Music Therapy:
All but one of the research projects highlighted have been conducted by or the sessions led by Music Therapists. The American Music Therapy Association (1999) cited by Green (2011) defines music therapy as the ‘clinical and evidence-based use of music interventions […] within a therapeutic relationship to address physical, emotional, cognitive and social needs of individuals. Bunt (1984) cited by Stige and Aaro (2012) explains that ‘much of the early work of the professional music therapist began in the large institutions for the mentally handicapped and mentally ill people (p 44). This lead McFerren (2010) to describe ‘the traditional music therapy practice as an intervention for unwell clients. (p 29).
The therapist will use a medical model to assess the needs of the individual and select an appropriate course of treatment that will have a positive effect on the assessed needs. The patient’s pathology and clinical diagnosis strictly define the aims, means and outcomes of the treatment. Effectiveness is determined according to a change in symptoms (Wood & Ansdell, 2018). Green (2011) describes how, when treating trauma survivors, the therapist creates a safe space to explore the meanings of the traumatic memories the trauma victim has and cites Cohilic, Lougheed and Cadell (2009) stating that it is widely excepted that, to recover from PTS or trauma, individuals must gain access to their traumatic memories so they can re-examine, modify and reconstruct them. Green (2011) explains that when someone is musically engaged with the therapist the emotional impact of the traumatic experience becomes accessible and that once those memories have been reconstructed the individual can face the task of creating a future identity and not be defined by the traumatic event.
To suit the clinical need the therapist can draw upon a range of intervention activities these could include: singing, musical improvisation, listening exercises, and a discussion of the emotions conveyed through a piece of music heard by the patient (Bond & Wigram 2002) cited by Landis-Shack et al. (2017) Although traditionally therapy is on an individual basis, Landis-Shack et al. (2017) also describe the use of group work, playing in bands, recording music and songwriting. Bensimon et al. (2012) also describe the use of group work with improvisation, drumming and listening to relaxing music.
Since the late 1990s, some Music Therapists have been adopting a more community-based approach rather than the ridged traditional approach. This has been termed Community Music Therapy and has been discussed by Pavlicevic and Ansdell (2004), Ansdell and DeNora (2012), Ruud (2012), and more recently by Ansdell and Stige (2015). Music Therapy achieved state registration in the UK in 1996 and is now classified as Allied Health Professionals by the Health and Care Professions Council (Wood & Ansdell, 2018). Mental health providers must refer clients to music therapists if they want to incorporate music therapy into the treatment (Landis-Shack et al., 2017).
Community Music:
In contrast to the academic, medical profession that is traditional music therapy Community Music traces its roots to the cultural radicalism of the community arts movement. Higgins (2012) describes CM as an expression of cultural democracy where the musicians create musical opportunities for a wide range of cultural groups and as having three broad perspectives:
1) Music of a community.
2) Communal music making.
3) An active intervention between a music leader or facilitator and participants.
It is, in essence, about widening the participation of music in the community rather than those with clinical needs. Community musicians seek to enable accessible music-making opportunities for members of the community (Higgins, 2012) and are committed to the idea that everybody has the right to and ability to make, create and enjoy their own music. Kelly (1984) states that Community Arts began as one strand of activism among many during the late 1960s. Veblen (2008) cites Cole (1999) and describes the theme of ‘access to arts for all’ that emerged in the 1960s and 1970, and the links between the term ‘Community Music.’ The early manifestations of Community Arts were associated with the working class and working-class values. There was opposition to what was seen to be the ruling classes and its highbrow approach and control over the arts and what was unworthy. This caused growing political activism and radicalism. The theme of CM became political, activism and justice are at the core of CM (Higgins & Willingham, 2017). The core value is that music should be accessible to all and CM practice is built on the premise that everybody has the right and inherent ability to create and participate in the music (Higgins & Willingham, 2017). The continued distrust of cultural hierarchies and institutionalism would cause resistance to professionalise the practice of CM and state registration of Community Musicians.
By 1989 ‘Sound Sense’ was created as a national development agency, by 1990 the different areas of employment for Community Musicians were identified and the first training courses in the UK found momentum by 1994 and the term training rather than education was used to describe the professional development as vocational rather than academic (Higgins 2012). This training continued to develop with Higher Education establishments including CM in their courses and the introduction of postgraduate courses. The academic discussions surrounding CM continued and in 2008 the International Journal of Community Music was established (Higgins 2012) and ‘as a direct response to this wave of international interest, the International Centre for Community Music (ICCM) was established (Bartleet & Higgins, 2018).
Higgins (2012) describes one perspective of community music as ‘an active intervention between a music leader or facilitator and participants.’ Deane and Mullen (2013) agree to cite Everitt (1997) that community music describes professional musicians carrying out interventions intended to have consequences other than musical (p26). Those that work this way do so with a commitment to a musical crucible for social transformations, emancipation, empowerment and cultural capital (Higgins & Willingham, 2017). The Community Musician achieves this by running Clubs, workshops, and community events taking music into the community.
Higgins (2012) bases the philosophy of community music on ‘acts of hospitality.’ This starts with the welcome of the participant to the group, the welcome is an invitation, an invitation to be included. This welcome although some may say is unconditional, there is an expectation that the new participant will actively take part in activities and that they understand this will be the case. The facilitators aim to provide a safe space that is built from trust and respect and friendship that evokes collective and inventive conversations that aim to encourage music making that is open, creative and accessible (Higgins 2012). Community musicians emphasize conversation, negotiation, collaboration and cultural democracy (Higgins & Willingham, 2017). The workshop is described as a democratic event where the participants are worked with rather than worked on and an element of responsibility exists (Higgins 2012).
‘Academic studies have backed up the common-sense notion that in all times, and in all cultures, music seems to have been closely associated with individual, social and spiritual healing’. (Gioia 2006; Gouk;2000; Horden 2006) citied by (Wood & Ansdell, 2018) . To extend this idea, in her TED Talk; ‘Community Music a Power for Change’, Nikki-Kate Hayes goes further than just widening participation and describes community music as being able to reduce street crime, raise standards in schools, speed up healing, slow down dementia, extend life, and save money for the NHS (TEDxTalks, 2017).
Community Musicians are also working in hospitals, care homes and prisons, many areas that were traditionally the domain of the Music Therapist. According to Wood and Ansdell (2018), this shift to working with other sociocultural enterprises and working with people with more overt pathologies began in the late 1990s. The diverse range of activities encountered by community musicians lead to this description by Kushner, Walker & Tarr (2001), cited by Deane and Mullen (2013):
Community musicians are boundary walkers [inhabiting public territories that lie between other professions. They take their music to health settings, schools, the voluntary sector, and the criminal justice system-and while denying they are therapists, teachers, community workers or probation officers, they find themselves working alongside these people and often doing what they do. (p4).
The guitar workshops for veterans in the US described earlier by Dhokai (2020) are a good example of CM in action. Other examples can be seen in Cohen and Henley (2018), ‘The Many Dimensions of Community Music in Prisons’. A key feature of this text is the concept of ‘possible selves’ they cite Markus and Nurius (1987) defining possible selves as representations of individual's ideas of what they might become, what they would like to become and what they are afraid of becoming and describe developing an identity as a transformative process. The relationship between the participant and the music facilitator has been found to be an important factor to develop social and personal agency and a context for a new social identity. The way that the facilitator welcomes the participant, and models positive musical and social behaviours help incarcerated people to feel normal (Cohen & Henley, 2018).
Birch (2020) provides another example of CM in prisons with Emerging Voices, a singing and songwriting project as part of the Prison Partnership Project between York St John University and HMP New Hal, a female prison. The program consists of weekly three-hour sessions at the prison. The principle of the welcome was maintained and although starting with 10 participants some left the project part way through, and others joined. Creating a safe space was paramount and reading the room required paying attention to body language and facial expressions to pre-empt emotional triggers and act accordingly. Standing in a circle gave a sense of equality and the women could share their music tastes and choices in the songs was important. Collaborative songwriting took place using inspirational quotes, words, and images as stimuli for ideas. Emerging themes from the project were 1). Improved emotional wellbeing, 2). Personal and creative skill development,3). Creation of positive social cohesion.
Unlike the music therapy model of re-visiting the trauma, the CM model does not focus on treating the trauma but recognises the potential for positive therapeutic outcomes in participatory music making such as healing, personal growth and positive social change. Birch (2021) describes how the prison partnership project discourages a focus on trauma-based narratives and avoids the triggering of traumatic memories while assuming that, as the figures suggest some of the group will be trauma survivors as the statistics suggest. Birch (2021) explains that with this in mind it is important that the mishandling of a potentially traumatic symptom due to misunderstanding or misinterpreting should be avoided. This can be done through education and training to be trauma-informed and understand what trauma is and its implications. The practitioner can then use a trauma-informed framework of safety, trustworthiness, choice, collaboration and empowerment in their practice.