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Interactive Music Therapy in Child and Family Psychiatry – Clinical Practice, Research and Teaching

br2007_081Oldfield, Amelia (2006). Interactive Music Therapy in Child and Family Psychiatry – Clinical Practice, Research and Teaching. London and Philadelphia: Jessica Kingsley Publishers.

Reviewed by Jinah Kim, Acting Coordinator of Music Therapy School of Music, The University of Queensland, Brisbane, Australia

A well-known British music therapist, Amelia Oldfield published two books in 2006. She describes the first (Oldfield, 2006a) as being based on her work at the Child Developmental Centre, while the second (Oldfield, 2006b) centres on the Croft Unit for Child and Family Psychiatry, both institutions located in Cambridge, UK. This review focuses on her second book, in which Oldfield provides a sensible, down-to-earth first person account of her work as a clinician, researcher and educator in music therapy. The volume consists of nine chapters with plenty of clinical vignettes and practical information that would be useful for students and clinicians in music therapy.

In some ways, this book is somewhat autobiographical in terms of how Oldfield addresses, introduces and integrates her ideas and thoughts on both the personal and professional aspects of her life. She describes its contents as “writing down thoughts about my work” and keeps the style of it throughout the book. It will surely be of interest for those curious about how a music therapist works, relates her work with her personal life, and develops her career over the years. However, a sense of a wider contextualization beyond such a personal account of music therapy seems to be lacking.

In the first chapter, Oldfield introduces the new concept of Interactive Music Therapy: an interactive and positive approach, which involves live and mostly improvised music making in child and family psychiatry. Given her work environment at the Croft Unit, Oldfield’s work naturally focuses on helping the children and families she works with. With the evolution of the Croft Unit from a treatment centre to a diagnostic centre, the nature of her approach has had to be flexible enough to adapt to the changes of the clinical setting. Therefore her clinical work has changed from long term to short term music therapy work in order to assist diagnostic procedure for the children referred to the Croft Unit.

After reading Oldfield’s definition and description of Interactive Music Therapy, I was left wondering about the very nature of improvisational music therapy as pioneered by Juliet Alvin, Paul Nordoff and Clive Robbins, and Mary Priestley. All these early pioneers of improvisational music therapy emphasized salient therapeutic aspects of musical interaction between the client and the therapist within live and improvised music traditions. As a clinician who was trained at the same institution as the author (The Guildhall School of Music and Drama, London), and one working with similar populations and clinical settings for the past decade, I cannot help wondering whether the approach outlined by Oldfield is anything beyond “ordinary” improvisational music therapy. From the theoretical point of view, Oldfield briefly mentions Carr, Winnicott and Stern; however, she does not attempt to incorporate any particular existing theoretical framework into her suggested approach, nor does she try to provide a theoretical grounding for this new approach in this book. Similarly, there is no acknowledgement to similar approaches in related fields such as Interactive Play Therapy. On the whole, the lack of theoretical foundation and that of distinction between her “new concept” and existing music therapy approaches make her approach less convincing to my mind than some other approaches.

At this point, I should emphasize that I am not disparaging her attempt to establish her approach as distinct from those used elsewhere in improvisational music therapy. Given the fact that music therapy is a relatively small, still evolving profession, I welcome her attempt, but it is one that comes rather short of providing sufficient rationale for establishing a new concept and a fresh approach. Having said that, I must admit my own possible personal bias and limitations at embracing new claims and attempts such as this. Whether her approach deserves distinctive recognition from the music therapy profession or not, has to stand the test of the time, and until then it may remain controversial and a topic for further discussion.

What is truly distinctive about this book is that Oldfield introduces her doctoral research, in which she created the Music Therapy Diagnostic Assessment (MTDA) in comparison to one of the most internationally recognized standardized diagnostic tool – Autism Diagnostic Observation Schedule (ADOS). The growing number of children diagnosed with Autism Spectrum Disorder (ASD) worldwide suggests the need for more reliable and valid diagnostic tools that can identify children with ASD with varying degrees of abilities and disabilities. Autism and developmental disorders in early childhood have long been the core clinical area in improvisational music therapy since its inception as a profession. While some earlier music therapy experts have either created, or used both assessment and evaluative tools within music therapy procedure, they rarely attempted to create a diagnostic tool for ASD, with the exception of Tony Wigram. In recent years, Wigram (1995, 1999, 2000, 2002) has introduced music therapy diagnostic assessment for children with ASD, using an approach quite similar to the MTDA focusing mainly on improvisational method. While Wigram demonstrated the possibility of using individual music therapy sessions for assisting diagnostic procedure for children with ASD, Oldfield created an original music therapy diagnostic tool that could be compared to the existing standardized diagnostic tools for ASD. Therefore the MTDA could be regarded as the product of an on-going successful research trajectory in that direction.

In Chapters 2, 3 and 7, Oldfield provides detailed accounts of the MTDA in practice. At close quarters, it can be seen that the MTDA is really based on everyday clinical practice, which was clearly derived from the author’s extensive clinical experience with this population. The MTDA employs a mixture of therapist-directed and child-led activities. Through these sets of activities, the tester can observe the child’s response and identify their strengths and weaknesses in non-verbal interactions. On the flipside, the MTDA gives more information on each individual child’s characteristics and uniqueness, rather than providing a clear indication for the reliable diagnosis of ASD. It must be noted that the MTDA is still in a rudimentary form, and as such needs to be developed further in order to be recognized as valid – being a somewhat differential and distinctive diagnostic tool. We should also recognize and celebrate that Oldfield has been successful in creating a clinically relevant and easily applicable diagnostic tool for children with ASD.

In the remainder of the book’s chapters (4, 5, 6, 8, 9), Oldfield describes various clinical work at Croft, and then moves on to explain her previous research projects and her experience as a researcher, supervisor, supervisee, and subsequently an educator in music therapy. Throughout these chapters, she provides plenty of practical information such as lists of activities together with detailed descriptions of each activity, as well as the purpose and rationale for employing such activities. Oldfield admits that some of these were based on her earlier publication – Pied Piper (Bean and Oldfield, 2001), or developed from it. While some of this information is useful, certain aspects of the practical information extend too far, for example she even provides the timetables of certain programme and the colour of the paper she was using at Croft. After reading all this intensely factual information, I was left wondering about the necessity of its inclusion in our present age of information overload. Throughout the book Oldfield genuinely advocates innovative and creative ways of thinking for both clinicians and researchers in music therapy. However, certain parts of the book inevitably become rather repetitive and clichéd at times, giving the impression that the book would be a much better read without certain chapters repeating similar information.

On the whole, this book is very much about Amelia Oldfield – the music therapist I have known for quite a while. Oldfield was the on site clinical supervisor for my very first clinical placement at Child Development Centre, Addenbrookes Hospital, Cambridge in early 1990s, and I visited the Croft Unit with her on a number of occasions. Having been trained by her for one term during my Guildhall days, I recognise many familiar music therapy activities described in this book, bringing up vivid memories of all the children we worked with together. In my mind, she was quite the classic English woman, and a clinician with pragmatic approaches to clinical matters with a tremendously positive enthusiasm for music therapy. She has had decades of clinical experience, teaching and supervising students and music therapists in her specialized field. All of these characteristics and her wealth of experience permeate throughout the book. I believe that the book will be useful for music therapy students, and novice music therapists working in child and family psychiatry and related fields. More importantly, Chapters 2 and 7 contain much of interest for experienced clinicians in the field of autism and autism research.


Bean, J. & A. Oldfield (2001). Pied Piper: Musical Activities to develop Basic Skills. London: Jessica Kingsley Publishers.

Oldfield, A. (2006a). Interactive music therapy: A positive approach: Music therapy at a child development centre. London: Jessica Kingsley Publishers.

Oldfield, A. (2006b). Interactive music therapy in child and family psychiatry: Clinical practice, research and teaching. London: Jessica Kingsley Publishers.

Wigram, T. (1995). A model assessment and differential diagnosis of handicap in children through the medium of music therapy. In Wigram, T., Saperston, B., & R. West (Eds.), The art & science of music therapy: A handbook. (pp.181-193). Harwood Academic Publishers.

Wigram, T. (1999). Contact in music: Analysis of musical behaviours in children with communication disorders and pervasive developmental disorders for differential diagonoses. In T. Wigram & J. de Backer (Eds.), Clinical Applications of Music Therapy in Developmental Disability, Paediatrics and Neurology (pp. 69-93). London: Jessica Kingsley Publishers.

Wigram, T. (2000). A Model of diagnostic assessment and analysis of musical data in music therapy. In T. Wigram (Ed.) Assessment and evaluation in the arts therapies (pp. 77-92). St Albans: Haper House Publications.

Wigram, T. (2002). Indications in music therapy: evidence from assessment that can identify the expectations of music therapy as a treatment for autistic spectrum disorder (ASD); meeting the challenge of evidence based practice. British Journal of Music Therapy, 16(1), 11-28.

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