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Music as Therapy: A Dialogical Perspective

br2006_074Garred, Rudy (2006). Music as Therapy: A Dialogical Perspective. Gilsum, NH: Barcelona Publishers. 344 pages. ISBN 1-891278-40-1. $44.00.

Reviewed by Laurel Young, MMT; MTA Temple University

Rudy Garred has written a book about a topic that often inspires passionate and heated discussion among music therapy professionals. Music as Therapy: A Dialogical Perspective is concerned with how to develop a general theory for approaches to clinical practice that use music as therapy. Garred uses the term “music as therapy” in a way that is synonymous with Kenneth Bruscia’s (1998) definition of “transformative music therapy” where it is “the music experience itself that leads to change” (p. 3).

While the book is concerned primarily with music as therapy, it is important to mention that Garred does not discount music in therapy approaches where music plays a “subordinate” role to other modalities; however, there are many variants of music in therapy, all of which have well-established psychological theories within which to frame practice and “…the question still remains as to what theory an experiential, transformative, music as therapy approach is to be based on” (p. 34).

Garred received his PhD from Aalborg University in Denmark and is influenced largely by a Nordoff-Robbins (music centered) approach. He is also a practitioner of the Bonny Method of Guided Imagery and Music – a method of music psychotherapy where music can be used in or as therapy. The diversity of Garred’s training and experiences as a practitioner may give him a unique vantage point as compared to other authors on music centered or music as therapy subject matter.

The book consists of twelve chapters, each one divided into subtitled sections. Topics emerge in a linear fashion as Garred meticulously builds his case. He achieves this through extensive references to literature, carefully constructed definitions of terms and the use of case examples. The Table of Contents lists every concept; this is very helpful if the reader wants to go back and review a particular idea. I often found this to be necessary given the complexity and magnitude of the material.

In order to contextualize the subject matter, Garred reviews not only the writings on music centered thinking to date (Paul Nordoff, Clive Robbins, Kenneth Aigen, Gary Ansdell and Mercedes Pavlicevic) but also the published debates that have occurred between psychoanalytic and music centered approaches (Elaine Streeter, Colin Lee, Gary Ansdell, Sandra Brown, Kenneth Aigen and Helen Odell-Miller). Musicological (Gary Ansdell and Colin Lee) and Community Music Therapy (Brynjulf Stige and Gary Ansdell) perspectives are also presented. This opening chapter in particular makes for very interesting reading and is a good overview for those who may not be familiar with how the controversy about music as versus music in therapy has unfolded in the literature. The differences are re-visited in Chapter 6 where the two most common “music as” and “music in” therapy models are compared: Creative Music Therapy developed by Paul Nordoff & Clive Robbins and Analytical Music Therapy developed by Mary Priestley. Readers need to keep in mind that because Garred is trying to build a theory for the “side” of music as therapy, he does not make a fair comparison between approaches. He acknowledges this up front but I believe that it bears repeating here. For practitioners who have established belief systems about preferred modes of practice, it is easy to get caught up in wanting to side with or against Garred’s arguments. This is the opposite of what he is ultimately trying achieve, which is to encourage inclusive rather than exclusive thinking about music therapy.

Upon outlining differences between underlying assumptions of the “opposing stances” Garred reaches a conclusion that challenges recent ideas on music centered thinking put forth by Kenneth Aigen (2005). I believe Garred’s conclusion articulates at least in part, why some music therapists feel uncomfortable with what I would refer to as purist music as therapy approaches. He believes it is insufficient to state that change through music is purely a musical matter AND that musical change in and of itself cannot be defined as therapeutic change. He feels that the relationships within the music as therapy dynamic need to be more closely accounted for and this leads to the proposed dialogical perspective.

The dialogical perspective is theoretically framed utilizing philosopher Martin Buber’s book I and Thou (1958) as the main point of reference. Although I would not claim to have anything more than a passing familiarity with Buber’s ideas, this did not interfere with my level of interest in the material or my ability to understand the proposed theory. References to developmental psychology based on infant-parent interaction research (i.e. Daniel Stern) are also used to support Garred’s ideas on relational knowing. A dialogical principle based on Buberian philosophy is a metaphor for humans’ relations with each other as well with anything they encounter in the world. It is not geared exclusively toward one-to-one relationships but can include groups, whole collectives and even clients’ encounters with music in music therapy. These encounters may include situations where an individual opens him/herself up to experiencing music. The music unfolds in new and unforeseen ways each time it is experienced—even with familiar pre-composed music because the context (i.e. time, place and specific circumstances) within which the musical encounters occur are never exactly the same. We cannot predict how the music will affect us. This open encounter with music where we relate to it and it relates to us gives it a quality of interactive address or dialogue. This suggests that music could be identified as a Thou (a Buberian term referring to a reciprocal and mutual process) rather than an It (a means to an end). Moments of meeting with or in the music are believed to facilitate interpersonal processes between therapist and client. Musical and interpersonal moments of meeting contain potential for personal transformation, increased capacity for relation, regeneration of stunted personal character, and building of morale or spirit. Garred utilizes a simple Music Therapy Triangle with two way arrows drawn between the three sides to visually represent moments of interrelation between therapist, client and music (on top peak). This is by no means a complete explanation of Garred’s theory but represents the overarching rationale.

In many ways, the proposed dialogical theory is quite straightforward but does not compromise the interpersonal OR the creative, musical and aesthetic aspects of music therapy—all of which I believe are essential, regardless of whether they are central or adjunctive parts of the process. Allow me to qualify this by saying that Garred makes a clear distinction between music as therapy and music as art, stating that the ultimate purpose in each scenario is different. I wholeheartedly agree with him on this point. I also appreciate that this is a general theory of music therapy not connected to any one model of practice. Garred states that a practitioner in any model could be utilizing a music in or music as therapy approach, or alternating between them. He emphasizes, however, that although one therapist may shift between approaches, they may not be combined because the roles of the music in each approach are not simultaneously compatible. Techniques may be interchangeable to a certain extent but the therapist needs to be consistent in terms of the philosophical assumptions underlying the process. In this way, the roles of therapist and client are clearly defined and the approach based on what is needed for each particular situation.

I had a few minor challenges with this book. The material is quite dense and cannot be read quickly. Although the author consistently states that he is not arguing against music in therapy approaches, there are times when the arguments utilized to build a case for music as therapy could be perceived as a bit one sided. While I appreciated that a chapter each was devoted to dialogical perspectives in community oriented and receptive music therapy practices, they were not explored as extensively as I might have liked. Perhaps these chapters could be utilized as springboards for future publications.

Garred is not attempting to create something new but rather clarify a view that is found implicitly in much music therapy practice. He states in the Preface that this is not an introductory text but wants it to be readable to anyone interested in the theme of music as therapy. Music therapy practitioners from all walks of life should read this book and especially music therapy educators. We can have preferred models of practice based on personal beliefs that we hold about music and/or therapy. But unless we completely reject the notion of music as therapy—we need to have a clearly outlined theoretical framework to support and define the practice. This could provide clarification to health care administrators who may question the efficacy of a music as therapy approach. It will also help music therapists who struggle to articulate why they do what they do and most importantly, will benefit clients who may specifically require music as therapy intervention. I believe this book makes a highly valuable contribution to the field of music therapy and I strongly recommend it.


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

Bruscia, K.E. (1998). An introduction to music psychotherapy. In K. Bruscia (Ed.). The dynamics of music psychotherapy. Gilsum, NH: Barcelona Publishers.

Buber, M. (1958). I and Thou (R. G. Smith, Trans., 2nd ed.). New York: Scribner.

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