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Ethical Thinking in Music Therapy

Dileo, Cheryl (2000).Ethical Thinking in Music Therapy. Cherry Hill, NJ: Jeffrey Books.

Reviewed by Ruth Eckoff

Br2002_13I got the opportunity to review a most interesting and useful book, Ethical Thinking in Music Therapy by Cheryl Dileo. I use the word opportunity because before starting the review I found myself in different situations where I had been confronted with ethical dilemmas of which I did not have adequate answers for. I met such dilemmas both when teaching methods in music therapy to students, when presenting case materials in lectures and in running a newly started private practice.

This book was really helpful to me in finding answers to these situations. As I was reading, the lack of systematic training in ethical thinking in my own education became clear to me. I have participated in shorter lectures on systems of ethics, but the lecturers were never music therapists, and were not bringing the theme down to concrete, specific situations relevant to my work. Also in the places were I have been working for several years, discussions on ethical issues relevant to my profession have been absent. This was of course partly due to the ambiguous situation of being a music therapist within educational settings where all other co-workers are teachers.

The author has a broad and thorough knowledge in the field of ethics. Twenty years ago she wrote her doctoral dissertation on this theme, she has conducted a lot of research on the topic, has been teaching at a number of Universities, and has had many leadership positions spanning from the World Association of Music therapy to the National Association. She has comprehensively compared and revised different Codes of Ethics. These Codes are printed in the last section of the book. Cheryl Dileo has written 10 books and a vast number of chapters in different books.

The book tries to meet the practical needs of ethical thinking for music therapists in all sorts of areas, and can therefore be used as a reference book. After each chapter the reader will find a chapter summary, detailed suggestions for additional learning experiences and a number of ethical dilemmas written in a few sentences. These dilemmas have been collected through years of research and teaching.

In the beginning of the book Dileo discusses why this topic is so central. According to her opinion “ethical thinking is considered to be the most important skill a music therapist can acquire”. This statement seemed a bit extreme, when I was in the beginning of the book. However, throughout the chapters Dileo shows through the book how ethical questions and dilemmas are to be found in every topic of music therapy.

To give the reader an impression of the topics covered in the book I will mention the themes of the different sections. One chapter deals with qualities of “the virtues music therapist”; caring, empathy, courage and prudence. Also the topic of competencies are treated; the professional, the personal and the importance of self-caring also in private life.

Another section describes clients rights and therapists responsibilities. This is also very interesting because the legal side of the issue is included here as well as in some other sections. Dileo has really informed herself well in this complicated area. She emphasises however that these legal matters differ a lot from country to country, and this book is clearly written in the context of the United States. As this section also thoroughly treats the legal aspects of the music therapist in private practice this was interesting to me personally. In many chapters Dileo accounts for the many facets of relations between ethical thinking and juridical regulations.

A whole section is given to the theme of confidentiality and yet another section takes up the problems concerning boundaries and dual relationships. A dual relationship is when you have more than one relation to the same client or student. These kinds of situations create many ethical dilemmas, and by reading this section you gain knowledge about how to deal with great complexity in relationships.

I am also impressed with the section discussing multicultural and gender perspectives in music therapy. It contains useful and concrete information for music therapists meeting clients from different countries. When working with clients from all over the world, a music therapist easily might feel the need of specific knowledge of each culture, both musically and in other respects. Dileo however simplifies the situation by describing the importance of an open attitude and awareness of biases from ones own culture to try to avoid ethnocentrism. A model of cultural integration development is presented, and different issues that might create misunderstandings between eastern and western cultures are described. One example of controversial issues here is the differences between individualist and collectivist values.

As a teacher and supervisor in music therapy education I found many useful reflections how to safeguard the interests of students as self-experiential subjects and during supervision. Dileo suggests to work out a contract with every group of students, she points out the importance of using informed consent, and she clarifies different options how students might participate in self-experiential work.

One chapter deals with ethical standards in research and publication, another with financial and advertising issues and responsibilities, still another with responsibilities to colleagues, employees, employers and the professional organisation.

The final chapter sums up all the issues that have been discussed throughout the book under the headline of “Promoting ethical behavior”. As appendixes, she has included ethical codes of different American and one Canadian professional organisations of music therapy. When I read these I am impressed about the standards and at the same time I become aware of the importance to take a look on the status of code of ethics in the professional organisations of my own country, Norway.

The book cannot be read quickly if one intends to grasp the deeper meaning. To me it was a longer process, at times emotionally hard work, confronting, inspiring and at the same time supportive. One might expect such a book to be full of rules and as such somewhat strict. However, the basic tone of the text is kind, supportive, pointing out the importance of aspiring to higher standards of reflection. Such a reflective process cannot happen unless considering one’s own feelings, values, and personal history, and it cannot be done in a purely theoretical manner. At times, whilst reading the book, I began to blame myself for situations that I had not handled adequately according to the standards presented in the book. In the text I also found emotional support to move on in an inspirational process. Dileo is pointing out the importance of ethical thinking as a very personal process and the important thing is to get started, not to solve all issues at once.

She also points out the importance of teachers of music therapy being good role models, showing a good sense of integrity. An important point, not easy to live up to for those of us who are teaching students of music therapy.

Critical comments:
I would have liked the author to state her own ethical position more clearly and explicit in the first part of the book according to hermeneutic thinking. The front page picture actually suggests a hermeneutic spiral (not too unlike some earlier covers of The Nordic Journal of Music Therapy). Dileo’s theoretical position may however be extracted through careful reading: She does not seems too happy about everlasting universal ethical rules. Her view could also be described as situative, she includes many perspectives; cultural relativism, musical codes, feminist ethical thinking, historical changes etc. I also find her position to be discursive, that ethical thinking best occurs in co-response with others; clients, co-workers, employers, employee, supervisor, the professional organisation or a lawyer. My impression is that her ethical standard is very high without pressing colleagues or blaming them.

I found the ethical dilemmas written after each chapter to be useful. However sometimes they were formulated too shortly to really make the problem clear to the reader. Dielo commented on these dilemmas by pointing out the importance of students formulating their own dilemmas as the best method of teaching.

As far as I know it was not until the beginning of the nineties that this topic came on the agenda on a European music therapy level. As a young profession, we are still in the beginning of ethical thinking in music therapy. This is a good starting point for many of us, I would think. It would have been interesting to see if music therapists representing different theoretical positions of ethics might come to different conclusions how to solve specific ethical problems. But that would be perhaps be an idea for another project. Ethical thinking is changing all the time according to changes in culture, time and history and will need more books written by music therapists in the years to come.

This book fills an important gap in music therapy literature. It will be useful to students of music therapy as well as postgraduate students and experienced professionals. I strongly recommend it.

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