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BAMT Conference 2024 – Co-pilot vs Chauffeur

Last weekend I spent two days in Leicester for the BAMT (British Association for Music Therapy) Conference. I was really looking forward to it and, as a Midlander myself, it was great to be in that part of the country again. If truth be told though, I always get a bit queasy about these kinds of events too. Is it going to be worth the money? Am I going to be preached to? Am I going to enjoy the company of fellow professionals or am I going to want to run for the hills?! 

I am pleased to report that I genuinely had a brilliant time and felt really proud to be part of this small, but evolving and increasingly diverse profession. Seeing so many people from different stages of my career and hearing about so many different kinds of approaches was fairly mind-blowing, so this blog is part one of my attempt to process and distill a few essential takeaway themes.

In a talk about neurodiversity and neurocosmopolitanism (I’ll come back to these concepts another time), Hilary Davies referenced the idea of a Music Therapist being more akin to a co-pilot than a chauffeur. It was a memorable comparison and one that chimes a lot with my experience and philosophy. But what does it really mean!? And how does it relate to my approach at Thame Music Therapy? 

The Destination

So first thing’s first, where are we going in Music Therapy and who decides? If I was the chauffeur in Music Therapy, I would be taking my instructions from the client and then taking sole responsibility for getting us where we need to go. Heathrow Airport, you say? Done. Anxiety reduction you wanted? No problem. More robust self-esteem requested? Of course. 

Only it really doesn’t work like that. 

First of all, the intended destination in Music Therapy might not always be clear from the start. Or it might be very clear, but as time goes on, there might be a consensus that a different destination is actually more important, more relevant or more realistic. 

Sometimes I work with people who have referred themselves with a very clear intention in mind and this will remain consistent. At other times, I work with people who like the concept of Music Therapy and have an idea of how it could help, but for whom it takes time to fully ascertain what they really want and can gain from sessions. Often I work with people who have been referred by someone else; a parent, a teacher, a mental health professional. And what that referrer has in mind for the client doesn’t always tally with what the client thinks they’re in the sessions for. So Heathrow Airport is regularly not Heathrow Airport at all! 

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From my side as the therapist, whatever the initial reasons for referral are, whether directly from the client or from someone connected to them, I wouldn’t automatically consider them to translate into mutually agreed therapeutic aims. In fact, I would avoid setting specific aims for therapy until I’ve got to know the client over at least four sessions (my typical assessment period), often a little longer. I would certainly never offer blanket promises or guarantees about what Music Therapy could offer before I’ve had the chance to get to know someone.

During an assessment period, I can start to gauge levels of interaction and engagement. I can consider what might be possible for this person in this environment, given what I am beginning to understand about their strengths and challenges in and out of sessions. Even then, once I have set my aims, I remain open to the fact that they may evolve or change over time, particularly in long-term pieces of work. Circumstances change, context changes, working relationships change. With that in mind, I have to keep a certain amount of flexibility about what these sessions are offering. Which brings me to my next point…

The Route

Let’s imagine, after an assessment period and some reflections on how Music Therapy is working out in reality (as opposed to the hopes or aspirations before sessions started), we do have a specific, or at least rough, destination in mind. How are we going to get there? 

This is where that analogy of the therapist and client as co-pilots is so crucial. For the route is a collaborative, changeable and often unpredictable process. 

My approach to Music Therapy is broadly* improvisational, both on a micro and macro level. 

On a micro level, this means that within any particular interaction, whether a conversation, a spontaneous piece of music or a more structured musical activity, I am remaining open to the fact that things could go in any number of different directions. I am trying to go with the flow of the client’s ideas and responses, accept that I am not master of the ship and that things could change at any moment. Take this example:

I see an opportunity to try a structured song with a four-year-old who seems a bit lost in the room. They start off in a very responsive manner, but then get distracted. I might try to see if they can refocus and encourage them back to what they were doing. Or maybe I would tweak the song so that their distraction can be somehow connected and integrated into the original activity. Or I might just have to scrap the song and concentrate on what they’re now doing. That’s where I can best connect with them and to me that is taking an improvisational approach. 

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On a macro level, this means that I am remaining open to how a whole session might turn out, even how a group of sessions or a whole period of therapy might work out. Psychoanalyst Wilfred Bion wrote about considering individual sessions to have “no history and no future” and listening “without memory or desire”. Although I can’t claim to take that stance in every session, and sometimes it’s not suitable to do so, in the main I try to hold on to its essence. Not being fixated on what happened last week or on the client’s long-term condition (memory) or not having specific hopes or expectations for today’s session (desire) means I am much more likely to be emotionally present, be available for authentic human interaction and offer the client a more powerful experience of connection. 

The purest form of listening is to listen without memory or desire. Every session must have no history and no future.

Wilfred Bion

For both micro and macro levels, that doesn’t mean I’m just passively letting sessions happen. I’m still one of the pilots. I facilitate and suggest musical activities. I ask questions. I challenge when I think it’s important and timely to do so. I reflect outside sessions (both on my own and with my supervisor**) about difficulties, barriers, opportunities in the work. But I am not the de facto expert in the room dictating what we’re going to do and how we’re going to do it. I have certain areas of expertise and experience that I can bring to the table and I take responsibility for facilitating a safe therapeutic space, but that doesn’t mean I am necessarily the expert of any one client or any one journey. And I want clients to feel empowered to become the expert of themselves and be able to affect what we do in sessions.

*I say ‘broadly’, because there are times when it feels really important for certain clients to have a clearly established routine and structure in sessions. In which case, I would still try to have scope for improvisation on a micro level, but less so on a macro level. 

**An essential part of Music Therapy practice is to have what’s called clinical supervision. This takes the form of a meeting with a supervisor who is usually another Music Therapist (but can be a therapist of another discipline) and who supports you with your work in and out of the therapy room. 

Co-pilots and lightbulbs

Forgive the mixed metaphors, but if anyone knows the old series of lightbulb jokes, there’s one (with various incarnations) about therapy. It goes something like this:  

How many therapists does it take to change a lightbulb? 

Only one but the lightbulb has to really want to change. 

It’s crude but there is an element of truth there; this idea that if a client is seeking change, they have to be invested in it, open to new ideas, willing to be challenged, up for doing some ‘work’ on themselves. Six or twelve or twenty sessions of therapy could be relatively meaningless if attendance for a client is just a cursory, tick-box exercise, with no connections to any other parts of their lives.  

But in line with my connection to the co-pilot analogy, I’d like to challenge the joke when it comes to Music Therapy on (for now) two levels. 

First off, it might actually be the therapist who, at least in part, needs to change. Now there’s a radical idea. This could be a hugely poignant and empowering experience for the client. Finally there’s someone who’s really listening to them and understanding what they need. Finally there’s someone who is willing to adapt their approach to make it more inclusive, accessible and open for collaboration. Finally there’s someone who takes off their figurative white coat and thinks about the core human elements of connection and interaction. I really think an essential part of being a therapist is to learn and adapt practice in a spirit of humility and respect for different individuals. It’s certainly something I aspire to. So how about, in a much less catchy form…

How many therapists does it take to change a lightbulb?

Only one, but the therapist has to understand that change is a mutual process, realise that their previous experience of changing light bulbs could be redundant, accept that they (the therapist) will often get things wrong, give the lightbulb multiple opportunities to explore the kind of change they want and, most likely, get plenty of supervision along the way.

Or something like that. 

Secondly, and I could easily go down a rabbit hole here, Music Therapy can be about very different kinds of change for different individuals. There’s an implication of change in the joke being about improvement and self-betterment. The lightbulb is presumably going from dim to bright after all. It feels like quite a linear, upward-looking process. That can sometimes be the case in Music Therapy, but the change is more likely to emerge in different ways. It might not be about the client changing themselves per se, more about becoming themselves more and feeling accepting of who that self is. It might be about having a different experience of being oneself with another person, which then in other contexts translates to opportunities for change in other relationships. Or it might be about understanding and relating to an event or an experience in a different way. I could go on, but to my mind all of that stuff would be very difficult without a collaborative, co-pilot relationship.

So there you have it. Just as Shrek declares that “ogres are like onions” I hereby declare (until I change my mind) that Music Therapists are like co-pilots and not like chauffeurs.