MUSIC THERAPY IN A

MULTICULTURAL CONTEXT
of related interest
Creative DBT Activities Using Music
Interventions for Enhancing Engagement and Effectiveness in Therapy
Deborah Spiegel with Suzanne Makary and Lauren Bonavitacola
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Creative Arts Therapies and the LGBTQ Community

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A Comprehensive Guide to Music Therapy, 2nd Edition

Theory, Clinical Practice, Research and Training
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Foreword by Helen Odell-Miller
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MUSIC THERAPY IN
A MULTICULTURAL
CONTEXT
A HANDBOOK FOR MUSIC THERAPY
STUDENTS AND PROFESSIONALS

EDITED BY
MELITA BELGRAVE AND SEUNG-A KIM
First published in 2021
by Jessica Kingsley Publishers
73 Collier Street
London N1 9BE, UK

www.jkp.com

Copyright © Jessica Kingsley Publishers 2021

Chapter 2 copyright © Kamica King 2021

All rights reserved. No part of this publication may be reproduced in any

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A CIP catalogue record for this book is available from the British Library

ISBN 978 1 78592 798 0

eISBN 978 1 78450 807 4
 Contents

Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . 7

1. Music as an Acculturation Strategy in

Culturally Informed Music Therapy . . . . . . . . . . . . . 9
Seung-A Kim, PhD, LCAT, MT-BC

2. Musical and Cultural Considerations for Building

Rapport in Music Therapy Practice . . . . . . . . . . . . . . 43
Kamica King, MA, MT-BC

3. LGBTQ+ Music Therapy . . . . . . . . . . . . . . . . . . . . 75

Beth Robinson, MT-BC
Leah Oswanski, MA, LPC, MT-BC

4. Exploring Aging Through a Multicultural Lens . . . . . . . 115

Melita Belgrave, PhD, MT-BC

5. Dance and Movement Across Cultures . . . . . . . . . . . 133

Natasha Thomas, PhD, MT-BC

6. Cultural Humility in Clinical Music Therapy Supervision 157

Maria Gonsalves Schimpf, MA, MT-BC
Scott Horowitz, MA, MT-BC, LPC, ACS

List of Contributors . . . . . . . . . . . . . . . . . . . . . . . 185

Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 187
 Introduction

As a culmination of work through the American Music Therapy

Association (AMTA), we are excited to share this textbook Music
Therapy in a Multicultural Context: A Handbook for Music Therapy
Students and Professionals. The editors and primary authors met while
serving on the Diversity, Equity, and Inclusion Committee. During
our time as a committee we presented regularly and our presentations
included status updates on goals and tasks completed by the
committee, training sessions, times for the members to discuss issues
related to diversity and multiculturalism, and more recently, diversity,
equity, and inclusion. At one of the conferences, we were approached
by Jessica Kingsley Publishers to create a book on multiculturalism
and music therapy. As co-editors, we knew that we wanted to include
as many committee members as possible in the project. Thus, we
invited authors to each write a chapter on a topic area of interest,
through a multicultural lens. Each chapter has a personal story from
the author or authors, a literature review on their selected topic, and
case scenarios or learning activities that relate to the chapter readings.
Over the years, there has been an increase in research articles,
textbook chapters, and textbooks on multiculturalism in music
therapy. In our years of teaching music therapy courses at a
university, we have found that the existing textbooks do not seem to
meet the needs of students and music therapists in their learning of
multicultural considerations in music therapy practice and musical
culture. Most books cover therapeutic considerations but do not
discuss the role of music, culture, and health in music therapy.
We are excited to contribute to the body of literature through this
handbook. We believe this book will be unique in the field and can
be used in any music therapy course that addresses diversity and

7
8 Music Therapy in a Multicultural Context

culture in therapeutic practice. For example, this text can be used

in music therapy foundation/topic courses or practicum classes to
address clients’ needs, in a psychology of music course to discuss
why people respond to music and why music therapy works, and
in an introductory music therapy course. In addition, this textbook
would be relevant for music therapy labs, world music courses, and
other culture and diversity classes. As culture itself is so immense,
we have selected some topics in this book that are essential and
currently lacking discussions in our field.
This book is very timely, as the profession of music therapy is
growing both in the number of practicing music therapists and the
number of patients served. In a recent survey conducted by AMTA’s
Diversity and Multiculturalism Task Force (Kaplan, Belgrave, & Kim,
2014), results showed that music therapists provide services to a
very diverse population in terms of ethnicity, religion, gender, sexual
orientation, and more. However, most practicing music therapists
lack the necessary diversified experiences and effective training. At
the same time, university programs in music therapy are accepting
more and more diverse students. Our colleagues and many other
educators in our field have felt the urgent need to teach the concepts
of multiculturalism and diversity but are at a loss as to where to start.
Therefore, we believe the text is instrumental for practicing music
therapists, educators, clinical supervisors, and students alike.
Other university professors teaching musical therapy courses,
as well as clinical supervisors working with students, can read and
implement the learning activities and include the text in their music
therapy courses. Practicing music therapists can purchase this book
to enhance their clinical practice.
Our cultural endeavours constitute a life-long journey. We hope you
enjoy our contributions and this book enhances your understanding
and skills related to diversity and cultures in music therapy.
Melita Belgrave and Seung-A Kim

Reference
Kaplan, R., Belgrave, M., & Kim, S. A. (2014, November). The AMTA Diversity
Task Force: A Status Report. Poster session presented at the annual National
American Music Therapy Association, Louisville, KY.
 CHAPTER 1

Music as an Acculturation
Strategy in Culturally
Informed Music Therapy
Seung-A Kim, PhD, LCAT, MT-BC

Prelude
Culture is all around me. I experience it every day. Everywhere I go,
whatever I do, whomever I meet, I experience culture through my own
reactions and interactions with people and the environment I am in.
I observe how it is deeply embedded in my daily life and how it has
evolved and changed over time. To me, culture is fascinating! Culture
is deep within us and keeps molding us. Every daily encounter has
influenced me to form my own culture. As culture is never constant,
my own culture is also dynamic, ever changing by accumulating daily
experiences. Therefore, getting in touch with my own cultural heritage
is so important because it has been transformed in the past and
continues to be transformed in the present. I look forward to witnessing
the continued growth of my cultural being.

CASE EXAMPLE
At one culturally informed music therapy (CIMT) session, Youngmi,
a middle-aged, well-educated, immigrant woman from South Korea,
openly shared her personal problems. Her story began when she
came to America 20 years ago and married a Korean immigrant man
who was the eldest in his family and responsible for the well-being of
his parents and siblings. Living in an extended family has required her

9
10 Music Therapy in a Multicultural Context

to make significant sacrifices. She is obligated to work in her husband’s

family business. After coming back from work, all the housework and
child rearing are her responsibility. Her husband has a dominating
presence in the household. The traditional Korean culture always
places her interests as a secondary priority. Moreover, her husband
maintains a close relationship with his mother, even in adulthood.
Thus, the couple’s relationship often takes a backseat to the priorities
and well-being of the children. Moreover, her children, now all grown-
up, do not even understand how their mother has not taken any
action regarding this family problem! Over the years, she has felt her
identity being consumed by her married life. Consequently, she has
developed culture-bound mental health syndromes and, as a result,
has had to make many visits to the physician. Youngmi’s symptoms
are known as Hwabyeong, or anger syndrome. The condition of Han
can also lead to somatic symptoms: “When people die of Han, it is
called dying of Hwabyeong, a disease of frustration and rage following
misfortune” (Kim, 1995, p.80). During the CIMT session, Youngmi
started to sing a song from a Korean children’s cartoon that related
to her loneliness, sadness, and endurance.

Study questions
1. What are the presenting problems in this case?
2. What is the symbolic meaning of this song?
3. What are the multicultural considerations?
4. Would you encourage the client to cry during the session or
confront the client’s family?
5. How would you address Hwabyeong or Han?
6. Is it the client’s responsibility to educate the music therapist
about unfamiliar cultural traits?
7. How might a music therapist’s own cultural expectations and
judgments be manifested in music therapy? Is it a problem if
that happens? If it is a problem, how can we address it?
 Culturally Informed Music Therapy 11

Overview
The role of culture has significant implications for music therapy
because culture influences the therapeutic relationship and further
affects the whole music therapy process-assessment, treatment, and
evaluation (Kim, 2013a; Kim & Elefant, 2016; Kim & Whitehead-
Pleaux, 2015): “The role of culture appears particularly important
when studying the effects of music on health and well-being: the
way we interpret, experience, and react to music is strongly shaped
by our personal attributes that are molded by our social and cultural
background” (Saarikallio, 2012, p.477).
For example, when working with immigrant clients who come
from collectivist societies, the music therapist must understand that
extended family members influence important decision making in
these societies. To understand cultural identity and group identity, the
therapist should be knowledgeable about the history of each group.
Otherwise, clients may feel misunderstood by the therapist who
comes from a mainstream culture (Kim & Whitehead-Pleaux, 2015).
Culture can be defined as certain shared beliefs, values, worldviews,
ideas, artifacts, and styles. The common behavior of the group and
its permanence are considered as a specific culture of the group
members. In this sense, we are all cultural beings. Multiculturalism
means that each group forms its own norms, values, beliefs, and
attitudes that are shared by the group members. Each individual
belongs to multiple cultural groups. Multiculturalism promotes
and respects the existence of various cultures, such as age, gender,
ethnicity, race, socio-economic status, affiliations, religions, spiritual
practices, and disabilities (Kim & Elefant, 2016; Kim & Whitehead-
Pleaux, 2015; Sue & Sue, 2013). This paradigm promotes social
justice, liberation, and community empowerment.
As a synthesis of various cultural traits, music has been used as
a healing method since preliterate times. Our musical endeavors
are naturally cultural, as we have learned them from the culture(s)
we belong to. Because music and culture are inseparable and the
phenomenon of culture is multilayered and dynamic, culture must
be taken into account from the start of the music therapy process.
For music therapists, questions related to culture inevitably
come up during clinical and educational practices: What is the role
of music within a specific culture? How is music used within that
12 Music Therapy in a Multicultural Context

community? How are health and illness viewed in a community?

How do I, as a music therapist, affect the clients? How do the clients
affect me? How much should the dominant culture be involved in
integrating immigrants? Is there any advantage or disadvantage
in cross-cultural music therapy? To better understand the role of
culture in music therapy, this section examines the characteristics
of culture and identifies implications for music therapy.

The characteristics of culture

Complexity
The idea of culture has both implicit and explicit meanings. On the
one hand, certain behaviors of groups of people are observable (e.g.,
customs) and are therefore explicit. On the other hand, expectations
or hidden norms are regarded as embodying implicit meanings.
Developing the concept of implicit meanings rests on the belief that
there are principles that regulate the culture, which may be inferred.
Therefore, some cultures, or some aspects of culture, are not obvious.
Culture is complex in nature (Berry, 1997). It is difficult to
formulate a single perspective about the fundamental nature of culture
because culture is never static (Kim & Elefant, 2016; Roland, 1996;
Sue & Sue, 2013). Also, within any culture, there is a great deal of
individual variation. Culture influences how we assign meanings to a
phenomenon. Depending on how we define music and health, a style
of music may be considered music to us but not to people from other
cultures. Also, the concepts of health and illness are seen differently
across cultures (Bruscia, 2014; Spector, 2012). For some within a
biomedical model, health and disease are seen in a dualistic way, while
for some other cultures, an imbalance between yin and yang causes
illness and there is a belief that psychosocial factors promote well-
being. In addition, the evaluation of whether a behavior is normal or
abnormal depends on social norms. Common symptoms of a disease
can be found across cultures, but their expressions may vary.
Therefore, the complexity of culture also plays a role in music
therapy (Stige, 2002). For example, the fundamental constructs
between individualism and collectivism drastically differ (Beer, 2015;
Kim, 2007). If the therapy treatment plans are designed within the
orientation of individualism, they may not apply well to clients from
 Culturally Informed Music Therapy 13

a different culture. Without the music therapists’ cultural awareness,

knowledge, and skills, cultural bias can occur at the initial session
and throughout the entire music therapy process (Kim & Whitehead-
Pleaux, 2015; Swamy, 2014; Whitehead-Pleaux & Tan, 2017):
As we are profoundly influenced by the culture surrounding us,
much of what we see, hear, and feel is imprinted in our minds. It is
through this cultural lens that we view our world. Unfortunately, some
of these messages with which we interpret the world contain biases,
and we carry them into our sessions with our clients. To practice
CIMT, we must embark on a journey of self-exploration to uncover
these biases and work through them. (Kim & Whitehead-Pleaux,
2015, pp.59–60)
Music therapy is based on elements that are general to humanity
rather than specific to a member of a particular cultural group
(Abrams, 2015). Thus, the gap that exists between the therapist
and the client is a fundamental, existential gap that exists among
all human beings. My direct clinical experience has proven to me
the principles expressed above: every therapist, regardless of his or
her culture, has to bridge cultural differences that exist between
the therapist and the client—in this regard, human insight and
understanding have a far greater importance than cultural factors.
This perception of human beings is crucial in the CIMT context
and also presents a dilemma. If music therapists focus on their clients
as a representative of their cultures only, then it would be hard to
understand them as whole beings. Furthermore, if music therapists
focus on cultural differences, then it is possible to miss other parts
of the clients that do not relate to cultural and historical contexts.
Therefore, how can music therapists possibly help the clients as
whole persons? Most importantly, can music fulfill a significant role
related to cultural divergence and transcend differences between the
client and the therapist?
Adaptations need to be made when the music therapist uses
methods and instruments originally developed for one group and
transfers those to another group (Kim & Whitehead-Pleaux, 2015;
Whitehead-Pleaux & Tan, 2017; Vandervoort, 2017). However,
cross-cultural transfers and adaptations of music therapy approaches
and methods can be problematic. Another option is to develop a
14 Music Therapy in a Multicultural Context

new method for the culture that would better fit that specific culture.
In his writings, Piaget (1976) stated that creativity and innovative
thinking in a given area can often be stimulated by transposing the
ideas from a different discipline or context into the situation at hand.
In the same way, a music therapist who originates from a culture
different from that of the client may be able to transpose musical
and other cultural elements into the framework of music therapy.

Theoretical foundations
CIMT (Figure 1.1) is an approach especially designed for clients
who have experienced living in two or more cultures. I was born and
raised in South Korea, and I came to the United States more than
30 years ago. As an immigrant, I have experienced and witnessed
many difficulties in the acculturation process. In the past 23 years
of my clinical experience as a bi-cultural music therapist and my
experience as an immigrant to the US, CIMT has evolved greatly.
Clinically, I have worked with a variety of populations, including both
American and Korean-American people who have developmental
disabilities, autism, Alzheimer’s disease, neurological problems,
depression and psychosomatic issues. As I have worked with these
populations, I strongly feel that special cultural considerations
should be addressed in music therapy.
It is my belief that the need for therapy is a human universal,
regardless of the structure of a society and whether it is based on
individualism or collectivism. Even in some cultures where therapy
is not considered a common or accepted phenomenon, this is not
because therapy is not needed but that community or religious leaders
and family members have taken on the role of the therapist. With time,
people’s roles change so that even those within ethnic populations that
are reluctant to share personal issues with outsiders become gradually
accepting of the function of psychotherapy, particularly because of its
confidential nature.
CIMT has been modeled after Priestley’s (1975, 1994) analytical
music therapy (AMT), a method that has greatly influenced my
work as a music therapist. My belief is that among the current music
therapy methods available, AMT is the method that most closely
resonates with Korean-American clients, particularly with older,
 Culturally Informed Music Therapy 15

first-generation immigrants. Being in harmony with psychoanalytic

thinking seems to be in accord with the Korean spirit. This probably
reflects some similarity between the society in which Freud lived
and the Confucius-influenced Korean society, because both societies
are hierarchical and male dominant (Kim et al., 2012; Kim, 2013b).
In conceptualizing this approach for the specific population with
which I worked—Korean immigrant families—I have drawn on
analytical music therapy (Priestley, 1975, 1994; Scheiby, 2001, 2013,
2015), community music therapy (Kenny & Stige, 2002; Pavlicevic
& Ansdell, 2004; Stige & Aarø, 2012), multicultural counseling and
therapy (Pedersen et al., 2016; Sue & Sue, 2013), Bruscia’s integral
approach (Bruscia, 2014; Lee, 2015), and Kenny’s field of play
(2006). All have had an important impact on my clinical thinking
and development as a culturally informed music therapist. Upon
integration of the ideas of these theoretical strains, I have developed
a set of beliefs that underlies CIMT. What follows is a description of
these theoretical beliefs.

We are cultural beings

Our daily cultural experience has shaped us into who we are today,
and we also have shaped the culture. It is reciprocal in nature. Every
moment in life is a cultural experience. We construct and reconstruct
the meaning of life continually as we accumulate life experiences.

Culture is both universal and relative

Can one’s psychological process be similar or different across cultures?
To what extent are musical and non-musical behaviors in a specific
culture universal or relative? Cultural universalism and relativism
are no longer viewed by researchers as a dichotomy. Instead,
depending on the range of the continuum, there are four positions:
extreme relativism, moderate relativism, moderate universalism,
and extreme universalism. Influenced by constructivism, which
emphasizes multiple realities existing in our society, multiple realities
(Vera & Speight, 2003) can exist and the interpretations may vary. For
example, wedding and funerals are a common practice in our society,
but they are not really universal in how they are conducted and are thus
16 Music Therapy in a Multicultural Context

among the most enduring markers of cultural differences. Depending

on the position that music therapists take, we focus on how important
external environments affect shared psychological functions as
a result of different behaviors or how psychological functions are the
results of the interactions between us and the context.

Culture in a context
We live within a context, which affects what a person does, says,
decides, believes, and values. In many ways, culture is a “living thing”
and always exists within the context of “the situation”—all those
factors that collectively affect the people who experience them—
including social, biological, physical, psychological, historical, and
practical. According to Ruud (1997), culture is “a way of living…
Cultural performance is linked to the individual’s situatedness, a way
of perceiving and giving meaning to the world informed by a certain
perspective. And this perspective is rooted in the private life-world
of the person” (p.89). This aspect of culture requires that the music
therapist see beyond the practices, values, and norms of the client’s
culture and understand the specific situation that confronts the client.
Music is always played within a context (Stige et al., 2010). In
some cultures, music is everyday life. The boundaries of music
may not be as distinct as in Western societies. Within a specific
culture, musical elements can be defined differently. For example,
the meaning of music is different between Venda culture in South
Africa and in America. Here in America, music is a performance
that may occur at concerts and is distinguished from other art forms;
however, in Venda, music is an integration of multiple art forms:
The embodied communicative function of music forms the
foundation of human musical interaction. This embodiment,
which ranges from the personal to the communal, from the
individual to the cultural directly impacts and regulates what music
communicates, why humans use music as a tool of communication
and the manner in which people have access to and benefit from any
level of musicality. (Stige et al., 2010, p.146)
Furthermore, health means vary (Bruscia, 2014; Spector, 2012). In
individualistic societies, physical or mental health is considered
 Culturally Informed Music Therapy 17

separately when discussing health, whereas in collectivistic societies,

body, mind, and spirit integration is emphasized and health is
meaningful when embracing the concept of social and community
health. Therefore, social justice philosophy must be integrated into
the music therapy process because “Our concerns about the well-
being of oppressed groups and incorporating into the philosophies
and professional roles for these individuals are not only merely
scholarly endeavors but also ‘our ethical and moral obligation’” (Vera
& Speight, 2003, p.253).

Cultural beings
Does culture derive from the innate nature of all human beings? Or
is culture a specific and individual expression of a particular group
of people, with a specific history, at a given time, and in response
to particular social, psychological, and environmental conditions?
Some scholars have integrated both universality and relativism
(Epstein, 1998; Sue & Sue, 2013; Wilber, 1979).
This integration is particularly related to the combination of AMT
and multiculturalism. I am aware of the innate conflict between these
two philosophical thoughts, but it is my belief that both concepts can
co-exist and be interrelated. For example, humans all have emotions
(universality) and yet experience and express emotions in a unique
way (relativism). Therefore, I embrace both concepts and integrate
them as a whole. A traditional Asian saying captures my belief: “All
individuals, in many respects, are like no other individuals, like some
individuals, and like all other individuals” (Sue & Sue, 2013, p.37).
Our cultural identity includes the individual, collective, and universal.

Tripartite development of identity

Sue and Sue (2013) pointed out that people typically believe in either
universality or cultural relativism and usually ignore the group or
collective component; in particular, “mental health professionals in
general have generally focused on either the individual or universal
levels of identity, placing less importance on the group level” (p.40).
In the tripartite model, there are three levels of personality formation:
uniqueness, collective, and universal. This model closely illustrates
18 Music Therapy in a Multicultural Context

my understanding of the multiple dimensions of a person’s identity,

but I see the dynamics of these elements in a slightly different
light. My understanding of a cultural being is as follows. Each
individual manifests three layers of culture: individual, collective,
and universal. The individual culture is expressed by the uniqueness
of each human being and the myriad of individual differences
among people. The collective culture is composed of gender, religion,
profession, education, and marital status, to name a few elements.
People may belong to multiple groups, but some group identities
may be more salient. The universal culture, which all human beings
share, is evident in biological and psychological similarities, as well
as common life events such as weddings and funerals.
Figure 1.1 shows the dynamics of how these three layers of culture
relate to one another and interact with music and consciousness to
produce an ultimate state of cultural well-being. The paragraphs that
follow define the various constructs in the diagram.

ULTIMATE STATE OF CULTURAL WELL-BEING

an d i n g c o ns c i o u sn
xp e ss
E
Fluidity
ic

M
us

us
Co
al
M

du

ic
ll
ec
ivi

Fluidity Fluidity
ti
Ind

ve

Universal
Mu
sic ic
Mus

Fluidity

Figure 1.1: Ultimate state of cultural well-being

 Culturally Informed Music Therapy 19

Individual cultural being

Because no one person on Earth is exactly like another, everyone can be
understood on his or her own terms and in reference to his or her own
self. Depending on life experiences over time, a person’s worldview
may change. Music therapists accept the fact that every client is
unique, which can help avoid making a mistake by overgeneralizing or
stereotyping. Each person is a unique individual, so even in a similar
situation, the individual’s experience and deciphering of meaning is
unique. As Bruscia (2000) pointed out, “each person gets completely
different samples of experiences, and that each person lives in the
implicate order in a different way, because of myriad factors. Thus,
throughout the course of life, each person accumulates a unique
combination of ‘meaning samples’” (p.86).

Collective cultural being

All human beings are innately social beings. Pavlicevic and Ansdell
(2004) stated that “we are beings who naturally take part with
others and with our surrounding environment” (p.25). The first
and fundamental society of human beings is their own family.
Every human being is born into a society and belongs to a family
as a microcosm of that society. At the very moment we are born,
the relationship between at least two human beings begins: we
immediately have a mother or primary caretaker. Clients can
therefore be understood in that context. As they grow, their social
affiliations expand. Each individual collective culture has its own
norms and expectations.
The collective nature of identity and the importance of group
experience is emphasized by Adler (1959), who states that the
essence of normality is having concern for others because human
beings have inherent social interest. Isolation, loneliness, and
alienation can be unhealthy (Yalom, 1995).
One can strongly feel not only the effect that takes place for
clients as individuals but also the effect on an entire group. This can
be an experience of healing and bonding for all the members of the
group. The energy that can permeate the group can help its members
become a community.
20 Music Therapy in a Multicultural Context

Universal cultural being

There are parts of us that are universal. Universality is part of innate
human qualities that include universal themes and similarities
in humans: “There are some similarities among all homo sapiens as a
consequence of the biopsychic unity of mankind, and there are further
similarities among those who have had more common experiences
and face the same sorts of problems” (Swartz & Jordan, 1980, p.158).
Regardless of one’s ethnic background, an individual goes through
similar life events and emotions. For example, music is a universal
phenomenon that people of all ages and cultures experience. Therefore,
universality allows us to not feel alone and helps us to “share similar
concerns, fantasies, and life experiences with others” (Yalom, 1995,
p.41). Yalom suggests that when working with a multicultural group,
it is important to emphasize for clients the process of moving away
from “cultural difference” toward “transcultural responses to human
situations and tragedies that all of us share” (p.7).

Music
Music brings out the growth of our cultural self. Music is used to
integrate all three dimensions: the individual, collective, and universal
aspects of a person. Using music, we express a way of living, who
we are, and where we come from. This is possible because each style
of music carries with it a particular framework of reference, just as
each individual’s lifestyle is unique. Moreover, music has a multi-
dimensional energy, which moves us holistically through mind, body,
and even spirit. When we listen to music, our body often starts to
move, our mind is drawn into the music, and sometimes we are deeply
touched spiritually. Like culture, music is never static: “like water, it
adapts itself instantly to the shape of its container. In a square vessel,
it is square; in a circular vessel, it is circular. This is true because of the
nature of the element itself ” (Hall, 1982, p.41).
A culturally informed music therapist can use diverse cultural
music to help a client prepare for living in a divergent modern
society. This cultural understanding helps develop the client’s life
in a richer way. Therefore, we can use the word “differences” in a
positive way. Ultimately, music can transcend time and space.
 Culturally Informed Music Therapy 21

As Aigen (1997) illustrated, “to participate in the culturally and

stylistically embedded music is to participate in culture—it is to
participate in the attitudes, values, feelings and experiences which
define the culture” (p.23). This is what connects humans collectively.
Music transcends the limitations of individuals. Regardless of one’s
cultural identity, people can connect with each other by sharing
musical experiences (Blacking, 1995).

The development of cultural identity

Cultural imbalance
We are the sum of our past, present, and future cultures. Our culture
is constantly changing with the accumulation of new understandings
in behavioral, psychological, emotional, and spiritual domains.
When a new understanding is attained, it expands our culture
by modifying or adding to already existing understandings. The
acculturation process can take place over time. The process may
involve changes in worldviews, values, and social and personal
relationships with people and environments.
During this process, a cultural conflict between the existing culture
and the new culture inevitably occurs (Kim, 2011, 2013c). This
causes a great deal of acculturation stress (Berry, 1997; Berry et al.,
1987). Depending on the person’s attitude and worldview, the level
of acculturative stress varies. It is important to manage this stress to
be healthy and to develop a healthier stage of one’s cultural identity.

Fluidity of consciousness
Bruscia (2000) formulated the concept of fluidity: “if we can be
fluid in our consciousness, then we have the richest potential for
conceiving what is” (p.86). I have come to believe that “fluidity” is an
essential quality for cultural well-being. As Bruscia (2000) asserted:
This lack of it, this rigidity, this inability to move one’s consciousness
in and around and through human fields of existence is the most
unmusical way of being in the world. Music is itself fluidity of
consciousness made audible. To be in the music, or with the music
22 Music Therapy in a Multicultural Context

or to be in any relation to the music is the process of being fluid. It

is a surrender to whatever will reveal itself from whatever develops
in the music and our experience of it. (p.91)
A person who encounters a new culture and integrates it as part of
himself or herself needs to be fluid between the two cultures. To fully
integrate the new culture and enjoy it, the first step is to redefine
each culture and resolve cultural conflicts. This can only be done by
the fluidity of one’s consciousness. These layers will be in balance,
continuously interrelated, and in touch with one another when a
person is in a state of fluidity.

Expanded consciousness
When the three layers of cultural beings are actively interrelated,
the person’s awareness of his or her consciousness can be expanded
toward a well-balanced cultural being to some extent. This is a
continuum, as people are informed by a new culture daily.
However, if there is an imbalance in these layers, the person
can become stuck, rigid, and unhealthy. When one or more of
these areas of our cultural entity is not in balance, psychological,
emotional, or behavioral problems can result. When people are
unaware that their functioning is diminished in one or more of
these areas, there are unhealthy psychological consequences. Also,
when a person is not willing to take responsibility for his or her life,
or experiences a loss of meaning in life, then he or she becomes
unhealthy. These feelings are both intrapersonal and interpersonal.
When they have experienced unhealthy relationships with others,
they become unhealthy and tend to repeat the same unhealthy
relationship patterns. It is important, therefore, to keep expanding
one’s consciousness.

Ultimate state of cultural well-being

Being in between more than two cultures can be overwhelmingly
demanding. Integration takes time and effort, and acknowledging
limitations is healthy. To reach a state of cultural well-being,
the client’s fluidity has to be activated in a full circle. Only then will
 Culturally Informed Music Therapy 23

the client achieve a state of playfulness, show concerns for others,

be in touch with nature, and have peace of mind. There are various
levels of enlightenment that a person can reach.

Therapist qualifications and self-awareness

Music therapists’ ethnocentric attitudes, stereotypes, and preconcep-
tions must be explored prior to their practice (Brown, 2002; Bruscia,
2012; Kim & Whitehead-Pleaux, 2015; Whitehead-Pleaux & Tan,
2017), as this greatly influences the therapeutic relationships with
their clients. Being flexible and open to people and life is the core
value for CIMT.
A culturally informed music therapist works with all dimensions
of human existence: individual, collective, and universal. In addition,
the understanding of varied worldviews should holistically take place
on both cognitive and emotional levels. The therapist should move
in and out of theoretical orientations, methods, and worldviews to
address the clients’ needs. Musically, the therapist should also be
“fluid.” Concerning music as an expression of one’s culture, how can a
therapist be culturally empathetic in understanding the clients without
this fluidity? As Brusica (2000) explained, the therapist’s responsibility
is to share their fluidity of consciousness with their clients.
Needless to say, the culturally informed music therapist needs to
have sufficient knowledge about music from a variety of cultures and
the history of music in a specific context. The ability of the therapist
to listen to the music, analyze it, and engage in the session’s verbal
encounters is critical in identifying culture-related transference and
countertransference phenomena that may arise in the sessions.
If the culturally informed music therapist can utilize the client’s
primary language, it would be beneficial to facilitate the process,
although matching cultural backgrounds between the therapist and
the client is not necessary. Because one of the goals in music therapy
is to facilitate the client’s acculturation process, it is even beneficial
for the therapist to have a different cultural background.
It is particularly important that culturally informed music therapists
acknowledge that we, as culturally informed music therapists, are also
human beings who can make a mistake. (Kenny, 2006; Scheiby, 2001).
24 Music Therapy in a Multicultural Context

It is human to admit that we are not flawless. Learning about cultures

is a life-long task that is on a continuum of learning about human
beings and their lives.

Clinical uses
The CIMT approach described in this chapter is particularly useful
with immigrants because it considers the problems and issues that
may arise during the acculturation process. If the approach is used for
ethnic groups, specific cultural considerations must be made. Since
this method has been developed with an emphasis on issues, gender-
specific needs have to be addressed. Likewise, when the method is used
on a population of children, appropriate modifications are necessary,
according to their age and developmental stages. For people who have
disabilities, this method can be used only with proper adaptations.

CIMT goals
The following primary goals are addressed in CIMT, in addition to
the specific personal issues of the client:
• supporting the client’s acculturation process
• identifying the cause of psychosomatic symptoms and
working through the healing process by the use of music
• managing acculturative stress
• resolving acculturation conflicts
• facilitating the formulation of strategies and coping skills
• balancing the three layers of one’s cultural being
• working toward a healthier level of cultural identity
• collaborating to change one’s lifestyle so that it is more
satisfactory within the context of family and the community
• establishing and practicing life strategies and resources
• integrating one’s cognitive, psychological, and spiritual di-
mensions.
 Culturally Informed Music Therapy 25

Session format
The session format is a combination of individual and group sessions.
On completion of the assessment, the client will be recommended
for individual, group, or dual sessions. The client recommended for
individual sessions will eventually be transferred to group sessions:
If we always deal with the difficulties of life in isolation, as the
individual, and never relate ourselves to the whole, any solution or
cure is likely to be merely an illusion, and short-lived. Many of the
modern systems of therapy concentrate entirely on the individual.
(Kenny, 2006, p.23)
Therefore, the last stage of CIMT is group work, which every client
will have an opportunity to experience. It is noteworthy that people
of non-Western backgrounds can be more private than others and
maybe this is generally common in most non-Western cultures. In
addition, confidentiality is very important for them, so more in-
depth work may be done in individual sessions.
The group size is limited to a maximum of six to eight people,
including the therapist who maximizes the benefit of the group and
increases opportunities for clients to interact with one another. If
available, male and female therapists can lead the session together.
Since this is similar to having a father and mother figure in therapy,
transferential reactions may arise more frequently. Also, a translator
or family members may attend the sessions, if that is conducive to
the therapeutic process.
The worldviews of music therapists and their clients actively
negotiate as intersubjective cultural identities. Eventually, they
create a transcending form of music community. Thus, every session
should bridge this cultural gap.

Music experiences
In Korean culture, for example, “heart-to-heart communication”
denotes non-verbal communication (Kim, 2007). Koreans are used
to reading gestures, facial expressions, body posture, and other non-
verbal cues. Because of culturally fostered difficulty in expressing
feelings verbally, Koreans rely more on music for emotional expression
26 Music Therapy in a Multicultural Context

(Kim, 2007, 2013c). It can be a therapeutic experience when one uses

music to express oneself, especially negative feelings, because it is non-
threatening. In CIMT, both receptive and active music experiences
are provided. In choosing to use either receptive or active experience,
it is important for the therapist to consider the client’s individual
preferences. The same client might even need other modalities,
depending on the day, the circumstance, and their communities.

Receptive music experience

Musical analytical meditation, a new AMT technique created
by Scheiby (2013), can be used to address acculturation issues
and explore the unconscious mind. As Scheiby shared (personal
communication, 2013):
During the musical meditation process, the client often enters a stage
of consciousness that is similar to a dream state, and the symbols
received from the subconscious can be experienced as dream-like.
Just as symbolic material from dreams is worked within AMT to
discover the solutions they offer for psychological issues, the images
and symbols that come up during musical meditation are similarly
analyzed.
There are five stages of musical analytical meditation: assessment,
deepening the breath, musically accompanied traveling, verbal
processing, and musical closure ritual. Depending on the client’s
needs and his or her functional level, this meditation can be
performed by the client playing alone, together with the therapist,
or by the therapist playing alone.

Active music experience

In CIMT, I incorporated AMT techniques by allowing the client to
use all types of instruments and musical idioms, as improvisational
music is used as symbolic expression (Priestley, 1994; Scheiby, 2015).
It is also used to stimulate thoughts and feelings associated with one’s
life events. This enables clients, regardless of their cultural or musical
backgrounds, to explore their individual issues. The client can play
 Culturally Informed Music Therapy 27

music, sing, talk, or do all three; they can also sit in silence. The clients’
self-exploration is enhanced by this great freedom and a variety of
mediums to express themselves better.
It is important to consider individual preference in whether
receptive or active music experience is used. The same client might
even need other modalities, depending on the day, the circumstance,
and changes in his or her cultural being.

A wide variety of music in CIMT

Many people believe that cross-cultural factors between a therapist
and a client can cause problems. In fact, traditional thinking in
this area has only viewed the realm of cross-cultural factors in a
problematic light. However, my belief is that such cross-cultural
elements can actually be an advantage in therapy when there is a
willingness to grow on the part of the client and the therapist. For
example, a culturally informed therapist can use diverse cultural
music to help a client prepare for living in a divergent society. This
cultural understanding can help develop the client’s life in a richer
way. Therefore, we can use “differences” in a positive way, as Aigen
(2002) stated:
Different styles of music lend themselves to particular types of
expression and experiences, and the music therapist who can bring
forth different styles in the improvisational setting is better equipped
to create the variety of moods and experiences individually suited
for particular clients and circumstances. (p.9)
Some examples of music experience methods are described in
“Stress reduction and wellness” (Kim, 2013c).

Assessment
Culturally informed music therapists must understand well influential
factors such as acculturation, class, education, ethnic identity, within-
group and between-group differences, religion and spirituality,
and socio-political environmental factors including, racism,
discrimination, prejudice, economic status, level of acculturation,
28 Music Therapy in a Multicultural Context

and generational differences (American Music Therapy Association,

2019a, 2019b).
Cultural factors are very powerful influences in the development
and the ongoing life of every individual, but they are not absolute
determinants:
The noted French sociologist Emile Durkheim stressed that culture
is something outside us exerting a strong coercive power on us.
We do not always feel the constraints of our culture because we
generally conform to the types of conduct and thought it requires.
Yet when we do try to oppose cultural constraints, their strength
becomes apparent. (Swartz & Jordan, 1980, p.165)
This process of self-discovery and self-understanding has been a
critically important part of my development as a music therapist
and as an individual.
I find it effective to integrate three tools for the CIMT assessment:
Scheiby’s assessment (2001) Bruscia’s Improvisation Assessment
Profile (1987) and the multicultural assessment (Hadley &
Norris, 2016; Pedersen et al., 2016). There are three major areas in
assessment: musical, non-musical, and cultural.
The following are musical parameters: rhythm, melody, harmony,
tempo, phrasing, themes or motifs, dynamics, choice and use of
instruments/vocal, musical idioms, range, articulation, and timbre.
Second, the following informational categories are identified in the
music and described (Scheiby, 2001): affective, relational, cognitive,
developmental, transpersonal, aesthetic, kinesthetic, creativity,
energetic, listening skills, and cultural information. In addition, the
worldview, cultural identity stage, and the acculturation of the client
are included in the assessment:
• How is gender conceptualized?
• What is the socio-political history of the group to which the
client belongs?
• What is the client’s generational status?
• What is the status of the client’s religious and/or spiritual
belief?
 Culturally Informed Music Therapy 29

• What is the client’s stage of life?

• What languages does the client speak?
• Was migration of the client’s group a free choice, or was it
forced?
• How long have they lived in the US?
• What is the client’s sexual orientation?
• What is the client’s ability/disability status? What are their
musical culture and family traditions?

Evaluation
Quarterly, semi-annual, and annual evaluations will take place. All
the items described above will be evaluated. Family and community
leaders can be a part of the evaluation team.

Therapy procedure
In typical AMT sessions, an issue is identified and a title is then
suggested, usually by the therapist, on which to improvise. The
selection of the AMT technique depends on the issue being explored.
Sometimes, the client and therapist improvise without a title or
focus. Feelings and reactions arising during the improvisation are
usually verbally processed following the improvisation. Art, clay
sculpture, imagery, movement, and body work are also ways in
which to process these feelings and reactions (Priestley, 1975).
In CIMT, depending on the client’s developmental stage and needs,
this traditional procedure can be used or modified: 1) identifying an
issue; 2) selecting a musical program: meditation, voicework, and so
on; 3) sharing a musical experience; and 4) discussion.

Techniques
One size does not fit all. Culturally diverse clients often identify
with more than one cultural group. This is why applying multiple
30 Music Therapy in a Multicultural Context

modalities may be effective in sessions. Many indigenous cultures

value multiple modality. Commonly, music and movement are
inseparable, just as music and spirituality are inseparable. Utilizing
multiple creative arts methods in a study is recommended.

Meditation
Through meditation, the client can bring mental processes under
greater voluntary control. This will result in bringing out new levels
of awareness, concentration, joy, love, and compassion: “developing
the ability of the mind to focus attention without distraction on
specific objects, such as the breath, an emotion, or sound. Awareness
meditations, on the other hand, aim at exploring any experiences
that occur” (Walsh, 1995, p.388). The aim is to develop optimal states
of psychological well-being and consciousness. Meditation enhances
longevity, confidence, self-esteem, empathy, and creativity. Healthy
qualities such as mindfulness, love, compassion, concentration, and
calmness can be cultivated.

Voicework
When working with women who have lost their voice due to socio-
political reasons, I find it effective to do voicework accompanied
by movement. As Uhlig (2006) noted, “Where does the voice
come from? Everybody is born with a voice as a natural, biological
instrument, which is becoming a cultural phenomenon through
its adaptations” (p.45). The aim is to find their real voice so that
the voice transforms from unheard to audible. Meditation, which
helps the client concentrate, focus, and relax, is followed by work
on voice and movement. Like entrainment and toning, using vowel
sounds and listening to the emotional qualities of the voice are
important factors in this work. In addition, making movements
helps them to lessen their cultural stress levels. Depending on their
developmental stages, the movements can be done by the clients
themselves or with a therapist.
 Culturally Informed Music Therapy 31

Psychodynamic Movement
The pyschodynamic movement was developed by Priestley and
modified by Pedersen and Scheiby (Pedersen, 2002). It is a technique
that is useful for clients from diverse cultures to gain greater insight
into their own body, mind, and spirit. The tenets of this movement
are as follows: “The core of psychodynamic movement is improvised
movement by one or more persons on an agreed topic, accompanied
by one or more persons who follow and interpret the movements
in a parallel instrumental/voice improvisation.” This is also called
“improvised movement to improvised music” (Pedersen, 2002,
p.191). This movement helps clients maintain their emotional well-
being and develop strategies to deal with existing acculturative stress
(some useful information is described in Chapter 5).

Stages of CIMT
The length of treatment varies according to individual needs. The
therapy can be terminated when an individual has reached an
integrated cultural self and is able to adjust adequately to the
environment. It is highly recommended that ongoing support and
culture-related stress reduction are essential for the immigrant
population. Once the client develops unique coping skills for the
meditation practice, it can be done in a peer group. Since this
method emphasizes the importance of being in contact with people
and the community as much as possible, practicing meditation alone
is discouraged.

The role of music

Music as ritual
The client’s status of cultural being is explored in a “ritual space”:
“Music is always a doorway to ritual space though not every person
is able to go through it or recognize the place to which it leads.
When we awaken to that recollection, the music takes us through in
an instant” (Kenny, 2006, p.77). “Ritual” activities originated from
ancient systems and are “a more intimate” earth connection. These
32 Music Therapy in a Multicultural Context

activities reinforce the idea that we are part of the whole system
and interrelated with one another. The wholeness represents both
preventative and curative balances:
Improving quality of life means that as persons we feel better about
ourselves, less isolated in society, we keep the right balance between
our roots (past tradition) and our present life, between our uniqueness
and the group’s identity. When we gather together, share and make
music with each other, we feel less isolated. (Amir, 2004, p.254)

Music as cultural identity building

I believe that among all human experiences, music most closely
expresses and elicits the cultural self of human beings. The aim of
doing improvisation is to reflect unconscious dynamics so that this
material can surface and ultimately reflect psychological, physical,
spiritual, and cultural aspects of the client’s intrapersonal and
interpersonal lives. Therefore, music is an indicator of the client’s
status of cultural being (Halick, 2017; Higgins & Mantie, 2013). In
turn, because music is an expression of culture, through musical
experiences, it is possible that the client will develop a higher level
of cultural awareness: “music mobilized in particular ways…is a
key way of building cultural bridges, or helping re-socialization,
acculturation and integrating into new cultural homes” (Pavlicevic
& Ansdell, 2004, p.25).

Music as community building

Music provides a social space where we explore ourselves relating to
ourselves and to others, while at times transcending time and space.
Within the realm of the social space, there are opportunities for
clients such that “new contacts may be established and other persons
give us access to values and social experiences. Music becomes a
social resource, a way of getting to know groups, communities and
cultures” (Ruud, 1997, p.95).
 Culturally Informed Music Therapy 33

Music as a transcending energy

Music helps transcend one’s own culture and creates a new culture in
the music therapy context—no boundary, no judgment, just clients
connecting as human beings. When clients play music together
in a group, they are able to bond with one another at a deep level.
When their cultural entities actively engage in music and open to one
another, the “click moment” of musical experience can take place. It
might be because the magical aspect of music facilitates the almost-
instant formation of alliance between them, because their individual
connection to music already exists. It carries with it the feeling of being
related, as though they are somehow members of a musical family.
We all share the secret that most clients who are not directly
involved in music therapy groups do not know—the enchantment,
the transforming power, the inherent transcendence of music, for all
humans. Music helps us transcend time and space. It helps beyond
our cultural boundaries and unites us as a collective culture.

Music as a cultural learning facilitator

Learning language is more than just learning vocabulary and
grammar. It also involves the culture of the language, including
feelings, history, and usage. Clients can gain benefits when learning
English from songs or other musical activities. These benefits might
be new vocabulary, idioms, and even customs, because music
embodies so much of our culture (Blaking, 1995; Kim et al., 2012).

Music as an acculturation stress reliever

When engaged in verbal interchanges, immigrant clients may seem
to concentrate intently, in order to be certain that they understand
what is being said and to correctly formulate their own thoughts
in words. Although I believe that all people go through this to
some degree, it is more demanding for them because English is
their second language. However, when they are engaged in musical
communication or self-expression, they are able to simply hear, feel,
and intuitively understand the meaning of the music. This musical
experience can provide a better sense of freedom and autonomy
34 Music Therapy in a Multicultural Context

when compared to verbal discussion. In addition, because of their

culturally fostered difficulty in expressing feelings verbally, they can
rely on music as a means of expression. The clients feel relieved when
they make an improvisation without words in English.

The role of a culturally informed music therapist

Cultural vessel
As a cultural vessel, culturally informed music therapists should
have a good understanding of their own musical background and
cultural endowment as well as the client’s (Shapiro, 2005). Culturally
informed music therapists work not only with their clients but also
with their families and communities. The therapists’ tasks entail in-
creasing their own awareness of the client’s culture and collaborating
with the client to come up with possible solutions within their own
cultural contexts. Therefore, the role of the therapist is to facilitate
family relationships, empower clients to utilize their own resources,
and activate community support systems.

Flexibility and openness to new environments

Culturally informed music therapists’ flexibility in their attitudes
and understanding of their clients’ experiences are very important
to build effective therapeutic relationships. In addition, the
openness to their client, regardless of cultural match, is crucial.
McFadden (1999) is also supportive of this position: “To understand
cultural conditioning, one needs to move beyond the concept of
race and ethnicity to understanding aspects that clarify the human
condition in general and the specific way people consider their
universe, the world, and the people and objects within it” (p.28).

Cultural empathy
Culturally informed music therapists know how important it is to
express empathy to clients because humans are all cultural beings.
Empathy has a large impact on the therapeutic relationship and the
therapist’s overall efficacy in addressing the client (Brown, 2002;
Kim, 2008; Swamy & Kim, 2019).
 Culturally Informed Music Therapy 35

Examples of CIMT applications

Crafting a cultural bridge in music therapy
Seung-A Kim, a culturally informed music therapist
When I started to practice music therapy many years ago, most of
my clients were Americans. As a Korean-American music therapist, I
witnessed how music therapy can help people in life, and I was eager
to introduce music therapy to the Korean community. At first, I faced
some challenges within the community. The cultural crashes between
Korean and American norms were apparent. Parents often wanted me
to teach their children to play the piano. There is a common Korean
saying, “PPali PPali.” They wanted to see results right away. They
thought music therapy was a miracle to cure all, but there was also a
stigma. Some clients and parents refused music therapy and did not
share the information pertinent to helping their child.
Since 2000, I have made efforts to introduce and promote music
therapy to the Korean immigrant community in the Tri-State area.
There are several projects I have undertaken for the community, and
I would like to share them with you in this chapter. I hope this will
be helpful in your current and future endeavors.
I created a music therapy program for Korean immigrant families
in Bethpage, New York, to serve children, adolescents, and their
families. The clients are bilingual and have learning disabilities,
autism spectrum disorder (ASD); Korean-American Alliance for
Creative Arts Therapy (KAACAT), and problems related to cultural
adjustments. Another effort was made to organize Korean-licensed
creative arts therapy meetings and provide workshops to members
of the Korean community regularly. Most recently, I have been
working closely with the Esther Ha Foundation, educating and
promoting music therapy to Korean immigrant families. The three
major projects this foundation has offered to the Korean community
are a healing concert, a healing camp, and mental health education
on a radio station.
As a music therapist, I have consulted with other health
professionals to organize these healing concert events. The concert
took place in October 2018, and we highlighted music therapy
in the program, which consisted of receptive, compositional, and
improvisational music therapy methods. There were a couple of
36 Music Therapy in a Multicultural Context

well-known guest artists who performed songs matching the concert

theme. Then we had a few clients who performed songs they wrote
with music therapists in the sessions. Interaction with audiences was
possible during community singing and the drum circle. Then, the
“aha” moment! Over the years, I have witnessed the tears and openness
Korean clients have demonstrated, as well as their appreciation. It
might take time to build a relationship with Koreans, but once they
build trust with you, they will be very open to you and pour out their
emotions and expressions in music. We just need to think outside the
box and utilize a variety of approaches to work with them.

Language considerations in conducting music therapy

with children and young adults of Korean descent
Jon Reichert, MS, LCAT, MT-BC at SUNY Stony Brook Medicine
As a graduate music therapy student at Molloy College, I had the
opportunity to do clinical fieldwork with one of my professors, Dr.
Seung-A Kim. The site was a large Korean church, which offered
various programs for Korean children, adolescents, and young adults
with developmental delays, learning disabilities, and emotional
issues. Dr. Kim led the music therapy program at the church.
I am a middle-aged, Caucasian male. While being excited at the
prospect of doing clinical work with Dr. Kim, I was also somewhat
apprehensive about working with this specific population, primarily
because I do not speak Korean. When I initially voiced this concern
to Dr. Kim, she assured me that language should not be a problem
because most of the clients attended American schools, and their
parents encouraged them to speak English in the church’s programs
as a way to further reinforce their use of English.
I was also concerned about the music to be used in the sessions.
Would the music be mostly or entirely Korean songs? Would I need
to spend time learning an entirely new, culturally specific list of
songs which would then have limited applicability when working
with other populations? In general, I was apprehensive about
working with a population that I perceived could be culturally quite
different from my own.
Overall, I found the clients to very accepting of me and generally
 Culturally Informed Music Therapy 37

willing to participate in the suggested musical interventions. When I

first met most of them, there were no apparent distinctions between
their own cultural background and my own. A few clients seemed
particularly intrigued by me and my presence in the sessions.
When I first arrived at the site, I discovered that it was a very
large facility, with a congregation of about 1500. The clients had
various levels of developmental delays and learning disabilities,
were at various points on the autism spectrum, and one had cerebral
palsy. Dr. Kim said they were “1.5 generation Americans,” meaning
they were born in Korea but moved to the US before becoming
young adults. The clients who were verbal were all fluent in English,
although Korean was likely the primary language spoken in their
homes. There were some clients that Dr. Kim and I worked with for
only a short duration, but during my time at the church there were
three individuals and a small group of two to three members that we
worked with on a consistent basis.
The songs used in the sessions were primarily sung in English,
with an occasional Korean song. When working with these clients,
we felt it was important to acknowledge their cultural heritage, and
one way of doing that was to incorporate Korean words and culture
into our musical interventions. One simple practice was to use the
Korean word for “hello,” which is “anyoung,” in our greeting songs. I
learned that different cultures have different human vocalizations for
the sounds that animals make. So, when singing “Old MacDonald,”
rather than singing “cluck-cluck” for a chicken, a Korean chicken
would make more of a “cuuk-cuuk” sound.
One individual client we worked with was Seon, a male in his late
teens. He had moved to the US from Korea within the last 18 months.
Seon was one of the higher functioning clients. He presented as very
affable during our sessions but had anger management issues as well
as depression.
Seon preferred to have his sessions conducted in Korean because
he was not fluent in English. He seemed to appreciate my presence
in his sessions because, as he was developing his English-speaking
skills, he liked to try them out on me. He was somewhat tentative,
preferring to ask his questions of me in Korean to Dr. Kim, and then
have her translate them into English for me. However, when Dr. Kim
38 Music Therapy in a Multicultural Context

prompted him to ask me directly in English, he usually did. Seon was

knowledgeable about contemporary Korean pop music stars, and he
introduced me to K-pop.
After we’d been working together for a couple of months, Seon
asked if we could listen to a recording of the Korean song “1000
Winds,” which was about the disastrous ferry accident that had
happened in Korea earlier that year, where several hundred people
drowned, many of them high school students. This song became
the main focus of his sessions going forward. Initially, we would
just listen to the song during the session. Dr. Kim asked Seon if he
knew anyone directly impacted by the ferry accident, and he replied
that he did not. She asked him how the song made him feel, and all
he said was, “sad.” From the somber look on his face as we listened
to the song, it appeared to be having an emotional impact on him.
In subsequent sessions, Seon began singing along to the recording,
and Dr. Kim and I eventually began accompanying him on piano
and guitar. Seon told us that he wanted to perform the song for the
church’s congregation sometime.
Why was Seon so taken with this song? As a recent immigrant
to the US, Seon had experienced his own losses: his culture, friends,
familiar surroundings, as well as his ability to easily communicate. It
appeared that Seon was using “1000 Winds” to help him process his
grief from his own loss, and as a means of communicating his grief.

Conclusion
What we see is what we perceive, which leads to what we believe.
What I have come to believe is that there is not just one rigid
method that is effective for all clients. As Pavlicevic and Ansdell
(2004) stated, “In the twenty-first century, wherever we practice,
we can no longer simply state that music therapy is ‘such and such’
a practice, described with the help of ‘such and such’ theories,
without addressing a crucial third bit: context” (p.45). In the past,
differences between cultures were considered negative. To work
with culturally diverse clients, thinking outside the box is helpful.
Rather than waiting for clients to come, music therapists must go to
them, work closely with community leaders and other professionals,
 Culturally Informed Music Therapy 39

and continue to educate about the benefits of music therapy. I see

difference as a strength, wholeness, and an opportunity to expand
one’s horizons. The differences among people can stimulate the
expansion of one’s worldview. Expanding the self can be achieved
by fluidity on the part of the therapist, and sharing that fluidity with
the client and the community. As Bruscia (2000) stated, “We have to
celebrate differences. We have to move in and out of them” (p.95).
Such a cross-cultural experience can actually be advantageous in
life, such that when one faces a new environment, it is possible
to understand that “variety is the spice of life.” As I worked with
the clients over time and the therapeutic relationship developed
and strengthened, any differences in our cultural backgrounds
seemed to become less obvious and less relevant. I evolved from
thinking of them as Korean clients to approaching them as clients
who were of Korean descent, and incorporating that culture into
the musical experiences. Working with these clients was a very
unique and rewarding experience. Thus, the culturally informed
music therapists’ methods are constantly moving, connecting, and
reconnecting to the past, present, and future, as their cultural beings
have expanded to the ultimate state of health.

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 CHAPTER 2

Musical and Cultural

Considerations for
Building Rapport in
Music Therapy Practice
Kamica King, MA, MT-BC

A first-generation Trinidadian-American, I grew up in an intercultural

environment among many other immigrant families. With music
as a central staple in my family’s household, you could hear R&B/
soul, gospel, soca, reggae, hip-hop, rock, jazz, pop, and even a dash
of country playing at any given time. Family friends hailed from
five of the seven continents, so in addition to the fusion of Trinidadian
and American culture that influenced my upbringing, I was exposed
to a host of cultural customs, foods, and music from all over the
world. I attended a pre-kindergarten program intentionally housed
in a healthcare center for older adults that provided meaningful
opportunities for intergeneration interaction from a young age as well.
All of these experiences provided a foundation that helped me to
begin to learn about others. In my approach, I foremost honor the
humanity in others, connecting at the points of similarity, while also
seeking to understand the differences. What I didn’t know at that
time was that those intercultural and musical experiences of my
youth would help prepare me to naturally build rapport with clients
who, from session to session or even within the same session, come
from diverse cultural backgrounds and generations, with varied life
experiences and musical preferences.

43
44 Music Therapy in a Multicultural Context

While the experiences of my upbringing may resonate with some

who are reading this, over time I came to realize that experiences of
deep connection with diverse groups of people were not as common
as I had thought among colleagues or the students I supervised.
Some came from very homogeneous communities, whether that
community’s lack of diversity was by default or design. With regard
to practicum supervision, a few common challenges surfaced among
students training in diverse psychiatric, medical, and community
settings focused on adult mental health and psychosocial goal areas.
These were: limited knowledge of contemporary music history, a
lack of familiarity with music outside a narrow scope of genres, and
uncertainty about how to engage with a client they perceived as having
significantly more and/or different life experiences than them.
Another trend was that as students were still learning how to
practice music therapy, a strong focus on what to do next would often
take them away from being present with the client in the moment.
That would equal missed cues from the client in real time that could
have positively informed the student’s clinical decision-making process.
Some students were so used to the ability to fully carry out a session
plan as written that when a situation required on-the-spot adaptation,
they would have great difficulty. Working in settings where the age can
range from 18 to 95 with seemingly as many cultural backgrounds,
I found that the ability to build authentic rapport, exercise cultural
humility, and adapt to the needs of the client(s) in real time was
imperative to success in these environments.
Therefore, the challenges the students faced required additional
supervision that spoke to their development both intrapersonally and
interpersonally, while laying the foundation for them to learn, grow
and exercise cultural humility. This chapter shares many of those
elements, with a focus on building rapport, cultural considerations
in music therapy practice, and thoughtfully expanding one’s musical
repertoire and knowledgebase to meet clients’ needs.
In my work as a music therapist in Dallas, Texas, one of the ten
largest metropolitan cities in the US, the clients and patients I see in
both community-based and medical settings come from a variety of
cultural backgrounds (U.S. Census Bureau, 2018). Though most often
clients differ with regard to ethnicity, belief system, socio-economic
 Musical and Cultural Considerations for Building Rapport in Music Therapy 45

status, age, and ability, the differences also show up in musical

preferences and cultural - and generation-based thoughts on therapy.
In this chapter I will draw from my experience working with
adult clients and their families, addressing mental health needs
primarily in outpatient oncology, as well as inpatient psychiatric and
community-based settings. The terms “patient” and “client” will be
used interchangeably. Tools for practice will also be discussed.

Introduction
A review of the literature regarding music therapy and rapport
showed that while the term “rapport” was often seen in the literature,
it was not the direct focus of the material, and generally went
undefined, alluding to it being considered a universally understood
concept (Darrow & Johnson, 2009; Silverman, Letwin, & Neuhring,
2016; Williams & Abad, 2005). In addition, while much of the music
therapy literature communicates that rapport is an essential element
early in the therapeutic process, few sources explicitly detail the
steps to be taken to establish and build authentic rapport with clients
(Bolger, McFerran, & Stige, 2018; Rolvsjord, 2016; Silverman, 2019).
With so much of the process of building rapport being implied
and/or hidden in studies and chapters that are more broadly
focused, I’ve distilled the most applicable information from music
therapy and counseling literature as well as my own experience as
a practicing music therapist. This content is meant to provide a
framework to include ways of thinking and being that can inform
practice when it comes to not only establishing rapport, but doing
so across cultures. While culture and ethnicity are often used
synonymously, culture is a broad term that also encompasses beliefs,
customs, communication styles, ideas, and values central to a group
of people (Gallardo et al. 2012).
For every person, their unique mix of the aforementioned yields
a blueprint for living and interpreting reality through their cultural
lens based on what they’ve been taught by others and what they’ve
learned through lived experience. Therefore, awareness of, knowledge
about, and the demonstration of respect towards our clients and their
culture are of great significance to the therapeutic process. While it’s
46 Music Therapy in a Multicultural Context

impossible to know everything about every culture we may encounter

in our work as music therapists, it is imperative that we take our
clients’ culture(s) into account to inform our approach and practice,
and to move towards an equitable experience for all the clients we
serve (Chase, 2003; Dileo, 2000; Kim & Whitehead-Pleaux, 2015).
In synthesizing music therapy literature on building rapport,
building trust and being genuine were themes that emerged (Baker,
2014; Grocke & Wigram, 2007; Hanser, 1999). Other aspects of
the literature typified verbal, non-verbal, and musical techniques
to engage clients early on, including asking open-ended questions,
being mindful about body language, using preferred music, and
engaging in improvisatory musical play (Baker, 2014; Bruscia, 1989;
Jones, Baker & Day, 2004; Sadovnik, 2016; Silverman, 2019).
While rapport isn’t explicitly mentioned in the book, Music
Therapy: A Fieldwork Primer, Borzcon (2004) outlines a variety of
personal and professional attributes that align with the elements
needed to establish and build rapport, including having a genuine
interest in people, exercising empathy, openness to new ideas, and
being caring and professional (Leach, 2005). These attributes are
based on the American Music Therapy Association’s (AMTA) (n.d.)
overview of the personal qualifications of a music therapist.

Culture: Competence, humility, and consciousness

Cultural competence “can be defined as the acquisition and
maintenance of culture-specific skills required to (a) function
effectively within a new cultural context and/or (b) interact effectively
with people from different cultural backgrounds” (Wilson, Ward,
& Fischer, 2013, p.900). The AMTA’s Code of Ethics (2019) uses
similar language, encouraging therapists to “acquire knowledge and
information about the specific cultural group(s).” However, given the
complexity of culture and the many layers that make up a singular
identity, the term “cultural competence” has been critiqued, particularly
with older definitions implying an achievable stopping point, rather
than a lens through which one can be immersed in an inclusive,
evolving way of being and thinking when it comes to learning about
another’s culture (Patallo, 2019; Tervalon & Murray-Garcia, 1998).
 Musical and Cultural Considerations for Building Rapport in Music Therapy 47

Rather than competence through acquisition, the idea of striving for

cultural humility has gained traction over time as a more equitable
and just term, strengthening the connection from theory into practice.
Cultural humility is defined as “an others-oriented stance that seeks
to develop mutual partnerships that address power imbalances with
interpersonal respect, as well as a lifelong commitment to openness
to new cultural information, critical self-examination of cultural
awareness, and motivation to learn from others” (Upshaw, Lewis &
Nelson, 2019, p.2).
Similarly, in the ways that we will likely encounter a wide variety
of clients throughout our careers, we should aim to be culturally
conscious in our efforts and deliver equitable, quality services
to all. This concept of cultural consciousness is a process that
entails increasing our awareness of culture, including that of our
own and others’ (Páez & Albert, 2012; Kumagai & Lypson, 2009).
Knowledge of culture is one thing, but awareness, understanding,
and the ongoing expansion of the aforementioned signify a deeper
comprehension, similar to the difference in relationship between
you and a close friend versus someone who is just an acquaintance.
To take it a step further, once the aforementioned elements are in
place, action in the form of putting what you have learned into
practice is a necessary next step. While the Certification Board for
Music Therapists (CBMT) may be alluding to cultural consciousness
in their Board Certification Domains, in our field of music therapy,
there is not enough of a basis for practice beyond the ideology and
no formal cultural training in the curriculum that would hint at
those discrepancies being addressed to evolve the future of the field
(Certification Board for Music Therapists, 2015; Kim & Whitehead-
Pleaux, 2015).

Rapport and the therapeutic process

Within the music therapy process, there are several elements that
go into creating the proper “formula” for therapeutic work to take
place. With variance in the theories and philosophies that anchor
the ways in which music therapy is practiced, the formula, approach,
and emphasis can be different depending on who you ask. At the
48 Music Therapy in a Multicultural Context

same time, there does seem to be an element that is universal—the

necessity to build rapport with clients in order to develop a beneficial
working relationship; the client–therapist relationship, also known
as the therapeutic relationship. As it relates to clinical foundations,
the AMTA (2013) states that therapists should exercise “appropriate
self-disclosure, authenticity, empathy, etc. toward affecting desired
therapeutic outcomes.” The aforementioned elements can be viewed
as essential components of the building blocks of rapport. Designed
to be a springboard for further exploration, this section will provide
a brief overview of rapport and some of the key elements it is
comprised of as it relates to the therapeutic process.
Rapport is the result of interactions where there is synergy and
connection; “a conscious feeling of…trust, empathy, and mutual
responsiveness between two or more people…that fosters the
therapeutic process” (Farlex Partner Medical Dictionary, 2012).
Rooted in communication, both verbal and non-verbal, building
rapport requires “genuineness, openness, and warmth,” as well as
active listening and acceptance through a “non-judgmental posture”
(Hanser, 1999, p.62). This posturing is not solely about physical
positioning and body language, but also encompasses tone of voice,
affect, and the overall presence of the music therapist.

Authenticity
From a basic humanities standpoint, at their core, clients want to
be heard, understood, accepted, and cared for. Approaching clients
from a place of authenticity, while communicating positive regard
for them, is key in the establishment of the therapeutic relationship
(Dileo, 2000; Silverman, 2019). Thinking about this as it pertains to
working with adults addressing psychosocial goal areas, if a client is
able to detect that you are genuine, approachable, and competent,
trust can begin to be built if they are open to it. Your posturing,
confidence and communication, both in style and content, go
into the larger view of how your client perceives and, in turn,
receives you.
 Musical and Cultural Considerations for Building Rapport in Music Therapy 49

As some of this information is abstract in that it describes a way of

being rather than concrete actions, below is a sampling of directives
from Borzcon (2004) to help guide the therapist, as detailed in Music
Therapy: A Fieldwork Primer:
Generally speaking, your affect needs to be one of acceptance. Your
eyes need to be focused on the client in a way that allows the client
to find safety within them. You need to observe, be present within
the session, and not stare. You need to smile when appropriate and
have it be natural and not contrived. Your body language should
signal to the client that you are comfortable within the session and
with him/her. (p.10)
Though Borzcon (2004) writes this specifically about affect, those
directives can also be applied to approaching your client in a
welcoming and authentic way.

Empathy
Expressing empathy toward a client communicates an inherent
understanding of them that can deepen the therapeutic bond and
create space for the client to open up more (Dileo, 2000). Empathy
is “a complex capability enabling individuals to understand and feel
the emotional states of others,” something that Valentino (2006)
stresses as more than just being present with a client (Riess, 2017,
p.76). There is a sensing and a knowing on account of the therapist
that has to take place in order for the experience to be categorized
as empathy, an intrinsic download of information from the client
about their world. Of note is that this informational download can
be rooted in a cognitive process of deduction based on an automated
cycle of assessment and evaluation, or it may stem from a more
intuitive or instinct-based place, featuring an “inner knowing”
that isn’t able to be rationalized in the same way as the cognitive
process (Brucsia, 1998; Brescia, 2005). Empathy is just one example
of the interplay and nuances that go into building rapport and co-
constructing an effective therapeutic relationship.
50 Music Therapy in a Multicultural Context

Food for thought: When in session with a client, what are some
ways that you can communicate empathy?
Ideas: Is your demeanor warm and inviting? Do your responses
and your body language communicate care and consideration,
respect and understanding? Consider a time when someone
demonstrated warmth and understanding. What characteristics
made you feel their warmth and understanding?

Intersubjectivity
While with empathy the therapist expresses it towards the client,
intersubjectivity takes it a step further in that it is a shared,
interpersonal process. Intersubjectivity is a bi-directional, co-
constructed exchange of “conscious information, knowledge, or
emotions between individuals” where there is “joint attention” and a
“shared world of meaning” as it relates to the therapeutic relationship
(Trondalen, 2019, p.2; Reber, Allen, & Reber, 2009). In the Penguin
Dictionary of Psychology, Reber, Allen, & Reber (2009) present a
definition of intersubjectivity that conceptualizes the therapeutic
relationship, denoting the verbal and non-verbal elements of the
exchange and also presenting room to negotiate or even usurp
hierarchical systems through an emphasis on mutuality and
empathy. Within music therapy, intersubjectivity is also examined
as it pertains to music-making and the musical relationship (Arthur,
2018; Birnbaum, 2014, Scheiby, 2005; Trondalen, 2019).

Self-awareness
Exercising self-awareness means getting to know yourself well and
understanding what you bring to the session not only as a therapist,
but foremost as a person. Who you are informs how you interact
with clients. In the ways that building rapport is a cornerstone of the
therapeutic relationship between client and therapist, the foundation
of that relationship is a person-to-person connection; a human
connection (Dileo, 2000; Rolvsjord, 2009). This intertwining of our
personal and professional selves is solidified in Cormier, Nurius,
 Musical and Cultural Considerations for Building Rapport in Music Therapy 51

and Osborn’s (2009) writings on the professional skills of people

in helping professions comprising: a) personal characteristics, b)
training, c) academic knowledge, and d) clinical knowledge.
The practice of self-awareness allows you to take inventory of
yourself, identifying your thoughts, attitudes, and how those display
in your daily and clinical interactions. Self-awareness is also an
important tool to recognize your own personal bias and examine
its impact on the therapeutic process—an essential part of working
with clients of different cultural backgrounds (Pieterse et al., 2013).
The internal and personal work you do as a part of the process of
being self-aware can also help you recognize countertransference,
process feelings about transference, connect to your client, and vice
versa. If you are wondering how to begin this exploration, consider
seeking supervision or entering into therapy as a client (American
Music Therapy Association, 2019; Chase, 2003; Hahna, 2017).

Active listening
In their chapter entitled “Cancer Care,” McDougal-Miller and
O’Callaghan (2010) explain that some clinicians, particularly those
who are new, may miss information, context and cues for clients
if they are too focused on planning next steps in session during
opportunities to actively listen to the client. In contrast, remaining
fully present when clients share leaves room for the information
the therapist is receiving to guide next steps and intervention
choices naturally, and at appropriate transitional times. To further
examine the processes of active listening, let’s take a look at how the
Encyclopedia of Child Behavior and Development defines it: “Active
listening entails the listener’s involvement in hearing for intellectual
and emotional messages. The listening focus is with what the person
is saying, while confirming the accuracy of the content and the
effect of the message” (Teniente & Guerra 2011, p.27). Of note is
that the confirmation process happens through dialogue directly
with the speaker to verify message meaning periodically. Deeper
than verbatim, a client may ascribe meaning through implication
rather than direct (explicit) verbalization, resulting in a duality
between what is being said and the deeper levels of what is also
52 Music Therapy in a Multicultural Context

being implied. Teniente and Guerra (2011) describe this process as

“identifying explicit and implicit patterns of communication” where
“verbal communications are received and reflected along with the
underlying expression of feelings in an attempt to understand or
explain a core message.” Silverman (2019) also writes about active
listening as a sign of respect for the client that contributes to the
therapeutic alliance.

Verbal processing
As a practicum supervisor, particularly in mental health and medical
settings, I find that students tend to have trouble figuring out how to
respond to patients in real time during music therapy experiences
that yield opportunities for verbal processing. Sometimes clients are
facing situations and expressing difficult emotions that can be hard
for students to process, let alone figure out the “right words to say”
in response. In those instances, I remind them that the clients seek a
safe space to be heard first and foremost, so their demeanor, affect,
and posturing will set the tone beyond words. Clients want to be
understood, so active listening, and being present in the moment with
them goes a long way. I have also found that clients are not typically
looking for advice, but rather the room to explore, express, and make
sense of things for themselves. Validation, paraphrasing, and reflecting
are techniques that can be used to provide support and encourage
clients as they open up. Each technique is related to a verbal
response from the therapist that provides a space for the client to
confirm, clarify, and further process their thoughts (cognitive) and
feelings (affective) (Cormier & Hackney, 2008). Validation involves
understanding, accepting, and affirming the information the client
shares (Kim & Kim, 2013; Oxford Living Dictionary, n.d.). When it
comes to paraphrasing and reflecting, Cormier and Hackney (2008)
differentiate between the two, sharing that paraphrasing focuses on
rephrasing the cognitive, while reflecting involves responding to the
affective content shared in session.
If students are still stuck trying to figure out appropriate
responses, I implement a role-playing exercise to help them further
develop their response mindset. During that exercise, I ask them
 Musical and Cultural Considerations for Building Rapport in Music Therapy 53

to think about how they would respond if they were talking to a

friend. The next part of the exercise is to explore that response and
ways to filter it to be appropriate for use with a client. The trick is
that the “friend” experience can feel more practical and relatable
for the student, while filtering the response for the professional
environment works toward preserving the integrity and ethics of
the client–therapist relationship.

Self-disclosure
Self-disclosure “refers to the process of revealing personal…infor-
mation about oneself to others” (Brunell, 2007, p.81). It is a thera-
peutic technique sometimes used by the therapist to build trust and
foster a deeper connection with the client. At the same time, it is
important to institute boundaries around the content and context
in which the therapist shares personal information, so that the fo-
cus of music therapy remains on the client and their needs (Corm-
ier & Hackney, 2008; Silverman, 2019). It is important to note that
self-disclosure must be ethically sound and professionally warrant-
ed so that the differences between the therapeutic relationship and
that of a friendship are clear, thus avoiding the presence of a dual
relationship (Rolvsjord, 2009). This is critical toward the session re-
maining client-focused.

Discussion question: During an assessment (or introductory

session), the patient turns to you after answering a few
questions and says, “So tell me about yourself.” How do you
respond?
Food for thought:
• What might their reasons be for asking you that?
• Is the patient seeking to shift focus away from themself?
• Are they just curious and wanting to learn more about
you or your qualifications?
54 Music Therapy in a Multicultural Context

Cultural considerations in music therapy practice

In the music therapy setting, the client is invited to communicate
their thoughts, feelings, and needs to the extent in which they are
comfortable. Within that, as a part of our clinical foundation as
music therapists, we are to “demonstrate awareness of the influence
of race, ethnicity, language, religion, marital status, gender, gender
identity or expression, sexual orientation, age, ability, socioeconomic
status, or political affiliation on the therapeutic process” (American
Music Therapy Association, 2013). To take that concept a step further
beyond awareness, cultural humility should be activated. Of note is
that at times, the client’s communication of their needs may be a)
a non-verbal process, b) an indirect verbal process (implied), or c)
an unconscious process. Thinking about styles of communication
culturally, people communicate, emote, and choose what levels of
information to disclose, based on the rules of their culture. These are
often unwritten rules inherent to the identity and operations of that
culture. The process of active listening can help the therapist decipher
and accurately derive meaning from the content shared by the client.

Challenges of the colorblind approach

Due to the fact that there are so many nuances to cross-cultural
interactions, for some, it may seem best to circumvent culture all
together, only looking at the person’s individual qualities and character,
but not race, ethnicity, or any other aspects of culture (Williams,
2001). In the ways that our professional responsibilities call for us
to “Conduct [ourselves] in an authentic, ethical, accountable, and
culturally sensitive manner that respects privacy, dignity, and human
rights,” the colorblind approach goes directly against our duties to be
both culturally sensitive and respectful when it comes to working with
clients from all backgrounds (American Music Therapy Association,
2013; Certification Board for Music Therapists, 2020, p.4).
This colorblind lens also disregards culture in a way that strips
a person of what may be an essential part of their identity. This
is because it ignores cultural factors that affect how your patient
views the world and how the world views your patient (Curtis,
2017; Hadley, 2017; Williams, 2001). Operating from a colorblind
 Musical and Cultural Considerations for Building Rapport in Music Therapy 55

lens can bring a false sense of equality that may not apply to your
patient’s reality, particularly outside the session. It can also damage
the strength of the therapeutic relationship in terms of equity,
inclusion, personal agency, and power dynamics if the client is not
recognized as a whole person, but rather as just the fragmented
pieces the therapist prefers to acknowledge (Hahna, 2017; Kim &
Whitehead-Pleaux, 2015; Rafieyan, 2017).
It can be difficult to know where to start when it comes to
recognizing and dismantling stereotypes and biases, but starting
with self-awareness of these constructs at play within the self can
help you uncover and eventually dismantle those in existence
personally and professionally. Seeking supervision from a qualified,
culturally adept professional can aid your process as well (Chase,
2003; Hadley & Norris, 2016).

Assessment and treatment planning

The AMTA (2013) calls for therapists to “recognize the impact
of one’s own feelings, attitudes, and actions on the client and the
therapy process.” This recognition is important because, for example,
during assessment, even unknowingly asking a client questions
based on stereotypes can limit the scope of content, resulting in
critical information being missed. Caution should be taken against
stereotyping, where opinions about interactions and discoveries
with one person (or group) are applied en masse to a belief that
all people of that culture are the same way (Kim & Whitehead-
Pleaux, 2015). Instead, the process should be multidimensional,
as the CBMT board certification domain on assessment advises us
to “identify a client’s cultural…background in a number of ways”
(2015, 2020, p.55). A thorough, culturally sensitive assessment is
necessary to help provide a well-rounded understanding of the
client, including how they view and express themselves and their
culture. An individualized assessment process is imperative as
when you meet someone from a particular culture, you’re meeting
a unique individual and should not default to working with them
solely based on your past knowledge of that culture (Chase, 2003).
At the same time, when approached ethically and without bias or
56 Music Therapy in a Multicultural Context

assumption, it can be of great benefit to mentally index facts about a

culture like language, music, customs, and beliefs. Facts can inform
your practice and interaction for the better and can shed light on
how you might equitably approach working with the client. For
example, being familiar with the dos and don’ts of a given culture
can also help you adjust in a way that is respectful of your client
(McDougal-Miller & O’Callaghan, 2010). With regard to cultural
norms, be aware that the degree to which your client does or does not
ascribe will vary as their unique identity or intersectionality cannot
be predicted. It is for these reasons that you must be open to learning
about your client’s culture and how they perceive and express their
identity (Adams, 2004; Chase, 2003; Valentino, 2006; Walker,
2004). One resource to consider is the book Cultural Intersections
in Music Therapy: Music, Health, and the Person, edited by Annette
Whitehead-Pleaux and Xueli Tan (2017). Among other topics, the
book details cultures of heritage, religion, sexual orientation, gender,
disability, and survivorship.

Food for thought: Building rapport can be easier when we are

among people of a familiar culture, and interacting around
music that is familiar. However, how do you proceed when
those elements aren’t present for you in a music therapy
session?

Even musically speaking, with regard to preferences, there are several

things to consider when treatment planning such as, a) the person’s
background, b) where they grew up, c) the types of cultural and
musical influences that were around them, d) the styles they gravitate
towards, and in some cases, e) the role of assimilation and integration
in a person’s life (Certification Board for Music Therapists, 2020;
Kim & Whitehead-Pleaux, 2015; Whitehead-Pleaux, Brink, & Tan,
2017). For example, over time I came to notice that my older clients
who liked Christian music typically preferred hymns. During an
assessment with a couple in their 70s, I wrongfully assumed that
they liked hymns when they mentioned a love of Christian music.
 Musical and Cultural Considerations for Building Rapport in Music Therapy 57

To my surprise, they preferred current, contemporary Christian

songs. Their preferred music was the result of the styles they had
been exposed to through the contemporary services at their place
of worship. That encounter reminded me not to assume even when
I’ve been able to identify a trend among patients, because it won’t
apply to everyone.

Client-preferred music
Particularly in the music therapy setting, “…a therapist’s awareness
of his/her own ethnic identity should include reflection upon his/her
musical biases and preferences” (Valentino, 2006). While it is okay to
introduce new music to a client, it should not be used exclusively in
place of your client’s preferred music. This is because it is important,
within the context of the therapeutic relationship, to utilize the
patient’s preferred music in session (Hinman, 2010; Silverman, Letwin
& Neuhring, 2016; Standley, 1986; Valentino, 2006). In some instances,
it’s actually recommended that therapists only use other types of music
after building rapport incorporating the client’s preferred music first
(Silverman, 2019). Studies on the use of patient-preferred music
(live and pre-recorded) show its efficacy with regard to multiple goal
areas in the medical setting, including psychosocial needs (Crawford,
Hogan, & Silverman, 2013; Hogan & Silverman, 2015; Madson &
Silverman, 2010; Mitchell & MacDonald, 2006).

CASE EXAMPLE: STUCK BETWEEN WORLDS

To the outside world, this patient and I were both black, but, beyond
race, our cultures were very different. It was early in my career, and
the level of disclosure that I was used to from my patients wasn’t there
in this case. I found myself questioning my effectiveness as a therapist.
With this patient, music played a primary role in the session whereas
with most others, there would be a mix of music, verbal processing,
and emotional expression. In the medical setting, most of the patients I
encountered were primarily low-context communicators—they spoke
directly and were relatively open even on first encounter; what they
said was exactly what they meant, without the need for interpretation
(Croucher, et al., 2012; Sue & Sue, 2016). At the same time, while
58 Music Therapy in a Multicultural Context

still expressive and highly communicative, some patients incorporate

aspects of high-context communication, using euphemisms to avoid
naming their diagnosis or reporting on aspects of their prognosis in
a cryptic manner, requiring me to interpret the hidden meaning and
deeper context behind what was said (Croucher, et al., 2012; Nam,
2015; Sue & Sue, 2016).
With this particular patient, though she exuded a gentle kindness,
my interactions with her were met with brief, generalized answers;
she was reserved. Her responses were sometimes direct, though
closed-ended in a way that I would later learn alluded to high-context
content that I was ill-equipped to interpret and unaware of at times.
During musical moments which were largely receptive methods, she
would sometimes close her eyes and lean her head back into the tall
chair. At other times, she would fix her gaze at a point across the
room. After the music, a calm, quiet “thank you” broke the silence
and she asked me to return during her next treatment. I did so.
And at her request, I did so again the next time. On one occasion
when I let her know I was going to be away on the date of her next
session, to my surprise she said, “No, you can’t take time off when
I’m going to be here!” Though lighthearted in manner, the patient
communicated both understanding and disappointment in that
moment. It clued me in that there was more going on therapeutically
than I was able to perceive initially. In hindsight, the scope of my
assessment had been narrowed in a way that hampered me when
presented with this patient whose culture and communication style
was different from that I was used to.
In the session following my absence, the patient stated that she
had really missed having a session. Over time, I came to know a
little bit more about her life and work in the general sense, though
our sessions remained music focused and receptive in nature. With
patient-preferred live music as the central experience in sessions,
I later realized that the autonomy the patient established in the
song selection decision-making process was therapeutic in and of
itself, with song choices also serving as forms of communication and
expression for the patient (Dileo, 2000; Silverman, 2019).
One day, something the patient mentioned about her children
made me ask a clarifying question about their level of awareness
 Musical and Cultural Considerations for Building Rapport in Music Therapy 59

about her disease. Her response shed light on an internal conflict

she was having. In a distressed manner the patient stated, “My kids
don’t even know. They see my hair falling out and they know I’m
sick, but my husband says no. Our native culture is very private, but
I told him we are in the United States now…he insists no, though.
My cousin also had cancer and my kids are asking questions because
they saw what happened to her…but I can’t tell them…”
In that moment, for the first time, I came to understand that her
reserved demeanor was a facet of her cultural identity, and what she
shared from session to session was to her degree of comfort and
according to her cultural norms. I realized that I had been evaluating
her and the efficacy of my work based on a measurement that did not
identify or acknowledge her cultural identity. If she wasn’t able to speak
openly with her children, who was I to think that she should open up
to me, a stranger? At the same time, I was thankful that we reached a
point in our therapeutic relationship that she felt comfortable enough
to express herself so deeply (Davis, Gfeller, & Thaut, 2008).

Study question
1. What are some ways that you can assess a client’s progress
when their communication style differs from your typical
benchmarks?

In their article on musical multicultural competency, Hadley and

Norris (2016) share that “through human socialization, both implicit
and/or explicit, individuals learn what their outer world deems as
important, relevant, valuable, acceptable, and/or normative” (p.131).
Conflict can be present when one’s outer world changes, leaving the
person to figure out if they will adapt, as well and how and to what
degree. Of note, is that this process is non-linear, and can be ever-
evolving. The patient in the case study above certainly had a change
in her outer world between her home country and the United States.
Though she had a desire to adopt certain aspects of the more liberal
American culture, the client’s husband believed in maintaining the
norms of their native culture. Within the private and patriarchal
nature of her native culture, she was ultimately unable to be open
with her children. However, the trust built over time in the music
60 Music Therapy in a Multicultural Context

therapy setting enabled the patient to open up to me when needed

(Potvin, Bradt, & Kesslick, 2015).
Since then, I’ve had many other instances where identifying
the client’s culture helped me to better assess, meet needs, and co-
construct the therapeutic relationship (Dileo, 2000). In turn, this has
enabled clients to verbalize needs when comfortable and as needed,
and it beneficially challenges me to actively listen, observe, and
understand the variety of ways clients communicate their needs (Kim
& Whitehead-Pleaux, 2015; McDougal-Miller & O’Callaghan, 2010).

CASE EXAMPLE: MEXICAN MUSIC/

SPANISH-LANGUAGE OFFERING
I remember encountering a patient on his first day of chemotherapy
who had multiple family members present. After introducing music
therapy services, the patient exclaimed, “If you don’t know any
Mexican songs, I don’t want it!” In that moment, I found myself
quickly thinking through my repertoire. I knew some songs that were
in Spanish, but with the specificity of his request, I didn’t want to
make assumptions about the national origin of those songs’ artists.
My approach was to make the distinction and inform him that I knew
some Spanish-language songs. He said, “Oh, I was just kidding, but
what do you know?” The first name I called out was the Mexican-
American singer Selena. To the one-word name the client responded,
“Who, Selena Gomez?” and began to laugh with a relative. I clarified,
pronouncing the singer’s name as it would be spoken in Spanish. The
patient exclaimed, “Oh, SELENAS! Why didn’t you just say that?”
Next, he inquired about my knowledge of west coast rap: “Do
you know any Ice Cube or Snoop Dogg?” I was familiar with the
music of both artists, but had never attempted either on acoustic
guitar or used it in session before. I was up for the challenge though,
so I quickly searched to find comparable chords and sang the chorus
to one of Snoop’s songs. The client was ecstatic. He relaxed back
into his chair; I had passed his test. From there, he asked for me to
sing a Selena song. After the song, he and his brother reminisced and
were easy to engage in the music therapy session. When his parents
returned, he asked that I share the Selena song again.
 Musical and Cultural Considerations for Building Rapport in Music Therapy 61

Before bringing that initial session to a close, I took time to ask

the patient more about his musical preferences, including favorite
Mexican songs and artists. As he named artists and genres that I was
unfamiliar with, I took note (Baker, 2014). The exercise became a
family activity and at times became a jovial debate as to which songs
were the best for whom, and why.
During that initial assessment session, which was also the patient’s
first treatment, he also identified and communicated to his mother
which song he wanted played at his funeral and why, translating the
theme of the song into English for me. With an unknown prognosis,
it was powerful to see the patient discuss his own mortality and
communicate aspects of his final wishes through the context of song
preference in the music therapy setting. With the patient and family
requesting follow-up, knowledge of his preferred music helped me
to prepare for future sessions.

Study questions
1. What types of cultural dynamics were present?
2. What interpersonal dynamics were present?
3. What other approaches could you take to effectively work
with a patient whose musical preferences are outside what
you are familiar with?

Chapter discussion
We will all come across clients and patients of another culture,
even if we are the same ethnicity. How can we prepare to
work with them successfully, particularly in a first session
when we don’t have access to background information before
we enter the session? What type of approach, techniques, and
ways of being can we employ to help us serve our clients?
Things to remember— the therapeutic exchange:
• Create an environment where you can continually learn
about the client (their point of view, culture, etc.).
62 Music Therapy in a Multicultural Context

• Connect on the sameness, acknowledge the differences

(the latter is not always a verbal process).
• Keep your therapeutic goal in mind.
• Be a student and the facilitator, exhibiting an openness
to learn and guide.
Food for thought: Think about equity as part of this process,
being in partnership with the patient as well as honoring
patient agency.

Music
As music therapists, we will encounter a wide variety of clients
throughout our career. Since “no single style of music will be
valued by all people,” it is imperative that our musical repertoire is
eclectic enough to serve all of our clients (American Music Therapy
Association, 2013; Certification Board for Music Therapists, 2020;
Davis, Gfeller, & Thaut, 2008, p.69). This section will provide tips,
techniques and insights for you to keep in mind as you build your
own musical repertoire.

Pre-section discussions
You’ve just learned that your next music therapy site is going
to be at a cancer center where the patient age range is 20–
90, with a median age of 50 years old. The patients vary in
terms of race, ethnicity, socio-economic status, and level of
education.
What steps can you take to build an intentional and varied
repertoire of songs for use in music therapy sessions where
the target goal is to provide psychosocial support to adult
patients?
In an online search, what keywords would you use and why?
 Musical and Cultural Considerations for Building Rapport in Music Therapy 63

Building repertoire intentionally

For many of us, it was our love of music, in part, that led us to the
field of music therapy. Even when you are well into your professional
years, I encourage you to continue to be a student of music—not just
technically with skill, but also with the depth and breadth of your
musical knowledge (Silverman, 2019). As a start, be sure to expand
beyond the music you grew up with and typically listen to. As you
delve into genres outside your foundational knowledge base, think
about the following: “What makes the art form the art form?” Of
note is that genres are broad categories that can be broken down by
style into smaller, more specific subgenres. For example, if a client
likes hip-hop, that information is only a broad entry point into
determining that aspect of their musical preferences, as the genre is
so vast (Reed & Brooks, 2017). For a more complete picture, you’ll
need to retrieve more information about their preferred artists,
songs, eras, and style(s) of hip-hop.
Learning a new song is much more than reading the sheet music
or a lead sheet and memorizing what is on the page. Is there a
particular strum pattern, feel or vocal styling that makes the genre
what it is? How can you stay true to those elements when learning
and when playing the song live? Care and consideration should
also be taken to preserve the integrity of the style through study of
the original recordings. For instance, when playing a reggae song,
implementing a reggae strum accenting the offbeat (the “and” of
each beat) is advised for authenticity, rather than using a generic
strum that emphasizes the “1” as the down beat like many standard
American tunes do. Other aspects to consider are themes—what
emotions, feelings, or imagery does the song tend to evoke? What
themes are contained in the lyrical content? A working knowledge of
all these will come in handy when needing to select music to match
or evoke a particular mood or sentiment in the session.
Adding to your repertoire can seem like a daunting task, but
as a starting point, you can begin by familiarizing yourself with
the prominent styles in your region, also considering cultural and
ethnic issues. Are there lyrics you should omit from a song as a non-
native of that culture? Are certain types of music used religiously or
ceremonially to the degree that it would be inappropriate to bring
64 Music Therapy in a Multicultural Context

them into a session (Chase, 2003; Hahna, 2017)? In the case of

music from another culture, when you don’t have access to someone
native to that culture, online resources may be helpful, granted you
carefully curate sources and verify. You can also look into workshops,
webinars or other online content.

Pop culture
For a deeper analysis, when learning new music and familiarizing
yourself with the artists and eras, also pay attention to any applicable
elements of pop culture and history. Your client may have personal
connections to the time period or music that you can utilize in
session if you are aware of this history. For example, beyond the
music:
• Cyndi Lauper was a 1980s pop culture icon and influencer
when it came to fashion and inspiring women and girls.
• In the 1960s, much of the folk music was comprised of protest
songs during the Vietnam War. At the same time, Beatlemania,
the term coined to signify the massive popularity and fan
hysteria of the Beatles, prompted the British Invasion in the
US, where UK bands such as The Rolling Stones, The Who,
and The Animals rose to fame (Robbins, 2018).
Having this knowledge strengthens your musical expertise and adds
to the possible points of connection available to build rapport with
your client.

Decades
Beyond genre, song selection can be informed by the patient’s
preferred decade(s) of music. This makes it important to be able
to categorize your music by decade and recall that information in
session. When expanding your musical repertoire, you can add
in popular songs from the range of decades that are pertinent to the
population(s) you are working with.

Geographical relevance
Finding out where your client is from may clue you into what types of
 Musical and Cultural Considerations for Building Rapport in Music Therapy 65

regional music they may like. For example, a patient originally from
New Jersey, who is seeking treatment in Texas may like Billy Joel and
Bruce Springsteen (artists from the north east who are very popular
in that area) over Willie Nelson (a native Texan whose music is very
popular in the South). While all are well known artists, their music is
a staple in different parts of the US, coinciding with their regions of
residence and the stylistic sounds most popular in those areas. While
we can’t take these cultural notions as absolutes, we can utilize them
as guideposts when needed, to be verified in dialogue with the client.
Practicing in the state of Texas, I find that many clients like
country music, but as mentioned earlier with the hip-hop example,
the specific type of preferred music within the broad genre can vary
greatly. Some clients’ musical preferences are influenced by what was
popular with their parents or grandparents, while others prefer the
music from their own era or that of their children. Geography can
also play a large role, based on who and what styles are popular in
that region (Kim & Whitehead-Pleaux, 2015).
For example, since moving to Texas from the north east, I have
come to learn a lot more about country and western music. There
are certain niche styles of country like red dirt music specific to
Oklahoma and North Texas, and truck-driving country that
encompasses lifestyle songs about the truck-driving industry. Both
of those genres sound very different from the contemporary and
pop-influenced country music styles I had previously used to define
the whole genre. As it applies to the clinical setting, consulting the
client to draw out the details of their preferences is always advised
and can offer valuable insight about the client, based on the nature
of their preferences and the ways in which they speak about them.

Food for thought: If a patient likes a certain artist, what does

that indicate about the era, genre, and possible similar artists
and styles of music that they may also like?
Exercise:
• Working in pairs, write down the names of three
66 Music Therapy in a Multicultural Context

popular musical artists or groups, ensuring that a variety

of time periods and genres are represented.
• Now trade papers and write down the genre, time
period, and two to three similar artists or groups for
each name listed.
This will help you to broaden your knowledge base of music,
so that if you are in a situation where a patient says they like
James Taylor, for example, but you don’t know how to play
any of his songs, you might at least know that he was a folk-
rock-style artist who rose to prominence during the 1970s
singer-songwriter era (Encyclopedia Britannica, 2018). You
could think about what 1970s folk or similar style of music
you know of to use in the session instead.
In a clinical setting, this type of information also helps you
to get a picture of the patient’s likes and dislikes, based on their
thoughts about similar artists, enabling you to get a deeper
sense of their musical tastes. Having this knowledge is especially
helpful during your first encounter with a patient where they
may feel “put on the spot” or otherwise unprepared to think
of their musical preferences. In seeking to enable success for
the patient, being able to quell potential feelings of inadequacy
by providing a springboard for the patient to choose from,
and/or be supported by, is essential when it comes to learning
about their preferred music and artists.

Initial encounters
If you find that you are completely unfamiliar with your client’s
preferred music, but are already in session, how can you utilize their
expertise to learn more about it from or with them?
• Inquire about the style, the history, and key artists that define
the genre. Sometimes the patient will know those levels of
detail and take great delight in the opportunity to share them.
In other instances, it is best to ask direct, yet open-ended
questions to guide the conversation:
Musical and Cultural Considerations for Building Rapport in Music Therapy 67

– “Who should I search for?”

– “Who is popular in that style?”
– “Who are your favorite groups? Why?”
Any time you have a series of questions to ask a client, be sure
to pace yourself rather than ask the questions in immediate
succession. This method leaves room for natural dialogue and
for the patient to elaborate or reflect as desired. Keep in mind
that your questions are a starting point for active listening
and learning, rather than a one-dimensional checklist to get
through in order to determine next steps. The difference in
approach is the difference between the interaction feeling
like a conversation, or just a one-dimensional interview for
the client. When it comes to building rapport, the former is
a stronger tool than the latter. It is the development of your
therapeutic skills that will enable you to more easily facilitate
discussion, while recognizing and adapting to evolving patient
needs in a session.
• If age-appropriate for patient and song era (at least 20 years
ago, granted they were adults or at least teens at that time),
ask “What were times like when this music was first popular?”
This can serve as a tool for reminiscence and information
gathering. If the client/caregiver isn’t so familiar with those
details, guide the conversation in a way that they can still
contribute without feeling pressure to recall. This is why it’s
important to figure out how people consume music early on in
the session and to determine their relationship with it. Some
will know a lot of details down to band history, while others
may just know what they like when they hear it, without ever
paying particular attention to the artist.
While you can write down the information shared with you for
future reference, there is an additional option:
• Use an internet-connected tablet computer such as an iPad to
explore patient suggestions in real time, engaging the client in
68 Music Therapy in a Multicultural Context

a music listening experience. As you are listening, regardless of

your personal opinion of the song, ask yourself the following:
– “What aspects of the music—lyrics, musicality, function,
philosophy, style—can I appreciate?”
– “What points of connection can I find?” You want to be
genuine, listen openly, and, if nothing else, know that you
gained a deeper understanding of the patient and their
music.
As the client is listening, also observe them. Are there shifts in their
temperament, facial expression or body language? What effect did
the song have on them? Supplemental questions can help you learn
more about the patient as well. Additionally, showing a genuine
interest in learning more about your client and the music that is
meaningful to them can be very beneficial towards building rapport
(Baker, 2014).
You can ask the following to gain more insight into the client’s
perspective:
• What was it like to listen to this music in this moment?
• What initially drew you to this music?
– How did you first get introduced to this music?
• What has kept you listening to this group/music over the
years?
– What do you like about the music/the artist/group?
All things considered, introducing music as the mutual “friend” and
showing consideration enough to incorporate the music that they’re
already connected to can help you to build rapport by association.
When you do that, you’ve integrated a mutual “friend” whom the
client already knows and likes. As you gather information and
familiarize yourself with the client’s preferred music, you may be
able to draw from your own repertoire as well, to introduce the
client to new music that resonates with themes and elements of
their preferred music and clinical needs area(s) (McDougal-Miller
& O’Callaghan, 2010).
 Musical and Cultural Considerations for Building Rapport in Music Therapy 69

Summary
Music, culture, and interpersonal relations are vast and complex
subjects interwoven into the very fabric of music therapy practice. At
the same time, while cultural considerations are spoken about, they
have not been fully integrated into the field. As expressions of culture,
preferred music and styles of communication vary between clients; it
is important to exercise cultural humility over cultural competence.
This chapter was designed to be an informational springboard
to inspire further research, reflection, and preparation as it per­
tains to building rapport and addressing the psychosocial needs
areas of culturally diverse adult clients. Though the entry-level
curriculum in our field does not currently teach cultural humility
as a standard part of music therapy programs across the US at this
point in time, it is my hope that not only will that change, but that
over time, more students and therapists will be aware of, open to
and do the individual work required to help our field become more
inclusive, and equipped to serve everyone equitably.

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 CHAPTER 3

LGBTQ+ Music Therapy

Beth Robinson, MT-BC
Leah Oswanski, MA, LPC, MT-BC

Beth: I have been called: “it,” “faggot,” “dyke,” and “disgusting” among
other slurs. I have been told to act more feminine, told to stop pretending
to be a man. I have been told I was going to hell, that I was ruining
my life, and that I was ruining other people’s lives, that I was hurting my
family and community. I have been told I would amount to nothing
and would drop out of college. That I could end up dead from being
murdered or from contracting AIDS or from a drug overdose. I have
been threatened. I have been physically assaulted. I have had the
windows of my car smashed and a chair thrown at my head. I have
been told that the discrimination I received was my fault because I had
chosen my “lifestyle.” I have experienced teachers, professors, friends,
and colleagues turn their backs on me and remain silent when I was
facing discrimination. I have been made to feel less-than, subhuman,
and broken.
All these life experiences had to do with one thing: being LGBTQ+.
The above examples happened within my first ten years of coming
out between the years 1990 and 2000, during my music therapy
schooling and first years working as a music therapist. Some of these
experiences and messages came from people I loved and trusted: family
members, friends, and teachers. Some messages came from society
and media: TV shows, news, local and federal government, school
and college, and organized religion. While this happens to be my
personal story and experience, it is not so unique within the LGBTQ+
community. Everyone in the LGBTQ+ community experiences some
level of discrimination and is subject to microaggressions in their lives.

75
76 Music Therapy in a Multicultural Context

I identify as LGBTQ+, as a gender queer pansexual person who has

been out in some form since my teen years. I finished my internship,
passed my boards and received my BA in music therapy in 1996 and
began working as a music therapist the same year. Today, I still continue
to work as a music therapist as well as run a music therapy business
in the Bay Area. Remembering back to my life as a young queer music
therapy student in the 1990s, I can honestly say that I did not feel
seen or supported by my professors or supervisors. Nor did I have any
education on working with LGBTQ+ clients. There was no education or
discussion about LGBTQ+ culture, topics, history or people in the music
therapy curriculum. It was as if we would never meet or work with an
LGBTQ+ person in a clinical setting. Or if we did, that their sexuality
and gender were not important.
While there was not much overt homophobia or transphobia in
my music therapy education, what I did experience were constant
microaggressions, invisibility, heteronormativity and minimizing of the
LGBTQ+ existence. “What happens in your bedroom is not business
of mine,” “I don’t care who you love, I just don’t want to see it” and
similar sayings were commonplace during this time and it was usually
said to convey acceptance or tolerance toward LGBTQ+ people. As if
it was only the act of sex that identified that person as LGBTQ+ and
if we just didn’t discuss that…POOF…suddenly we are all the same!
This is similar to statements like: “I don’t see color” when discussing
race. That statement is often said to convey acceptance but basically
communicates, “I don’t see you.” LGBTQ+ people have different lived
experiences from heterosexual cisgendered people, just as people of
color have different lived experiences from white people. If you don’t
acknowledge that, you are not acknowledging the existence of that
person. There is more to an LGBTQ+ person than just who they are
having sex with. There is more to a transgender (T) person than their
gender. There is a lifetime of unique experiences and LGBTQ+ culture
that they are part of.
While I will never experience the privilege of living a life free of
discrimination, in 2019 I do live a life demonstrating more acceptance,
understanding and protections than 20 years ago. This positive
progression has come from macro levels of change, including federal
and state laws, a level of societal acceptance, and healthier LGBTQ+
 LGBTQ+ Music Therapy 77

representation in the media and society. There are also micro levels of
change within schools, places of employment, and communities. Living
in California, I have the right to marry, the right to start a family and
have child custody. There are anti-discrimination and hate crime laws
in place that help protect me from being assaulted, fired, being refused
housing, or healthcare here. Unfortunately, many of these laws are
state laws, which are offered in only a few of the states in America.
Protections and laws can be stripped away quickly, as we have seen
during the Trump administration.
The LGBTQ+ community is rich and diverse and part of our larger
American society. LGBTQ+ people come in all ethnic backgrounds,
socio-economic backgrounds, all religious backgrounds, all ages, and
all genders. My interest and passion in writing about LGBTQ+ topics
are to keep visibility and education progressing. With this chapter, I
hope to create more visibility for LGBTQ+ people and culture in the
music therapy setting. To invite conversations and discussions about
LGBTQ+-related topics into the classroom. To challenge students and
educators to acknowledge and unpack bias they might have toward
the LGBTQ+ community, understand what unique challenges and
stressors LGBTQ+ people are facing as a minority, and deepen students
and educators’ awareness of how to become better allies for the LGBTQ+
community.

Leah: I sat down to write the personal story for this chapter and I stared
at the screen blankly for what seemed like hours. How do I write from a
vulnerable place as to why this topic is important to me while balancing
my role in oppression with my experience of being oppressed? How do I
share my experiences without getting caught in the trap of internalized
phobias and “isms” that I battle? How can I do all this without exposing
my personal life to you, most of whom are strangers to me? That’s the
weird thing about being LGBTQ+. In order to have conversations
about our marginalized identities, we may have to share very private
information to help people have a frame of reference. Another weird
thing for me about being LGBTQ+ is that my privilege is fluid and
depends on the gender (or perceived gender) of my partner. This is a
very different experience of privilege than a fixed attribute such as skin
color or a visible disability.
78 Music Therapy in a Multicultural Context

My intersectional identity includes being white, cisgendered, female,

and queer. Both my cisgenderedness and whiteness give me a great
deal of privilege. Although everyone’s personal experience is their own
and we are all unique, I realize that my representation and writing
are filtered through my privilege and that my experience of LGBTQ+
oppression is quite different from that of an LGBTQ+ woman of color
or a person who has more marginalized identities than I do. When
I say that I am queer, I am indicating that I can be attracted to and
partnered with all genders, including gender identities that don’t have
a binary male/female system. Some people use the word bisexual or
pansexual for this identity. Bi-erasure and biphobia are very real
experiences for many people like myself who don’t fit neatly into a
binary sexuality framework. I guarantee you that I am not confused
or lying to myself because I “won’t pick a side.” There are far more than
two sides. It is very difficult when people from both the straight and
LGBTQ+ communities do not think that your identity “exists.”
When partnered with a cisgendered male, things are pretty easy as
far as what I have to deal with on outward appearance. Society seems
to be respectful of me (not as a woman, but in a relationship context)
when I adhere to the societal constructs that are currently in place.
The pairing doesn’t make people “uncomfortable.” There are no worries
about access to housing, employment, healthcare, or being in public
spaces. There is freedom to hold hands without thinking about safety
and that is just the tip of the iceberg on the unearned privileges handed
to me. Multiply that by ten because of whiteness. I don’t have to worry
about my children being bullied because of my queerness either.
Being partnered with someone who is not a cisgendered male
strips me of these privileges (although if I were partnered with a white
transgender man and we “looked straight” I would still retain quite a
few). I have the potential to make a lot of people uncomfortable. And
do. Now society says that I am “different” at best, or horrific at worst.
My relationships within my entire community change as a parent,
professionally, and socially. In this pairing, we both have to work hard
to stay safe. We can’t travel to certain countries or even feel comfortable
in some parts of our own country. We can’t be mindless about public
demonstrations of affection. We have to deal with staring all the time
and potential weirdness for us at most every turn. Sometimes I am
 LGBTQ+ Music Therapy 79

not sure if they are staring because they are not exposed to LGBTQ+
people very often and are curious, or if they are staring because they
are homophobic, angry, and perhaps trying to intimidate us. There
are microaggressions. Awkward silences. I have to prep my kids to the
potential of bullying and rudeness about my identity. Sometimes it
feels like so much more energy is expended to exist in public spaces in
this partnership.
But I am thankful that I happen to live in one of the 21 states where
I am protected against discrimination for housing, employment, and
public accommodation. I am thankful that I live in a part of the country
that is more diverse and queer friendly than others. I am thankful that
there is community to be had within the field of music therapy. I am
thankful that my kids have only known marriage equality and don’t
live within a religious community or oppressive environment that has
fed them with hate speech. I am thankful that I can basically live an
open and authentic life no matter who I am partnered with, even
though my privilege can shift drastically.
I love the quote from Audre Lorde “If I didn’t define myself for
myself, I would be crunched into other people’s fantasies for me and
eaten alive” (1984, p.137). It resonates for me so deeply. She was a
brilliant writer, civil rights activist, LGBTQ+ icon, womanist, feminist,
and fierce black woman whose expressions about gender, sexuality, and
race have always been incredibly powerful for me. I spent a LOT of
years trying to define myself as to what I thought I “should” be or what
seemed “right.” At one point, I felt suffocated by the weight of living like
that. It wasn’t until I defined myself for myself and myself only that I
was finally free.

Introduction
It is almost inevitable that every music therapy student or professional
reading this book will work with someone who identifies as lesbian,
gay, bisexual, transgender, queer or questioning, as well as additional
identities indicated by the + sign including but not limited to non-
binary, pansexual, asexual, intersex, and (LGBTQ+) no matter what
region, age, population, or facility you work with/in. The American
Music Therapy Association (AMTA) Code of Ethics states that we
80 Music Therapy in a Multicultural Context

“provide quality client care regardless of the client’s race, religion,

age, sex, sexual orientation, gender identity or gender expression,
ethnic or national origin, disability, health status, socio-economic
status, marital status, or political affiliation” (1.1), and “identify
and recognize their personal biases, avoiding discrimination in
relationships with clients, colleagues, and others in all settings” (1.2)
(AMTA, 2019).
Yet for many, familiarity about the LGBTQ+ community is lacking
in education, training, and knowledge. Ahessy (2011) was the first
to research, through universities and organizations, the shortage of
global music therapy education and training specifically relating to
LGB people. Ahessy (2011) also noted that the main education was
focused on LGB people with HIV or AIDS. Thankfully, in recent
years there has been an increased focus on LGBTQ+ education
through the AMTA, and updated research on the current state
of LGBTQ+ education and training on a global university and
organizational level is warranted.
In a 2013 survey, Whitehead-Pleaux et al. found that 58 percent
of music therapists had not received training regarding LGBTQ+
issues and from the ones who had received training, 59 percent did
not feel prepared to work with people in the LGBTQ+ communities.
Our attitudes about the LGBTQ+ community may include personal
biases and/or misinformation. How do we as music therapists
commit to becoming effective, supporting, and affirming music
therapists to our LGBTQ+ community? What are possible theories
that can inform our work? What are some music therapy models and
accompanying interventions?

The LGBTQ+ experience

The LGBTQ+ experience and culture is broad and multifaceted and
includes fashion, art, music, vernacular, social venues, media,
and literature. The culture runs deeper than the iconic rainbow flag.
It’s nearly impossible to define the many subcultures and experiences
of people who have a variety of marginalized identities related to
gender or sexuality. The people within the LGBTQ+ umbrella are
a mix of intersectional identities that include age, gender, class,
 LGBTQ+ Music Therapy 81

ethnicity, race, culture, ability, and regional culture. Levels of power

and privilege within each intersectional identity shift the person’s
experiences in and of the world. It’s important to note that the
variation of being “out” or “closeted” (or a mix of both depending
on circumstances) also relates to privilege as well, and many factors,
including safety.

LGBTQ+ people of color

The erasure of the voice and identity of people of color in the
LGBTQ+ community is a prime example of disparities within a
culture. White, affluent cisgendered males have historically been
the mainstream identity most associated with the LGBTQ+ rights
movement and what is “acceptable” in media portrayals. However,
in 2012 it was estimated that one-third of the LGBTQ+ population
are people of color and this includes large numbers of immigrants
(Movement Advancement Project et al., 2013). LGBTQ+ people of
color face higher rates of unemployment and poverty for reasons
including: educational barriers, taxation, hiring bias, discrimination
in the workplace, and unequal pay (Movement Advancement Project
et al., 2013). At the time of writing this book, we are hopeful that
the trend towards greater inclusivity and accurate representation of
LGBTQ+ people of color continues. Nevertheless, this is an upward
battle, as the systemic issues of racism, patriarchy, sexism, ableism,
cisgenderism, and heteronormativity are rampant in 2019.

Violence against LGBTQ+ people

In 2018, the Federal Bureau of Investigation (FBI) reported that
federal hate crimes in the United States had risen an alarming 17
percent, which continues a three-year upward trend and the largest
increase in hate crimes since 9/11/01 (Fitzsimons, 2018). Fitzsimons
also reports that 17 percent of the hate crimes have been targeted
at people due to their gender identity or sexual orientation (2018).
Sadly, Pezzella, Fetzer, and Keller (2019) insist that these numbers are
still likely a major undercount of the total number of bias incidents,
because a majority of hate crimes go unreported, as evidenced by
82 Music Therapy in a Multicultural Context

the drastic difference in the FBI statistics and the National Crime
Victimization Survey. In particular, transgender women of color are
of higher risk, encompassing four out of five of all anti-transgender
homicides due to anti-transgender stigma, racism, and sexism
combined (Human Rights Campaign Foundation, 2018).

LGBTQ+ youth
Compared to growing up LGBTQ+ before 2010, there is currently a
more supportive atmosphere and more support available depending
on where you live in the country. That being said, a whopping 40
percent of homeless youth identify as LGBTQ+ (Human Rights
Campaign Foundation, 2018). LGBTQ+ youth are twice as likely
to be physically assaulted in some way, and 70 percent report being
bullied at school (Human Rights Campaign, 2018). Additional
stressors face LGBTQ+ youth of color due to bias around their
intersecting identities, which further complicates the experience
of being LGBTQ+ (Human Rights Campaign, 2018). Supportive
environments and community, and free services to utilize in a crisis
are essential to help mitigate the difficulties facing LGBTQ+ youth.
In a meta-analysis of 62,923 participants, Marx and Kettrey (2016)
found that the presence of a Gay Straight Alliance (GSA) within
a school equates to significant decreases of self-reports of safety
concerns, homophobic victimization, and remarks. The Trevor
Project is a national service that offers free 24/7 intervention and
suicide prevention services via text and phone to LGBTQ+ youth up
to the age of 25 (The Trevor Project, 2019a). Its research has shown
that “youth with at least one accepting adult were significantly less
likely to report a suicide attempt” in relation to disclosing their
LGBTQ+ status (The Trevor Project, 2019b).

Current legal issues of LGBTQ+ people

It appears that there is false sense of security regarding the legal
protections of LGBTQ+ people following the 2015 ruling by the
Supreme Court declaring same-sex marriages legal in all states.
At the time of this writing, 30 states have laws in place that could
 LGBTQ+ Music Therapy 83

deny an LGBTQ+ person housing and services, and do not protect

them from being fired for their identity. Only 15 states have laws
that prohibit discrimination against students in public education
on the basis of sexual orientation or gender identity. Only 16 states
have laws banning the use of conversion therapy with youth by
licensed professionals (Human Rights Campaign, 2019). While the
movement towards equality is hopeful progress for LGBTQ+ people,
we are a long way from actual equality and safety on a legal level.

LGBTQ+ affirming music therapy

The above information is provided to help inform you of various
issues that may cause stress for your LGBTQ+ clients or their
families and community. When working with LGBTQ+ clients, do
not pathologize being LGBTQ+ as the problem, but instead consider
all of the minority stress processes which impact their experience
in music therapy. It is critically important to not assume that the
presenting issue is related to being LGBTQ+ or to make their sexual
orientation and/or gender identity the focus of your work.
There are several resources available within music therapy
literature to assist in further education about LGBTQ+ topics and
affirming practices, including in-depth definitions of common
terms, the use of pronouns, appropriate language, creating inclusive
assessments, forms, and documentation (Whitehead-Pleaux et al.,
2012; Oswanski et al., 2018), historical realities versus popular
myths (Hardy & Whitehead-Pleaux, 2017), resources for educators
(York, 2015), resources for supervision (Oswanski et al., 2019), and
general resources including online training, LGBTQ+ civil rights
and legal organizations, and media (Hardy & Whitehead-Pleaux,
2017; Oswanski et al., 2018; Oswanski et al., 2019). It is imperative
to seek education beyond this chapter in order to provide quality
affirmative care for LGBTQ+ people.
The focus of this chapter is on identifying theoretical domains
that can provide an open and affirming LGBTQ+ practice by
viewing the client within the lens of interrelated factors instead of
individual isolation within their presenting issue. Although there
are many differences within the LGBTQ+ community, the “shared
84 Music Therapy in a Multicultural Context

experience of living outside dominant sexuality and sex/gender

norms, and the close links between sexuality and sex/gender, merit
an inclusive approach” (Clarke et al., 2010, p.5).
We feel that the safest and most effective music therapy practices
for LGBTQ+ people are intersectional, non-heterosexist, non-
genderist, and radically inclusive approaches to therapy—not based
in pathology. Although there can be significant crossover in many of
the areas of practice we are listing—queer, community, social justice,
and feminist—their theoretical foundations shape how they view the
presenting issue of the client differently from each other. Generally,
the orientations listed above take a macro systems view of the client’s
current needs and presenting issues. By accounting for the myriad
of interrelated and interdependent influences when working with a
client, the therapist has a greater awareness of how the intersectional
identity impacts the therapeutic process. Queer, social justice, and
feminist foundations consider the impact of multiple influences,
including marginalization and privilege, on the person. Community
music therapy is context-based and can create community as well as
create awareness of/for a community. Many music therapists practice
with a blend of these orientations in order to provide comprehensive
care for their clients and their communities.

Queer theory and queer music therapy

If you search the phrase “what is queer theory” you will get a
result of thousands of articles and books on the topic: queer
theory related to gender and sexuality, queer theory related to
physical education pedagogy, queer theory implemented in public
relations, queer theory as it relates to ethnicity, race, culture, and
beyond. Queer theory is a multifaceted and complex topic. Some
queer theorists even feel that offering a definition is conforming to
societal norms and, in itself, is counter to the principles of queer
theory (Sullivan, 2003). When in the context of LGBTQ+ therapy,
queer theory can be very broadly defined as a way of challenging
the notion of fixed sexual identities or a fixed gender binary
(Jagose, 1996), which have been created by heteronormative and
cisnormative societal constructs.
 LGBTQ+ Music Therapy 85

In 2016, Bain, Grzanka, and Crowe delineated the connection

between queer theory and music therapy and suggested a move
towards a radically inclusive approach to music therapy (queer music
therapy) with LGBTQ+ people. Queer music therapy would offer
an opportunity to combat heteronormativity though highlighting
the complex nature of sexuality, positively influence interpersonal
relationships, empower queer people to express and live their sexual
and gender identity, support of expression surrounding conflicts due
to oppression, highlight the commonality of cause vs. identity, and
counteract negative social pressures (Bain et al., 2016).
In 2017, Boggan, Grzanka, and Bain implemented qualitative
research to critically evaluate the queer music therapy model above.
Twelve board-certified music therapists were interviewed who
identified as LGBTQ+ or worked with LGBTQ+ clients. Questions
included music therapy background, experiences with LGBTQ+
clients, and feedback on the Bain et al. (2016) model. The data was
analyzed using a critical discourse approach, and indicated that the
queer music therapy model has strengths, including the rejection of
pathologizing LGBTQ+ identities, a community music therapy focus,
and an emphasis less on commonalities and more on a common
cause. However, the exploration highlighted needed development
in areas of intersectional queer identity in relation to age and ability
status. Other themes unearthed were the lack of diversity in the
field, privilege and barriers in the current educational programs,
as well as the clear lack of multicultural awareness training in our
undergraduate programs (Boggan et al., 2017).

Social justice music therapy

Social justice movements have a long history of the use of music as
motivating, connecting, and empowering people. In the literature of
the last 20 years, music therapy concepts point to the hypothesis
of music as an influence towards socio-political transformation
(Baines, 2013; Hadley, 2006; Kenny, 2006; Stige, 2002; Vaillancourt,
2012). Although it is difficult to arrive at one concise definition of
social justice, it can broadly be defined as the fair and equitable
86 Music Therapy in a Multicultural Context

distribution of privilege, opportunities and wealth in society (Social

justice, 2019).
In some community and feminist music therapy contexts, social
justice is an integral part of direct practice (Ansdell, 2002; Baines,
2013; Curtis, 2015; Hadley, 2006; Ruud, n.d.; Vaillancourt, 2012).
Baines (2013) suggests in order to “do” anti-oppressive music therapy,
we have to “continue to seek to address social inequities on multiple
levels including through regular social action” (p.4). We feel that
social justice ally education and development should be a mandated
requirement for all music therapists to provide a framework for
affirming, anti-oppressive therapy with marginalized individuals,
groups, and communities. Referring to social justice ally development,
Oswanski and Donnenwerth (2017) state that the “development
and practice of an ally is not optional as a music therapist, but an
ethical requirement” (p.259). While many music therapy students
and professionals are interested in social justice activism and ally
development, they are uncertain how to integrate these concepts into
their clinical work.
In order to practice social justice music therapy, one must
undergo training, education and critical reflection on social
justice issues. Curtis (2012) points out that there are many different
ways to approach social justice work, just as there are many
different ways to approach music therapy practice. That being said,
the foundation of social justice ally development and direct practice
must include the music therapist engaging in ongoing critical self-
reflection regarding their awareness of their identity markers, values,
and privileges (Oswanski & Donnenwerth, 2017). As Vaillancourt
(2012) points out, social and cultural countertransference is a
concern without examination of the music therapist’s socio-
cultural experiences. In work with LGBTQ+ people, this process
is paramount considering the heteronormative and cisgendered
society that filters our socio-cultural experiences. In-depth personal
analysis of organized religious beliefs should also be included.
Something important to note from the counseling literature is
that “counselors’ higher frequency of church attendance, political
conservatism, heterosexist, and rigid and authoritarian orientations
of religious identity exhibit more negative attitudes and prejudice
 LGBTQ+ Music Therapy 87

towards LGBTQ+ people” (Balkin, Schlosser & Levi, 2009; Bidell,

2014; Farmer, 2017; Oswanski et al., 2019; Rainey & Trusty, 2007;
Sanabria, 2012; Satcher & Schumacker, 2009).
Service learning projects, conference presentations, continuing
education courses, community education, and online resources
through social justice organizations are mechanisms for obtaining
further education. An excellent peer-reviewed interdisciplinary
journal for social justice, inclusivity, and socio-cultural awareness
in music therapy is Voices.1
After training and critical self-reflection, direct action is the
next step. Without action, social justice music therapy is not being
practiced. National organizations to partner with for LGBTQ+
social justice advocacy and action include, but are not limited to,
the Human Rights Campaign, the National Center for Lesbian
Rights, the Transgender Law Program, and the American Civil
Liberties Union. There are many ways to advocate for and with the
LGBTQ+ community, including working to change discriminatory
laws and organizational policies, working with local organizations
and communities, working towards decreasing LGBTQ+ healthcare
disparities, political action, or getting involved in grassroots
LGBTQ+ advocacy.

Community music therapy and health musicking

Community music therapy and health musicking are intrinsically
connected by addressing the health of both a person and the health
of their community. Musicking, which means to music, is a term
credited to Chris Small, who describes the act of taking part in music,
be it dancing, listening, performing, practicing, composing (Small,
1998). As Bonde (2011) and Small (1998) point out, musicking is a
relational experience, as a person will establish a relationship with
the music they are accessing.
The topic of community music therapy is broad and the definitions
vary depending on the music therapist and their approach. In 2002,
Stige stated that two main notions of community music therapy

1 https://voices.no/index.php/voices/index
88 Music Therapy in a Multicultural Context

exist: 1) music therapy in a community context, and 2) music

therapy for change in a community. Both notions require that the
therapist be sensitive to social and cultural contexts, but the latter
notion to a more radical degree departs from conventional modern
notions of therapy in that goals and interventions relate directly to
the community in question. Music therapy, then, may be considered
cultural and social engagement and may function as community
action; the community is not only a context for work but also a
context to be worked with (p.328).
As highlighted earlier in this chapter, in order to provide affirming
and anti-oppressive music therapy services for LGBTQ+ people
we need to move away from the conventional modern notions of
therapy and towards radically inclusive and empowering therapeutic
constructs to appropriately serve our clients. Ruud (n.d.) articulates:
“People become ill, sometimes not because of physical processes, but
because they become disempowered by ignorance and lack of social
understanding” (p.4). Daily microaggressions, marginalized identity
stressors, discrimination, isolation, fear of violence, and lack of basic
protections through oppressive laws place LGBTQ+ people at high
risk for “illness(es)” related to their spiritual, physical, and emotional
health. Community music therapy through health musicking can
offer a platform for individual and collective community goals to be
achieved simultaneously that ultimately create change and increase
the quality of health for LGBTQ+ people.
Bonde (2011) points out that health musicking can be a
professional music therapy practice, community musicking, and
also lay-therapeutic musicking (meaning it is not facilitated by a
professional and can be solitary). Often clients are looking for health
through music outside a professional one-on-one music therapy
session. Encouraging participation in community musicking and
supporting the development of lay-therapeutic musicking can also
be a comprehensive approach for LGBTQ+ clients towards health
and wellness. In direct practice, community music therapy in this
context might involve creating a band or orchestra at a community
LGBTQ+ space, facilitating a choir for trans and/or non-binary
singers, or the creation of an opera or musical theater piece written
by the LGBTQ+ community. All of these examples can eventually
 LGBTQ+ Music Therapy 89

lead to performances, or further expansion to support and empower

the LGBTQ+ community. Queer music therapy support groups
using improvisation, songwriting, relaxation techniques, dance,
movement, and health musicking that push against the constraints
of societal norms and allow a safe space for expression are also
powerful forms of community music therapy.

Feminist music therapy

Feminist music therapy, which can be practiced with any gender
(Curtis, 2012), has been described by Hahna and Schwantes (2011)
as a philosophical approach with numerous perspectives in music
therapy practice and education. Curtis (2012) asserts that feminist
music therapy incorporates community music therapy with the
addition of feminist analysis, including gender and power as
the central tenants. Considering how much gender and power play
a role in the repression of LGBTQ+ people, a feminist analysis offers
another layer of strength in implementing inclusive music therapy
practice. Feminist music therapy examines the intersectional
dimensions of clients. As Seabrook (2019) explains:
Intersectionality is a specific feminist theory that interrogates
both the ways that different identities combine to create unique
and complex dynamics of oppression and power for individuals and
communities as well as the broader social structures that sustain the
marginalization of certain identity positions. (p.2)
Because of the focus on the layered marginalized identities
of LGBTQ+ people, a feminist music therapy lens can be an
incredibly affirming and empowering approach to music therapy
practice. Hadley (2006) and Curtis (2013, 2017) have indicated
that if we are to provide a gender and culturally sensitive practice
as music therapists, it is wise to obtain further education on feminist
music therapy practices.

Clinical interventions
There has been little research published in music therapy literature
90 Music Therapy in a Multicultural Context

on work with LGBTQ+ people. Due to shifting trends we are hopeful

that young music therapy clinicians will be adding to this body of
knowledge in the coming years, as we have seen a sharp increase in
presentations on LGBTQ+ issues since 2012 when the Whitehead-
Pleaux and colleagues Best Practices document was published.
Bain, Grzanka, and Crowe (2016) highlight several therapeutic
interventions based in queer music therapy with LGBTQ+ youth.
Some of these interventions include music autobiographical
assessment to help “gain a holistic picture of a client’s need in
music therapy” (Bain et al., 2016, p.27). During this intervention,
one creates a past, present, and future timeline of their life using
song choices that resonate or connect to important life events
and how one identifies with them. This intervention can be used
in many different forms, to explore gender, sexual identity, and
identify oppression and discrimination. Bain et al. (2016) explains,
“queering this intervention can provide focus on empowerment,
affirmation rather than reinforce heteronormativity” (p.27). Gender
bender song parodies and performance can allow for exploration and
affirmation of gender and sexuality. Gender bending is the act of
transforming, bending, and/or defining traditional, stereotypical,
or expected gender roles and gender expression. Mainstream
music is predominantly heteronormative and gendered. This can
feel oppressive if one’s gender or sexual orientation is not often
represented in the music one hears. Gender bending these songs,
either by filling in the blank songwriting or performing from
a different gender can queer the experience. Choosing to play
with gender, gender roles, and sexuality during song parodies or
performance can challenge the pervasive heteronormative narrative
and create the space for liberating and affirming music therapy.
Critical lyric analysis, discussion, and engagement around the lyrics
of a song can be particularly powerful when using a song that has a
queer narrative or point of view.
Hardy (2018) conducted a mixed-methods pilot study to
investigate the influence of a community-based music therapy
workshop with transgender adolescents. The researcher created a
one-day community-based workshop that consisted of:
 LGBTQ+ Music Therapy 91

• non-referential and referential group improvisation—

including focused improvisations on issues related to the
LGBTQ+ experience, such as directives to play how gender
dysphoria feels, and non-referential improvisations based off
of a chord progression
• queering the dance space—allowing freedom to move outside
the limiting societal binary gender roles and rules. This can be
empowering and affirming
• group songwriting—creating cohesion, reducing feelings of
isolation, creating opportunities for one to creatively express
oneself, celebrating differences, commonalities, strengths, and
resilience. In this approach to songwriting, the piece of music
can also become a ritualized anthem that can be utilized for
opening or closing a session.
Results included meaningful changes in the areas of perception
of gender identity, increased confidence, a decrease in gender
identity questioning, a rise in self-esteem, and an increased sense
of community, with the biggest impact in an increase in positive
coping (Hardy, 2018).
In their 2019 master’s thesis, Gumble weaves in queer theory as a
piece of an autoethnographic framework that explores the possibilities
of gender-affirming voicework in music therapy. Voicework with
transgender or non-binary clients can include changes to one’s voice to
better align with one’s gender and is traditionally provided by speech
and language pathologists. The American Speech-Language-Hearing
Association lists the voice and communication services provided for
transgender and gender-diverse populations, including assessment
and treatment goals which can target the following areas: vocal health,
resonance, pitch, intonation, volume, articulation, language, and
non-verbal communication (American Speech-Language-Hearing
Association, 2019).
In music therapy, voice feminization, masculinization or gender-
neutralizing goals can be addressed and explored as well. This might
include support in speech and vocal changes, singing range, and
non-verbal communication. Clients might also seek music therapy
92 Music Therapy in a Multicultural Context

to provide an outlet for creative expression and emotional support

while experiencing and working on vocal changes. Achieving a
voice that is congruent with one’s true gender can decrease gender
dysphoria, as well as provide a critical piece to one’s quality of life,
emotional health, and physical safety. While the music therapist
may have a unique skillset to assess and work on transgender and
non-binary voicework, there is a specific training and education that
needs to occur as well as possible co-treatment with the client’s speech
therapist or other related disciplines. Three resources available for
educating oneself in voicework with transgender clients are: Voice and
Communication Therapy for the Transgender/Gender Diverse Client
(Adler, Hirsch, & Pickering, 2019), The Voice Book for Trans and Non-
Binary People (Mills & Stoneham, 2017), and The Singing Teacher’s
Guide to Transgender Voices (Jackson & Kremer, 2018).
When preparing music therapy interventions with LGBTQ+
clients, whether using improvisation, lyric analysis, voicework,
music and art experientials, songwriting or any form of musicking, it
is important to have a frame of reference for the musical history and
culture of the LGBTQ+ community. Like most marginalized groups,
there are historical connections that have impacted the history of
LGBTQ+ musical culture. The following section provides a short
overview of LGBTQ+ music in the United States from the 1920s
through to 2019.

LGBTQ+ artists and music through the decades

Every letter in the LGBTQ+ acronym has its own unique musical
culture and history, from the lesbian singer songwriters of the 1970s
to the gay men’s dance club scene of the 1980s, to the representation
of LGBTQ+ artists in the current hip-hop scene. As within most
cultures, and arguably even more so within the LGBTQ+ umbrella,
there is variety and difference within the many subcultures. LGBTQ+
music and artists cover all styles of music, including classical, jazz,
country, pop, disco, techno, folk, funk, musical theater, camp, rock,
punk, metal, hip-hop, rap, and so on.
In the book, Cultural Intersections in Music Therapy, Hardy and
Whitehead-Pleaux (2017) provide details about the meaning of
 LGBTQ+ Music Therapy 93

LGBTQ+ music, roles, performers, venues, and songs. Within their

chapter, they discuss how music can create and unite the LGBTQ+
community. Adding a historical perspective to this discussion,
we can thread together a timeline addressing the significance of
highlighted songs, musicians, and performers of the LGBTQ+
community with the current events of the times.
Music therapists may provide care for LGBTQ+ clients of all ages.
The use of music that is connected to the client’s culture and identity
can be a very effective and affirming tool. It’s important to have a
strong understanding of the music and also the interwoven historical
context of the client’s generational LGBTQ+ cultural experience to
provide accurate music therapy services.

1920–1930s
Prohibition began in 1920 and ran until 1933, which resulted in
the prominence of speakeasies. The Pansy Craze is the term used to
describe the gay music and entertainment club scene at that time,
which was part of the speakeasy scene (Elledge, 2010). There were
fewer discriminatory laws on the books that specifically singled
out LGBTQ+ people than in the following decades. Although
being LGBTQ+ was not the norm and there was still plenty of
ignorance and discrimination in America regarding LGBTQ+ people,
there was also more tolerance and acceptance in the entertainment
industry, particularly in urban areas. Many musicians could be more
open about their sexuality and gender expression within their music
and performance, and some made their expression of gender and
sexuality part of their act.
Within the Pansy Craze era, many performers performed in
drag and there were songs with double entendre and tongue-in-
cheek lyrical content hinting at homosexuality and gender bending.
Popular drag performers included Jean Malin and Gladys Bentley.
This is considered to be the beginning of the gay nightlife scene,
including drag and camp, music and dancing. There was also a
blues scene that included sex positive and queer sexualities within
their lyrics and performers. Bessie Jackson’s (also known as Lucille
Bogan) “BD Women’s Blues” (Bogan, 1935) and Ma Rainey’s “Prove
94 Music Therapy in a Multicultural Context

it On Me Blues” (Rainey, 1928) both openly express queer sexuality

and were written and sung by queer performers. BD is short for “Bull
Dagger,” a term used for a butch lesbian at that time.

1940s–early 1960s
During and after World War II, there was a strong push towards
social conservatism in America. Federal and local laws were passed
allowing for discrimination against LGBTQ+ people, including a ban
on holding federal jobs. In 1952, the first edition of the Diagnostic
and Statistical Manual (DSM-I), published by the American
Psychiatric Association, classified being “homosexual” as being
a mental disorder and as a “sociopathic personality disturbance”
(Drescher, 2015), which gives an indication of the intense climate of
hostility towards LGBTQ+ people at that time. In the entertainment
industry, the Hays Code, sometimes known as the Moral Production
Code, banned LGBTQ+ representation in film and theater and
attempted to “bind movies to Judeo-Christian morality,” including
suppressing films with themes of birth control, drinking, suicide,
criminal violence, sexual license, abortion, race relations and the
depiction of national or ethnic groups (Vaughn, 1990, pp.39–40).
By the middle of the 1950s, an opposition against increasing
gender and race discrimination had begun with the civil rights and
feminist movements. There was also the development of Daughters
of Bilitis (DOB), the first known lesbian rights organization in
the United States. The DOB hosted small, safer private social
functions, trying to avoid police raids and the threats of violence
and discrimination in bars and clubs (Gallo, 2006).
During this time period, LGBTQ+ musicians and performers
were in or returning to the closet. It was a dangerous time to be
out about sexuality or gender that did not conform to heterosexual,
binary cisgender roles, which is reflected in the music. Many LGBTQ+
musicians were not out publicly, such as: Dusty Springfield, Little
Richard, Leslie Gore, Billie Holiday and Leonard Bernstein. Billy
Strayhorn was one of the few musicians and composers who was out
with their sexuality. Jackie Shane, a pioneer transgender rhythm and
blues (R&B) and soul vocalist, was not officially “out” in the 1960s
 LGBTQ+ Music Therapy 95

but refused an offer to appear on The Ed Sullivan Show when they

made the offer contingent on her presenting as male (Farber, 2019).
Despite constant police raids and threats of violence, there were
still some gay clubs that included drag and camp shows. The Jewel
Box Revue was one of these clubs and one of their famous singers
and performers was Stormé DeLarverie (Yardley, 2014). The Jewel
Box Revue was a variety show in which Stormé dressed as a man
and the rest of the cast, all men, dressed as women (Yardley, 2014).

Late 1960s–1970s
By the end of the 1960s the LGBTQ+ community had become more
organized and began to fight back against police violence, threats and
bar raids against them. This was happening all over the country, but
one of the most powerful events was the Stonewall Riot of 1969. This
is considered to be the beginning of the LGBTQ+ rights movement.
(History.com, 2017). As the LGBTQ+ rights movement continued
to grow and become organized, we saw the first gay pride marches,
and the inception of gay/lesbian band and choruses, some of which
still exist today, such as the Gay Men’s Chorus.
During the late 1960s and 1970s, the mainstream American
culture began to shift again toward a more open, sex-positive attitude
about sexuality led by the youth and hippy movement. This is the
time that LGBTQ+ music and the club scene developed more fully.
In the rock genre, disco and glam rock become popular music for
dancing and dance clubs. Both have elements of freedom of gender
expression and freedom of sexuality. Some of the LGBTQ+ artists
and bands performing at this time included David Bowie, Freddie
Mercury, Sylvester, Elton John, and The Village People.
There was also a women’s feminist folk and singer songwriter
movement in America during this time. The music had folk roots
and included vocals, and accompaniment of acoustic guitar or
piano and fewer electric instruments. The movement had a strong
lesbian presence in both musicians and audiences. The women’s
music festivals were created to give women musicians a place to
perform and have their music recognized as well as to provide a
safe place for women to celebrate and enjoy this music and each
96 Music Therapy in a Multicultural Context

other. At its height, there were over 20 states that had some form
of annual women’s music festival, and some continued for decades
after this. One of the largest and longest-running festivals was the
Michigan’s Womyn’s Music Festival. Some of the artists from this
movement include Holly Near, Meg Christian, Cris Williamson, and
Joan Armatrading.
A few important LGBTQ+ songs from this time period include:
• “You Make Me Feel (Mighty Real),” performed by Sylvester
(Wirrick & Sylvester, 1978)
• “YMCA,” performed by The Village People (Morali & Willis,
1978)
• “Boys Keep Swinging,” performed by David Bowie (Eno &
Bowie, 1979)
• “Dancing Queen,” performed by ABBA, (Andersson, Ulvaeus,
& Anderson, 1976)
• “We Are Family,” performed by Sister Sledge (Edwards &
Rodgers, 1979)
• “Got To Be Real,” performed by Cheryl Lynn (Lynn, Paich, &
Foster, 1978)
• “I Will Survive,” performed by Gloria Gaynor (Perren &
Fekaris, 1978).

1980s–early 1990s
The most impactful circumstance of the 1980s for LGBTQ+ culture,
by far was the HIV/AIDS crisis. By the end of the decade, there were
“At least 100,000 reported cases of AIDS in the United States and
[an] estimated 400,000 cases worldwide” (History.com, 2017). In the
LGBTQ+ community, especially for gay men, people were losing their
entire community within a decade. Radical social justice LGBTQ+
organizations such as ACT UP and Queer Nation were created to
fight against discrimination and demand visibility, protections, and
medical funding (Morris, n.d.). LGBTQ+ performers like Freddie
 LGBTQ+ Music Therapy 97

Mercury’s and Sylvester’s AIDS-related deaths, and the impact of

AIDS affected the entire music industry. Musicians who were out
in the 1970s were pressured to go back into the closet during the
1780s and 1990s.
During the 1980s and early 1990s, music videos and MTV
became a new influence for popular music, adding a visual element.
Musical artists wore flashy, colorful clothing or leather. There was
a playfulness to gender expression with make-up and dance moves
that were connected to LGBTQ+ culture, while still very few of the
artists were publically out about their sexuality, at least within
the entertainment industry. An example of this dichotomy is George
Michael of Wham, Pete Burns of Dead or Alive, and Rob Halford of
Judas Priest. A rare few musicians did come out publicly in the late
1980s, including Elton John and Boy George.
There were also number of British male groups who were
composed largely of gay men, including Soft Cell, Frankie Goes to
Hollywood, Erasure, Pet Shop Boys and Depeche Mode. RuPaul is
an LGBTQ+ superstar who came onto the scene during the 1990s.
Joan Jett, Melissa Etheridge, K.D. Lang, Debbie Harry, the Indigo
Girls, Tracy Chapman, and Ani DiFranco were important musicians
of the LGBTQ+ women’s music scene of the 1980s and 1990s.
A few important LGBTQ+ songs from this time period include:
• “I’m Coming Out,” performed by Diana Ross (Edwards &
Rodgers, 1980)
• “I Want to Break Free,” performed by Queen (Deacon, 1984)
• “A Little Respect,” performed by Erasure (Clarke & Bell, 1988)
• “Vogue,” performed by Madonna (Madonna & Pettibone,
1989)
• “Freedom! ‘90,” performed by George Michael (Michael, 1989)
• “Groove Is in the Heart,” performed by Deee-Lite (Brill et al.,
1990)
• “Come To My Window,” performed by Melissa Etheridge
(Etheridge, 1993)
98 Music Therapy in a Multicultural Context

• “Supermodel,” performed by RuPaul (RuPaul, Harry, & Tee,

1992)
• “If I Could Turn Back Time,” performed by Cher (Warren,
1989)
• “Closer to Fine,” performed by the Indigo Girls (Saliers, 1988)
• “Constant Craving,” performed by K.D. Lang (Lang & Mink,
1991)
• “True Colors,” performed by Cyndi Lauper (Kelly & Steinberg,
1986).

Mid 1990s–2010
The post-AIDS crisis climate of the 1990s continued to be a harsh en-
vironment for the LGBTQ+ community. This time period produced
many anti-gay policies like Don’t Ask, Don’t Tell policies, which at
the time was actually an improvement for LGBTQ+ military mem-
bers being dishonorably discharged from the military, yet it still
created an anti-LGBTQ+ atmosphere. President Clinton, making it
legal for states to refuse to recognize same-sex marriages, signed the
Defense of Marriage Act (DOMA) into law.
However, the 1990s were also a creative time for female musicians
who were gaining success in the male-dominated music industry. A
good number of these musicians identified as bisexual or lesbian.
With ties to the women’s music festivals of the 1970s and 1980s, the
Lilith Fair was created by Sarah McLachlan. It was a musical tour
consisting of women and women-led bands in the late 1990s. Some
of the LGBTQ+ identified women who performed at the Lilith Fair
were: Indigo Girls, Tegan and Sara, Tracy Chapman, Brandi Carlile,
Queen Latifah, and Miranda Lambert. The 1990s also saw a rise
in Riot Girl music, with roots in feminism and punk music. This
style of feminist punk music started off in the Pacific Northwest.
LGBTQ+ musicians and bands in Riot Girl scene where also known
as Queer Core and included Sleater-Kinny, Team Dresch, Tribe 8,
and Bikini Kill to name a few. There were also gay male queer core
bands, including Pansy Division.
 LGBTQ+ Music Therapy 99

A few important LGBTQ+ songs from this time period include:

• “32 Flavors,” performed by Ani Difranco (DiFranco, 1995)
• “Heavy Cross,” performed by Gossip (Ditto, Paine, & Billie,
2009)
• “The Origin of Love,” from the musical Hedwig and the Angry
Inch (Trask & Mitchell, 1999)
• “Rebel Girl,” performed by Bikini Kill (Hanna et al., 1993).

2010s through current

Since 2010, we have seen great strides toward LGBTQ+ equality,
protection, and rights gained, including Marriage Equality in 2015
and Don’t Ask, Don’t Tell repealed in 2011. In particular, transgender
rights have gained national support for protections. However, from
2017 to the present day we have seen some of these rights taken
away, including a transgender ban in the military. It is our hope
that as we look forward and past the 2020s, we will continue the
progress made and see LGBTQ+ equalities and protections achieved
and championed.
Current transgender and non-binary musicians from 2010
onwards include Laura Jane Grace from Against Me, Anhoni, Mx.
Justin Vivian Bond, Shea Diamond, Big Freedia, and Lucas Silveria.
Other LGBTQ+ musicians from this time period include Janelle
Monáe, Sam Smith, Sia, King Princess, Hayley Kiyoko, and Mykki
Blanco. There are and will be many, many more to come.
A few important LGBTQ+ songs from this time period include:
• “True Trans Soul Rebel,” performed by Against Me! (Grace,
2013)
• “Born This Way,” performed by Lady Gaga (Germanotta &
Laursen, 2010)
• “She Keeps Me Warm,” performed by Mary Lambert (Lambert,
2013)
100 Music Therapy in a Multicultural Context

• “Closer,” performed by Tegan and Sara (Quin, Quin, & Kurstin,

2012)
• “Raise You Up,” from the musical Kinky Boots (Lauper, 2013)
• “I Am Her,” performed by Shea Diamond (Diamond, 2018)
• “Make Me Feel,” performed by Janelle Monáe (Robinson et al.,
2018).

CLINICAL CASE SCENARIOS

The following are clinical case scenarios to stimulate conversation
and learning about working with LGBTQ+ people in music therapy.
Consider the complexities of each case, including personal bias,
heteronormativity, intersectionality, and LGBTQ+ misinformation.

CASE SCENARIO 1
You are a music therapist at an adult intensive outpatient mental
health hospital facility. As you are attending the weekly team
treatment meeting, the team brings up a patient who is a transgender
woman. You listen to a team member make rude comments about
this patient’s gender expression and not respect her pronouns.
In your initial music therapy intake meeting with this patient, she
had requested she/her/hers pronouns, and asked to be called a name
that did not match the name on her facility intake form. You had
noticed that this patient was expressing both masculine and feminine
features in their presentation. They were wearing a feminine dress
and heels. However, the dress was small and poor fitting. They wore
make up that appeared very bold. They also had body hair, a beard
coming in and short masculine hair.
A nurse at the team meeting referred to this young woman
as a “hot mess” and continued to refer to her as “he.” The nurse
commented, “If he wants to be taken seriously, he should clean
up his appearance and make a better effort to look more female.”
Several people at the meeting snickered and agreed.
 LGBTQ+ Music Therapy 101

Study questions
1. How do you best advocate for this patient in regard to her
gender, pronouns and gender expression? How do you address
the team members who have made these remarks?
2. Why might a patient’s name and gender not match what
is on their intake form, driver’s license or other forms of
identification?
3. What should your music therapy intake form include to make
sure you are aware of patients’ gender and pronouns? Most
inclusive option for gender/sex would be a blank space to fill
in. If it needs to be boxes to check, make sure the form has
options for transgender male, transgender female, intersex,
gender non-binary, and other, as well as male and female
options. Make sure your intake form has an area for pronouns.
Again, most inclusive would be a blank space to fill in. If there
are boxes to check, include they/them/their as well as others
along with she/her/hers and he/him/his options.)
4. What resources might you use to help support your advocacy
for this patient? (Are there enforced non-discrimination
policies that specifically protect LGBTQ people and gender
identity at your facility? What does it say about gender and
gender expression? Are there gender expression and/or
transgender non-discrimination laws in place for your city?
State?)
5. How might class, race and gender have an impact on this
situation?
i. How could privilege or the lack thereof impact what
medical care is given and ability to receive transitioning
medical procedures and treatment for this client?
ii. How might a trans woman of color be seen differently
from a white trans man in our society?
iii. What might be the root of this difference?
102 Music Therapy in a Multicultural Context

6. Do this patient’s mental health issues impact the way others

process her gender? How?
7. How does one’s views of gender being either a binary system
or a gender spectrum impact how we see this patient’s gender
and gender expression as healthy or unhealthy?
8. How might you affirm and support this patient’s gender and
identify through music therapy?

CASE SCENARIO 2
You are a music therapist working at a residential senior center. On
your caseload is an elderly male client who is quiet, mostly stays in
his room and keeps to himself. You have recently learned that this
man identifies as gay, and his long-time partner has just died. They
had been together since the 1970s, and this client is now showing
signs of grief and depression. This is new information for you because
his intake form had written that he was not married, and you had
always assumed that he was single and heterosexual.

Study questions
1. Does this new information change your perception of this
client?
2. What is heteronormativity? How can this have a negative
impact on our relationship and treatment of clients? How
might it impact our understanding of one’s life experiences,
identity and family?
3. Why might someone in a residential senior center be in the
closet about their sexuality?
i. Within older generations, what are some of the shared life
experiences being LGBTQ in the 1960s, 1950s, 1940s and
earlier that are different from today’s LGBTQ youth? And
how might that impact their sense of safety to disclose
their sexuality and identity?
 LGBTQ+ Music Therapy 103

4. What can you do to acknowledge this new information in

your next music therapy session together?
5. What questions can you ask to learn more about this
gentleman’s life history, his life as a gay man, and his relationship
with his partner?
6. How can you acknowledge and address this person’s grief at
losing his long-term partner musically?
7. What musical artists and songs might you use that are in this
client’s demographic which now you know includes identifying
as LGBTQ+?

CASE SCENARIO 3
You are a music therapist in an adolescent brain injury rehabilitation
center. You are meeting a client for the first time in a music therapy
group. You have not had a chance to see the client’s intake form and
are unaware of the client’s gender or pronouns. Halfway through
the group, you refer to the client using she/her/hers pronouns. The
client corrects you and informs you that they go by they/them/theirs
pronouns.

Study questions
1. What is a respectful way to address misgendering someone?
(Answer: What should you do: Apologize, correct yourself
and move on. Be conscious of using the correct pronouns
moving forward. What should you avoid doing: Avoid long-
winded explanations and apologies. This can be embarrassing
for the misgendered person and also moves the focus from
the person who deserves the apology and onto you and your
discomfort.)
2. What might you do when running future groups to help prevent
this situation from occurring again? (Answer: 1) Have intake
forms that ask for pronouns. The most inclusive being a space
to fill in the blank. If using boxes to check, make sure there
104 Music Therapy in a Multicultural Context

are “they/them/theirs” and also “other” as options along with

“she/her/hers” and “he/him/his.” (Answer: 2) Include pronouns
as part of introductions at the beginning of your session. Begin
with yourself “Hi my name is…, my pronouns are she/her. Can
we all go around the room introducing ourselves and include
pronouns as well?” (Answer: 3) In general, don’t assume gender.
Use gender-neutral language when addressing group members,
such as, “They chose a song to share” versus “She chose a song
to share.”
3. What does it mean to have they/them pronouns?
i. Classroom exercise: Practice how to use they/them in
singular form in a conversation. In pairs, take five minutes
to discuss something you did recently with a date or friend.
For example, discuss going out to dinner or going to a
concert or a coffee date; however, use only gender-neutral
pronouns when talking. Have the class list neural pronoun
options: they/them/theirs, person, folks, everyone, ya’ll, and
so on.
4. What does it mean to identify as gender non-binary, gender
queer, gender fluid, agender?
i. What is the gender spectrum and how does it differ from
the binary lens of gender?
ii. There are many terms that fall under a non-binary umbrella.
How many gender identities and definitions do you know?
5. How might this information change how you perceive this
client?
6. What might you do to exhibit support and a safe space for
non-binary clients in your group?
i. How might you be more inclusive clinically and musically to
your non-binary clients?
 LGBTQ+ Music Therapy 105

CASE SCENARIO 4
You are a music therapist in a residential treatment facility that
focuses on substance abuse and eating disorders. During an individual
session with a young woman, she makes a comment about another
patient, “I don’t want to sit next to her, she’s a nasty dyke. You know
what I mean? I’ve got to watch my back with her.”

Study questions
1. How do you address this? In the moment? In follow-up?
(Answer: The Gay, Lesbian & Straight Education Network’s
Safe Space Kit. A Guide to Supporting Lesbian, Gay, Bisexual
and Transgender Students in Your School has a section titled
“Respond to Anti-LGBT Language and Behavior” (p.16) that
is useful when discussing this topic. While it is meant as a tool
for teachers, much of the information can also be used by
music therapists.)
2. Would you address homophobic language in an individual
session differently from a group session? How and why?
What are some possible responses to LGBTQ+- derogatory
comments?
i. Classroom exercise: create a list of possible responses to
homophobic and derogatory remarks both in an individual
session and a group setting.
3. If you replaced the word “dyke” with a racial slur, would you
address the comments differently? How and why?
4. Would you react differently if the patient stated, “Yeah, I’ll sit
next to her. She’s alright. She’s a dyke, you know what I mean?”
i. Is the word “dyke” always a derogatory word? If not, when
is it not?
5. What is reclaimed language? How is it used in the LGBTQ+
community? Who can use it? What can you do to support the
patient at whom the comment was aimed?
6. What impact can homophobic and LGBTQ+- derogatory
106 Music Therapy in a Multicultural Context

language have on your LGBTQ+ clients? What about the

impact beyond LGBTQ+- identified clients?

CASE SCENARIO 5
You are a music therapist in a children’s hospital. A 6-year-old child
has just been admitted and while reading the intake form you see
that this child has two moms. You are preparing your first session
with this child and will be meeting the child’s parents in this
session as well.

Study questions
1. When prepping for your first sessions with this child, what
might you do or say to indicate you are an LGBTQ+ ally?
How might you exhibit support and validation to this child
and parents during your session with them?
2. What might you do musically to validate this child’s family unit
and experience?
3. Can you think of ways this family might experience stress and
discomfort from heteronormativity and/or microaggressions
in a hospital setting?

CASE SCENARIO 6
You are a music therapist in private practice. One of your clients is
black and identifies as bisexual. She is coming to music therapy to
address generalized anxiety and depression, and to develop coping
skills. She has expressed to you that she has constant feelings of
isolation and invisibility regarding her sexuality and her identity.
She expresses feeling unaccepted in the straight and gay world.
She has heard messages from the straight community and gay
community such as, “Nobody is bisexual, you’re just a closeted gay,”
“Bisexuals just can’t make up their mind,” “Bisexuals want it all,”
and “Bisexuals cannot be in monogamous relationships.” She also
expresses how some of her straight black friends perceive being
LGBTQ+ as a white thing, stating “We don’t do that.”
 LGBTQ+ Music Therapy 107

Study questions
1. What stressors and microaggressions might a person who
identifies as bisexual have that are unique in the LGBTQ+
umbrella? (Answer: Discuss double discrimination.)
i. Why can it be more challenging to find support and
community as a bisexual person?
ii. How might this woman’s life experiences change depending
on the gender identity of who she is partnered with: a
cisgendered man, a woman, a transgender man, and so on?
2. As a music therapist, how might you explore the identity of
bisexuality?
3. What musical artists and songs might you include who also
identify as bisexual and persons of color, and address the topic
of bisexuality?
4. How is this client’s intersectional identity of being bisexual and
black significant?

CASE SCENARIO 7
You are a music therapist working in a middle school setting. A
student you are working with one on one through an individual
education plan identifies as queer. She discloses to you that she
recently came out to her family. Her father is no longer talking to
her. Her mother told her they will not accept her sexual orientation
and will kick her out of the house if she “starts dressing like a man.”
They refuse to accept her identity. They have also told her that she
is too young to understand, and that other lesbians at school are
influencing her. She states she is afraid they will kick her out and is
heartbroken with their response.

Study questions
1. What unique stresses do LGBTQ+ youth face?
2. What does it mean to “come out?”
108 Music Therapy in a Multicultural Context

3. What are some of the concerns and stressors that may be

involved in coming out of the closet with:
i. family
ii. friends
iii. work/school
iv. religious organizations
v. other community members.
4. What can you do as a music therapist to affirm and validate
her identity?
5. What could you do to address her fear and sadness about her
family’s response?
6. What resources should you have available for her?

Conclusion
It is our hope that the information in this chapter is helpful in
expanding the readers’ knowledge of LGBTQ+ culture, history,
music, and potential music therapy approaches. The unique, and
often separate, identities within the LGBTQ+ umbrella, which are a
mixture of different sexualities, genders, and intersectional identities,
all help create a queer and colorful kaleidoscope lens through
which each LGBTQ+ person experiences life. Understanding that
LGBTQ+ culture is different from heterosexual cisgender culture,
and awareness of the impact of heteronormativity, will deepen one’s
understanding of LGBTQ+ clients and families.
Recognizing and critically examining our own privilege, power,
and value systems on a personal and professional level can enable
us to adjust our music therapy practices accordingly (Oswanski &
Donnenwerth, 2017). Witnessing, appreciating, and celebrating our
LGBTQ+ clients is essential in creating and keeping an open and
affirming music therapy practice for all clients, and allows the space
for LGBTQ+ clients to feel safe, seen, and accepted.
LGBTQ+ clients will come in and out of your practices, whether
 LGBTQ+ Music Therapy 109

you are working with babies, children, teens, adults, or seniors;

whether at the beginning of life or the end; whether you are working
in schools, hospitals, or private practice; whether they are out and
open to you or remain closeted. How you educate yourself, present
yourself, and prepare your practice to create a safe, affirming space
will have a large impact on your effectiveness as a music therapist.

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 CHAPTER 4

Exploring Aging Through

a Multicultural Lens
Melita Belgrave, PhD, MT-BC

On first glance, you might assume that I identify as an African

American woman who was born in the United States. However, after
getting to know me you would know that I was born in the United
States after both my mother and father migrated from Belize, located
in Central America, and that I identify as being a Belizean woman
who was born in the United States. Although I grew up state-side, I
definitely lived in a traditional Belizean multigenerational home. My
maternal grandmother lived with us and was my earliest friend. She
cooked for me, watched TV with me, and played with me while my
parents were at work during the day. We listened to Belizean music
in our home and ate traditional Belizean meals. There was a strong
Belizean community in Chicago, so I grew up around other Belizean
friends who lived the same culture and traditions that I did. Many of
the homes I spent time in as a kid and teen were multigenerational.
Looking back, it makes sense that I would be drawn to working with
older adults and creating intergenerational programs, since that is how
I grew up. Many of my memories with my immediate and extended
family include music-making experiences (my paternal grandmother
insisted that the grandchildren learn to play the piano), with either
cousins or uncles playing the piano and everyone singing. Additionally,
all events and gatherings included recorded music and at some point
in time there was multigenerational dancing, including the youngest
and oldest family members.
I remember the first time that I thought about culture and aging

115
116 Music Therapy in a Multicultural Context

while I was observing a music session in graduate school. The room

was made up of mostly white older adults, with a few black older
adults. Yet the music was the same as if there was a room of only
white older adults. In that moment, I thought to myself what would it
look like if my parents were present for the session. What assumptions
would a music therapist or entertainer make about them? Would the
therapist assume that they were black older adults who grew up in
the south and liked Baptist music? If so, the initial assumption would
be wrong because my parents are Belizean immigrants who migrated
in their early 20s. They grew up Protestant and they enjoy all types of
music, including classical, ragtime, jazz, soca, calypso, and more. This
observation experience made me really think about the assumptions
we make when scanning a room of older adults, and that we tend to
categorize older adults by their illness or their preferred music genre
but that is it. Yet is this really reflective of the whole person? What
more do I need to consider as a therapist?

Background
Today there are over 44 million people living in the United States
who are labeled as foreign born, meaning they were born outside the
United States. The individuals categorized as foreign born comprise
12.9 percent of the population. This is an increase from the 1970s
where 9.6 million people (4.7 percent) were labeled as foreign born.
Currently, the largest population of foreign-born individuals migrate
from Mexico (25 percent) followed by India and China (6 percent),
Philippines, (5 percent), El Salvador, Vietnam, Cuba, and Dominican
Republic (3 percent), South Korea and Guatemala (2 percent) (Zong,
Batalova, & Burrows, 2019).
In a recent migration policy report (Zong et al., 2019), it was
found that “over 66 million people in the United States speak
a language other than English in their home” (p.7). The most
common language spoken in homes is Spanish (62 percent). Other
languages include Chinese, Tagalog, Vietnamese, Arabic, French,
Korean, Russian, German, Haitian Creole, Hindi, Portuguese, Italian,
Polish, and Urdu. Sixteen percent of the immigrant population are
aged 65 and older (Zong et al., 2019).
 Exploring Aging Through a Multicultural Lens 117

With the growing number of immigrants and diversity within

the immigrant population across languages spoken and countries
where persons migrate from, there is a good chance that music
therapists will work with clients who are different from them. It is
important for music therapists to apply a multicultural lens when
working with older adult populations. This chapter will explore the
literature related to multiculturalism, music therapy, and aging.
Additionally, this chapter contains learning activities related to the
literature on music therapy experiences with older adults utilizing
a multicultural lens.

Multiculturalism in music therapy

Multicultural aspects in music therapy have been explored since
the 1990s with early writings by Bradt (1997) as well as Darrow
and Molloy (1998). These early writings focused on developing a
lens and framework for multicultural music therapy practice. Bradt
(1997) introduced music therapists to multicultural counseling
theories and how those theories could be used as a framework for
music therapy. Darrow and Molloy (1998) explored how educational
training occurred for music therapy students and clinicians.
Findings revealed that students received training in elective and
general education courses. The majority of clinicians shared that
they received training through experience as a music therapist, and
that they did not receive enough training in school on multicultural
music or working with clients from other cultures.
More music therapists continued to contribute to the literature
by expanding on earlier frameworks from models utilized in other
professions like multicultural counseling (Brown, 2001). Whereas
other music therapists began to explore the use of multicultural
music therapy in the United States and other countries (Chase,
2003; Valentino, 2006), Brown (2001) expanded on earlier writings
by defining terms related to multiculturalism. Brown (2001) also
shared the importance of being a culturally centered therapist and
having cultural empathy in music therapy practice. Additionally,
Brown introduced a new model that could be used in music therapy:
the ADDRESSING model developed by Hays (1996). Each letter of
118 Music Therapy in a Multicultural Context

the word ADDRESSING represents a cultural category: “A—Age and

generational influences, D—Developmental disability, D—Disability
acquired later in life, R—Religion and spiritual orientation, E—
Ethnicity/race identity, S—Socio-economic status, S—Sexual
orientation, I—Indigenous heritage, N—National origin, and G—
Gender” (Hays, 2013, pp.15–16).
In 2003, Chase continued to contribute to the literature by reviewing
the multicultural music therapy literature in the United States and
Canada. In addition to providing the review, Chase provided steps
for clinicians to explore inside and outside music therapy sessions to
improve their multicultural lens and flexibility when working with
diverse clients. Valentino (2006) conducted a descriptive study to
explore cross-cultural empathy for music therapists in Australia and
America. Results revealed that music therapists who received cross-
cultural training in their academic programs were rated with a higher
level of cross-cultural empathy compared to music therapists who did
not receive cross-cultural training in school.
As the area of multicultural music therapy continues to grow,
more clinicians are developing research articles, book chapters, and
textbooks which share steps that clinicians can take to strengthen
their multicultural journey and lens. The steps include:
moving beyond a one-dimensional lens of culture, such as repertoire
or language, into a multidimensional lens which includes a variety
of aspects within an individual’s culture such as the meaning of
medicine and wellbeing, the meaning and function of music,
worldviews and historical realities, and diversity within the culture.
(Belgrave, 2017, p.473)
Additionally, authors encourage music therapists to be aware of
their own biases and assumptions regarding their culture and
other cultures. Other steps also include being aware of the various
categories of culture, including culture of heritage, culture of religion,
culture of generation, culture of location, and culture of identity,
and how these categories affect the therapeutic relationship for the
client and the therapist (Goelst, 2016; Hadley & Norris, 2015; Kim
& Whitehead-Pleaux, 2015; Olsen, 2017; Stige, 2015; Whitehead-
Pleaux & Tan, 2017).
 Exploring Aging Through a Multicultural Lens 119

Multiculturalism in music
therapy with older adults
Music therapy for older adults is a topic that has been well researched
and documented in research articles and textbooks (Belgrave et al.,
2011; Clair & Memmott, 2008; Clair & Davis, 2008; Ridder &
Wheeler, 2015; Wilhelm & Cevasco-Trotter, 2018). This literature
focuses on the benefits to older adults in wellness settings, older
adults diagnosed with dementia and Alzheimer’s disease, older adults
in intergenerational settings, and older adults in palliative care and
hospice settings. A review of the literature related to aging and music
therapy is beyond the scope of this chapter, due to the lack of
multicultural topics within the literature. I chose to review articles
related to multicultural music therapy and aging.
One of the topics related to multicultural music therapy and
aging is the application of various theories of aging in the music
therapy setting (Cohen, 2014; Wheeler, 2015). Aging is often
associated with declines and losses, and there is an early theory of
aging related to the concept of loss. It was believed that aging could
be described with the disengagement theory, where older adults
become withdrawn as they age. Another early theory combatted the
idea of disengagement with activity theory, where healthy aging was
measured by how active an older adult was. Cohen (2014) explored
both of these theories as well as additional sociological aging theories
and then created strategies for the music therapist to use while
employing each of the aging theories. One of the tenets of using a
multicultural lens in music therapy is seeing the client as a whole
person and recognizing the influence of a person’s culture on how
they engage in the therapeutic process. There are two sociological
theories of aging that relate to this tenet: the continuity theory and
age-stratification theory.
Practitioners who utilize the continuity theory view the role of
older adults’ social lives as an important factor. This theory supports
the idea that older adults cope with aging by maintaining the social
roles and experiences that they held during the age range of 45–65.
Cohen (2014) shares several strategies that music therapists might
adapt if they are working with older adult clients and utilizing the
120 Music Therapy in a Multicultural Context

continuity theory. Practitioners who utilize the age-stratification

theory view the role of older adults’ lived experiences in a historical
context and the effect that those lived experiences have on the
therapeutic process and relationship. This theory supports the idea
that older adults experience aging with the lens of their past
historical experiences. Therefore, every generation of older adults
would be different in how they approach aging because their lived
experiences at any point in their life would be different and would
have affected them in the past differently, based on their age. Cohen
(2014) shared several strategies that music therapists might employ
if they are working with older adults in a setting that utilizes the age-
stratification theory. For more information on applying the strategies
located in the article please see Learning Activity 9 later in the
chapter (Cohen, 2014).
There is a small literature base pertaining to multiculturalism,
music therapy, and aging. A further exploration of this literature
reveals that the majority of research articles have been conducted
in Australia with older adults who are categorized as culturally and
linguistically diverse. Music therapy sessions have happened in
group settings and individual sessions (Baker & Grocke, 2009; Chan,
2014; Forrest, 2000; Ip-Winfield & Grocke, 2011; Ip-Winfield, Wen,
& Queena, 2014; Lauw, 2016; Mondanaro, 2016; Shapiro, 2005).
Forrest (2000) conducted a case study on an older adult woman
receiving music therapy while in hospice care. The patient resided
in Australia as an adult, but she was from Russia and also spent
time in England. As part of the music therapy sessions, the patient
identified that she enjoyed a variety of musical styles including
Western classical, popular, and film music. During the early music
therapy sessions, the music therapist played music from the genres
requested by the client. The client actively engaged in the sessions
and shared verbal responses of what she liked about the music.
However, once the patient’s health declined she exhibited physical
signs of distress such as difficulty breathing, verbal expressions of not
having enough time, and decreased orientation to time, place, and
person. The music therapist interviewed the patient’s sister about
their past and discovered that the patient and her sister were forced
to leave Russia during World War II as young women. They moved
 Exploring Aging Through a Multicultural Lens 121

to England while waiting for the rest of their family to join them.
Unfortunately, their family members did not survive and the patient
and her sister migrated to Australia. The patient’s sister shared that
they never spoke about their migration story. They talked about
their childhood but never discussed or shared the music of their
childhood, although music was a large part of their growing-up
experience and included Russian folk and classical music. The music
therapist suggested bringing in music from the patient’s childhood
to assist with processing memories and feelings associated with
childhood and her migration story.
When cultural music from the patient’s past was brought into the
session the patient actively engaged in the session through singing and
verbally processing her migration story. She expressed her feelings
and memories surrounding that time in her life. This included feelings
of loss associated with family members and difficulty adjusting to a
new life in Australia. The music therapy session included the patient’s
sister, as well as the daughter and granddaughter of the patient. This
case study demonstrates the benefit of viewing an older adult client
through a multicultural lens. There were memories and feelings
that the patient needed to process for herself as well as with family
members. Finding a safe space to unlock those memories and feelings
occurred because of the music therapist’s journey and willingness to
explore the patient’s culture (Forrest 2000).
Other researchers (Baker & Grocke, 2009; Ip-Winfield & Grocke,
2011) explored the experiences of music therapists working in
Australia with older adults who were categorized as culturally and
linguistically diverse through descriptive studies. The authors of
both studies examined the music repertoire and music therapy
interventions used by music therapists when working with clients
who are of different cultures and speak different primary languages
from the therapist. The researchers found that clients who were
categorized as culturally and linguistically diverse had different levels
of engagement in a music therapy session depending on their cultural
background. Some older adults from certain backgrounds were more
observably engaged, whereas others were more reserved in their
engagement. Engagement included active singing, culturally specific
greetings, and various forms of non-verbal communication. Music
122 Music Therapy in a Multicultural Context

therapy methods and interventions that were easy to implement were

receptive, improvisation, reminiscence, music listening (recorded
and live), instrument playing, and movement-based interventions.
This could be possibly due to the limited use of language needed to
participate in many of those interventions. Similarly, songwriting
was shown to be difficult for clients with limited English proficiency.
Additional lessons learned when providing music therapy sessions
for older adults utilizing a multicultural lens included:
• Building rapport takes time, which makes sense if a therapist
is taking an approach of understanding someone’s culture and
the role it plays in their life.
• The use of non-verbal communication is important, and
music therapists suggested learning a few greetings, words
and/or phrases in the language of the older adult clients to
ease communication.
• It’s important to research the use of music in the clients’
culture.
• Music therapists need to understand the use of personal space
and boundaries as they relate to the client’s culture.
The remaining research articles describe music therapy programs
delivered in individual settings that utilize a multicultural lens.
Music therapists demonstrated cultural empathy and openness to
other cultures by gathering information from their clients pertaining
to culture, values, beliefs, and languages. In a sense, this went
beyond what type of music the client liked to who the client was
as a result of the culture they grew up in. Music therapists found
that client benefits included an increased sense of self and identity,
and improved cognitive, physical, psychosocial, and communication
skills (Chan, 2014; Ip-Winfield, Wen, & Queena, 2014; Lauw, 2016;
Mondanaro, 2016; Shapiro, 2005).
In one study (Chan, 2014), the therapist learned the role of music
in the client’s culture (German). Although the music therapist did
not typically sing in German, she learned the German folk songs
that were important to the client. They also co-wrote hello and
 Exploring Aging Through a Multicultural Lens 123

goodbye songs in German. The therapist shared that using music

that was culturally important to the client provided an opportunity
for self-identity and connection to her culture and home country.
The therapist also shared the importance of learning the influence
of the client’s culture on help-seeking and coping behaviors for the
client, as these vary across different cultures. In one instance, asking
for help was seen as a loss and decline, and therefore the client was
only able to ask for help when she was in severe pain.
Additionally, researchers have encouraged music therapists to
identify other hidden rules or norms for cultures that affect how an
older adult shows up to a music therapy session or even if the older
client shows up for a therapy session. One researcher found that
the way an older adult was invited to the session and who initiated
the invitation contributed to whether or not the older adult would
participate in and attend the music therapy session. Also, how the
older adult was addressed in the sessions mattered; some older
adults preferred a formal greeting, i.e. Mr. or Mrs., or something
else that showed respect (Lauw, 2016).

Learning activities
This section contains a series of learning activities that can be
completed as stand-alone assignments or in-class modules related
to multicultural music therapy and aging.

Learning activity 1: Who am I musically?

Background: This learning activity is based on the reading “Music
Therapy and Cultural Diversity” by Seung-A Kim and Annette
Whitehead-Pleaux (2015). First, read the chapter, and then begin
the learning activity. This activity will assist you in exploring the
relationship between your music preference and your culture
of location, culture of heritage, culture of generation, culture of
religion, and culture of identity. Answer the questions below.
124 Music Therapy in a Multicultural Context

Step 1
• Where are all the places you have lived? (Location)
• Where were your parents born and where did they grow up?
(Heritage)
• Where were your grandparents born and where did they grow
up? (Heritage)
• Is there a history of immigration in your family? If so, please
describe. (Generation)
• What decade where you born in? What decade/years were
you as a teenager? What decade/years were you in your 20s?
(Generation)
• Has religion, faith, or spirituality played a role in your life? If
so, please describe. (Religion)
• What songs, styles/genres, artists, instruments, musical
experiences are associated with your culture of heritage,
location, generation, and religion?
• Are there any other musical traditions or experiences that
your family did/does together? (Heritage, generation, location,
religion)
• What music do you listen to now and why? (Identity)

Step 2
Create a visual representation that describes the effect of your
culture on your musical preferences. Remember to be creative. You
must include at least three of the five categories of culture:
• culture of heritage
• culture of location
• culture of generation
• culture of religion
• culture of identity.
 Exploring Aging Through a Multicultural Lens 125

Step 3
If using as a class assignment, have students bring a hard copy
or digital copy of their visual representation to share with their
classmates. Use the following questions for group discussion.
• What did you learn about yourself?
• What was easy, and what was difficult to complete for the
project?
• How can you use this activity as an assessment intervention?
• How else could you use this activity in a music therapy setting?

Learning activity 2: My view on aging

Background: This activity is based on the reading the article “Music
therapy and sociological theories of aging” by Nicki S. Cohen (2014).
This activity will assist you in identifying your personal experience
with aging and how that influences your views on aging theories
and perception of aging. Read the article and then complete the
steps below.

Step 1
• Think about the relationship and experiences you had with
your grandparents and any other older adults in your life.
• List any experiences that you had with both your maternal
and paternal grandparents. Also, be sure to include if you
did not have a relationship with your maternal or paternal
grandparents.
• Do the same thing for any other older adults in your life.
• What are the lessons that you learned from your grandparents
or other older adults in your life as a child, teen, and young
adult?
• Identify which sociological theories of aging from the article
relate to the relationship, experiences, and/or life lessons that
you had with grandparents or other older adults in your life.
126 Music Therapy in a Multicultural Context

Learning activity 3: Musical expansions

Background: This activity is based on the reading the article
“Challenges of working with people aged 60–75 years from
culturally and linguistically diverse groups: Repertoire and music
therapy approaches employed by Australian music therapists” by
Felicity Baker and Denise Grocke (2009). This activity will assist you
in expanding your multicultural musical repertoire for older adults.
Read the article and then complete the steps below.

Step 1
• Table 6 contains patriotic songs, Table 7 contains folk songs,
and Table 9 contains Italian, Greek, Polish, Chinese, German,
Dutch, Russian, Spanish, Yugoslavian, and French songs.
Choose a total of two songs from Tables 6, 7, or 9 to add to
your repertoire list.
• Explore the background of the song utilizing the bullets below.
– What is the history of the song (culture, time period)?
– Who wrote the song?
– Who popularized the song?
– Have other artists sung or covered the song? If so, who?
• Explore the music of the song using the bullets below.
– What is the song structure?
– What is the key of the song?
– What chords are in the song?
– What general instruments are in the song?
– Does a group or an individual perform the song?
– What parts of the song will be easy to sing?
– What parts of the song may be difficult to sing?
– What parts of the song will be easy to replicate?
 Exploring Aging Through a Multicultural Lens 127

– What drives the song (the lyrics, chord structure, rhythm,

etc.)?
– How can you replicate that in your arrangement of the song
(accompaniment pattern, accompaniment instrument,
etc.)?

Learning activity 4: Translation

and language learning
Background: This learning activity will assist you in developing
phrases that are useful in a music therapy session when working
with clients who speak another primary language besides English.

Step 1
• Find three free translator apps and/or websites. Choose a lan-
guage and begin to develop greetings and phrases related to
music in different languages.

Step 2
• Compare and contrast your selected resources by creating a
pros and cons list with five to ten points for each app and/or
website.

Learning activity 5: Technology

bridges music around the world
Background: There are several apps that broadcast radio stations
from around the world. This learning activity will assist you in
developing technology resources that can be used to develop
interventions for clients.

Step 1
• Download the TuneIn app and use the browse icon to explore
radio stations from around the world.
128 Music Therapy in a Multicultural Context

Step 2
• What are two ways that you could use this in a session?
– What would be the benefit to the client?
• How could you create interventions for the client to complete
when you aren’t present?
– What would be the benefit to the client?

Step 3
• Find two more apps and complete Step 1 and Step 2 with each
app.

Learning activity 6: Cultural norms

Background: This activity is based on the reading the article “Mianzi
and other social influences on music therapy for older Chinese
people in Australian aged care” by Eta Lauw (2016) and the chapter
“Music Therapy and Cultural Diversity” by Seung-A Kim and
Annette Whitehead-Pleaux (2015). Review the readings and answer
the questions below.

Step 1
• Select one of the following cultures to explore for yourself:
culture of heritage, culture of location, culture of religion, culture
of generation, or culture of identity.
• What are cultural norms from your selected culture related
to music engagement, inviting people to a group setting,
measuring active engagement, leading an intervention, and
so on?
• What are cultural norms from your selected culture related
to aging?
• How would the cultural norms affect the way you might
structure an individual and a group music therapy session
with older adults?
 Exploring Aging Through a Multicultural Lens 129

Learning activity 7: Case scenarios and strategies

for implementing sociological theories of aging
Background: This activity is based on the reading the article “Music
therapy and sociological theories of aging” by Nicki S. Cohen
(2014). This activity will assist you in developing music therapy
programming and strategies for older adults in wellness settings
and assisted living or nursing homes, utilizing the continuity theory.
Read the article and then complete the steps below.

Step 1
• Read the strategies for music therapists in the continuity
theory section.

Step 2
• Case scenario: You are working as a music therapist with
older adults in a wellness setting. Determine the setting and
type of music therapy experience you will develop. Utilizing
ideas from Consideration 1, develop two to four roles and
experiences that could be used in the group. (Think about
potential musical and non-musical leadership roles.)
• How could you develop assessment materials to gather
information needed to define client roles and music therapy
experiences?

Step 3
• Case scenario: You are working as a music therapist with older
adults in an assisted living or nursing home setting. Determine
the setting and type of music therapy experience you will
develop. Utilizing ideas from Consideration 1, develop two
to four roles and experiences that could be used in the group.
(Think about potential musical and non-musical leadership
roles.)
• How could you develop assessment materials to gather
information needed to define client roles and music therapy
experiences?
130 Music Therapy in a Multicultural Context

Step 4
• Case scenario: Refer to the Consideration 2 section from
the article and your notes from Step 2 and Step 3. Develop
three questions that will assist you in exploring older adult
clients’ heritage traditions that would affect their willingness
to participate in your music experience, and two of the roles
you created from Step 2.
• Develop three questions that will assist you in exploring
older adult clients’ heritage traditions that would affect their
willingness to participate in your music experience, and two
of the roles you created from Step 3.

References
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60–75 years from culturally and linguistically diverse groups: Repertoire
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0/08098131.2017.1343372.
Belgrave, M., Darrow, A. A., Walworth, D., & Wlodarczyk, N. (2011). Music
Therapy and Geriatric Populations: A Handbook for Practicing Music
Therapists and Healthcare Professionals. Silver Spring, MD: American
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Chan, G. (2014). “Cross-cultural music therapy in community aged-care:
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 Exploring Aging Through a Multicultural Lens 131

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music therapy: The first step.” Music Therapy Perspectives, 34(2), 129–137.
doi:10.1093/mtp/miv045.
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counseling.” Journal of Counseling and Development, 74(4), 332–337.
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Oaks, CA: Sage Publications.
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cross-cultural aged care practice in Australia.” Australian Journal of Music
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Kim, S. A. & Whitehead-Pleaux, A. (2015). “Music Therapy and Cultural
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132 Music Therapy in a Multicultural Context

Ridder, H. M. & Wheeler, B. (2015). “Music Therapy for Older Adults.” In

B. Wheeler (ed.), Music Therapy Handbook (pp.367–378) New York, NY:
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Oxford Handbook of Music Therapy (pp.538–556). New York, NY: Oxford
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Whitehead-Pleaux, A. & Tan. X. (eds). (2017). Multicultural Intersections:
Music, Health, and the Person. Gilsum, NH: Barcelona Publishers.
Wilhelm, L. A. & Cevasco-Trotter, A. M. (2018). “Music Therapy with Older
Adults.” In A. Knight, B. LaGasse, & A. Clair (eds), Music Therapy an
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and-immigration-united-states.
 CHAPTER 5

Dance and Movement

Across Cultures
Natasha Thomas, PhD, MT-BC

CASE SCENARIO
There is a phenomenon I frequently experience when co-facilitating
with non-Black colleagues in classrooms of predominantly Black/
African American teens, particularly during drum-based experiences
that are rooted in playing West African rhythms on African-
style drums. A popular goal with this population is to increase
“appropriate” social interaction skills, such as collaboration and turn
taking, but often I find the definition of “appropriate” is culturally
bound. Specifically, I often observe when musicking with Black
participants that they seem to fluidly shift between tapping a foot
or two along with their instrument playing and rising to their feet
to enter the center of the playing space and move to the beat. This
never seems to me to disrupt the flow of the group—in fact, fellow
participants often seem to encourage it, with clapping and even
verbal cheers to urge the moving participant onwards.
Yet, non-Black co-facilitators often seem uncomfortable with
these mannerisms, insisting instead that participants remain seated
in their chairs throughout the entirety of the experience, sometimes
even shouting over the beat of the music for individuals to “stay
in your seats please,” whenever they get up, or utilizing sweeping
gestures for dancers to move away from the center of the space
and find their chairs. To these facilitators, such movement is not

133
134 Music Therapy in a Multicultural Context

considered an “appropriate” social interactive skill. But, more often

than not, when Black participants are forced to remain seated and
more or less “still” during playing experiences, they generally seem
frustrated by this. I’ve observed participants waving dismissingly
or glaring at my co-facilitators after being instructed to return to
their seats, and/or resuming playing with a flattened affect from
what they had displayed before while moving. Some might just
return to their seats but not resume playing at all, leading me to
wonder: How is this apparently more “appropriate” interaction in
any way better than what was happening before? Is the loss of that
individual’s participation on the whole worth it to have them meet
that measure?

Study questions
1. What underlying assumption is being made by non-Black co-
facilitators who insist that Black students stay in their seats
throughout drumming experiences?
2. What is lost for Black participants by co-facilitators insisting on
in-seat engagement? What might be gained if the co-facilitator
encourages their unique form of out-of-seat engagement?
3. How might such experiences be conducted differently so
that participants could still reach their goals while being more
meaningfully engaged? What information might you need to
know to do this?
In this chapter, we will explore various traditions across the world
relating to the movement of the body in conjunction with the music
that we as music therapists might be bringing into our sessions. But
first, we’ll begin with defining some key terms and investigating
those elements of our field that interact with the field of dance and
movement therapy, in order to carefully distinguish our scope of
practice in the context of movement, and most competently discuss
how we might be more sensitive to the traditions and experiences
of the individuals we serve.
 Dance and Movement Across Cultures 135

Music and movement

The act of “musicking,” a term that may be familiar to some
proponents of community music therapy (Ansdell, 2002), was
originally defined by musicologist Christopher Small in 1998 as
“to take part, in any capacity, in a musical performance” (p.9). In
elaborating on this definition, Small makes a point of including dance
and movement as capacities in which one can take part in music,
given that movement can, and often does, in fact, contribute to the
atmosphere being created. Small further expands on this definition
to include listening and even rehearsing or practicing as elements of
musicking, essentially asserting it as an active process that is distinct
from the product of music itself. This definition may be helpful in
this chapter as we further investigate how the products that we as
music therapists may present in terms of intentionally organized
or improvised sound may interact with the process of movement of
the human body, whether in the most basic forms of posture (how
one “holds” oneself) or the more socialized forms of what many call
dance (organized or improvised intentional movement).
Movement and music heavily feature as complementary
components in several theoretical foundations of music therapy,
including improvisational music therapy (Bruscia, 2014), and
analytic music therapy (Eschen, 2002). Research in music therapy
generally supports the idea that music serves as a motivator
for movement and can aid motor functioning (Clark, Baker, &
Taylor, 2012; DeBedaut & Wardon, 2006; Kwake, 2007). One of
the most overtly connected music therapy interventions related to
movement is Rhythmic Auditory Stimulation, or RAS, which is a
neurologic music therapy technique where external auditory stimuli
are presented as a means of encouraging the body to regulate its
movements to an external beat (Kwake, 2007). Outside neurologic
music therapy, however, there is limited research relating to any
specific kind of movement that is either encouraged or recognized
as an influence in music therapy. Similarly, there is research in
dance/movement therapy to support the idea that music choices do
influence the types of movements that individuals present (open
versus closed posturing, etc., Stahl, 2003). Even if an individual
has a limited movement capability, there is evidence to support the
136 Music Therapy in a Multicultural Context

fact that the observation of movement can improve memory and

emotional state (Cross et al., 2012).

Distinctions between music therapy

and dance/movement therapy
With breath at the start of life is both movement and sound, which
history tells us even the earliest civilizations recognized and sought
to understand (Chaiklin & Wengrower, 2009). Gesture and the
earliest attempts to produce and amplify sounds were thus utilized
not only as ritual to honor life but as practical attempts to influence
the living environment. During the early 20th Century, as dancers
like Isadora Duncan and Ruth St. Denis were attempting to bring a
semblance of this earlier life–body connection to the contemporary
dance world, performers like Marian Chace (who studied under Ruth
St. Denis) began to notice that an increasing number of students
who were not at all interested in performance were taking classes
on these re-emerging forms of expression. This paralleled the rise
of psychotherapists like Jung and Freud, and before long, Chase was
working in a hospital for returning veterans of World War I, where
the field of dance therapy’s history begins to sound very familiar
to that of music therapy. In those early days, the waltz was often
used as a means of opening the space for movement, since it seemed
heavily connected to the memories of patients Chase was working
with at the time (Chaiklin & Wengrower, 2009). Since Chase’s era,
dance/movement therapists have worked with both structured and
unstructured musical pieces, or no music at all, in order to address
a variety of clinical domains through movement.
Dance/movement therapy is defined as the “psychotherapeutic
use of movement to promote emotional, social, cognitive and physical
integration of the individual” (American Dance Therapy Association,
2018). Registered dance/movement therapists (R-DMTs) practice
in a variety of clinical settings with a diverse array of populations
and needs, and work within a core therapeutic relationship similar
to music therapists, but they use movement as the primary means
of assessment and intervention. The use of the term “primary” is
important to note here, as analytic music therapists may also make
 Dance and Movement Across Cultures 137

general assessments of a session participant’s posture and movement

as they relate to the process of musicking (Eschen, 2002). Similarly,
music therapists trained in the Bonny Method of guided imagery
with music may also be familiar with some body-based assessment
as it relates to the musicking experience (Viega, 2009); however,
even in those session structures, as with most music therapy, the
body is part of a musical whole, with music as the primary source of
assessment information and means of addressing participant needs.

Examples of differing assessment foci

Dance/movement therapist Judith Kestenberg is recognized in the
field for her creation of the Kestenberg Movement Profile, or KMP,
which is one of several assessment tools widely used by R-DMTs.
The profile is based on a rhythmic paradigm that mirrors Freud’s
psychosexual theory of development, from the oral stages of infancy
to the more genital stages of 5- and 6-year-olds (Loman, 2016).
Similar to Freud’s theories, these stages have been considered by
many to be universal, with subconscious pathology being indicated
if someone appears “stuck” in a particular stage or pattern. As with
most prominent constructs familiar to both music and dance/
movement therapists, however, these perspectives are undoubtedly
Western in nature, and worthy of questioning (Hadley & Thomas,
2018). It can never be guaranteed that any one theory, perspective,
or profile will be universally applicable across all cultures and
traditions, thus this particular profile (the KMP) is not presented
in any sort of definitive way here, but rather as a framework from
which we can further discuss the distinction between how registered
dance/movement therapists and music therapists view and integrate
movement into the treatment process.
According to the KMP, individual movement vocabulary begins
as early as the fetal stages of development, with healthy individuals
progressing through a series of “tension flow” rhythms that are either
“indulging” or “fighting,” across developmental levels. An overview
of the KMP, adapted to include developmental ages as parallels
from Freud’s psychosexual stages of development where those exist,
is provided in Table 5.1. Please note that the latter two stages are
138 Music Therapy in a Multicultural Context

unique to the KMP and do not have developmental correlations to

Freud’s theory of stages.

Table 5.1: An overview of the Kestenberg Movement Profile

Phase Indulging rhythms Fighting rhythms
Oral (birth to 1 year) Sucking Snapping/Biting
Anal (1 to 3 years) Twisting Strain/Release
Urethral (3 to 6 years) Running/Drifting Starting/Stopping
Inner genital Swaying Surging/Birthing
Outer genital Jumping Spurting/Ramming

In discussing the KMP with some practicing R-DMTs, it would seem

that the rhythmic terms utilized above are universally understood
among them, but many music therapists (myself included!) may
find they need further explanation. Visually notated examples of
the rhythms included in the KMP have been conducted by Longstaff
(2007) and are available online. I’ve taken the liberty of interpreting
those notations for more auditory mediums in Figure 5.1.

Sucking rhythm

Snapping/Biting rhythm

Figure 5.1: Musical interpretations of the

Kestenberg Profile rhythms

The above example would suggest that the term “sucking” might
almost be considered to represent a fluid, steady, and regulated
rhythm, similar to a heartbeat (Shree, 2018). By contrast then, the
snapping/biting rhythm would seem perhaps still steady, but more
prone to dysregulation, with sharp, singular beats that may have no
reverberation at all.
 Dance and Movement Across Cultures 139

In considering the KMP, many certified music therapists (MT-

BCs) may find themselves thinking of Bruscia’s Improvisation
Assessment Profile, or IAP (2001), which is presented in Table 5.2.

Table 5.2: An overview of Brusica’s (2001)

Improvisation Assessment Profile
Profile
Autonomy Dependent Independent
Variability Rigid Highly variable
Integration Irregular Well integrated
Salience Unstable Stable
Tension Strained Relaxed
Congruence Disconnected Connected

Here, we can see some parallels, in that individual profiles in the

IAP, similar to Kestenberg’s stages, can exist along a spectrum of
presentation. One might say, in interpreting an individual utilizing
the KMP, that the “sucking” rhythm is operating with what Bruscia
might call a “stable” degree of salience, or rhythmic prominence, as
opposed to the “snapping/biting” rhythm, which is more “unstable.”
Also shared between the KMP and the IAP is the important
distinction that no stage or profile is considered to be greater or
lesser than any other, and—relatedly—no position on the spectrum
is ascribed any value judgment either. Rather, each stage, profile, and/
or position along their respective spectrums is considered to simply
serve as a means of identifying patterns in musicking, which can
then be applied to the session participant’s goals and objectives to
determine any pathological issues in need of being addressed. For
instance, in considering the IAP of salience, there may be some
situations that call for a less stable sort of rhythmic prominence in
improvisation, perhaps in order to promote a sense of comfort with
the unknown or uncertainty, where another session participant or
situation might require more stability. It is up to the therapist, in
conjunction with their session participants and their established
needs and goals, to determine the path forward.
Here is another way to frame the differences between how
140 Music Therapy in a Multicultural Context

MT‑BCs and R-DMTs perceive the needs of the individuals they

serve: music therapists are listening for body rhythms and processes
that are largely internal (processed inside our heads, regardless of
how or where the sound is produced), whereas dance/movement
therapists are looking for body rhythms that are more largely
external (produced/processed outside of our heads) as indicators of
the internal. Thus, the body serves as a primary source of assessment
information in dance/movement therapy, whereas it may function as
a contributor to assessment in music therapy, but never in any sort
of broad singular way, and always as part of a musical whole.
With this in mind then, we progress in this chapter with the
realization that we as music therapists are trained to perceive rhythmic
elements differently from dance/movement therapists, and should
never seek to make any broad assessments based on our session
participants’ movements apart from the music. We can certainly
consider how external movements may connect to the internal
processes at work in our music therapy sessions, and how we might
more efficiently recognize and utilize the body as an instrument
(Bendel-Rozow, 2018), but venturing to generalize any further about
what an individual’s posture or movement may say about them in any
larger sense outside the music-based interactions we have with them
is best left to a registered dance/movement therapist.

The value of personal exploration

As we move forward with the discussion of movement and music
in a cultural context, it is important to consider and become
comfortable with how our own bodies move as instruments and
cultural beings, so that we can facilitate such experiences most
effectively (Blanc, 2018; Eckhaus, 2018). This comes from bolstering
not only our knowledge of various cultural forms of movement and
expression, but honoring our own embodied experience with them.
For instance, I come from an ethnically mixed family, but all my
living relatives on both parents’ sides were born in the Caribbean,
so white, Black or otherwise, the Caribbean culture dominates our
traditions. Caribbean people love a good party, and dance always
features at every family gathering, whether the space appears to
 Dance and Movement Across Cultures 141

have been set up for it or not. In fact, one of my favorite childhood

memories of dancing is at a house party where dance broke out in
the kitchen, with my grandmother and aunts rhythmically grooving
from one appliance to the next, the smell of delicious curry and
other spices filling the air.
With this in mind, consider the case example that opened this
chapter. Something that might have been valuable for my white co-
facilitator to know in the drumming experience described at the
opening of this chapter is that any sort of musicking in most African
diasporic traditions is heavily tied to movement; thus, drumming
and dancing often go hand in hand. Attempting to separate or stifle
any one of these two elements limits the whole of the experience.
Once this knowledge was shared with my co-facilitator, and space
given for participants to move within the music in future sessions,
their affect and engagement on the whole improved.
Also important to note here in the exploration of one’s own
comfort with and intrinsic knowledge of how their body moves is
a willingness to be gentle with oneself in this process. Each culture
is an iceberg unto itself, and while at any given moment individual
elements of stylistic movement may be discernable to outside
observers as being unique to an individual or group of people,
beneath the surface of these icebergs lie large-scale beliefs about
elements such as modesty, gender norms, and societal roles, much of
which will be invisible to the outside observer (Hall, 1976). With this
in mind, it may be necessary for you to investigate and interrogate
any messages or beliefs you may have internalized (whether from
within your cultural group or outside it) regarding the vehicle of
your body and how it can, should, or does move. This is not to say
that you may need to change anything at all, but a healthy awareness
of your own sense of physical and internalized self should only serve
to strengthen your comfort with being a facilitator of movement-
based experiences for yourself and your session participants.
So, as you read on in this chapter about the different forms of
cultural movement discussed here, consider investigating where
in your community you might find a class to take or videos to
engage with in order to become familiar and comfortable with
how your own unique body moves through these various forms,
142 Music Therapy in a Multicultural Context

before you introduce them in the therapeutic relationship. Then, as

you introduce movement experiences to session participants, keep
in mind each individual’s comfort, priorities, needs, and abilities in
accordance with their music therapy goals (Grocke & Wigram,
2006). For example, in the drumming experience described earlier,
my co-facilitator was acting out of an assumption that an inability
to “stay in your seats” while playing was a disruptive behavior,
rather than an extension of participants’ musical engagement, thus
not allowing space for movement was counter-intuitive to those
participants in that moment. However, there can also be experiences
where the use of movement may be contraindicated, such that it
would interfere with client goals relating to comfort or focus in a
given area. Participant needs, as always, must be at the center of any
movement work.

Cultural forms of movement

I have chosen to organize the following sections into types of
movement as follows: fingerplays and action songs, group social
dances (circle and line dances, etc.), partner dances, and solo/group
“presentation-” style dances (dances intended for an audience).
These classifications are based on and influenced by my own sense
of how dance and movement are generally shared societally across
cultures, from smaller-scale engagement with young children on a
one-to-one level to larger-scale familial or celebratory events and/
or stage-based venues. Historical folkloric styles and more modern
pop styles will be covered in each setting, along with the following:
• A general overview of relevant terminologies and historical
context for describing the dance styles as well as any insights
from my own personal study, research, or perspectives of
dancers I’ve interacted with, as it relates to dance/culture
in the various geographical regions within which I’ve had
experience (or connections to others who have).
• Specific information for how movement may be connected
to music we bring into sessions without us realizing it, and
how we can be more conscious in doing this in music therapy
 Dance and Movement Across Cultures 143

practice, as well as any resources for you to locate more

information.
My focus in doing this will not be on teaching any specifics of these
styles, but rather highlighting them in a general sense to bring
awareness to how they may be referenced in a musical context. That
said, do be aware that some of this information may be supported or
contradicted by your own personal experience. We are all individuals,
and there’s no possible way I could represent all cultures to the fullest
extent of their depth and range in this chapter. What I have instead
endeavored to do here is to present as much as I can confidently discuss
from a place of respect and encouragement for you as a culturally
cognizant professional to consider the differing perspectives that
participants in your sessions may bring from various backgrounds.
Additionally, I will highlight a few traditions or customs that I’m
aware of in order to point you toward some possible directions for
inquiry or exploration into movement experiences that might be most
valuable for the individuals you are serving.

Fingerplays and action songs

Overview
Action songs that utilize the body to make beats or tell a story are
often some of the first music we can remember learning as children.
Note that this is different from the first music you may remember
hearing, as that can vary. Fingerplays and songs with beat motions
like “Itsy Bitsy Spider” (familiar to many individuals raised in
America) are passed down generationally, and serve as building
blocks for creative expression and explorations (Feierabend, 2003).
They can also help to build joint attention, a crucial skill for child
development which, over time, will lend itself well to other forms of
movement, like circle dances (Shree, 2018).

Guidelines and resources for clinical use

Fingerplays and related action songs can be incredibly useful
in integrative experiences that invite fine-motor engagement.
Professionals wishing to locate fingerplay songs from around the
144 Music Therapy in a Multicultural Context

world may benefit from visiting the Mama Lisa website,1 which
features children’s songs and nursery rhymes from around the world,
usually complete with lyrics in both the native language of the song
and English translations (or a request for such information if they
don’t have it). Some songs are even accompanied by audio files. A
similar resource in paperback form is John M. Feirabend’s (2003)
The Book of Fingerplays and Action Songs, which is part of a series
of texts on songs for children which include sheet music of songs
presented in their original language. Similar to the Mama Lisa site,
however, not every song has a translation. Both resources tend to
heavily favor Western/Eurocentric music. However, with the Mama
Lisa site being a living document at least, new material or resources
may be uploaded there at any time.

An important note on cultural sensitivity

As an additional consideration, it might also be worth investigating
gestures to avoid as much as you seek out gestures to use. You may
well find in conversation with your session participants or others
from related cultures that there are gestures that might have a
connotation we wouldn’t otherwise realize, but definitely wouldn’t
want to accidentally utilize to cause offense! Examples that come to
mind are the solitary middle finger presented with the back of the
hand (in American culture), or the first two fingers, also presented
with the back of the hand (considered a rude gesture in the UK).
In general, as with most of the guidelines you’ll find here, you’re
encouraged to ask your clients/participants in your sessions (and
their loved ones) as much as possible about any songs that may
be familiar or meaningful to them, and then follow up with your
own research to locate materials you can use to supplement the
information you’ve received.

Group social dances (circles and lines, etc.)

Overview and guidelines
Folkloric dance is defined as dance that is performed within a

1 www.mamalisa.com
 Dance and Movement Across Cultures 145

community by the members of said community for recreational

or ritualistic purposes (Folk dance, 2017). From the American and
Australian Country Line Dances to the Jewish Hora and beyond,
circle and line dances are a cross-cultural phenomenon—every
cultural group seems to have them. These dances are not typically
intended for an audience, but may be staged, as many often are (we’ll
discuss staged/performance-based dances later in the chapter). In
this section, however, we’ll be focusing solely on those dances that
are recreational in nature, as some individuals or cultures may not be
comfortable doing ritual cultural dances in mixed company, or with
someone who is not from their culture. Some dances, like many of
those found in indigenous (Native American) communities, are part
of traditions that are closed to outsiders. Considering the exploitation
that has occurred to some of these marginalized populations, this is
understandable! When I find myself encountering a closed tradition,
I typically just thank the individual or group who informed me of
that fact, and then move on to ask what else I might bring to the
musical environment that might be meaningful.
Even in recreational group dance, some cultural groups may have
perspectives on gender mixing in dance that are important to keep in
mind. I’ve observed and been informed of rules relating to men and
women in Orthodox Ashkenazi Jewish communities, for example,
who dance on separate sides of the room (if they do so in each other’s
presence at all) (Bendel-Rozow, 2018). There may also be issues of
touch, as many circle dances involve holding hands, and some women
may not be comfortable holding hands with a man in a circle.
Some circle dances in various cultures, like the Dabke (a dance
found in many Middle Eastern Muslim cultures) have a designated
“leader,” someone who cues the rest of the group with movements
and travel directions, sometimes turning the circle into a snake
like pattern that weaves across a room (Dinicu, 2011). Many
Latin American line dances (like the Cumbia, a dance commonly
performed at Quinceaneras and other celebrations of life) operate
in similar fashions. In these situations, it’s valuable to defer to the
individual leading the dance, as there may be individual nuances
to how their particular cultural group conducts the movements.
As an example, a Lebanese Dabke is going to look different from
146 Music Therapy in a Multicultural Context

a Palestinian one, even if the rhythm used to accompany them is

exactly the same. You may also notice differences between more
urban and rural performers of the dance. City folk may present
with more rhythmic diversity and fills but smaller ranges of motion,
where more rural groups might possibly present less complicated
rhythmic variations but with a larger range of movement, more
instrument use, and singing (Shree, 2018).
Group social dances may also involve the use of props. Coming
up in this section, I’ll discuss my own experience as a Caribbean-
American with the popular Caribbean dance/game of “Limbo,”
but another that comes to mind is the Filipino Tingling dance,
which involves one or two dancers performing a series of steps
and jumps between two bamboo bars that are held parallel to each
other and alternately tapped on the ground or tapped together
under the dancers’ feet. Props, in dances like these, can be a vital
part of the musical and cultural tapestry of the tradition.

Resource suggestions
As with any of the dance/movement styles mentioned in this chapter,
your best resource is going to be your clients/participants in your
sessions. The following questions may help you in ascertaining some
names of songs or dances you might find useful for adding to your
music library. I’ve also answered the questions provided from my
own experience as a Caribbean-American as an example. From
that point, once you’ve got some answers to questions like these,
YouTube is often an excellent resource for tutorials on any of the
dance names you may receive.

Group social dance questions

Think back to your experience with rites of passage in your family
(births, weddings, funerals, etc.) What are the major dances or songs
that are consistently used at rite of passage events in your cultural
tradition?
• Who performs these dances (everyone, just the men/women,
etc.)? Who gets to watch these dances (do women dance just
for women, etc.)?
 Dance and Movement Across Cultures 147

• What types of physical locations are these dances performed

in (any space, or a particular space)?
• What (if any) physical props are used in conjunction with
these dances (scarves, canes, chairs, etc.)?
• How would you describe the movements used? Does everyone
do the same movements or are there parts/characters to the
dance?
• Any favorite artists or arrangements that you prefer over
others?
• Anything else I should know?

My experience: The Caribbean Limbo!

One of the most prominent dances that comes to mind in my
Caribbean family that appears in some form at every family
gathering is the Limbo. These days it is as much a game as it is a
dance, but rumor has it that the Limbo has origins in ritual ceremony
honoring West African deities. Both men and women perform this
dance and get to watch it. The dance is performed in a variety of
spaces with the iconic physical prop of the Limbo bar, a long pole
that’s held between two individuals, initially at about eye level, with
participants invited to dance their way underneath it. The primary
rule is that no part of the body can touch the bar. The additional rule
that makes this dance/game a challenge, however, is that the body
cannot bend forward to escape striking the bar. The body can only
bend backward (or sideways, which can occasionally be useful for
adjusting one’s balance).
People use all kinds of motions to contort their body as they
try to progress under the bar, usually starting with a gentle squat/
stepping motion to get in time with the beat and gradually lower
themselves by bending backward until they feel comfortable enough
to start progressing forward. Arms sometimes swing or hang behind
the body, are placed parallel to the sides, gently resting on the thighs,
or they are held out to the sides away from the body. Once the body
has successfully cleared the bar they may use the same gentle squat/
148 Music Therapy in a Multicultural Context

step to raise the body back to an upright position, or swing the body
around the side and end leaning forward as part of their victory
dance (and there’s always a little victory dance after clearing the
bar!). In the event that the individual doesn’t clear the bar, there’s
usually still some sort of moment for them to slap the floor or find
some other way to boogie back their dignity before the next dancer
comes along.
After everyone in the group has either gone under the bar
successfully or been eliminated (by falling down, striking the bar, or
breaking the body-bending rule), then the bar is lowered at an
interval determined by the two individuals holding it. Usually the
increments are smaller and kinder earlier in the game and then get
wider and more challenging as the game goes on. At the end of the
game/dance, when only one individual is left who can successfully
cross under the bar, that person wins money or some other pre-
determined prize. The game/dance can be quite lucrative! In fact, it’s
not uncommon in my family for people to toss money at dancers as
they go under the bar in general, as a form of encouragement and
reward for making it through each additional round. This practice
of rewarding dancers or individuals of honor by tossing money or
pinning it to their clothing is actually something you may see in a
number of traditions from the African diaspora. Even today, in
places like New Orleans, it’s a tradition for people on their birthdays
to wear a bobby pin prominently attached to their clothing, with the
intention that throughout the day, people will pin money to it. This
practice has also been utilized at my family’s weddings—the bride
and groom get pinned with money (though I also have a childhood
memory of someone pinning money to me too as I got down on the
dance floor!).
My family’s country of origin is St. Vincent and the Caribbean.
As such, they have some local music that everyone in the family
recognizes and loves to move to. The song we used at my own
wedding that got all the Vincentians on the floor was “Jean and
Dinah” by the Mighty Sparrow, who’s a native of St. Vincent. But
my immediate family also has a quirky favorite that’s unique to us,
which I also utilized at my wedding Limbo: Disney’s “Sebastian Party
Gras,” a concept album of songs by the character Sebastian from the
 Dance and Movement Across Cultures 149

The Little Mermaid. None of the songs on that album are from the
original The Little Mermaid movie, but are instead Caribbean songs
reimagined by the character of Sebastian, with a minimal little side
plot about him trying to throw a party for Ariel’s family under the
sea. His version of “Limbo Rock” is a particular favorite of mine!

Partner dances
Overview
When most individuals think of partner dance, what they picture is
Western European heterosexual couples in each other’s arms, gliding
across a ballroom floor. Now there is definitely an element of truth
to some of this—take, for instance, the Argentine Tango, where the
male is expected to invite and lead the female with a strong degree
of “machismo,” or “manliness” (Toyoda, 2012). But ballroom dance
is just one facet of partner dancing, and while it has become more
globalized—as have less formal styles like the Polka, or more modern
partner dances like the Lindy Hop (the first major dance form to
be created by African Americans in the Northern United States)
(Wells, 2013)—these often gender-bound concepts of leadership and
following may not translate the same way between cultures. What
does seem to universally translate about partner dancing is its role in
the social act of courtship; it is a uniquely physical—and yet socially
acceptable, in most cultures—way of “testing out” how one interacts
with another, and may bring to the fore questions of agency, power,
and sensitivity (Aloff, 2006).

Guidelines and resources

One of the most obvious immediate concerns to consider with
partner dancing is that of touch. There are some cultures—Jewish
Orthodox traditions, as an example—for which physical contact
between men and women is not permitted, or is looked down upon
(Eckhaus, 2018). So be sure to inquire into participants’ comfort
with physical contact before engaging in this type of movement
experience. It’s also important to consider the possibility that
individuals may not be comfortable dancing within the confines of
heterosexual gender roles and may wish instead to dance outside
150 Music Therapy in a Multicultural Context

this boundary. There is a TED Talk available on YouTube under

the title “Liquid Lead Dancing” that explores possible alternatives
to cis-heter-male-dominated leading in ballroom dance. For those
interested in learning more traditional ballroom styles, a textbook
like Moore’s (2012) Ballroom Dancing, which contains diagrams
of steps for major forms like the Waltz and Foxtrot, along with
guidelines for music selection (mainly with regard for tempo, etc.)
is very useful.
I have used partner dancing (often adapted for use with
wheelchairs or other assistive devices) with relative success in care
settings for the elderly, largely in a receptive sense, to encourage
reminiscence and assist in maintaining gross motor dexterity and
endurance as long as possible. It can also be useful in opening
the door for increased communication or improvisational self-
expression between group members. As with other forms of social
dance presented here, you can ask participants in your sessions to
provide you with their preferred or remembered songs to dance
to, as well as their comfort with various forms and roles. Conducting
YouTube searches for performances of various styles may also yield
productive results for finding music.

Solo and group “presentation-” style dances

(dances intended for an audience)
Here we enter into what is probably the most diverse and complicated
form of dance in any culture, and the form you may find yourself
least likely to use in a therapeutic setting, unless you’re working with
a group that wishes to use it for recreational, improvisational, or
compositional purposes (which is entirely possible!). As was stated
at the beginning of this chapter, there is no possible way I could
present for you every existing cultural dance and its therapeutic
applications and implications here, but what I will endeavor to
provide in this section are some regional overviews of solo or group
presentation-style dances that I have either witnessed, or been lucky
enough to learn and perform myself, with some collective insights
into how they may be useful in a therapeutic setting.
 Dance and Movement Across Cultures 151

Dances from the African diaspora

African cultural dance (and its descendent forms across the diaspora
of countries influenced by the slave trade) may serve tremendous
cultural value to participants in sessions, particularly in settings with
a large Black American population. Evidence suggests that Black
or African American adolescents, for example, are more likely to
engage with academic or other information when it is presented
to them in a culturally relevant way (Sampson & Garrison-Wade,
2005). West African dance classes are among the easier to find
of dance styles from the African continent (and most relevant to
descendants of the slave trade), and can be easily paired with drum
circle experiences like the one I mentioned in the scenario at the
beginning of this chapter. Others may find, however, that beginning
with more modern Black cultural dance icons like Michael Jackson,
Prince, Beyoncé, and Rihanna, may be a more accessible route for
engaging with the unique way the Black community moves. In
general, relaxing your hips and moving with the beat (as well as
clapping on the two and four of any given measure!) will get you far.

Dances from Asia and the Middle East

Over the last several years, I have been fortunate to be a student of
Middle Eastern dance, which often intersects with both African and
Asian forms of dance, largely through a unique blend of beautiful
cultural exchange, unfortunate stereotypes, and outright exploitation.
The history of dance in the Middle East in particular (as well as some
parts of Asia) can be difficult to trace because of the way it has been
portrayed historically through a Western lens, which often hyper-
sexualized the folkloric and social dances it perceived as being solely
for the male gaze (which couldn’t be further from the truth!). In fact,
in many Middle Eastern cultures, certain social dances were only
ever meant to be performed by women, for women, as a form of
recreation and social education (Dinicu, 2011). Some of this is still
the case in some Muslim households (again, indicating the value of
asking individuals about their comfort with performing dance styles
in mixed company), but many forms of Asian and Middle Eastern
dance are now widely performed on stages and in classrooms alike
as forms of exercise and aesthetic exploration.
152 Music Therapy in a Multicultural Context

Some solo and group performance styles, like the social dances
we’ve discussed previously in this chapter, will use props, like the
Chinese water sleeves, which are long silk extensions sewn into
the sleeves of dresses for Chinese cultural dance. Many individuals
will be familiar with the use of veils in bellydance, which function
with similar aesthetic qualities. Other cultures might use balance
props, like the large ceramic jars of Tunisia or bowls in the Uyghur
region of China. Some of these practices evolved from practical
use, carrying water into a city from wells on the edge of town, for
example. Others are purely for aesthetic purposes, but can be strong
catalysts for emotional expression and compositional development
in the therapeutic relationship.
For music therapists looking to utilize Asian and Middle Eastern
dance in therapeutic settings, the book You Asked Aunt Rocky by
C. Varga Dinicu (2011), which I’ve referenced a few times in this
chapter, is an incredible resource for learning history and some basic
overviews of various Middle Eastern cultural dances. Bellydancer
Mahin also cultivates a website,2 which releases valuable information
on a daily basis about various forms of bellydance as a performance
style, including the occasional instructional video! For those
interested in more East Indian styles, Bollywood and Rajastani dance
are valuable counterparts to Google (Rajastani is more historical
folkloric dance, where Bollywood is a booming modern industry
full of dramatic and energetic music for movement). Rhythms worth
learning for those dances include Ghoomer (which contains what
my friend Ritu calls a very “biting” rhythm), and Gharbha (which
she says is more “mixed”, Shree, 2018).
One final note on this region of the world: It is possible in
exploring forms of dance from the Middle East and Asia that you may
come across music that is intended for ritual and prayer/meditation.
As was mentioned earlier in this chapter with indigenous Native
American dance, some of those traditions are closed and should
not be utilized in the therapeutic setting (unless both you and the
participant come from that background of course, in which case,
proceed with discretion towards the use of spirituality in therapy).

2 https://bellydancequickies.com
 Dance and Movement Across Cultures 153

In general, if ever you see the words “temple” (often associated with
Hindu dance) or “prayer” included in the title of a song or dance,
avoid its use in clinical settings.

Dances from Europe and North America

Something I frequently tell individuals I work with in multiculturally
themed workshops is that every individual has a culture that is
unique to them, even if they don’t realize it. Often individuals
(particularly in the United States) from European backgrounds
will say, “I don’t have a culture,” but I find that once we delve a
little deeper, great diversity can be found in European culture as
well. Ask an Irish dancer how they like Highland dancing (which
originates in Scotland) and their reaction will surely tell you (on a
related note, from personal experience—don’t ever conflate those
two things)!
As with many other forms of dance around the world, some
of these solo and group dances emerged from practical everyday
actions and rituals, like preparing weapons for a hunt. Others
emerged primarily as forms of aesthetic expression, like Ballet
did in France, or Flamenco did from the nomadic Roma tribes
who traveled from India, merged with the Sephardic Jews around
Israel, and then continued across North Africa into Spain (Dinicu,
2011). Yet others are rumored to have emerged as forms of social
rebellion, like the dances of Ireland and Scotland, which began as
social and competitive dance styles but some say evolved into the
straight-armed forms we know today when families were instructed
by puritan Catholic priests that it was ungodly to dance with too
much abandon in their households—so they learned to dance solely
from the waist down, so that to any passers-by it would look as if
they were simply standing in place (Gavigan, 2013)! These types
of origin stories can be valuable for building rapport and cultural
relevance with participants in music therapy sessions, as well as
inviting creative exploration in improvisation- and composition-
related experiences.
154 Music Therapy in a Multicultural Context

Conclusion
In this chapter, we’ve explored various movement traditions across
the world as they relate to the music that we as music therapists
might be bringing into our sessions, often without realizing it. We
reviewed how music can serve as a motivator for movement and
can support motor functioning, but how we often don’t consider
movement with any sort of specificity with regard to how we might
utilize it in sessions, or how it might be necessary to consider
its cultural relevance before doing so. But there is great value in
investigating the role that movement can play in therapy, as rooted
in cultural experience, in order to be more sensitive to the traditions
and experiences of the individuals we serve. My intent in the sharing
of these resources and suggestions is that students and clinicians
will feel encouraged to explore their own experience and movement
traditions, as well as empowered to engage their session participants
more meaningfully and authentically as movers and impactors in the
musicking experience.

Closing discussion questions

• How might you define your own movement history or how
dance and/or movement fit(s) into your cultural identity?
Are there forms of movement with which you are more
comfortable or have more experience? What personal
blockages or boundaries might you have regarding movement
that need to be further explored or defined?
• Where might you begin to implement more culturally
cognizant movement practices into your clinical work?
Identify some areas of strength as well as areas where you
may need to do some additional exploration or skill building.
• What are some of the resources available to you for exploring
or expanding your own personal history and comfort with
movement? How about for the populations with which you
work?
 Dance and Movement Across Cultures 155

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analysis_reviews/laban_analysis_notation/effort_dynamics_eukinetics/
Kestenberg_rhythms.htm.
Moore, A. (2012). Ballroom Dancing (tenth edition). New York, NY: Routledge.
Sampson, D. & Garrison-Wade, D. F. (2005). “Cultural vibrancy: Exploring
the preferences of African American children toward culturally relevant
and non-culturally relevant lessons.” Urban Revolution, 43(2), 279–309.
doi:10.1007/s11256-010-0170-x.
Shree, R. Personal communication, 6 Jan. 2018.
Small, C. (1998). Musicking: The Meanings of Performing and Listening. Hanover:
University Press of New England.
Stahl, J. (2003). “The development of the open/closed movement analysis scale:
A pilot study of the effects of different musical styles on freedom of body
movement.” American Journal of Dance Therapy, 25(2), 123–125.
Toyoda, E. (2012). “Japanese perceptions of Argentine tango: Cultural and
gender differences.” Studies in Latin American Popular Culture, 30, 162–
179.
Viega, M. (2009). “Body listening as a method of understanding a music
program used in the bonny method of guided imagery and music.” Journal
of the Association for Music & Imagery, 12, 21–45. Retrieved from https://
search.ebscohost.com/login.aspx?direct=true&db=awh&AN=56602256&
site=eds-live.
Wells, C. J. (2013). Lindy hop (dance). Salem Press Encyclopedia. Amenia, NY:
Grey House Publishing.
 CHAPTER 6

Cultural Humility in Clinical

Music Therapy Supervision
Maria Gonsalves Schimpf, MA, MT-BC
Scott Horowitz, MA, MT-BC, LPC, ACS

Defining supervision
Supervision is the foundation of education, training, and ongoing
professional development for all music therapists and students.
While we have some seminal texts addressing the practice of music
therapy supervision (Forinash, 2001; Odell-Miller & Richards, 2009),
and an increasing body of literature beginning to explore the various
dynamics of supervision in music therapy (Jackson, 2008; Lim &
Quant, 2018; Rushing, Gooding, & Westgate, 2018; Silverman, 2014;
Swamy, 2011), there appears to be only a small sample from which to
draw. For this reason, it is necessary for us to also look outside our own
field to those of related disciplines such as psychology (Falender &
Shafranske, 2004; Falender, Shafranske, & Falicov, 2014; Stoltenberg &
McNeill, 2009), counseling (Bernard & Goodyear, 2014), and marriage
and family therapy (Aponte & Carlsen, 2009; Hardy & Bobes, 2016)
to examine a much broader perspective on supervision theory and,
more specifically, the importance of culturally sensitive supervision.
Falender and Schafranske (2004) define supervision as:
a distinct professional activity in which education and training aimed
at developing science-informed practice are facilitated through
a collaborative interpersonal process. It involves observation,
evaluation, feedback, the facilitation of supervisee self-assessment,

157
158 Music Therapy in a Multicultural Context

and the acquisition of knowledge and skills by instruction, modeling,

and mutual problem solving. (p.3)
In her book, Music Therapy Supervision, Forinash (2001) writes:
The focus of the supervision relationship is to address the
complexities involved in helping supervisees in their ongoing
(and never-ending) development as competent and compassionate
professionals. Supervision is a relationship, one in which both
supervisor and supervisee actively participate and interact. (p.1)
What is clear from both of these definitions is that supervision
involves an interpersonal relationship between the supervisor and
supervisee, but also that it is in the service of therapeutic treatment
of clients. In this way, supervision can be understood as a triadic
relationship in which the supervisee, supervisor, and clients are all
stakeholders in that relationship.
As supervisors, we are responsible for supporting our supervisees
in their development of the knowledge, skills, and awareness
needed to provide the highest possible level of care and music
therapy services to their patients, clients, and communities.
Simultaneously, a part of this process is to utilize the supervisory
relationship to support supervisees in their own personal
development, including, arguably, the encouragement and exploration
of a multidimensional view of themselves (Hardy & Bobes, 2016). This
requires the supervisor’s commitment to engagement in their own
learning and growth experiences in order to adopt a stance of curiosity
and interest, not one of expert. The field of music therapy offers us
some guidelines for the education standards which dictate the amount
and level of supervision that students must experience in their path to
becoming a music therapist (American Music Therapy Association,
2018). However, as a field we do not provide much acknowledgement
or guidance in the importance of ongoing professional supervision
other than some acknowledgement in the professional competencies
(American Music Therapy Association, 2013) and advanced
competencies (American Music Therapy Association, 2015; Swamy
& Kim, 2019).
 Cultural Humility in Clinical Music Therapy Supervision 159

Models of supervision
As noted in a recently published article in Music Therapy Perspectives
by Rushing, Gooding and Westgate (2018), there seems to be a
lack of any clear model of music therapy supervision as utilized
by internship supervisors. However, if we again look outside our
music therapy literature, there are in fact distinct, defined theories
and models of supervision. Bernard and Goodyear (2014) identified
three main categories of clinical supervision models, psychotherapy-
based, developmental, and process (sometimes referred to as
integrative).
The first category is those based on psychotherapy theories,
including, psychodynamic, humanistic, cognitive-behavioral, systemic,
and constructivist. The second category includes developmental
models of supervision such as the Integrative Developmental Model
(IDM) model of supervision (Stoltenberg & McNeill, 2010) and the
Life-Span Model (Rønnestadt & Skovholt, 2003), among others. The
third category is identified as process models but in literature is also
referred to as integrative models, including the Discrimination Model
(Bernard, 1997) and Systems Approach (Holloway, 1995).
Despite the existence of these discrete models of supervision
theory, it has been repeatedly acknowledged that most supervisors
lack opportunity for specific training in supervision (Falender &
Shafranske, 2004; Bernard & Goodyear, 2014). Estrella (2001) cited
Bernard and Goodyear’s studies in her chapter referencing supervision
training as an infrequent occurrence, and problematic, over a
decade and a half ago. Even today, many supervisors’ approaches to
supervision are informed primarily by their own personal experiences
in supervision and by their orientations as therapists. While the models
referenced here are most certainly useful and applicable resources,
we are not fully engaging with effective supervision practice if we
do not integrate supervision theory and research into our practice.
As this theoretical and research base has grown, there is increasing
attention being devoted to culture, multiculturalism, and diversity in
supervision (Watkins et al., 2019; Estrada, Frame, & Williams, 2004;
Falender et al., 2014; Hardy & Bobes, 2016; Hook et al., 2016).
160 Music Therapy in a Multicultural Context

Supervisory relationships
It is clear from any definition of supervision that it is a relational
experience which incorporates the supervisor, supervisee, and clients.
While we have previously referenced this as a triadic relationship,
within that triad is the important relationship between supervisor
and supervisee. This has been referred to as the supervisory
relationship or supervisory alliance (Bernard & Goodyear, 2014;
Falender & Shafranske, 2004). The time and attention given to the
development and maintenance of this supervisory relationship
is of utmost importance, and without an effective supervisory
relationship, the potential of supervision outcomes is significantly
limited. Falender and Shafranske (2004) state, “it is only in the
setting of a strong working alliance that the inevitable personal
and professional challenges associated with clinical training will
be disclosed and supportively addressed” (p.30). Just as in any
other relationship we encounter as human beings, the supervisory
relationship is influenced by the attitudes, beliefs, knowledge, and
skills of both the supervisor and supervisee. Also, as in any effective
relationship, it is a partnership in which both parties must be
actively engaged and work to maintain effective communication and
collaboration. However, one aspect of the supervisory relationship
which is present and will be discussed further as it relates to cultural
humility later in this chapter is the existence of a power dynamic
between supervisor and supervisee (Dileo, 2001; Zetzer, 2016).
Zetzer (2016) references Bernard and Goodyear (2014) as well as
Falender and Shafranske (2004) in her discussion of the power and
privilege dynamics that are inevitable in supervision. She notes not
only the dynamic inherent in a relationship with a more senior
professional and a trainee but also the other dynamics present—
related to race, gender age, and prominence in the field (Zetzer,
2016). This is particularly present in supervision of students, but
also exists in the context of professional supervision in which the
supervisor is often more experienced than the supervisee.
Also, important to consider within the context of supervision,
and the triadic relationship expressed within it, is the guidance of
supervisory interventions that comes from reflection on parallel
process within supervision. The concept of parallel process emerged
 Cultural Humility in Clinical Music Therapy Supervision 161

in the 1950s, initially labeled reflection, and was intended to reference

the unconscious process by which the dynamic between client and
therapist is recreated or reflected within the supervisory relationship
(Searles, 1955; Falender & Shafranske, 2004). As a concept rooted
in psychodynamically or insight-oriented psychotherapy, parallel
process often capitalizes on transference and countertransference
within supervision. Zetzer states that it is “a key ingredient in
multicultural supervision,” (p.29). It is, once again, to the field of
counseling and psychology that we turn to understand the influence of
the intersecting identities expressed within the triadic relationship—
by the client, trainee, and supervisor—and how these can assist in the
fostering of that which Zetzer references as multicultural competence
within our supervisee (p.29). She references two models used to assist
in the fostering of multicultural competence: Ladany, Friedlander,
and Nelson’s (2005) Critical Events Model (CEM) and Ancis and
Ladany’s (2010) Heuristic Model of Nonoppressive Interpersonal
Development (HMNID), both of which note parallel process to be a
key ingredient. Additionally, she highlights the consensus that parallel
process in supervision is also in play within supervisory relationships,
and quotes Zetzer (2016, p.28), stating “This now has become the
best-known phenomenon in supervision: perhaps even the signature
phenomenon,” We will explore this within the case examples later.
Although there are distinct differences between the therapeutic
alliance developed to work effectively with clients and the
supervisory alliance, there are also many similarities, some of which
parallel process highlights by its very nature. A quality supervisory
relationship includes a combination of attitudes, behaviors, and
practices, such as development of trust, a sense of openness, and a
sense of empathy and caring for others within the relationship. Some
qualities which have been identified as desirable in supervisors
include empathy, warmth and understanding, flexibility, genuineness,
a sense of validation or affirmation, approachability, attentiveness,
respect for personal integrity, autonomy, and a non-judgmental
stance (Falender and Shafranske, 2004). As will be discussed later,
it is our belief that a culturally humble supervisor is prepared to
not only engage in the development of the supervisory relationship
162 Music Therapy in a Multicultural Context

with humility, but also to assist the supervisee in the development of

cultural humility within both supervision and their clinical practice.

Cultural competency or cultural humility?

The importance of attending to culture in healthcare practice is
exhibited by the multitude of associated terms such as cultural
awareness, cultural sensitivity, culturally responsive practice,
cultural competence, and cultural humility, to name a few. Although
there are overlapping and interrelated ideas within each of these
concepts, there are also some distinct differences. For the purpose
of narrowing the scope of this chapter, we will primarily focus
on two of the most prominent concepts in the literature: cultural
competence and cultural humility.
Sue and Sue (2016) utilize a common conceptualization of cul-
tural competence as the development of awareness, knowledge, and
skills. This involves awareness of one’s own cultural background
and the ways it influences personal assumptions, biases, and values;
knowledge of different cultures informing varied worldviews; and
development of skills to implement culturally sensitive interventions
and techniques (Sue, Arrendondo, & McDavis, 1992; Sue & Sue,
2016). As Swamy and Kim (2019, p.221) note, “familiarizing our-
selves with the cultural backgrounds, norms, worldviews, gender
roles, behaviors, communication styles, and sociopolitical history
of different racial or ethnic groups,” is central to the development
of cultural or multicultural competence. Authors have worked to
highlight the importance of these concepts by developing guidelines
or standards for multicultural competencies in education, training,
research, and practice (Sue et al., 1992). Most prominently, the
American Psychological Association published guidelines of cul-
tural competency for psychologists in 2003. These guidelines have
served as a foundation for the field of psychology and other related
therapy professions.
However, cultural competence is often mistaken for an endpoint,
something one can achieve through specific training and clinical
experience rather than an ongoing task. In reality, cultural competence
is an aspirational goal and it must be acknowledged that no single
 Cultural Humility in Clinical Music Therapy Supervision 163

individual can ever become completely competent or reach a point of

mastery (Hook et al., 2016; Sue & Sue, 2016). Due to the limitation
of competence being inaccurately viewed as a wholly attainable goal,
some authors have introduced the use of additional or supplementary
concepts such as cultural humility. Keselman and Awais (2018)
explored the application of cultural humility in medical art therapy
and identified that “cultural humility has been offered as an alternative,
complement and sometimes precursor to cultural competence” (p.77).
Cultural competence has been referred to as “a way of doing,”
whereas cultural humility is “a way of being” (Sue & Sue, 2016,
p.62). The term cultural humility was first coined in a seminal article
discussing the training of physicians by Tervalon and Murray-Garcia
(1998). Since the introduction of this concept, many authors have
worked to better define it and its application within various helping
professions such as medicine, nursing, social work, and mental
health care (Tormala et al., 2018). Hook and colleagues (2013) define
cultural humility simply as “the ability to maintain an interpersonal
stance that is other-oriented (or open to the other) in relation to
aspects of cultural identity that are most important to the client”
(p.354).
As opposed to cultural competence which is more self-oriented,
focusing on what the therapist knows or can do, cultural humility
positions the client (or supervisee) as expert. In this way, cultural
humility can be noted as having both intrapersonal and interpersonal
components. Intrapersonal components focus on the need for
individuals to have a more accurate view of the self and greater
awareness of their limitations. Chang, Simon, and Dong (2012) note
that fully engaging in self-reflection and self-critique with a goal
of recognizing inherent power dynamics is a key starting point for
developing cultural humility. Additional authors describe this “as a
lifelong commitment to self-examination and the redress of power
imbalances in the client-therapist-supervisor dynamic” (Hook
et al., 2016, p.150). Another cornerstone of cultural humility is
maintaining an open and aware mindset (Falender et al., 2014). With
this type of mindset, one can engage in interpersonal relationships
(therapy/supervision) in which one is able to learn from patients
(supervisees) and maintain mutually respectful partnerships (Chang
164 Music Therapy in a Multicultural Context

et al., 2012). A final crucial element of cultural humility is that it is

a life-long process of developing a way of being in the world and in
relationships with others and self (Chang et al., 2012; Hook et al.,
2016; Tervalon & Murray-Garcia, 1998). While this idea of an
ongoing process is present in many of the other concepts of working
with culture in therapy, it is truly at the core of cultural humility, and
a key reason that many have moved towards this concept in addition
to, or instead of, cultural competence.
The term “competency” implies that we are seeking an arrival. And
yet in a world of rapidly shifting dynamics (Hardy & Bobes, 2016) and
in the critical and ongoing self-reflection required of us as therapists,
the objective arrival points may not apply. Even generally agreed-on
standards adapt over time as understanding and perceptions evolve
(see the National Center on Disability and Journalism website1).
This means our self-perceptions in addition to our perceptions of
our clients and supervisees will continue to be fluid and evolving.
We bring a mixture of several contextual variables that give our lives
meaning (Hardy & Bobes, 2016) to every human interaction, and,
therefore, our worldview is distinctly ours. It shapes the lens through
which we view others as well as the lens through which we are viewed.
Conceptualizing competencies as ongoing processes with shifting
finish lines based on our own personal identity work and where
we are relationally, as well as among evolving understandings and
perceptions of various identity components (or cultural components
of identity), may be a more beneficial starting point.
The focus of this chapter is not how we, as supervisors, might
work with socio-cultural identities of supervisees distinct from our
own, or how we might guide supervisees in their work with client
populations with socio-cultural identities different from theirs.
Instead, the focus is on the continual evaluation and re-evaluation of
our identities and their influences on our supervision and therapeutic
relationships. Swamy and Kim (2019, p.226) highlight this. They
state, “examining our own socio-cultural backgrounds routinely will
help us…have a clear understanding of culture-related interactions
with our supervisees… This should be an ongoing process as our

1 https://ncdj.org
 Cultural Humility in Clinical Music Therapy Supervision 165

socio-cultural beings are continually developing.” While later in the

chapter we will discuss the use of the concept of “location of self ”
(LOS) to engage in this self-examination of socio-cultural identity,
we first turn to the exploration of the very specific term “cultural
humility” as it pertains to music therapy supervision.

Cultural humility in music therapy supervision

Our field of music therapy has been curious about how to better
equip ourselves to work with clients with cultural, ethnic, and
“diverse” identities or backgrounds different from our own. In their
2016 article, Hadley and Norris discuss the importance of cultural
awareness as a first step, stating that “increased awareness enables
us to recognize the ways in which oppression influences music
therapy spaces and propels us to become more culturally aware,
knowledgeable, and skillful music therapists” (p.8). As referenced
by Hadley and Norris (2016), there has been a steady increase in
the music therapy literature addressing multicultural issues. This
has included promotion of cultural awareness and sensitivity in the
training process and continuing education of music therapists as a
priority. However, we, too, may have inaccurately relegated them to
the category of competencies. We run the risk of simplifying culture
and becoming prescriptive when doing so.
Recent publications (Kennelly, Baker and Daveson, 2017; Swamy &
Kim 2019) within our field regarding diversity and multiculturalism
have demonstrated the increasing awareness of the importance of
diversity, cultural awareness, and intersectionality. While the field
of music therapy seems to be devoting the majority of its attention
to the important factors that culture and diversity play in our clinical
practice, some authors have begun to write about supervision from a
culturally centered perspective. Swamy’s (2011) article on culturally
centered music therapy supervision references the support of a
supervisee in the development of her shifting ethnic identity. Overall,
however, the impact of culture and identity within clinical supervision
has received limited attention within the field of music therapy. It is
immensely important that, as clinical supervisors, we are giving ample
attention to how we are speaking about, discussing, modelling, and
166 Music Therapy in a Multicultural Context

working with issues of culture and diversity for both our supervisees
and the clients they are serving. Research indicates that it is incumbent
on the supervisor to broach topics of culture in supervision and this is a
part of, dare we say it, supervisor competence (Falender & Shafranske,
2004). And often doing this requires that we have the courage to
misstep, accept our limitations, and admit what we do not know
(Zetzer, 2016; Swamy & Kim, 2019). “Instead of viewing mistakes or
cultural missteps as experiences to avoid, supervisors can benefit by
seeing errors as a natural part of the learning process,” (Swamy & Kim,
2019, p.223). A case example utilized later in this chapter highlights
that “by accepting what we do not know, we open ourselves to learning
more, giving ourselves permission to ask questions and challenge
our existing approaches,” (Swamy & Kim, 2019, p.224). When we, as
supervisors, model the acceptance of responsibility for our learning
and growth as well as model “having the courage to walk the tightrope
by engaging in these necessary conversations,” (Watson, 2016, p.62),
we de-center our own position to make room for other voices (Swamy
& Kim, 2019). Additionally, highlighting the triadic relationship
once again, we honor our commitment, simultaneously to both our
supervisors and the diverse clients we serve (Watson, 2016).
We can no longer rely on a course or two in training programs, nor
the few songs in Spanish or the few associated with ethnic or cultural
minority populations we may encounter, to prepare our students
to be culturally competent, culturally humble, or even curious.
Dedicated, conscious, acute attention to the preparation of culturally
sensitive clinicians (Hardy & Bobes, 2016) requires a comprehensive
pathway that we are beginning to forge. The supervisor-supervisee
relationship is a powerful place in which to do this work given
the opportunities inherent in the client–therapist–supervisor
dynamic (Hook et. al., 2016). We, as supervisors, can utilize this
relationship to explore the cultural self—both our own and those of
our supervisees—and promote self-reflection and awareness. This
relational work is the context for cultural humility in supervision:
“The more comprehensively we can see ourselves and others, the
greater the degree of compassion, understanding, and humility we
can have for each other” (Hardy & Bobes, 2016, p.6). How do
we come to comprehensively see ourselves?
 Cultural Humility in Clinical Music Therapy Supervision 167

Comprehensively seeing ourselves—

locating ourselves in supervision
While, as we’ve described, our call to action across the last several
decades has been to see the “other,” doing so in the absence of
seeing ourselves is problematic. What is the process by which
we come to comprehensively “see” ourselves? Locating ourselves
(location of self or LOS) (Jones 2016) is an important place from
which to begin, and doing so in supervision is a critical first step.
While some music therapists may never before have thought
about their multitude of identities, we, as supervisors, can begin
to disclose our identity in order to model and support the identity
work of our supervisees. Examination and increased awareness of
our overlapping identities—racial, ethnic, cultural, marital, parental,
socio-economic class, sexual orientation, gender identity, religious/
spiritual status, among others—can help us to understand how the
social locations in the room impact our work as supervisors. How do
each of our identities hold and express power in our society (Zetzer,
2016)? How do they situate us within socially oppressed groups
and socially privileged groups? What are the potential influences
of the particular privileged and subjugated identities we hold? Our
social locations and relationship comfort, feelings of worth as well
as our relationship wounding and distress are linked (Jones, 2016).
How do our identities—and our subsequent relational comfort and
wounding—inform the information we present?
While there is “growing literature on self-disclosure” (Jones,
2016, p.17), its use within therapy, for many of us, is uncomfortable.
Many of us have not been taught the use of self-disclosure as a
therapeutic tool and yet if we are modeling disclosing and discussing
social location in supervision, it is ultimately in service of its use in
therapy. But the personal is always present. Can the deeply personal
be integrated into or co-exist with the wholly professional within a
multicultural therapeutic or supervisory relationship (Zetzer, 2016)?

Location of self (Maria Gonsalves Schimpf)

My perspective of this work is shaped by my identities. Because
168 Music Therapy in a Multicultural Context

they inform what and how I share, locating myself with some of my
current and primary identities is important. I am a 40-something,
white, first generation Catholic Portuguese-American. I am married
to a man and am a mother to three small children, one of whom
is intersex. I benefit from white, heterosexual, non-disabled and
cisgender privilege (Zetzer, 2016).
Also significant is that it was through the “final hour” support
of a friend who identifies as queer and questioned my choice to
follow medical professionals’ strong advocacy for genital surgery
for my third child that I was given permission to make a different
decision, canceling his surgery (hours before) and allowing him to
remain intersex. I am the child of a working-class single mother
who intermittently required the support of government assistance
programs during my youth; I am also the child of a working-class
immigrant father who I visited on weekends in an entirely Portuguese
community. It is a result of my identity work as a therapy supervisor
that I now know the ways in which I internalized my mother’s
shame and her subjugation as a woman. Additionally, my dad’s
internalized racism as a US citizen—and his quest to assimilate
despite preservation of his deep cultural values—confused me as a
child and young adult. As his embrace of US conservative culture
and rejection of marginalization as well as ideology associated
with social justice came into focus for me, so did my commitment
to social justice. I am the first generation within my family to earn a
college degree. I am a psychodynamically oriented analytical music
therapist with multiple graduate degrees. All of these circumstances
have been important prompts for self-reflection for me in my
conscious attempt to understand where I place myself, knowing that
my identities dictate what I see (Hardy & Bobes, 2016).

Location of self (Scott Horowitz)

As noted by my co-author, I too would like to acknowledge that
my perspective on this topic of cultural humility in supervision
is shaped by my identities. I feel it is therefore very important to
locate myself and perhaps most importantly identify the privileges I
hold due to many facets of my identities. I am a white, heterosexual,
 Cultural Humility in Clinical Music Therapy Supervision 169

cisgendered, able-bodied male in his late 30s. I am married to a

woman and am a father to two children. I am the child of divorced,
middle-class parents and, at the age of 26, experienced the loss of
my only sibling, a sister, due to a car accident when she was 29 years
old. I was raised within the Jewish religion and identify as Jewish;
however, I find myself more drawn to the cultural heritage than the
traditional religious practices of Judaism. I was born and raised
in a suburb of Philadelphia and recognize that both my suburban
upbringing and experiences in the city of Philadelphia influenced
my worldview from an early age. Additionally, throughout my
childhood, my mother hosted international students from around
the world who lived with us while they attended a college English-
language program. This too had a profound impact on my worldview
and awareness of different cultures.
Through my own processes of learning and development around
topics of culture, I have been able to recognize that with many of
the identities labeled above, I move through my life as a US citizen
with a great deal of privilege. These privileges associated with such
identities as being white, being male, and being heterosexual have
impacted my interpersonal relationships, and the opportunities
and advantages that I have received throughout life, including the
opportunity to contribute to this book chapter. As someone who
attempts to have awareness of their privilege (although certainly
imperfect in that endeavor), I find myself at times questioning why
I should be the one to speak, write, or hold power in a relationship
such as supervision and teaching. It is for this reason that I feel
passionately about the concept of cultural humility. As I have
learned more about this topic, it provides not only a way for me to
understand cultural dynamics in therapy and supervision, but also
guidance on a way of being—one in which I can have awareness,
openness, curiosity, and learning, while also recognizing that I will
continue to make mistakes and missteps from which I can learn if I
maintain this practice of humility.
170 Music Therapy in a Multicultural Context

CASE EXAMPLES (MARIA GONSALVES SCHIMPF)

In all of the following examples, names are pseudonyms and patients
and supervisees have been annonymized.

CASE EXAMPLE: SUPPORT OF A

SUPERVISEE’S IDENTITY WORK
Case example 1a: Pronounce my
name as you like (no music)
Naasih is a 24-year-old first-year graduate student under my
supervision in an outpatient behavioral health setting for adults.
While, by external markers, he appears to be a person of color,
within our supervisory space, Naasih has been hesitant to address
his cultural identity and his social location, including his race. What
he shared in our first supervision session was that he grew up in
an urban and diverse community within the US. Additionally, he
referenced his social class, noting himself to be the son of parents
who went to graduate school and have high-powered careers.
In our co-facilitation of music therapy groups shortly after
he began under my supervision, I noticed that clients regularly
mispronounced his name and sometimes even asked several times for
help pronouncing his name. Generally, Naasih’s response was apathetic
and he deferred to whatever pronunciation the client had chosen.
Additionally, clients, many of whom are Latino, people of color, and/
or from marginalized and oppressed groups, began to ask, “Where are
you from?” Naasih typically responded, “I’m from California.” Clients
appeared unsatisfied. Additionally, he was often unfamiliar with the
musical styles of the client population and appeared self-conscious
as a result. As we stepped into our second supervision session, I
recognized that he was eager to discuss treatment of clients but was
not yet prepared to address his social location or the ways in which
his identity was influencing the music therapy.

Study questions: Who am I?

1. Why could Naasih’s apathy about the pronunciation of his
name be significant?
 Cultural Humility in Clinical Music Therapy Supervision 171

2. Why could Naasih be actively resisting acknowledgement or

disclosure of his racial/cultural or ethnic identity in sessions?
3. How could an open discussion about their influence on the
therapy be integrated into supervision? How could this occur
within a supervision framework that also honors the scope
of supervision as distinctly separate from personal therapy?
4. What is my responsibility inherent in my role as a supervisor—
and, moreover, as a white-presenting supervisor—to encourage
Naasih’s identity work? Alternatively, what are the ethical
concerns associated with the encouragement of this work on
the part of a supervisee who feels vulnerable and ambivalent?

Discussion
In my subsequent supervision with Naasih, I made a conscious decision
to lead in and with vulnerability. I attempted to facilitate self-awareness
and self-reflection as it relates to intersecting identities within therapy
by first clearly and overtly locating myself in our supervision sessions.
My hope was that this would invite deeper conversations in our
supervision that would eventually transfer to deeper conversations in
his work with clients. Jones (2016), in her teaching of location of self
within supervision and training, describes how she first asks trainees
to locate themselves in terms of race, ethnicity, class, parental status,
and, if heterosexual, in terms of sexual orientation. She also highlights
the importance of honoring the need some trainees may have to keep
invisible identities private if they do not feel comfortable sharing. Given
the visibility of race, and yet with awareness of the ways in which I have
unearned privilege as a result of my race, I first modeled the ways in
which I clinically offer my awareness of my racial and ethnic identities
in a therapy session. We began with a very simple contrast between
the ways in which I am first received in session with an introduction of
myself as “Maria,” and the ways in which he is first received in session
with an introduction of himself as “Naasih.” Together, we reflected on
clients’ curiosities about my Hispanic name’s co-occurrence with my
white skin color and how I choose to socially locate myself for patients
amid the need for clarity, and how my identities influence therapy.
172 Music Therapy in a Multicultural Context

While it is true, as Watson (2016) writes within her chapter

titled “Supervision in Black and White,” that “color, even more so
than gender, is likely the first observable physical characteristic of
a person, particularly in a race-based society such as the United
States of America,” making race the most “visible and prominent
marker of a person’s identity” (p.43), I came to learn that there were
additional layers of complexity for Naasih in his understanding of
his skin color. Over time, and several supervision sessions, Naasih
began to socially locate himself. A slow unfolding was required, as it
was a painful process of unpacking his responses to clients in order
to see himself and his unconscious processes more clearly. I utilized
my observations of him within groups, his process notes, and my
perception of his openness and willingness in supervision to gauge
Naasih’s readiness to begin his identity work. Knowing that a strong
level of trust and alliance was necessary, I remained curious but was
careful and cautious, all the while ready to sit in the discomfort when
he was. Additionally, I also maintained awareness of power in my
supervisory capacity as a system of checks and balances for myself.
Eventually, Naasih, in supervision, came to identify himself as a
male of South Asian descent. He shared that his family of origin is
from Trinidad though he is first-generation American. He intentionally
diminished his color/race and other intersecting oppressions (Ashton,
2016) in order to maximize his class status, especially in the face
of the indentured servitude that brought his ancestors to Trinidad
from India. He recognized that he had deeply internalized the class
consciousness present within his culture and family of origin. As
the process of transformational learning (Hadley and Norris, 2016)
unfolded, Naasih began to understand the unconscious way in which
he did not want his race to hinder his class. In Hardy and Bobes’s
(2016) conceptualization, it could be said that Naasih’s race was
a dimension of his cultural self that was difficult for him to own
and embrace in the face of the cultural importance and associated
pride of his class status. Eventually, Naasih began to distinguish
between those identities that elicited pride and those that elicited
shame within him. And he began to notice their influence on and
hindrance within the therapeutic process.
 Cultural Humility in Clinical Music Therapy Supervision 173

Case example 1b: Inshallah

Several months later, in a group music therapy session facilitated
by Naasih, and observed by me, Naasih responded, “Inshallah,” in
response to a withdrawn client’s expressed hope that his psychiatric
and substance use treatment would be effective. Naasih then, for
the first time, selected a song in Arabic for a receptive listening
intervention amid a diverse group of multi-racial and multi-ethnic
group members. The client referenced here was powerfully and
positively affected, and significant rapport building with Naasih began
which ultimately changed this client’s engagement with his treatment.
Nassih created a strong therapeutic alliance with this client and then
successfully utilized it—and the client’s Muslim identity—across
several group and individual sessions.

Study questions
1. What shift occurred in this session for Nassih?
2. How do you interpret the meaning of his choice of a song in
Arabic?
3. How could this session be utilized in supervision as an oppor-
tunity to explore additional dimensions of Nassih’s cultural
self?

Discussion
In supervision, I began by noting his use of the term “Inshallah” in
the session and my associations with the Spanish and Portuguese
equivalents—”ojala” and “oxala”—all meaning “God willing.” In the
same way that he utilized his identity in the service of the therapy
of the client, I utilized my identity in the service of my supervision
with Nassih. Suddenly, parallel process (Bernard & Goodyear, 2014)
was in play and, eventually, could be explored within our supervisory
relationship. Nassih noted that he learned of the client’s Muslim
identity through a chart review. He acknowledged his desire to
assist this client with the utilization of his religious and spiritual
resources. Though Nassih felt hesitant to disclose his religion or
spiritual identity, an invisible location (Jones, 2016), he shared that
he was beginning to recognize the influence of the ways in which his
174 Music Therapy in a Multicultural Context

conglomeration of identities and the ways in which they intersect

impact his worldview and influence how he is received by others. He
acknowledged the power of his use of an Arabic phrase in terms of
its impact on the client’s openness and willingness to utilize therapy.
Eventually, Naasih, in supervision, came to share his invisible
identities, first locating himself within his identity as a Muslim. And
eventually, within a supervision session, Naasih brought his sexual
orientation, a second invisible location, into the space when reflecting
on whether or not visible qualities of his person factored into a
transgender patient’s draw to working with Naasih as her therapist.

CASE EXAMPLE: THE SHARING OF POWER—

BEING SUPERVISED BY THE SUPERVISEE
The redressing of a power imbalance
The following case example is multi-layered and multi-part. There are
several highlighted components of this singular superviser–supervisee
relationship. This case example is comprised first of a clinical
session of which both supervisor and supervisee are a part. What
follows are two supervision sessions which punctuate a supervisee’s
individual session, the content of which is all focused on the same
client. Additionally, the case session content is presented somewhat
objectively for the purposes of the handbook.
I (Maria Gonsalves Schimpf) was supervising Stephanie, a 28-year-
old black, American, Christian, cisgendered female in a heterosexual
relationship. Stephanie was raised by a single mom and a white
stepdad. She had strong clinical skills in the second year of her graduate
program and, in a music therapy group within an adolescent residential
treatment facility, often made use of clinical music improvisation.
Additionally, she regularly worked individually with patients in the
treatment facility.
While at this point in her training Stephanie was often doing
her own clinical work independent of me, in this case example, she
engaged as a co-therapist in this client-centered (Rogers, 1951) and
client-led music psychotherapy group of which I was the primary
facilitator. Partway through the group session consisting of five
multi-racial and multi-ethnic peers, Keyvon, a 17-year-old African
 Cultural Humility in Clinical Music Therapy Supervision 175

American male, arrived and sat on the group’s periphery. He was in

treatment due to suicidality and while he was nearing the completion
of his treatment at this facility, his mother had not returned
communications from the treatment team and, consequently,
his placement was ambiguous. Keyvon appeared ambivalent and
uncertain when he entered the music therapy group and abruptly
left the group shortly after he arrived; he was absent for five minutes
and then returned.
He, once again, sat on the group’s periphery, appearing somewhat
guarded and ambivalent. Every other group member was very
actively engaged in the group process and Keyvon appeared to be
assessing the cohesive group dynamic. He remained passive and
silent; receptive at best. At the conclusion of an improvised song
created entirely by the group members, Keyvon startled us with a
question. He asked, “Where’d you get that?” pointing to a djembe
across the room and in the hands of a peer. While I responded,
“West Music,” I also understood that an African American male
was asking about the etiology of a West African instrument so I
intentionally inquired, “But is that the question you are really asking?”
What ensued was a Keyvon-initiated discussion about the imagery
on the djembe and its similarity to his family of origin’s emblem.
The group members listened in near silence for the first time since
the group started, as I prompted Keyvon to share the instrument’s
name, origins, and function. Additionally, Keyvon referenced
the phrase, shared with him by elders in his family, associated
with the family emblem and its English translation. There was a sense
of pride emanating from Keyvon and I felt relieved that he had been
heard in group. Then group members asked me if I’d been to Africa.
When I responded that I had, a group member prompted me for
exact countries and I was vague, and referenced, “Many.”
Though we were nearly out of time, I guided us back into our
clinically improvised song, intentionally weaving in the ancestral
phrase Keyvon referenced in our discussion of his family emblem,
utilizing both its original iteration and his English translation. Stephanie
was playing an egg shaker and several other group members were on
drums, including congas and djembes. I recognized that as we entered
the music, Keyvon’s response contradicted what I anticipated. He
176 Music Therapy in a Multicultural Context

almost appeared more ambivalent than when he entered the room,

despite his deep personal sharing with the group. I then switched
to the largest djembe in the room to match the drumming of
group members with the hope I would affirm him in my joining
the drumming dynamic, on the very instrument that inspired his
contributions. His response was almost one of repulsion. He turned
his body to the side so that he was no longer facing the group circle
and though he was smiling, Keyvon referenced the music as being
“disrespectful.” In response, a dominant group member responded
in an address to me, “You can’t do that with his music because they
don’t use music like we do. It’s a tribal thing that isn’t like regular
music.” I heard Stephanie to my left, “Hmmmm…” becoming curious
and receiving my eye contact. She responded to the comment made
by the group member about “his music,” by commenting, “Many
of us have had the experience of a change or alteration of parts of
ourselves and who we are by others.” The group began a dialogue
about this concept and we were directed by staff to close the group
due to time.

Study questions: Opportunities for

reflection as supervisor
1. How might you have interpreted Keyvon’s question about the
djembe and how does this inform your case conceptualization?
2. How is your case conceptualization shaped by your dominant
privileged self and your dominant subjugated self (Hardy, 2016)?
3. As a supervisor with your conglomeration of identities and
your social location, what is your understanding of Stephanie’s
final comment to the group?
4. Given the dimensions of “self” that significantly inform how
you think about yourself, would you have integrated Stephanie
into the session? If so, more or less than in this example?
5. What cultural dynamics would you have explored in supervision?
Which would have been easiest to discuss? And which would
have been difficult (Hardy, 2016)?
 Cultural Humility in Clinical Music Therapy Supervision 177

Self-reflection and supervision 1

I felt depleted, shocked and very uncertain about the group at
its close. In our supervisory processing time just following group,
Stephanie referenced the alliance Keyvon was building non-verbally
with Stephanie across his time in group. She was attuned to his
eye contact with her and the timing of his choices to seek her out
non-verbally. Stephanie had often acknowledged that, as the only
clinician who is a person of color at the facility, she became a refuge
for many of the clients of color. I was sure that following up with
Keyvon was critical and needed to happen emergently, and I offered
Stephanie that role.
As I reflected on my role in the session, I thought about Keyvon’s
question. I believed I knew this territory as a white therapist undertaking
work that was addressing oppression and, as a music psychotherapist,
the cultural appropriation inherent in the use of indigenous instruments
within music therapy. My ongoing self-consciousness about the use of
djembes (or Native American flutes for that matter) somehow felt
protective. I felt as though I had been presented with an opportunity
to both address the appropriation and elevate Keyvon, whose voice I
had been convinced we wouldn’t hear. I had the opportunity to remain
open to receive his experience and to encourage the group to care.
And I considered Keyvon’s peers’ response to Keyvon’s reference to
disrespect. It was clear to me that this group member was attempting
to align with and “protect” Keyvon. But while I sensed a discordance
and a misstep, I hadn’t been sure where to take it. And Stephanie did,
very aware that many group members were people of color and yet
wanting to overtly protect Keyvon by utilizing the use of the djembe
in the group to highlight the multitude of ways in which important
cultural markers have been culturally appropriated by those within
dominant, oppressive cultures.

Study questions: Supervisor’s self-reflection

1. Why did I suggest that Stephanie had an individual session
with Keyvon?
2. How might you have chosen to follow up post-group session?
178 Music Therapy in a Multicultural Context

3. And how might your choices have been influenced by your

social location and conglomeration of identities?

Self-reflection and supervision 2

Following Stephanie’s individual session with Keyvon, Stephanie and
I stepped into supervision. She was able to share with me that the
processing with Keyvon was critical. It was expansive, and had depth
that I didn’t anticipate. What I heard Stephanie describing to me
was the impact of my white silence in the presence of racist words.
Stephanie described how Keyvon referenced that he often heard,
“I’ve been to Africa,” and how he experienced this as subjugating—
as though another conquering occurred with this declaration on
the part of white people. Finally, while I had concern about cultural
appropriation of the djembe given its place within and relevance to
Keyvon’s family ancestry, what I did not anticipate was the way in
which I appropriated the ancestral phrase of his family emblem, pulling
the words and its articulated meaning into a group improvised song.
My desperation to pull him in and make him heard honored only my
barometer and markers for this, and did not actually acknowledge
his need at all—which was related to his deep need to connect to his
family of origin and his ancestry. His current family dynamics and
the ways in which they contributed to his suicidality, all within the
context of his mother’s current silence and absence, were part of
this. As I reflected, I began to understand how my approach and my
insufficient attunement to the cultural dynamics (Zetzer, 2016) had
been disempowering. In many ways, I was replicating his interpersonal
and socio-political dynamics (Zetzer, 2016, p.32) and while my desire
to be inclusive of him was valuable, my approach was wrong. My
intent had little worth in the face of its impact. Remaining open to
this, and in a place of non-defensiveness, required deep, conscious
cultural humility.
Knowing that, as a white therapist, there are limits to my
experiences of oppression while simultaneously wanting to provide
Keyvon with the assurance that I had understood how racism
impacts people of color and that I was an ally in the defeat of and
healing from oppression (Jones, 2016), I knew inviting Stephanie
to inform me that I may have been encountering blind spots was
 Cultural Humility in Clinical Music Therapy Supervision 179

important. As she continued to share the details of her session with

Keyvon, I consciously shifted the power dynamic that is, by design,
present in our supervisor–supervisee relationship, opened into my
vulnerability, and allowed myself to be guided by my supervisee.
Ultimately, it became clear that I needed to address the rupture
with Keyvon. Again, seated in a place of deep cultural humility, I
explicitly and directly asked Stephanie to share with me the things she
perceived Keyvon as needing to hear from me directly—not for my
benefit, but for his. She openly, directly, and compassionately shared
with me. In the repair that followed with Keyvon, I experienced
no resistance, none of the ambivalence present in group and no
palpable resentment. Only connection and rapport. I hypothesized
that because Stephanie’s session with him came to include the open
discussion of manifestations of oppression in therapy, relational
processes among us had the opportunity to deepen (Jones, 2016).
This meant that his relational processes had shifted as a result of
his work with Stephanie, and that this then influenced my relational
process with Stephanie, which then influenced his relational process
with me. His work with her had been first off, healing, and second,
somehow a bridge that allowed him to receive my apology and
further decipher his own experiences. I shared my blind spots, my
lack of attunement to his needs and his cultural context, and its
negative affect on him within the group. Keyvon then asked very
explicitly if we could commit to continue to educate others—both
people of color and white—within the therapy space.
While Keyvon did discharge to his family soon after our session,
it was our hope that his magnified voice in his psychotherapeutic
relationships—the triadic relationship that was Keyvon, Stephanie
and me—would influence his capacity to be heard in his familial and
community relationships, preventing a re-admission and fostering
hope, resilience, and self-efficacy.

Study questions: Supervisor as supervisee

1. In what ways were the benevolence of my actions insufficient?
2. In what ways was cultural humility employed? Why was it
important?
180 Music Therapy in a Multicultural Context

3. What is required of a supervisory relationship to allow this

kind of role reversal/power realignment?
4. When did you misstep within a case that involved a supervisee?
How did you resolve it?

Commentary
My need to remain curious, humble, and courageous was obvious and
it took mindful focus and attention on my part. As a white supervisor
supervising a therapist of color, working with clients of color, I knew
I needed to be “open to learning about nuances of racial meaning
and experience” to which I couldn’t be privy (Jones, 2016, p.22).
This absolutely requires relentless cultural humility. Additionally,
I had to turn the power and privilege dynamics inherent in the
supervisor–supervisee relationship upside down and on their heads.
This meant actively seeking Stephanie’s perspective as it related to my
missteps and remaining open and able to hear them. A rupture in our
supervisory alliance could have meant a rupture in the therapeutic
alliance with Keyvon. Preserving our alliance meant that I needed to
be able to expose my vulnerabilities, and engage in transparency and
risk-taking. “Trainees who feel unsafe in the supervisory relationship
are unlikely to raise questions about cultural differences between
themselves and their clients or supervisors, let alone invite dialogue
about differences” (Zetzer, 2016, p.29). Fortunately, Stephanie was
willing to allow my vulnerability, allow my mistakes, allow me to
“keep her race in the room,” as she boldly stated when describing
our supervision, and guide and teach me. While we recognized that
“those who possess greater degrees of power must also assume
greater responsibility in relationships” (Hardy & Bobes, 2016, p.12),
Stephanie first allowed me to deliberately initiate a conversation and
then accepted a power realignment, receiving an opportunity to
supervise the supervisor.

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 List of Contributors

Melita Belgrave, PhD, MT-BC

Associate Professor of Music Therapy
Arizona State University

Scott Horowitz, MA, MT-BC, LPC, ACS

Clinical Instructor, Director of Field Education
Drexel University

Seung-A Kim, PhD, LCAT, MT-BC

Associate Professor of Music Therapy
Molloy College

Kamica King, MA, MT-BC

King Creative Arts Expressions, LLC

Leah Oswanski, MA, LPC, MT-BC

Morristown Medical Center

Beth Robinson, MT-BC

Rainbow Music Therapy Services

Maria Gonsalves Schimpf, MA, MT-BC

Denver Health Hospital Authority

Natasha Thomas, PhD, MT-BC

Visiting Assistant Clinical Professor of Music and Arts Technology
Indiana University Purdue University at Indianapolis (IUPUI)

185
 Index
Aarø, L. E. 15 multidimensional approach 55–6
Abad, V. 74 authenticity 48–9
Abrams, B. 13 Awais, Y. J. 163
acculturation stress 21
action songs/fingerplays 143–4
Bain, C. 85, 90
active listening 51–3
Baines, S. 85, 86
active music experience 26–7
Baker, F. 46, 61, 68, 120, 121, 126, 135, 165
Adams, R. 56
Balkin, R. S. 87
ADDRESSING model 117–8
Batalova, J. 116
Adler, A. 19
Beer, L. E. 12
Adler, R. 92
Belgrave, M. 8, 118, 119
aging see older adults
Bell, A. 97
Ahessy, B. T. 80
Bendel-Rozow, T. 140, 145
Aigen, K. 21, 27
Bernard, J. M. 157, 159, 160, 173
Albert, L. 47
Berry, J. W. 12, 21
Allen, R. 50
bias, cultural 13
Aloff, M. 149
Bidell, M. P. 87
American Dance Therapy Association 136
Billie, H. 99
American Music Therapy Association (AMTA)
Birnbaum, J. 50
28, 46, 48, 51, 54, 55, 62, 80, 158
Blacking, J. 21, 33
American Psychological Association 162
Blanc, V. 140
American Speech-Language-Hearing
Bobes, T. 157, 158, 159, 164, 166, 168, 172, 180
Association (ASHA) 91
Bogan, L. 93
Amir, D. 32
Boggan, C. 85
analytical music therapy (AMT)
Bolger, L. 45
active music 26–7
Bonde, L. O. 87, 88
meditation 26, 30
Borzcon, R. 46, 49
overview 14–5
Bowie, D. 96
receptive music 26
Bradt, J. 60, 117
see also culturally informed music therapy
Brescia, T. 49
(CIMT)
Brill, D. 97
Ancis, J. R. 161
Brink, S. L. 56
Anderson, S. 96
Brooks, D. 63
Andersson, B. 96
Brown, J. M. 23, 34, 117
anger syndrome (Hwabyeong) 10
Brunell, A. 53
Ansdell, G. 15, 19, 32, 38, 86, 135
Bruscia, K. E. 12, 15, 16, 19, 21, 23, 28, 39, 46,
Aponte, H. J. 157
49, 135, 139
Arredondo, P. 162
Burrows, M. 116
Arthur, M. H. 50
Ashton, D. 172
assessment Caribbean Limbo 147–9
in analytical music therapy 27–9 Carlsen, J. C. 157

187
188 Music Therapy in a Multicultural Context

case examples/scenarios cultural vessel role 34

client-preferred music 57–61 cultural well-being 22–3
LGBTQ+ clients 100–8 culturally informed music therapy (CIMT)
older adults 129–30 applications of 35–8
supervision 170–80 assessment in 27–9
Certification Board for Music Therapists 47, goals of 24
54, 56, 62 overview 14–5
Cevasco-Trotter, A. M. 119 session format 25
Chaiklin, S. 136 stages of 31
Chan, G. 120, 122 techniques 29–31
Chang, E. S. 163, 164 variety of music in 27
Chase, K. M. 46, 51, 55, 56, 64, 117 voicework in 30
children see also analytical music therapy (AMT)
fingerplays/action songs 143–4 culture
language considerations 36–8 acculturation stress 21
circle dances 145 complexity of 12–4
Clair, A. A. 119 concepts of health within 12
Clark, I. N. 135 and context 16–7
Clarke, V. 84, 97 definition of 11
client-preferred music 57–61, 64–8 role of 11–2
closed traditions 145 Curtis, S. L. 54, 86, 89
Code of Ethics (AMTA) 79–80
Cohen, N. 119, 120, 125, 129
dance/movement therapy
collective culture 18–9
African cultural dance 151
colorblind approach 54–5
Asian dances 151–3
communication style 58–60
Caribbean Limbo 147–9
community building (music’s role) 32
circle dances 145
community music therapy 87–9, 90–1
closed traditions and 145
competence (cultural) 46–7, 162
European/North American dances 153
concerts 35–6
fingerplays/action songs 143–4
consciousness
forcing “appropriate” behaviour 133–4,
cultural 47
141, 142
expanded 22
group social dances 144–9
fluidity of 21–2, 23
Kestenberg Movement Profile (KMP)
context, cultural 16–7
137–9
Cormier, S. L. 50, 52, 53
line dances 145–6
Crawford, I. 57
Middle Eastern dances 151–3
Cross, K. 136
partner dances 149–50
cross-cultural transfer 13–4
physical contact 149–50
Croucher, S. M. 57, 58
“presentation” style dances 150–3
Crowe, B.J. 85, 90
vs. music therapy 136–40
cultural appropriation 177–80
Darrow, A. A. 45, 117
cultural bias 13
Daveson, B. A. 165
cultural competence 46–7, 162
Davis, W. B. 59, 62, 119
cultural consciousness 47
Day, T. 46
cultural humility
Deacon, J. 97
case examples 170–80
DeBedaut, J. 135
definition 47
Defense of Marriage Act (DOMA) 98
overview 162–5
DeLarverie, Stormé 95
in supervision 165–7
Diamond, S. 100
cultural identity development 21–3, 32
DiFranco, A. 99
cultural norms 128
Dileo, C. 46, 48, 49, 50, 58, 60, 160
cultural relativism 15–6
Dinicu, C. V. 145, 151, 152, 153
cultural universalism 15–6
Discrimination Model 159
 Index 189

Ditto, B. 99 Gfeller, K. E. 59, 62

Dong, X. 163 goals (therapeutic) 24
Donnenwerth, A. 86, 108 Goelst, I. L. 118
Drescher J. 94 Gooding, L. F. 157, 159
Goodyear, R. K. 157, 159, 160, 173
Grace, L. J. 99
Eckhaus, R. 140, 149
Grocke, D. E. 46, 120, 126, 142
Edwards, B. 96, 97
group size (CIMT) 25
Elefant, C. 11, 12
group social dances 144–9
Elledge, J. 93
Grzanka, P. R. 85, 90
empathy
Guerra, N. S. 51
cultural 34
Gumble, M. 91
towards client 49–50
Encyclopedia Britannica 66
Eno, B. 96 Hackney, H. 52, 53
Epstein, M. 17 Hadley, S. 28, 54, 55, 59, 85, 86, 89, 118, 137,
Eschen, J. T. 135, 137 165, 172
Estrada, D. 159 Hahna, N. D. 51, 55, 64, 89
Estrella, K. 159 Halick, M. E. 32
Etheridge, M. 97 Hall, E. T. 20, 141
existential gap 13 Hanna, K. 99
expanded consciousness 22 Hanser, S. 46, 48
Hardy, K. V. 157, 158, 159, 164, 166, 168, 172,
176, 180
Falender, C. A. 157, 159, 160, 161, 163, 166
Hardy, S. 83, 90, 91, 92
Falicov, C. J. 157
Harry, J. 98
Farber, J. 95
hate crimes 81–2
Farlex Partner Medical Dictionary 48
Hays, P. A. 117, 118
Farmer, L. B. 87
health musicking 87–9
Feierabend, J. 143, 144
Higgins, L. 32
Fekaris, D. 96
Hinman, M. L. 57
feminist music therapy 89
Hirsch, S. 92
Fetzer, M. D. 81
History.com 95, 96
fingerplays/action songs 143–4
HIV/AIDS crisis 96–7
Fischer, R. 46
Hogan, T. 57
Fitzsimons, T. 81
Holloway, E. 159
flexibility/openness 34
Hook, J. N. 159, 163, 164, 166
fluidity of consciousness 21–2, 23
Horowitz, Scott 168–9
Folk dance 145
Human Rights Campaign Foundation 82
Forinash, M. 157, 158
Human Rights Campaign (HRC) 83
format of sessions 25
humility see cultural humility
Forrest, L.C. 120, 121
Hwabyeong (anger syndrome) 10
Foster, D. 96
Frame, M. W. 159
Freud’s stages theory 137 identity development 17–20, 21–3, 32
Friedlander, M. L. 161 Improvisation Assessment Profile (IAP) 139
individual culture 13, 18–9
Integrative Developmental Model (IDM)
Gallardo, M. E. 45
model 159
Gallo, M. 94
intersectionality 82, 84, 89
Garrison-Wade, D. F. 151
intersubjectivity 50
Gavigan, A. 153
Ip-Winfield, V. 120, 121, 122
Gay, Lesbian & Straight Education Network 105
Gay Straight Alliance in schools 82
geographical influences 64–5 Jackson, H. L. 92
Germanotta, S. 99 Jackson, N. A. 157
190 Music Therapy in a Multicultural Context

Jagose, A. R. 84 Life-Span Model 159

Jewel Box Revue 95 Lilith Fair 98
Johnson, C. 45 Lim, H. A. 157
Jones, C. 46 Limbo dance 147–9
Jones, T. D. W. 167, 171, 173, 178, 179, 180 line dances 145–6
Jordan, D. K. 20, 28 listening (active) 51–3
location of self (LOS) 167–80
Loman, S. 137
Kaplan, R. 8
Longstaff, J. S. 138
Keller, T. 81
Lorde, A. 79
Kelly, T. 98
Lynn, C. 96
Kennelly, J. D. 165
Lypson, M. L. 47
Kenny, C. B. 15, 23, 25, 31, 85
Keselman, M. 163
Kesslick, A. 60 McDavis, R. J. 162
Kestenberg Movement Profile (KMP) 137–9 Macdonald, R. A. R. 57
Kettrey, H. H. 82 McDougal-Miller, D. 51, 56, 60, 68
Kim, E. H. 10 McFadden, J. 34
Kim, S. 11, 12, 13, 15, 21, 23, 25, 26, 27, 33, McFerran, K. S. 45
34, 46, 47, 55, 60, 65, 118, 123, 128, 158, McNeill, B. W. 157, 159
162, 164, 165, 166 Madonna 97
Kim, S. A. 8 Madson, A. 57
Kremer, B. 92 Mantie, R. 32
Kumagai, A. K. 47 Marx, R. A. 82
Kurstin, G. 100 meditation 26, 30
Kwake, E. 135 Memmott, J. 119
Michael, G. 97
Mills, M. 92
Ladany, N. 161
Mink, B. 98
Lambert, M. 99
Mitchell, J. C. 99
Lang, K. D. 98
Mitchell, L. A. 57
language
Molloy, D. 117
learning new 33, 127
Mondanaro, J. F. 120, 122
statistics of various (US) 116
Moore, A. 150
working with children/young adults 36–8
Morali, J. 96
Lauper, C. 100
Morris, B. J. 96
Laursen, J. 99
movement see dance/movement therapy
Lauw, E. 120, 122, 123, 128
Movement Advancement Project (MAP) 81
Leach, M. J. 46
Murray-Garcia, J. 46, 163, 164
Lee, J. H. 15
music
Letwin, L. 45, 57
building repertoire 62–4
Levi, D. H. 87
client-preferred 57–61, 64–8
Lewis, D. E. 47
decade preference 64
LGBTQ+ clients
geographical relevance 64–5
affirming music therapy 83–92
learning from client 66–8
artists/music (1920s - current) 92–9
learning new songs 63
clinical case scenarios 100–8
pop culture 64–6
clinical interventions 89–92
role of 31–4
Gay Straight Alliance in schools 82
variety of 27
hate crimes 81–2
musicking 87, 135–6
HIV/AIDS crisis 96–7
intersecting identities 82, 84
lack of MT training 80 Nam, K. A. 58
legal issues 82–3 Nelson, A. L. 47
people of color 81 Nelson, M. L. 161
young people 82 Norris, M. S. 28, 55, 59, 118, 165, 172
 Index 191

Nuehring, L. 45, 57 rapport

Nurius, P. 50 music therapy literature on 45–6
and therapeutic process 47–53
Reber, A. S. 50
O’Callaghan, C. 51, 56, 60, 68
Reber, E. 50
Odell-Miller, H. 157
receptive music experience 26
older adults
Reed, K. J. 63
case scenarios 129–30
relationship
cultural norms activity 128
supervisory 160
music from client’s past 120–1
therapeutic 48
musical expansions activity 126–7
relativism (cultural) 15–6
“my view on aging” activity 125
repertoire building 62–4
technology resources for 127–8
responses (finding appropriate) 52–3
theories of aging 119–23
Rhythmic Auditory Stimulation (RAS) 135
translation/language learning activity 127
Richards, E. 157
“who am I musically?” activity 123–5
Ridder, H. M. 119
Olsen, K. 118
Riess, H. 49
Osborn, C. J. 50
Riot Girl music 98
Oswanski, L. 83, 86, 87, 108
ritual (music as) 31–2
Oxford Living Dictionary 52
Robbins, I. A. 64
Robinson, J. M. 100
Páez, M. 47 Rodgers, N. 96, 97
Paich, D. 96 Rogers, C. R. 174
Paine, B. 99 Roland, A. 12
Pansy Craze 93 Rolvsjord, R. 45, 50, 53
parallel process 160–1 Rønnestad, M. H. 159
partner dances 149–50 RuPaul 98
Patallo, B. J. 46 Rushing, J. 157, 159
Pavlicevic, M. 15, 19, 32, 38 Ruud, E. 16, 32, 86, 88
Pedersen, P. B. 15, 28, 31
Perren, F. 96
Saarikallio, S. 11
Pettibone, S. 97
Sadovnik, N. 46
Pezzella, F. S. 81
Saliers, E. 98
physical contact 149–50
Sampson, D. 151
Piaget, J. 14
Sanabria, S. 87
Pickering, J. 92
Satcher, J. 87
Pieterse, A. L. 51
Scheiby, B. B. 15, 23, 26, 28, 31, 50
pop culture 64–6
Schimpf, Maria Gonsalves 167–8
Potvin, N. 60
Schlosser, L. Z. 87
preference in music (client’s) 57–61, 64–8
Schumacker, R. 87
Priestley, M. 14, 15, 26, 29, 31
Schwantes, M. 89
psychodynamic movement technique 31
Seabrook, D. 89
Searles, H. F. 161
qualifications 23–4 self, location of (LOS) 167–80
Quant, S. 157 self-awareness 23–4, 50–1, 140–1
Queena, Y. C. 120, 122 self-disclosure 53, 167
queer music therapy 85 self-expression 33–4
queer theory 84–5 session format 25
Quin, S. 100 Shafranske, E. P. 157, 159, 160, 161, 166
Quin, T. 100 Shane, Jackie 94–5
Shapiro, N. 34, 120, 122
Rafieyan, R. 55 Shree, R. 138, 143, 146, 152
Rainey, J. S. 87 Silverman, M. J. 45, 46, 48, 52, 53, 57, 58, 63,
Rainey, M. 94 157
192 Music Therapy in a Multicultural Context

Simon, M. 163 Uhlig, S. 30

Skovholt, T. M. 159 Ulvaeus, B. 96
Small, C. 87, 135 universal culture 18, 20
social dances 144–9 universalism (cultural) 15–6
Social justice 86 Upshaw, N. C. 47
social justice music therapy 85–7 U.S. Census Bureau 44
songs (learning new) 63
Spector, R. E. 12, 16
Vaillancourt, G. 85, 86
Speight, S. L. 15, 17
Valentino, R. E. 49, 56, 57, 117, 118
Stahl, J. 135
Vandervoort, A. E. 13
Standley, J. M. 57
variety of music 27
Steinberg, B. 98
Vaughn, S. 94
Stige, B. 12, 15, 16, 45, 85, 87, 118
Vera, E. M. 15, 17
stigma 35
verbal processing 52–3
Stoltenberg, C. D. 157, 159
Viega, M. 137
Stoneham, G. 92
voicework
Sue, D. 11, 15, 17, 57, 58, 162, 163
in analytical music therapy (AMT) 30
Sue, D. W. 11, 15, 17, 57, 58, 162, 163
with LGBTQ+ clients 91–2
Sullivan, N. 84
supervision
case examples 170–80 Walker, M. 56
cultural humility in 165–7 Walsh, R. 30
definition 157–8 Ward, C. 46
and location of self (LOS) 167–80 Wardon, M. 135
models of 159 Warren, D. 98
parallel process in 160–1 Watkins, C. E. 159
power dynamic within 160 Watson, M. F. 166, 172
self-disclosure in 167 Wells, C. J. 149
supervisory alliance 160 Wen, Y. 120, 122
Swamy, S. 13, 34, 157, 158, 162, 164, 165, 166 Wengrower, H. 136
Swartz, M. J. 20, 28 Westgate, P. 157, 159
Sylvester 96 Wheeler, B. L. 119
Systems Approach 159 Whitehead-Pleaux, A. 11, 13, 23, 46, 47, 56,
60, 65, 80, 83, 90, 92, 118, 123, 128
Wigram, T. 46, 142
Tan, X. 13, 23, 56, 118
Wilber, K. 17
Taylor, N. F. 135
Wilhelm, L. A. 119
Tee, L. 98
Williams, C. B. 159
Teniente, S. F. 51
Williams, K. 45
Tervalon, M. 46, 163, 164
Williams, M. A. 54
Thaut, M. H. 59, 62
Willis, V. 96
therapeutic relationship 48
Wilson, J. 46
Thomas, N. 137
Wirrick, J. 96
Tormala, T. T. 163
Toyoda, E. 149
training Yalom, I. D. 19, 20
cross-cultural 118 Yardley, W. 95
lack of 80, 117 York, E. 83
transcending energy (of music) 33
Trask, S. 99 Zetzer, H. A. 160, 161, 166, 167, 168, 178, 180
treatment planning 56–7 Zong, J. 116
Trevor Project 82
Trondalen, G. 50
Trusty, J. 87