Community Music Therapy

Oxford Handbooks Online

Community Music Therapy
Kenneth S. Aigen
The Oxford Handbook of Music Education, Volume 2 (2 ed.)
Edited by Gary E. McPherson and Graham F. Welch

Print Publication Date: Sep 2012 Subject: Music, Music Education

Online Publication Date: Nov 2012 DOI: 10.1093/oxfordhb/9780199928019.013.0010

Abstract and Keywords

This article provides an overview of community music therapy (CoMT). The discussions
cover the origins and foundations of CoMT; the spectrum of CoMT practice; music
therapy outside of a closed therapy room; performing with clients; conceiving of a
community as the client; and broadening the scope of legitimate therapy goals.

Keywords: music therapists, community music, clinical practice, music therapy

This chapter will introduce community music therapy (CoMT) and place it in the context
of contemporary music therapy practice. Its origins and development within the
profession will be traced, and its basic premises and practices will be highlighted by
focusing on a variety of contemporary international projects. The relationship of CoMT to
conventional music therapy practice and to community music (CM) will also be discussed.

CoMT is neither a model nor a method of music therapy. Its adherents do not claim a
unified theoretical framework or a set of practice guidelines. Instead, it is best considered
“a broad perspective exploring relationships between the individual, community, and
society in relation to music and health” (Stige, Ansdell, Elefant, & Pavlicevic, 2010, pp.
15–16). Consequently, a brief review such as this one is necessarily selective, and the
choice of ideas and practices to highlight reflects as much on the interests of this author
as on the phenomenon of study.

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Community Music Therapy

Overview of Music Therapy

Music therapy is a profession that is practiced globally, with organizations devoted to its
advancement throughout North America, South America, Europe, Asia, and Australia. In
the Middle East and Africa there are fewer countries with a (p. 139) professional and
educational infrastructure for music therapy—with important exceptions, such as Israel in
the former and the Republic of South Africa in the latter—but there are efforts to expand
professional music therapy into other nations throughout these two regions.

It is in the United States that music therapy has the longest tradition as an organized,
autonomous profession. The first university training program in music therapy was
established in 1944, and the first national organization devoted to its advancement was
created in 1950. Ansdell's (2002) description of the origins of music therapy in the United
Kingdom from the 1890s through the 1940s is an accurate portrait of what occurred in
the United States as well. Ansdell (2002) describes these proto-music-therapy forms in
medical and psychiatric hospitals as primarily nonparticipatory: music was generally
played to patients but not with them. The work was conceptualized as being medical or
recreational in nature as “large hospital communities attempted to mirror the ‘outside
world,’ with recorded music, hospital choirs and bands, performances for patients, or
sometimes by patients” (p. 1 ).

In the 1940s, the development of the profession was driven by large numbers of veterans
of World War II who suffered emotional and physical injury and were populating hospitals
and clinics. Volunteer musicians noted anecdotal benefits, thus stimulating the need for
academic education and professional regulation. As music therapy became a recognized
profession, Ansdell (2002) notes that it took on five characteristics that distinguished it
from the practice that had developed during the first half of the twentieth century: (1) a
change from exclusively receptive methods to participatory ones, (2) a use of
improvisation to allow spontaneous joint music-making, (3) an emphasis on the
relationship between therapist and client that was modeled after other forms of therapy,
(4) emphasis on individual sessions, and (5) allying with extrinsic medical and therapeutic
theory for both explanatory and legitimizing purposes.

Music therapists have engaged in an ongoing struggle to have the depth, potency, and
professionalism of their work recognized. Music therapists whose training orients them to
developing individualized treatment plans have traditionally preferred to work with
individuals, small groups, and in private spaces. Administrators in health-related
institutions who believe that music therapy is only a recreational or adjunctive treatment
medium have imposed restrictions on the activity of music therapists—such as requiring
them to service large numbers of people, work in public areas of an institution, or
organize nonclinical shows and music events—that do not recognize its potential as a
primary mode of treatment. It is important to consider these conflicting visions of how

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Community Music Therapy

music therapy is viewed internally and externally to fully understand the place of CoMT in
the profession because some of the practices that constitute CoMT recall those activities
that reflect a lack of awareness of the ability of music therapy to function as an in-depth,
primary treatment modality.

Origins and Foundations of Community

(p. 140)

Music Therapy
The concept of CoMT is relatively new. It was introduced by Bruscia (1998), who placed it
within the “ecological” area of practice, defined as follows:

included are any efforts to form, build, or sustain communities through music
therapy. Thus, this area of practice expands the notion of “client” to include a
community, environment, ecological context, or individual whose health problem is
ecological in nature. . . . Helping an individual to become healthier is not viewed as
a separate enterprise from improving the health of the ecological context within
which the individual lives; conversely, helping any ecological context to become
healthier is not a separate enterprise from improving the health of its members;
and helping individual and ecology to relate to one another harmoniously makes
both healthier. (p. 229)

CoMT received its first detailed expositions in Ansdell (2002) and Stige (2002). The impetus for
its elaboration came from two sources. Primarily, a number of clinicians internationally were
engaged in practices with their clients—such as public performances and creating recordings—
that could not be easily subsumed into existing clinical theory. Secondarily, the broader turn in
academia to constructivist epistemologies and social theories that emphasized the role of culture
and context was primarily manifest in music therapy through the writings on culture-centered
music therapy and CoMT (Stige, 2002). It is somewhat ironic that while music therapists have
advocated for individualized treatment, small groups, and closed environments in which to work,
the natural modes of relating to music favored by clients have led in the opposite direction,
eventually bringing the profession full circle through the introduction of CoMT. Thus, in the
1990s, when many music therapists found themselves working in different contexts and with
different goals, these changes were just as much a return to the origins of music therapy as they
were a reaction to an imbalance in trends that emphasized individualized, intrapsychic work
over more communal focuses. Ansdell (2002) described the conditions that led music therapists
to seek a more inclusive treatment framework that could incorporate their work:
• Therapists working with clients from very different cultures and who may not have
had a concept of therapy (such as indigenous peoples in Australia and South Africa)
• Therapists working with clients whose most pressing need was for connection to the
outside community

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Community Music Therapy

• Therapists who work in emotionally demanding settings—such as hospice care—who

found that their work addressed the needs of family members, clinical staff, and other
workers
• Therapists working with traumatized war refugees, where the treatment issues had
social and political dimensions
• Therapists whose clinical work incorporated performance and/or recordings

In meeting the needs of these clients, some music therapists came into conflict
(p. 141)

with conventional ethical and professional guidelines. There clearly was a need for an
expansion of existing theoretical, conceptual, professional frameworks to accommodate
these practices. The precepts of CoMT were developed in response to this need:

Community Music Therapy is an approach to working musically with people in

context: acknowledging the social and cultural factors of their health, illness,
relationships, and musics. It reflects the essentially communal reality of musicing
and is a response both to overly individualized treatment models and to the
isolation people often experience within society. (Ansdell, 2002, p. 1)

The goal of CoMT is to help clients access opportunities for musicing and to accompany
them from individualized therapy to social contexts of musicing. CoMT involves a
conceptual expansion of music therapy, not just taking existing rationales and approaches
into communal settings but instead rethinking the relationship between clinical practices
and communal contexts. Music is considered to be a natural agent of health promotion,
and CoMT practices are built on this belief.

An example of a CoMT framework is Wood's (2006) “matrix model” of music therapy. The
traditional view of music therapy has a nested structure that includes individual work at
the core that can move out to group work with the establishment of community
connections on the periphery of the music therapist's concerns. In contrast, Wood offers a
model where clients have the potential to make use of a vast range of musical life, best
represented as a matrix. In addition to the individual and group music therapy sessions
characterizing the traditional model, the matrix model consists of a number of additional
options in terms of the client's participation in music, including learning an instrument,
participating in ensembles, and engaging in performances. In this model the forms of
musical experience are arranged in a nonhierarchical way, people can develop by taking
advantage of what different musical experiences offer, and the system can accommodate
to each step in client development with the individual remaining at the core.

Three aspects of Wood's model are particularly important in understanding the novel
developments characterizing CoMT. First, Wood includes activities typically considered
outside the realm of music therapy, such as concertgoing and music for special occasions.
Second, the model is not hierarchical in the sense that individualized activities are not
considered more essential than are community-related activities. Third, there is no

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Community Music Therapy

sequential organization implied such that individualized activities necessarily precede

community-related activities.1

Ansdell (2002) has outlined four fundamental ways CoMT differs from traditional music
therapy.

Basic aims. In traditional music therapy, individual clients are supported in exploring
their inner emotional lives. The purpose is to develop personal insight through musical
experience. Music is considered a psychological phenomenon, not a sociocultural one,
and the focus is on inner change. In contrast, CoMT recognizes that musicing leads
people inward and outward—internal exploration is not (p. 142) the sole focus of the
music therapist. The drive to commune with others through music is as important as the
drive to self-expression and self-knowledge. Therefore, community music therapists
support their clients’ desires in both directions.

This notion is based on a characteristic of music that Pavlicevic and Ansdell (2004) have
termed the ripple effect, something that they identify as being essential to CoMT. They
observe that music naturally radiates outward, defying any efforts at containment: it calls
to people and binds communities together. Music leads people from an inward to an
outward focus as one follows its resonance. Therefore, the practices and precepts of
CoMT follow the naturalistic essence of music.

Mode of intervention. In the traditional conceptualization, music therapy is distinguished

from other music domains—such as education, performance, and music appreciation—not
just by goals but by means as well. Activities such as learning an instrument, composing,
or performing are minimized. In CoMT, clinical and nonclinical musicing are considered
to be quite similar, as music therapy can involve musicing formats that are similar to
those outside of therapy. These natural modes of relating to music are encouraged.

Professional identity and role. The traditional role of a music therapist is clearly different
from that of a music educator or performer. The nearest role model is that of a
psychotherapist, who has insight into clients and can decode symbolic meanings. In the
CoMT perspective, the music therapist's expertise is primarily musical rather than being
primarily psychotherapeutic or health-related. The goal is to promote music and musicing
for individuals and milieus by removing obstacles. Ansdell describes this role as a
“therapeutic musician in residence,” a formulation that challenges more traditional
hierarchical roles and relationships.

Location and boundaries of therapy processes. In the traditional approach, music therapy
occurs in protected, private spaces to ensure confidentiality. The work is primarily
intrapersonal, and its main context is the therapeutic relationship, either between client
and therapist or among clients in group settings. Extratherapy activities occurring
outside the session are generally not taken up. In CoMT, the music therapist takes her
musicianship wherever it is needed: this could be in a private room, or it might be in
more public spaces such as corridors, waiting rooms, or shared group recreational
spaces. In contrast to the traditional approach, in CoMT the therapeutic frame—

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Community Music Therapy

incorporating the ethical and practical aspects of clinical work—is more fluid and
permeable. The therapist's job is to work with the entire context of a client's life, with the
overall goal of increasing the musical spirit of a community and enhancing the quality of
life of its individual members.

The concept of community has multiple referents in CoMT: it can refer to a curative factor
or a clinical goal, such as when feelings of musical community are invoked as either the
target of one's work or as an explanation for why particular individuals were able to
better move toward health within a CoMT program; it can refer to the identified client, as
when a therapist asserts as a goal improving the well-being of the community; it can refer
to the locale where the activity occurs, such as when the residents of a circumstantial
community participate in a performance in the wider, geographically defined community;
and it can refer to the (p. 143) therapy process, as is the case when clinical goals refer to
the integration of clients into the broader community.

The Spectrum of Community Music Therapy

Practice
In traditional music therapy, clients engage with music through a range of receptive and
active forms: they may listen to, play, or compose music. If they are playing music, they
may engage in improvisation or the recreation of composed materials. These materials
might be of any conventional origin, or they may be composed for use in therapy. If
clients are playing music, they might sing, they may use instruments in which they have
some prior experience and/or proficiency, or they may use instruments that they have
never played previously. Many music therapists will offer clients a wide range of
instruments that do not require prior skills, but that still offer the means to achieve
expressively rewarding experiences, such as various pitched percussion instruments,
drums, cymbals, gongs, keyboards, and so on.

In spite of this great variety, there are some common elements that typify traditional
music therapy practice: the work generally takes place in a closed space; it is targeted at
a specific, nonmusical health concerns (e.g., increasing self-esteem, enhancing immune
system response, increasing the range of motion of a damaged limb);2 the process of the
therapy and its nonmusical results (rather than the creation of a particular musical
product or outcome) are considered the only legitimate rationales; the activities
comprising the therapy do not usually extend overtly into the world outside the therapy
room. A number of features of CoMT practice distinguish it from these elements of
traditional music therapy.

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Community Music Therapy

Creating Music Outside of a Closed Therapy

Room
At times, music therapists work in spaces that do not provide privacy because such a
room is not available. This might include a waiting room or a shared recreational space in
a medical or social services facility. However, when music therapists choose to work in
nonprivate spaces by intention, this is an example of CoMT. Such applications can be
considered examples of environmental music therapy, defined as “a systematic process of
using music to promote health in a specified environment inside or outside of
institutions” (Aasgaard, 1999, p. 34). A basic premise of this type of work is that physical,
social, and symbolic environments can be healthy or (p. 144) unhealthy and that the
health-musicing skills developed by music therapists can make a unique contribution to
the well-being of these various environments.

Aasgaard (2004) details a number of music therapy activities that fall into this category.
In one, Aasgaard functions as a “Pied Piper” as he regularly leads a musical parade
through the corridors of a pediatric hospital:

The participants are first of all the patients: some in wheelchairs, some in beds,
many with infusion pumps. But also relatives, students (of various kinds) and
people working in the hospital—altogether 20 or 30 persons—may be present.
Sometimes a dozen (young and old) start the event by marching (or rolling)
through the corridors playing and singing. In front, walks the music therapist in
top hat, blowing his trombone or recorder. As a rule, more and more participants
join the line of musicians as the procession slowly proceeds from the 8th floor to
the 4th floor. (p. 147)

The clinical purposes of such an activity are varied and embedded within it are goals
common to traditional therapy as well as ones that appear unique to CoMT. As an
example of the former, consider how—for the time period of the music—hospitalized
children are able to feel enlivened, engaged with life, and have their overall mood lifted,
all of which are important goals in a pediatric setting. As an example of the latter,
consider the effect on the life of the institution to regularly have costumed staff, medical
doctors, patients, family members, and other random visitors parading through the halls
while creating live music. Such an inclusive ritual can eliminate the rigid distinctions
among people that can create feelings of isolation, alleviate the constant stress and fear
endemic to a hospital environment, and remind everyone (participants and those who
only observe the parade) of another world “dominated by play, fantasy, and pleasurable
social interactions” (Aasgaard, 2004, p. 147).

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Community Music Therapy

Performing with Clients

There are3 different, often contradictory thoughts about the ethics and clinical value of
music therapists performing with their clients. Turry (2001) suggests a number of
potential risks, although they are basically of two types: therapists might be
unconsciously meeting their own needs for professional recognition, or they may perform
with clients to meet their own creative, expressive needs. In these instances, Turry raises
the important rhetorical question Who, then, is looking out for the client's best interests?

On the one hand, performance can be beneficial for clients in overcoming the inner
obstacles to performing; this can be such a significant accomplishment that Turry has
likened it to the “hero's journey,” as described by Joseph Campbell. The preparations for,
and successful realization of, a public performance can lead to a significant change in
one's sense of self-worth. Yet Turry also considers the opposite (p. 145) view about
performing embodied in the traditional psychoanalytic perspective that the need to
perform can be driven by unresolved psychological conflicts. In this view performance is
considered inauthentic, something that conflicts with the value that therapy should be
focused on helping clients to “get more insight into their ‘real’ self” (Ansdell, 2010, p.
173).

In contrast to the psychoanalytic view, practitioners of CoMT draw on more contemporary

forms of personality theory that suggest that the self “is a socially and culturally
constructed entity, whose nature is indeed performative” (Ansdell, 2010, p. 173). In this
perspective, the public display of knowledge, skill, and selfhood embodied in performance
is an essential human need, and as something that promotes the inner development of the
client's self, it is a legitimate activity in which music therapists should engage with their
clients.

Performing in an Institutional Setting

Music therapists have participated in performances within institutional settings since the
origin of the profession, although these types of activities were likely considered to be
outside the realm of their clinical duties. CoMT is providing new theoretical rationales for
performance that construe it as a vital aspect of a clinician's responsibilities rather than
as something apart from them. Many of these rationales reflect the fact that these events
are structured such that performance generally includes all the members of a community,
not just its identified clients.

One such example of how performance can improve the health of a circumstantial
community is the Happy Hour,3 developed by David Ramsey at Beth Abraham Health
Services, a residential rehabilitation facility in New York City. During this time,
residential patients are allowed two alcoholic drinks; doctors and nurses function as wait

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Community Music Therapy

staff; and music therapists, patients, family members, and any other employee can take to
a stage to perform. Many community-building and individual health-related goals are
addressed through this structure.

The most important of these goals is related to enhancing and normalizing the social
interactions and perspectives of the community members. For example, as the only time
when alcohol consumption is permitted in the institution, Happy Hour allows the patients
to be treated as the adults that they are. Having professional staff (such as doctors)
functioning as waiters serves to equalize the human relationships in the community,
making them more mutual. Providing an opportunity for everyone to perform—whether
patient, doctor, therapist, or janitor—serves to reinforce the common humanity shared by
all members of the community, a commonality that is all too often lost in the interactions
that characterize institutional hierarchies. Because of the disabilities of the patients, it is
really only through the expressive, interactive medium of music that this common level of
humanity can be realized. And perhaps most important, through the vehicle of musical
performance, health workers who care for individuals who may not be able to take
responsibility for any of their most personal physical functions are allowed to see these
people in a new light:

What happens for patients during performances is that the perception of

(p. 146)

being an invalid is almost instantly changed because you're on stage doing

something that is culturally idealized. And so if the [people] that bathe you [are]
watching you up on a stage singing, the next time they bathe you and tend to your
personal hygiene, they're going to think of you differently. It instantly and forever
changes that relationship. (David Ramsey, quoted in Aigen, 2004, p. 190)

For Ramsey, part of the rationale for including performance as a clinical vehicle is the
idea that performance is an extension of everyday social interactions, rather than
something fundamentally different from them. For example, one way that people in
everyday life assert their sense of agency and create a view of themselves as competent is
through the simple act of taking control of a conversation while speaking to a group of
people. However, this simple act is not available to clients with severe disabilities in the
areas of motor function, neurological function, and functional communication skills.
However, as Ramsey asserts, “when you've got somebody who can't raise their hand or
raise their voice, you have to artificially give them the stage to do that. Or else it won't
happen” (Aigen, 2004, p. 191). In sum, in CoMT, the desire for public performance is
considered to be reflective of a positive desire to interact with one's social world rather
than as a symptom of a psychological conflict.

Performing Outside of an Institutional Setting

When performance becomes a vehicle for music therapy processes, it can occur
completely within an institution, as was just described, it can involve individuals
belonging to a common institution performing in other institutions (see Jampel, 2006),

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Community Music Therapy

and it can involve performing in public squares or theaters with no particular institutional
affiliation. For example, beginning in the mid-1990s, Danish music therapist Sten Roer
organized a band of individuals with psychiatric illnesses and performed rock and jazz
music in outdoor, public spaces—he even brought the band on an international visit to the
United States. And Maria Logis wrote a theater piece with music about her experience as
a music therapy client with therapist Alan Turry that was performed at the New York
International Fringe Festival, a collection of shows and concerts occurring across a two-
week period in New York City (see Aigen, 2004).

Logis's piece is particularly interesting because of the way it originated and how it
simultaneously told the story of her therapy while acting as an extension of it. Logis was a
corporate executive who contracted cancer and who was reluctant to follow the standard
therapies prescribed by her doctors. Something within her told her to sing, but she did
not know how or why to do this or how it related to her medical issues. She tried vocal
lessons but felt that she needed more. Through a chance comment to her dentist she
learned about music therapy and thus began her experience, which took place over many
years. Her therapy process involved the spontaneous expression of thoughts and feelings
accompanied by Turry's improvisations on the piano. These improvisations gradually
evolved into songs, and Logis (p. 147) began performing this music: first live for friends,
then for professional audiences. Eventually a CD was recorded with professional
musicians, and ultimately the theater piece was created. While Turry supported this work
as an example of CoMT, his active participation in the public presentations of it gradually
stopped as Logis took these efforts on independently. The performances in the community
were conceived as logical consequences of her therapy work and reflected the personal
changes that took place there.

Although it did not include public performances such as those engaged in by Roer and
Logis, Anna Maratos (2004) describes a dramatic project in a setting for adults with
chronic mental illness that did include performance outside the institution in which it was
conceived. This work is particularly interesting due to its illustration of the way
performance-oriented music therapy can stimulate changes in the way power is wielded
by the medical staff.

This project entailed the creation, rehearsal, and performance of an operetta, called The
Teaching of Edward, which details “a fictional account of the English composer, Edward
Elgar's ‘discovery’ of music therapy through being persuaded by the patients at the
asylum where he was employed to go beyond his usual musician's role of performing to
patients” (Maratos, 2004, p. 136). In the story, Elgar is unsuccessful in generating
interest in performing his music, yet when he inadvertently begins a spontaneous
composition with the patients, they participate enthusiastically and with a confidence that
belies their psychological difficulties. The song is called “Take Us Where the Music Goes,”
and in its sentiment it could serve as an official anthem of CoMT.

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Community Music Therapy

The dynamics of rehearsal and performance offered a unique way of examining the roles
and interpersonal dynamics of the patients and staff. Maratos describes how the
psychiatrist who was the play's author also adopted the role of director. One of the
patients approached him asking if she could play the narrator in addition to the role of
patient. While this desire to portray a healthy, “sane” character was certainly a positive
one and should have been responded to affirmatively by the author-director-psychiatrist,
he instead replied that there was someone else he was thinking of for the part. In this
interaction, Maratos notes the same destructive interpersonal dynamics that typify life in
a psychiatric institution. The passive patient assumes a position of weakness and defers
to the more powerful psychiatrist. The psychiatrist's response reinforces the inequality
and lack of mutuality in their relationship.

However, reflecting on such interactions helped the participants to gain insight into their
unconscious and destructive nature. In fact, the patient went on to play both roles and
the psychiatrist-author became less controlling in the process, while gaining insight into
how his role was perceived: “I had not realised quite how much consultant psychiatrists
(with their powers of compulsory detention) were regarded with a combination of fear
and loathing. It also helped me to realise how much of what goes in formal ward reviews
is totally phoney [sic]” (Maratos, 2004, p. 142). In their professional role, psychiatrists
control access into and out of the institution. Patients who are working to rejoin their
external communities must convince (p. 148) psychiatrists of their ability to do so.
Analyzing this example of performance in CoMT demonstrates how this power imbalance
might serve to encourage supplicating and less autonomous behaviors in patients—in
order to curry the favor of psychiatrists—that actually serve to impede their ability to
function outside of the institutional community.

Conceiving of a Community as the Client

Practitioners of CoMT have enlarged the conception of the client to include the various
types of communities discussed previously. The community is not just a place in which
therapy occurs; it is also an entity on which the clinical work is focused.

Cochavit Elefant (2010) has described a CoMT project in Raanana, Israel, in which two
groups of children—one with special needs and one without them—were joined in the
creation of music therapy group. Although this project had benefits for both groups of
children, its rewards did not stop there and extended into the broader social networks of
the community. Because of the extensive ripple effect of this project, it makes for an apt
illustration of CoMT.

Elefant (2010) notes that although these two groups of children inhabited a common
community, they lived quite separately, and many of the children without disabilities had
never even met a child with special needs. Her intent was to facilitate the establishment
of relationships between the two groups with the idea that “music could become the

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Community Music Therapy

connecting ‘bridge’ for the purpose of uniting the groups” (p. 66). Initial activities
included singing songs, engaging in instrumental music play, and participating in
movement activities that included the use of scarves and parachutes with supportive
music. In discussions after each group meeting, the elementary school children initially
focused on their similarities with the children with special needs, stating things such as
“the special children are just like us, they laugh and cry, they sing and play, they look
normal” (p. 69).

After a few months, in the postsession meetings these children began asking about their
differences with the special needs children: “Why aren't they speaking? Why are some of
the children doing weird movements with their hands? Why are some drooling? Why does
it look like some have diapers?” While the educational staff members seemed
uncomfortable with such queries, Elefant's therapy expertise helped her to see these
concerns as part of the typical process that occurs when groups of people from different
backgrounds first get acquainted.

Because Elefant understood these questions as reflective of the desire to come closer to
the children with special needs and to better understand them, she allowed these
concerns into the therapy groups as part of the natural process of developing intimacy.
Starting with the idea that they are “just like us,” the difficult differences emerged, and
the elementary school children eventually began to realize that (p. 149) the special needs
children were indeed different from them in some fundamental respects. It was only after
these differences could be honestly and sensitively expressed and explored that the
elementary school children could establish a real sense of comfort in the group.

For their part, the children with special needs indicated that they felt the warmth and
concern that emanated from the other children. Elefant describes this stage of the group
process as being quite moving for her as the children changed “from being two separate
groups . . . to have become one whole unit with many different parts” (2010, p. 71). Again,
this process of establishing a stronger sense of identity and cohesion after some difficult
feelings can be expressed and worked through is also typical of most theories of group
therapy.

Approximately six months into the project, progress had been made, and significant goals
were achieved. The children from the two groups became close: absences were noted by
expressions of regret; feelings of respect and caring for each other were expressed
verbally by the elementary school children and through pointing, body language, and
assistive communicative devices by the special needs children. The group members began
bringing in their own favored musical activities to supplement those suggested by the
therapist, and they expressed their affection for, and comfort with, each other through
appropriate physical contact, such as holding hands while singing and dancing and
sharing hugs at the beginning and end of sessions. The goals achieved in this group were
as important for the elementary school children as they were for the special needs
children. For example, several of the elementary school children observed that “the
children with special needs had taught them about love and friendships” (p. 72). And

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Community Music Therapy

being in a social environment with children without special needs helped the special
needs children in important ways. Many of them “stopped their nonsocial or stereotypical
behaviors such as spitting, hitting or pinching” (p. 72) and instead developed more
functional ways to communicate with others.

In implementing this group over a period of four years, Elefant was determined to include
not just the children but to reach out to many of the social networks that surrounded
them, such as their parents, teaching staff, organization leaders, and representatives of
local government. The project extended to the whole community, as the changes in the
children rippled out into these other spheres. Elefant reports that many other such music
groups were developed as a result, and because of the success of the initial efforts, it
became easier to establish such groups. Important goals that were achieved in the
community included an enhanced level of tolerance for the special needs population and
increased funding for such services. The ultimate success of the project was reflected in
the fact that the special needs children achieved “inclusion in a community that until then
had not given many opportunities for their special residents” (2010, p. 73).

Elefant's work highlights one important aspect of CoMT that distinguishes it from
traditional music therapy. As clinicians, music therapists have the responsibility to
establish specific treatment goals for clients and to document progress toward these
goals. In contrast to this focus on individual change, Elefant notes (p. 150) that in
intergroup work the focus is more on the meeting and coming together of two diverse
groups of people where the focus is on learning to perceive and accept various types of
similarities and, more important, differences. Individual change can occur, but it appears
more as a by-product of the intergroup interactions than as something that is directly and
overtly targeted as an area of change.

Broadening the Scope of Legitimate Therapy

Goals
In addition to broadening notions of what constitutes a client, CoMT also encompasses an
expanded notion of legitimate focuses of clinical work to include things such as
empowerment and social justice. Two brief examples of CoMT work with nontraditional
goals will be described here, one in a Western context and one that takes place in a non-
Western context.

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Community Music Therapy

Community Music Therapy with Political Refugees in Berlin

Oksana Zharinova-Sanderson's (2004) work with traumatized refugees in Berlin at the

Centre for the Treatment of Torture Victims is just one of many projects with victims of
political violence. She notes that although integration into Berlin society can be highly
problematic for refugees, it is essential for both the well-being of the individual as well as
the health of the local culture because these refugees are “symbols of the new society's
attitude to foreign ideas and its capacity to integrate these ideas” (p. 235) into the
construction of the new capital of Germany.

Clients at the Centre experienced a range of music therapy activities and interventions.
In individual sessions, Zharinova-Sanderson describes percussion improvisations and the
active engagement of clients in playing and singing songs from their home culture. In
addition, performance was used as an extension of work from individual sessions. Also,
music-making with the entire therapeutic community took place at social gatherings such
as parties, with one example described by Zharinova-Sanderson as consisting of large
group chanting.

Zharinova-Sanderson reports that the focus in CoMT on resources and client strengths
conflicted with the existing treatment model of the host center. However, the fact that
Zharinova-Sanderson elected a treatment focus that did not involve direct targeting of
the clients’ trauma does fit in with more progressive views that emphasize the whole
person as opposed to a preoccupation with the trauma. Interestingly, while the clients in
this program came from extremely diverse backgrounds—including Kurdish political
activists, widowed women from Africa, and orphans from Kosovo—what united them was
not their shared trauma but their common challenges in the present, such as insecure
residential status, the lack of material resources, and fears of East German neo-Nazis.

Music therapy in this context helped clients to contact their inner resources for
(p. 151)

growth, and by using their own cultural music it allowed them to be more present in their
new culture as whole human beings. Performance opportunities that originated from
clinical processes allowed audience members to see past “the concept of a ‘traumatised
refugee’ into a real person with real feelings” (Zharinova-Sanderson, 2004, p. 240) for
whom empathy can be generated. Two of the most prominent issues faced by traumatized
refugees include a lack of trust in humanity and social isolation. One of the primary
benefits of CoMT in this context is the way that it can intervene with these issues and
disrupt their mutually reinforcing cycle. Individuals who do not trust others tend to avoid
social interaction; the resulting paucity of interaction reinforces the lack of trust. In
changing the way refugees feel about themselves and are perceived by their new
communities, Zharinova-Sanderson asserts that music can become a “force for
change” (p. 245) as the act of communal musicing acquires sociopolitical import.

Community Music Therapy with Young Girls in Sierra Leone

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Community Music Therapy

Sierra Leone suffered a civil war during the 1990s that devastated the country and its
people. Children were enlisted as soldiers, and the role of girls was especially complex,
because even though they were abducted, they were forced to fight and serve as spies,
soldier-wives, and camp followers (Gonsalves, 2010). The extensive role that girls played
in the war was not fully recognized—consequently, they did not receive adequate
government resources, and there was no formal demobilization, as whenever possible,
they just instinctively assimilated back into their communities (Gonsalves, 2010).

Maria Gonsalves worked as a music therapist with a team of four health professionals to
assess and assist in meeting the psychosocial needs of these former girl soldiers when
they attempted the difficult process of reentering their communities. The team enlisted
individuals to act as allies in the various social entities that comprised the community
where they worked. This included the local tribal chief; the chief of police; teachers, local
child protection officers, traditional healers, leaders of the women's secret society,
traditional birth attendants, and other elders, families; guardians, and the girls
themselves (2010). Their meetings included the girls with their mothers or babies, girls
without their family or those integrated into new communities, working in commercial
sex trade, or in skills programs (2010). Their translator was a teacher who was born and
lived in the community.

In the group meetings Gonsalves discovered that song was the natural mode of
communication in this culture, and it was through song that the girls communicated their
emotional and material needs, their histories and fears, and the nature of their present
difficulties. Her work showed her that increased understanding, re-engagement and
connections with others and promotion of healing (2010) are all facilitated through
creative musical interaction. Gonsalves makes the point that for traumatized victims of
social, political, and gender-based violence, creativity is especially important as it
represents a refusal to remain a helpless victim. In (p. 152) this context, creative
expression is an act of resistance as it restores the humanity that the various forms of
oppression attempt to erase. In this project, music therapy functioned to restore
connection and engagement with others. The case vignettes that Gonsalves (2010)
reports on demonstrate the capacity of music to achieve many human benefits, including
the creation of social solidarity and activism for peaceful coexistence, which, in turn,
works to block forces of oppression and abuse.

Concluding Thoughts: Boundaries of

Professional Practice
A number of authors who have been exploring the notion of CoMT have considered its
relationship with both traditional music therapy and CM (Ansdell, 2002; O’Grady &
McFerran, 2007). I would like to extend this spectrum so that it comprises a continuum of
four related areas of practice: (1) traditional music therapy, (2) community music therapy,

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Community Music Therapy

(3) therapeutic community music, and (4) CM. I am adding (3) in light of the increasing
numbers of musicians who are not professional music therapists but who are working in
health-related contexts that music therapists traditionally inhabit, such as hospitals and
hospices.

It can be difficult to distinguish the work that occurs as one moves across this spectrum,
especially when working at the boundaries of two related areas. As music therapists
increasingly move into the domain traditionally inhabited by community musicians and
take on more political and social goals, and as community musicians increasingly move
into the health-related domains traditionally inhabited by music therapists to focus on
work with individuals with illnesses and disabilities, there is a risk that each group will
develop new forms of practice without taking advantage of the knowledge that has been
gained by their musician colleagues. Equally, there is a danger that lack of awareness of
each other's professions will lead to unnecessary battles for professional legitimacy as
each group strives to protect its respective areas of professional practice.

Of course, it is important to proceed with a cognizance of these boundaries because they

exist to protect the clients of both groups. However, what should not be lost is that all
musicians—whether therapists or not, whether working in institutions or in the outside
community—are all engaged in following where music leads (Ansdell, 2010) in order to
promote human well-being. It is the enhancement of human lives through music that
binds together all music professions: teacher, therapist, community musician, and
performer. Constantly hewing to this value will enable the practitioners in these various
professions to negotiate the establishment of their shared boundaries in ways that are in
the best interests of all members of the community.

(p. 153) Reflective Questions

1. What practices and focuses distinguish community music therapy from
therapeutic community music?
2. In what ways can community music therapy practices challenge traditional ethical
guidelines?
3. In what ways does community music therapy expand the professional obligations
of practitioners?

References
Aasgaard, T. (1999). Music therapy as milieu in the hospice and paediatric oncology ward.
In D. Aldridge (ed.), Music therapy in palliative care: New voices (pp. 29–42). London:
Jessica Kingsley.

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Community Music Therapy

Aasgaard, T. (2004). A pied piper among white coats and infusion pumps: Community
music therapy in a paediatric hospital setting. In M. Pavlicevic & G. Ansdell (eds.),
Community music therapy (pp. 147–163). London: Jessica Kingsley.

Aigen, K. (2004). Conversations on creating community: Performance as music therapy in

New York City. In M. Pavlicevic & G. Ansdell (eds.), Community music therapy (pp. 186–
213). London: Jessica Kingsley.

Aigen, K. (2005). Music-centered music therapy. Gilsum, NH: Barcelona.

Ansdell, G. (2002). Community music therapy and the winds of change. Voices: A World
Forum for Music Therapy, 2(2). Retrieved July 18, 2002, from https://normt.uib.no/
index.php/voices/article/viewArticle/83/65.

Ansdell, G. (2010). Where performing helps: Processes and affordances of performance in

community music therapy. In B. Stige, G. Ansdell, C. Elefant, & M. Pavlicevic, Where
(p. 154) music helps: Community music therapy in action and reflection (pp. 161–186).

Farnham, UK: Ashgate.

Bruscia, K. (1998). Defining music therapy (2nd ed.). Gilsum, NH: Barcelona.

Elefant, C. (2010). Must we really end? Community integration of children in Raanana,

Israel. In B. Stige, G. Ansdell, C. Elefant, & M. Pavlicevic, Where music helps: Community
music therapy in action and reflection (pp. 65–73). Farnham, UK: Ashgate.

Gonsalves, M. (2010). Restoring connection and personal capacities for healing: music
therapy in Sierra Leone. In Elavie Ndura-Ouedraogo, M. Meyer & Judith Atiri (eds.),
Seeds taking root: Pan-African peace action for the twenty-first century. Lawrenceville,
NJ: Africa World Press.

Jampel, P. (2006). Performance in music therapy with mentally ill adults. Doctoral diss.,
New York University, 2006.

Maratos, A. (2004). Whatever next? Community music therapy for the institution. In M.
Pavlicevic & G. Ansdell (eds.), Community music therapy (pp. 131–146). London: Jessica
Kingsley.

O’Grady, L., & McFerran, K. (2007). Community music therapy and its relationship to
community music: Where does it end? Nordic Journal of Music Therapy, 16(1), 14–26.

Pavlicevic, M., & Ansdell, G. (eds.) (2004). Community music therapy. London: Jessica
Kingsley.

Stige, B. (2002). Culture-centered music therapy. Gilsum, NH: Barcelona.

Stige, B., Ansdell, G., Elefant, C., & Pavlicevic, M. (2010). Where music helps: Community
music therapy in action and reflection. Farnham, UK: Ashgate.

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Community Music Therapy

Turry, A. (2001). Performance and product: Implications for the music therapist.
Retrieved December 1, 2009, from http://musictherapyworld.net/.

Wood, S. (2006). Interdependence and emergence: Core concepts in community music

therapy? Voices: A World Forum for Music Therapy. Retrieved July 27, 2007, from http://
www.voices.no/discussions/discm51_02.html.

Wood, S., Verney, R., & Atkinson, J. (2004). From therapy to community: Making music in
neurological rehabilitation. In M. Pavlicevic & G. Ansdell (eds.), Community music
therapy (pp. 48–62). London: Jessica Kingsley.

Zharinova-Sanderson, O. (2004). Promoting integration and socio-cultural change:

Community music therapy with traumatized refugees in Berlin. In M. Pavlicevic & G.
Ansdell (eds.), Community music therapy (pp. 233–248). London: Jessica Kingsley.

Notes:

(1.) Although in Wood, Verney, and Atkinson (2004) the authors do propose a model where
clients move from individual music therapy sessions to group sessions to community
contexts, this sequence is based on the needs of a particular client group (individuals
undergoing neurological rehabilitation) rather than on fundamental notions of how music
therapy works, in general.

(2.) One exception is music-centered music therapy (Aigen, 2005), which articulates a
view in which the medium of musical experience assumes more prominence than any
other extrinsic, nonmusical, goal.

(3.) For readers who may be unfamiliar with the term, a “happy hour” is a promotional
device employed by bars to encourage customers to patronize the bar in the hours
between the end of the work day and before dinner (typically, 5:00–7:00 p.m.), by offering
discounted drinks and snacks. This program is described in detail in Aigen (2004).

Kenneth S. Aigen

Kenneth S. Aigen studied philosophy and psychology at the University of Wisconsin

prior to completing master's and doctoral degrees in music therapy at New York
University. He is currently an associate professor in the music therapy program at
Temple University. His publications focus on Nordoff-Robbins music therapy,
qualitative research methodology, music-centered music therapy, the use of popular
groove music in music therapy, and critical examinations of the evolution of music
therapy theory and research methods. He was the chairman of the scientific
committee of the Ninth World Congress of Music Therapy and is a past-president of
the American Association of Music Therapy. He is an associate editor of the Nordic

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Community Music Therapy

Journal of Music Therapy and is on the editorial board of Qualitative Inquiries in

Music Therapy. He is also president of the Nordoff-Robbins Music Therapy
Foundation (USA) and is a member of the International Trust for Nordoff-Robbins
Music Therapy.

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