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Culture-Centered Music Therapy

Stige, Brynjulf (2002).
Culture-Centered Music Therapy. Gilsum, NH: Barcelona Publications, 361pp.
ISBN 1-891278-14-2.

Reviewed by Leslie Bunt

br2003_030Every emerging discipline and profession benefits from scholars who are able to present a meta-perspective and critique from both theoretical and practical points of view. One of the most insightful thinkers working within the profession of music therapy today is Brynjulf Stige. Members of the profession have already benefited from his punctilious editorship of the Nordic Journal and Music Therapy and his pioneering work as a founder editor of the electronic journal Voices.  In this new book we now have the opportunity to follow the gestation of key areas of his thinking over of many years of clinical practice, teaching, supervision and research. I personally always find it very satisfying to read a text when it is possible to hear and accompany a single voice working through carefully-crafted ideas and arguments. Colleagues who have read the previously published work of Stige or have heard him speaking at conferences will hopefully share my enthusiasm for the emergence of this text. Here we find him balancing a variety of culturally inclusive perspectives, acknowledging differences and building theory from within a frame of his preferred metaphors
of dialogue and polyphony. 

Members of the profession have for a long time looked to the work of the Scandinavian music therapists for consideration of the links between music therapy and broader cultural, health and political issues that influence
both theory and practice. In this way we can place this new text Culture-Centered Music Therapy within a tradition epitomised by scholars such as Even Ruud, for example Ruud’s Music Therapy: Improvisation, Communication and Culture, also published by Barcelona. In his Preface to his new book Stige also attributes much influence from another mentor, Kenneth Bruscia and it is Bruscia who has written the Foreword to this book. 

The format of the book is very clear. After the opening Preface (in which there is further gracious acknowledgement of other significant influences), Bruscia’s Foreword and Stige’s overall Introduction
the text is divided into four main parts. The first part focuses on Premises that underlie the main themes of the book; the second introduces examples from clinical Practice; the third focuses on Implications
for the profession and discipline and the fourth is a series of research Investigations. There is a concluding Epilogue and a very useful Glossary which as Stige states is more a ‘statement of perspective’ than a ‘collection of definitions’ (p.325). A colleague seeing the text on my desk recently went straight to the reference section noting that this in itself read as a comprehensive and useful survey of highly relevant material for therapists exploring the relationship of their practice to broader cultural perspectives. 

Colleagues who attended the recent world congress in Oxford will recall Brynyulf Stige’s response to the opening keynote address delivered by Professor Nigel  Osborne within the area of Music, Culture, Social Action. During Stige’s response we heard of a music therapy project with a group of adults with Down’s syndrome based at a local Community Music School. Seeing photographs of the local brass band on the walls provoked a question from a member of this group: ‘May we too play in the brass band?’  The many layers of implications arising from Knut’s question influenced Stige’s thinking as a music therapist, the writing of this book and, for those of us at Oxford, much material for dialogue and debate throughout the week. It is the careful consideration and honest response to this kind of searching and challenging question that permeates this latest text. The writing arises from a profound respect and concern for the voices of the people with whom we work to be granted a central focus. From such a position all theoretical, practical and professional debate and issues seem to evolve. Culture is defined in the broadest and most flexible way taking account of biological, psychological, and social processes and from within both individual and collective perspectives. 

Flexibility and tolerance are key themes of the Introduction in which the evolution of a culture-centred music therapy is related to both Stige’s personal experiences as a practising clinician and in the
way local experiences interact with wider community and global cultural perspectives. A response to Knut’s question for all music therapists is to consider very carefully the links between the private music therapy session and the wider contexts to which it is connected. Such consideration goes beyond any one music therapy perspective, for example ecological music therapy, furthering understanding of both well-established and developing forms of practice. Reference to a story from Norse mythology is very refreshing, as is the image of the discipline of music therapy being more of a fjord than a lake, connected to other fjords/disciplines with groups of scholars exploring different fjords and eventually connecting to the larger ocean of shared concerns. 

The three chapters that comprise Part I focus on key Premises that inform the entire text. The first chapter explores an integration of themes from biology, history and culture. It opens with a concise and scholarly history of the concept of culture, discussing etymological roots and noting different uses and misuses throughout history. Reference is made to the disciplines of anthropology and ethnography, the latter playing a significant part throughout the text. The philosopher Wittgenstein is soon introduced, in particular his work on language games. Stige believes that we cannot discuss any definition of culture without recourse to understanding what it is to be human. He cites scholars integrating biological and psychological processes. The work of Stern and Trevarthen is well known to many as bio-psychological underpinnings to music therapy practice. I was interested to learn more of further links between music therapy and the work of Bruner and Vygotsky, in particular Vygotsky’s notion of Zone of Proximal Development.  In summarising some of this cultural background Stige outlines two central themes of his overall thesis: our inborn need to experience a sense of community and the process of reflexivity, ‘the ability to think of oneself in relation to others’ (p.33). He differentiates culture defined for music therapy with the various customs and technologies that regulate our existence from culture-centred music therapy (our awareness of music therapy as culture – page 42). Culture-specific music therapy is also defined as where the cultural identities of both client and therapist meet. 

The themes of the second chapter were more familiar to me, being an integration and development of published papers in 1998: ‘Perspectives on Meaning in Music Therapy’ (British Journal of Music Therapy, 12 (1)) and ‘Aesthetic Practices in Music Therapy’ (Nordic Journal of Music Therapy, 7(2)). Even if certain models of therapy purport not to place meaning and interpretation centrally Stige proposes that the constitution of various kinds of meaning is a theme that permeates all forms of music therapy. Once again such meanings are always related to their cultural contexts, shifting between personal, local and universal perspectives. There is a stimulating section on the evolution of a narrative perspective to music therapy with the concept co-authoring as an underpinning to the social nature of a music therapy process providing a rich area for further exploration. In concluding the discussion on aesthetics we are introduced to another key theme of the text, namely the notion of the situated
character
of any discourse. We are invited ‘to acknowledge a diversity of situated aesthetics and to examine music therapy as a set of aesthetic practices in relation to other aesthetic practices in society’ (p.71). For me this is a very healthy invitation.

The next chapter summarises some of the recent work of the so-called new musicologists and those psychologists focusing on the early musical patterning between child and carer that not only can be described as proto-conversation but here also as proto-musicality. The study of music both  ‘in and as culture’ (p.83) prepares the way for further dialogue between current thinking in musicology, ethnomusicology, anthropology and early developmental psychology. The chapter explores the relationships between the concepts of proto-musicality, different musics and Small’s now well-established concept of musicking.

The clinical section (Practices) is a development of papers from music therapy world congresses in Spain, 1993; Hamburg, 1996 and Washington, 1999. Here there are three contrasting examples of culture-centred music therapy in practice. Each story is also framed within an emerging theoretical perspective. Chapter 4 tells the story of the work with Knut and his group. It is a moving account of how the local community became ‘a context to be worked with’ (p.113). In order to respond to Knut’s question about the brass band Stige and his colleague needed to move outside the traditional boundaries and setting of the music therapy room to engage with music teachers in the local community, local musicians and eventually members of the brass band. There were public and political aspects to the work including musical performances. The postscript to this story links some of the themes of the practice to the ecological perspectives of an important text by Bronfenbrenner – The Ecology of Human Development (1979). The inter-connections between the various levels from micro- to macro-system form a highly relevant
backdrop to the various stages within the work with this group of adults.

Bronfenbrenner’s model is prevalent in the next study where a transactional and ecological perspective forms the frame to a study of the work with a child with Asperger’s syndrome. Paul’s story unfolds through a series of inter-linked transactions both inside and outside of the traditional setting of the music therapy room. Brynjulf Stige was to learn as much about Paul’s relationship to music from observing him in the playroom with other children and from Paul skiing in the woods by himself. Here there is a beautiful moment of Paul singing fragments of traditional songs to himself (something he would never do in the therapy room). Distance precluded visiting Paul on a regular basis so the main intervention was through a process of consultation. The music therapist supported the music-based small-group work carried out by the teacher. Evaluation of the consultation process was aided by the use of video during which time Paul’s mother also became involved. Through these series of interlocking transactions Paul’s
parents became more positive about the work at the kindergarten. Paul’s relationship to music and to the other children and adults developed. Additionally the teacher felt more comfortable using different kinds of musical interactions. All parties eventually discovered new perspectives.

The final study in this section is of a more traditional kind, focusing on one year of individual music therapy sessions for a woman attending a psychiatric clinic. What I find novel and exciting about this chapter
is the way in which the work is framed. Stige explores the relationships between text and storytelling (as increasingly discussed in psychotherapy) and music therapy. He not only explores how people construe meaning through narrative and text (including discussion of Ricouer’s notion of the interpretation of meaningful actions as texts) but also focuses on hypertextuality as a metaphor for much that takes place within the culture-centred nature of an individual music therapy process.  Music may have more in common with less linear forms such as poetry, movement and hypertexts (a term growing in familiarity through the constant developments in information technology). Working with hypertexts allows us to move in all directions, manipulating chunks of material and reading in more than two dimensions. Texts can nowadays also include sound, animation and graphics. In this
case study Stige is also able to make use of statements made by his client in two open-ended research interviews. The chapter includes excerpts from this rich material that are sometimes grouped in relation to various metaphors
that permeated the work. In the work Ramona would often move between songs as external links to the outside world and those that made more internal links to her own life narrative. Stige suggests very creatively that the therapy process is akin to tracking various nodes and links that open up a very ‘differentiated use of the text analogy in music therapy. .. Sometimes we can learn more from trying to understand how the music
links different experiences than from asking what the music means in itself’ (p.171).  This is a very open-ended perspective with the self situated in more than one context at once. It can be very messy with players construing new realities, new versions of self and, in the context of therapy, with further navigation through a web of interactions with the therapist.

The Implications of culture-centred perspective on the way music therapy is practised as a profession, defined and discussed as a discipline form the focus for the next three chapters. Central to all these chapters is the continued call for reflexivity and for awareness of relations between the local and the more general. The practical experiences described in the previous section necessitate a broad concept of any definition of music therapy (Chapter 7). In exploring a re-definition of music therapy Stige concentrates more on the relationship between music and health and the continuing dialogue between the diversity of music therapy approaches and contexts. In some contexts, such as palliative care, is the word therapy actually appropriate? Here and in other contexts do ‘music therapists work to promote musicking?’ (p.191). In most cultures music has had links with health since time immemorial and in this chapter different domains are identified: folk music therapy; music therapy as discipline; music therapy as profession and music therapy as professional practice. As folk music therapy Stige focuses on historical practices and discourses of music and health, revealing ‘people’s dreams about what music and life could be.’ (p.196). Music therapy as a discipline is defined as ‘the study and learning of the relationship between music and health.’ (p.198). As professional practice it is ‘situated health musicking in a planned process of collaboration
between client and therapist.’ (p.200).

The notion of music therapy as situated practice (‘health-related rituals embedded in culture and enclosed in social contexts’ – p.208) is central to the proposed model described in Chapter 8.  The model builds from
the earlier theoretical explorations and descriptions of practice. The collaboration between client and therapist is embodied within a variety of relationships, roles, rituals and rationales. Furthermore these are connected to multiple contexts: community, aesthetic, institutional and political. Some novel proposals are made, for example the role of project co-ordinator, the notions of “barefoot” supervision (p.217) and that a researcher or trainer can still be felt to involved as a music therapist even if not in direct contact with clients. In this key chapter Stige also brings together, in an inspired manner, the notions of communitas in context (after Turner, Ruud etc.) and reflexivity in action (after Habermas, for example). I would recommend purchase of this book just for this chapter alone and it will doubtless be a focus of much discussion and debate within the profession. Stige adds further dimensions to the earlier models of processes in music therapy proposed by Sears in 1968 and Bruscia in 1987.

Given the broad scope of the text up to this point it is logical that the next chapter challenges some time-honoured music therapy customs, exploring how various areas of practice relate to local links, target and time of
interventions. Different client populations, different cultural contexts, different local and general considerations will all impact of the manner in which music therapy is practised. There are new ethical considerations when a client’s relationship to local cultural values are explored and Stige develops what he calls the ‘ethics of culturally informed empathy’ (p.247).

The final part of the book includes some suggestions for music therapy research that  fall appropriately within frames of  ethical and theoretical considerations for a culture-centred music therapy. Stige has
for many years been a strong advocate of ethnographically informed inquiry, the focus of Chapter 10. As a tradition of social research, ethnography aims to learn about the culture of a person or group of people. Research
is carried out in natural settings. Stige discusses the research techniques of participant observation, interviews and interpretation of artifacts (which in the case of music therapy could include the
analysis of music or other artistic materials such as poems or drawings). There is a discussion of the role of the researcher in the field. The intertwining of what is referred to as thick description and interpretation is
a major issue within this approach as is the management of the huge amount of data that is often created (the collection of data being in itself a kind of interpretation).

Facing vast amounts of data is also a methodological challenge for researchers engaged in participatory action research, the subject of Chapter 11. Stige is skilled at presenting the historical and theoretical roots to a practical
approach and here we have concise descriptions of the work of two pioneers of action research: Kurt Lewin and Jacob Moreno. There is an exposition of the legacy of Critical Theory, returning again to the work, among others,
of Habermas. Stige proposes that action research is a third response (after quantitative and qualitative approaches) to the challenge presented by the demands of evidence-based practice. He provides a highly workable framework for doing participatory action research moving through a series of cycles that include reflection, diagnosis, plan, action and evaluation. Such a blueprint will be a valuable asset for both the beginning and more seasoned researcher.

I was keenly anticipating the next chapter where Stige explores where to position music therapy research in relation to the demands from the two cultures of art and science. He hinted at some of his views on these
issues in his paper to the European Congress in Naples (2001). Drawing on C.P. Snow’s famous exposition of ‘The Two Cultures’ he challenges the need to describe music therapy research as either quantitative or qualitative.
Further theoretical exposition (Comte’s positivism, logical positivism, Popper’s hypothetico-deductive approach, Kuhn’s notion of research paradigms, the challenge form hermeneutics etc.) leads Stige to explore a more peaceful
co-existence between approaches that avoids polarisation. He advocates ‘an inclusive and eclectic concept of truth, acknowledging the relevance of at least three perspectives: the empiricist perspective (correspondence),
the hermeneutic perspective (coherence/meaning), and the pragmatic perspective (application/effect).’ (p.307). Such a mixed approach evolves into a plea for a third culture, for a bridging of any gaps, more learning from each
other and with reflexivity in the research process as a central tenet. Participatory action research places the users of the music therapy service at the centre of any research process and helps to focus the researcher
on ethical and cultural obligations.

In the closing Epilogue we are reminded of the need for cultural sensitivity, for an awareness of how various disorders and diagnostic labels are also relative to the local community and culture of the person. The
personal and cultural levels of experience can be heard, ‘given voice’ in a reflexive approach to music therapy.

I am full of admiration for this very honest text. Even more so since Brynjulf Stige is writing in his second language. We can excuse the odd grammatical slip and idiosyncratic turn of phrase. Sometimes the text is
a little dense with a need to unpack further some of the complexities. This may however be linked with my unfamiliarity with some of the material. For the next printing would it be possible for full references to be given
for all of the very apt epigraphs that open each chapter?

In his Foreword Kenneth Bruscia heralds this book as ‘the coming of the fifth force in music therapy – culture centeredness’ (p.xv). This may be so and we have been waiting for some time for such a scholarly
and sensitive exposition of this theme. But what the book also reminds us is that whatever our clinical orientation
or practical approach to the work the areas discussed in this text concern us all. Our practice, clinical reflections and research need to be connected to both the local and general contextual and cultural situations in which all our work is situated.

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