavioral principles. Nordoff and Robbins went to great lengths to emphasize that musical behaviors only have clinical significance to the extent that the client s commitment and motivation to them can be determined. For example, the two primary categories of assessment in Scale III are instrumental rhythmic activity and singing. In neither one can the clinical significance of a response be determined by its structural character alone the degree of activation or engagement expressed in it must be recognized as having at least equal importance (Nordoff & Robbins, 2007, p. 419). Thus, the clinical significance of what a client does musically can only be determined in reference to the quality of engagement with which it is done. The way that musical engagement can serve as the template for self-actualization was illustrated in the very first extended 6 The concept of beauty intended here is a broad one that goes beyond the idea that aesthetic experience must conventionally pleasing. Instead this notion includes music that could be harsh, dissonant, or otherwise clashing. For an exploration of this issue see Aigen (1995, 2007, 2008), and responses to the 2008 publication from Smeijsters (2008) and Stige (2008).

6 Nordoff-Robbins Music Therapy 23 courses of therapy undertaken together by Paul Nordoff and Clive Robbins. In an unpublished manuscript, Nordoff and Robbins first discussed the role of musical interaction in the development of the self: It is characteristic of the therapy process that as his response ability develops and musical communication intensifies, the responsive organization he integrates comes to hold a positive experience of identity for him. In effecting and discovering a train of functional integrations and the communicative experiences they directly realize, he discovers and realizes himself. At this state of therapy he develops a musical self a musically organized and sensitive substratum in his personality that he feels to be an essential aspect of himself. (Nordoff & Robbins, cited in Aigen, 1998, pp ) It is this musical self that is the core of the developing personality and that first integrates the cognitive, affective, and physical aspects of the being into a coherent, unified self. The musical self and musical skills are not seen as existing on the periphery of the self and then requiring absorption into the core of the person in order to be clinically beneficial. Instead, it is the musical self that exists at the core and other areas of functioning and awareness radiate from this center. By acting on a person s music, the therapist is directly engaged with the most central aspects of the person s being. This notion directly speaks to the music-centered belief that musicing itself is an essential human activity that does not require translation or generalization into other areas in order to be a legitimate clinical focus. The development of the musical self becomes an orientation point, a new center, around which a more developed personality can constellate itself (Aigen, 1998, p. 144). NRMT focuses on behavioral manifestations not as items of interest in their own right but as reflections of the inner dynamics, structures, strengths, and limitations of the person s being. The idea is not simply to alter behaviors but to provide an alternative blueprint for the formation of a more functional, healthier personality structure. The music-centeredness of the approach is seen in the fact that it is music itself that provides the template for the development of the newer and healthier self: Much as the laws of DNA provide a plan for the structure of fully functioning physical bodies, aligning our naturally occurring propensities for emotional and cognitive development with the laws of music provides for fully functioning psychological beings (p. 144). In NRMT, the evolution of the clinical music reflects the development of the client so that experiences of merging with or becoming the music are not distractions; instead, they represent the clinical focus. The expansion of boundaries and consciousness enabled by music opens people to new experiences. To the extent that the person becomes the music, the dynamic processes characterizing the tonal and rhythmic aspects of the music become available to the client to experience. For example, physically-impaired clients can experience motion, emotionally constricted clients can experience the full range of human emotions, and isolated clients can commune with other people through things like rhythmic groove. And all clients, regardless of area of need, can experience the potential for transformation at the heart of musical development, either through active music-making or receptive listening. The Intrinsic Value of Music and Issues of Generalization in Therapy In music-centered music therapy approaches, the intrinsic rewards of musical participation are drawn upon in the development of treatment rationales. Music is not used as an inducement to other behaviors nor is it used as a vehicle for insight into other thoughts and feelings. It is the inherent rewards of musical experience that provide the client s motivation to musical activity and that explain the value of music therapy. The emphasis is placed on the creative, expressive, aesthetic, communal and transpersonal dimensions of music. These are functions of music that promote wellbeing in nonclinical domains. They provide essential human experiences (Ramsey, 2002) approached in unique ways through music. And for many clients, music therapy is the only way to access these experiences. Creative processes counter feelings of depression, despair, and a general withdrawal from life activities. Expressive musical processes bring us into more intimate contact with human emotions and music allows this in a way that bypasses barriers imposed by fear and anxiety. Aesthetic experience is considered to be a fundamental psychological human need as all people resonate to beauty in life. The inherent human drive to create and experience beauty motivates people to engage in activities that create the circumstances for its emergence. Communal experience provides us with feelings of participating in something larger than ourselves as is embodied in various intentional communities, family life, religions, political entities and various types of sub-cultures. However, many music therapy clients experience extreme isolation, such as those with mental illness, children with autism, and the elderly. The demands of creating music together involve moving beyond the isolation that characterizes many clinical conditions. For people whose conditions prevent them from meaningful participation in any type of social group, music therapy provides an experience of belonging to something larger than oneself. Moreover, there is an overall concern with client process and client experience in music-centered thinking because the process is the therapy. Client outcome is not a static state of being achieved at the end of therapy, but is instead something that unfolds within the clinical process itself as the music is realized. The way the person is during the musicing is the clinical outcome. Hence, the goal of therapy is not necessarily growth or change as is commonly understood, but the evocation of skills, capacities, functions, experiences of self and community that do not occur in other ways. What this means is that the generalization of functioning is not the validating criterion of the work as is typical with other therapy frameworks. Music therapists frequently see clients function in music in ways that are beyond what they are capable of in other areas. However, the absence of generalization is not considered a deficiency in music-centered theory. This somewhat unconventional sense bears some explanation. By virtue of their career choice, music therapists all have music at the center of their lives. Speaking as a music therapist, I can say that many of us have special feelings about music and about ourselves in music. We can create beauty in music, we can commune with others, and we can feel more

7 24 in tune with the forces of nature and with other people. Yet we have these feelings primarily when actively engaged in music. We may or may not see these feelings generalize to other spheres of activity, but that does not mean we value them any less. This is because the experiences in music contribute to an overall sense of meaning and purpose in life. In music-centered thinking, this same right is granted to music therapy clients. Individuals without disabilities have the means to engage as deeply as they like with the world of music without having to justify their involvement based on the accruing of benefits in nonmusical areas. Music-centered thinking asserts that clients with disabilities and without the means to control their own access to musicing should have the same opportunities as nondisabled people without having to justify their access to music based on its extrinsic benefits and generalization into other areas. This generalization, although valuable when it occurs, should not be the criterion that validates the worth of music therapy for an individual. Music therapists create an environment where clients can function at their highest level. At times, other people will not see these gains in other milieus or areas of functioning. But the fact that others cannot structure their environments and relationships in a way to evoke the higher capacities of clients should not be considered a deficiency of music therapy. Music therapists have a tool that shows what people are ultimately capable of when they are offered a mode of functioning tailored to their strengths. It is the responsibility of individuals in other contexts to alter their programs or treatments to evoke those higher levels of functioning. Thus, the absence of generalization is seen not as a deficiency in music therapy but rather as due to what is and is not afforded by the values, activities, demands, and relationships that characterize other areas of human functioning. Underlying NRMT is the value that therapists have an obligation to provide music to individuals who are difficult to reach through other means. For people with significant levels of affective or cognitive impairment, musical interaction can represent the only means for them to manifest their intelligent awareness and to connect with other people through this intelligence. Music therapists with the tools to facilitate communication and relationship through music with people for whom these experiences are not otherwise available are under a moral imperative to do so. Relationship and communication are the two elements directly evaluated in NRMT through two primary evaluation scales: Scale I. Child-Therapist Relationship in Coactive Musical Experience 7 and Scale II. Musical Communicativeness (Nordoff & Robbins, 2007). As indicated by the titles of these scales, it is purely and solely within music that assessment and evaluation take place. Scale I considers relationship in music because in NRMT the therapeutic relationship is fundamentally an interactive relationship centering in and around making and experiencing music arising in the special circumstances of therapy. It results from and takes expression in the musical-personal interresponsiveness of child and therapist (Nordoff & 7 Although the word child is used in the name of the scale because it was developed primarily with child and adolescent clients, there are no elements of it that are specific to clinical work with children and it can be used with clients of any age. Music Therapy Perspectives (2014), Vol. 32 Robbins, 2007, p. 372). Scale II is similarly circumscribed by musical functioning as it evaluates the extent to which the client is involved in a process of awakening to musical awareness, to its perception and pleasures, and to the experiences of communication, personal freedom, and accomplishment that can ensue (p. 396). The focus in NRMT on musical goals is one of its defining features that differentiates it from the predominance of music therapy practice. As Gary Ansdell describes, because of this musical emphasis, to understand the therapist s intention and the nature of the process for the client, listening is more important than watching: For different kinds of music therapists the work looks different. In a type of work that focuses on interpersonal goals you tend to see therapists searching out for eye-contact and explicit communication. Whereas very often if you watch a video of a Nordoff-Robbins session it can appear that therapist and client are not physically focused on each other... they re involved in the music through playing their instruments. But if you just listen to that session you can hear them communicating intimately inside music. (Verney & Ansdell, 2010, p. 68) Ansdell s comments highlight the fact that in NRMT sessions, the therapist focuses efforts at relatedness primarily into the musical medium. The idea is that musicing represents the client s area of strength and the therapist endeavors to channel the client s energy, focus, and communicative motivation into musical relating. Moreover, it is not a relationship as a reified entity that is central to NRMT. Instead, it the process of relating to other people through the mobile, expressive medium of music that is emphasized over the establishment of an enduring interpersonal relationship, a point made succinctly by Rachel Verney: Therapists always talk about the relationship as if it s a thing. But actually what we re working on are qualities of relatedness which is something quite different from a relationship (Verney & Ansdell, 2010, p. 69). In NRMT, music is an essential part of what it means to be human, both in a phylogenetic and ontogenetic sense. In this vein, to be born is to be musically endowed, and to be musically endowed is to inherit a readiness to share in the companionship of musical communication (Nordoff & Robbins, 2007, p. 395). Clive Robbins in particular drew from the notion promoted by Victor Zuckerkandl (1973) of homo musicus or man as musician, the being that requires music to realize itself fully (p. 3). In NRMT, this innate capacity to relate musically and the innate need for musical relating to fulfill one s human needs and drives is what warrants the provision of music to clients in music therapy. Because music is a necessary part of human self-development, the client s growth within it is self-justifying in a clinical sense. Music is Employed as an Autonomous Clinical Force In a variety of music therapy applications, music can be used to take on functions that are typically assumed by the person of the therapist. For example, in music psychotherapy music can be used to nurture a client or to provide a reflection of underlying affect, and in rehabilitative music therapy the rhythmic aspect of music can be used to replace verbal encouragement.

8 Nordoff-Robbins Music Therapy 25 There is another way music is used toward this end that is specific to music-centered work. In this use of music, its specific inner workings, structures, and processes are used to depersonalize aspects of therapy that might otherwise be more problematic, threatening, or challenging to clients. Here, music itself is used to take on the more difficult demands of the therapy process. For example, in active approaches specific compositions or styles of music can be used whose realization pose challenges to clients in their areas of need. Slow, reflective pieces can be used with hyperactive children; pop music requiring the production of a constant, stable rhythmic groove can be used with clients with a wide range of motor and cognitive deficits who might otherwise find sustained, focused activity to be challenging. Clients are motivated to overcome areas of limitation not out of an external compliance to the therapist s desires but because of internal motivation to have the experience afforded by meditative or groove-based music. In these applications, the client s inner motivation to realize the style is used to overcome deficits without activating problematic relationship dynamics that could cause a client to feel overly pressured or challenged by a therapist. This way of using music can be employed in receptive music therapy as well. Consider how Lisa Summer (1998) has talked about idea of the pure music transference in guided imagery and music (GIM). In this conceptualization, music takes on potentially problematic transferential projections, thus preserving the therapist-client alliance. In the Nordoff-Robbins approach, music is considered to possess inherent qualities, seen in things such as the forces and impetus to motion that exist in its tonal and rhythmic constituents. Through the intentional choices of melody, harmony, rhythm, tempo, dynamics, timbre, touch, and musical style, NR music therapists engage in the full range of potential clinical interventions through the music. This includes supporting, containing, inspiring, inviting, challenging, and even confronting them. Yet because they are embodied in music, all of these interventions are implemented without the same level of resistiveness or reflexive rejection that overt verbal interventions might elicit. For example, the therapist will not say things like Look at me or Come closer or Beat the drum slower or softer. Instead, the therapist s music will say these things intrinsically. Moreover, when a direct verbal communication is desired by the therapist, this can often be done with sung lyrics. Thus, when the client does establish eye contact, seek out physical proximity to the therapist, or play in more sensitive or expressive manner, these things are done not merely as result of complying to the therapist s wishes but they are reflecting a desire on the client s part to relate to the therapist or the music, or the therapist through the music. These behaviors are coming about not due to obeisance to an external directive but as a reflection of an inner motivation. The client relates more intimately to the music, the therapist, and the situation in general not because he is being told to but because something has been awakened within him that wants to relate in this way and that now feels safe in doing so. The development of the inner person is a lasting change not dependent upon the vagaries of environmental contingencies. Music-Centered Aspects of Nordoff-Robbins Theory The Music Child The original music-centered concept in music therapy is that of the music child, first proposed by Nordoff and Robbins (1977, 2007). As with any resilient concept that becomes familiar with much use, it can be beneficial to revisit it with fresh eyes to see how it relates to contemporary concerns and questions. It is the central idea in the work of Nordoff and Robbins, and much of the book Creative Music Therapy (Nordoff & Robbins, 2007) is devoted to portraying its living manifestation. The music child is explained as that entity in every child which responds to musical experience, finds it meaningful and engaging, remembers music, and enjoys some form of musical expression. The music child is therefore the individualized musicality inborn in each child: the term has reference to the universality of human musical sensitivity the heritage of complex and subtle sensitivity to the ordering and relationship of tonal and rhythmic movement and to the distinctly personal significance of each child s musical responsiveness. (p. 3) The term music child denotes a constellation of receptive, cognitive, expressive, and communicative capabilities that can become central to the organization and development of the personality insofar as a child can be stimulated to use these capabilities with significant self-commitment. (Nordoff & Robbins, 2007, p. 4) Three of the more important aspects of the music child that relate to concerns of music centeredness are its inborn nature, its universality, and its role as a central point around which personality development can be constellated. It is reasonable to consider why human beings would be born with a propensity to music with others unless music is essential to fulfilling human nature. We have other innate psychological constellations, such as a template to learn verbal language and a tendency to bond with a primary caregiver. Both of these are activities that have clear survival value, and they suggest that relating verbally with others and establishing parent-child relationships are essential experiences to have as human beings. The fact of music s innateness suggests that it is an essential human activity, without which we are less complete as human beings. If this is so, then the idea of musical experience as a clinical focus and as a medium of experience is warranted because it provides an essential human experience. Many clients with whom music therapists work are deprived of either receptive or expressive language, or both. This includes individuals as varied as children with developmental delays, adults with different types of brain injuries, comatose individuals, and those with more advanced forms of dementia. But the universality of the music child suggests that the opportunity to music in some form is present in all of these individuals, regardless of deficits in other areas. Sometimes, the music therapy experiences can be used to develop skills in other areas. But even if there is no such generalization, the universality of the need for music suggests that all people deserve opportunities to music, regardless of the degree to which the musicing advances functioning in any other areas of their life. The idea that music therapy treatment does not necessarily