Twyford, K., & Watson, T. (Eds.). (2008). Integrated team working: Music therapy as part of transdisciplinary and collaborative approaches. London: Jessica Kingsley.
Reviewed by Alison Ledger, Leeds Institute of Medical Education, University of Leeds, United Kingdom (A.Ledger@leeds.ac.uk)
The publication of Integrated team working in 2008 marked a significant step in the development of music therapy as an allied health profession. In preparing this text, Twyford and Watson gave due consideration to an important yet frequently overlooked aspect of music therapy practice – working with others. Twenty-four contributors discussed the benefits and challenges of collaborative work in music therapy and reflected on the role of the music therapist in interprofessional teams. This writing exposed teamwork as an essential part of music therapy practice that is not necessarily easily and comfortably achieved. Effective teamwork was presented as an accomplishment that requires considerable time, commitment, flexibility, reflection, and skill. This was significant, as it promoted open discussion of an aspect of practice that many of us have experienced as stressful. Additionally, it allowed exploration of ways in which services for clients could be improved.
Following a helpful introduction to collaborative working by the editors, the book is neatly structured into chapters by client group (children, adults with learning disability, adults with mental health issues, adults with acquired neurological conditions, and the elderly). Short case studies are presented throughout and provide practical examples of music therapists’ collaborations with a diverse range of professionals. Alison Barrington then places collaborative working in a wider historical and political context, before the editors summarise the key themes arising from the book. The writing is scholarly throughout and the contributors demonstrate ways in which aspects of music therapy work can be clearly articulated to others. This is a major contribution of the book, as effective communication has been identified as a core competency of interprofessional working (Suter et al., 2009).
A particular strength is the way in which the contributors locate teamwork in particular contexts. Each chapter or case study begins with a description of the location, the history of the organisation, the needs of the particular client group and/or the theoretical assumptions underpinning the collaborative work. Although most of the work was undertaken in the United Kingdom, by music therapists who trained at Roehampton or the Guildhall, sufficient detail is provided for readers to understand why a particular approach was taken. Readers are then able to determine whether an author’s experiences are relevant to their own particular work contexts. This is critical, because no two care teams are the same and the work of teams is likely to be influenced by a range of complex historical, organisational, and interpersonal factors (Atwal, 2002; Kvarnström, 2008; Suter et al., 2009).
The back cover states that the book is intended for music therapy students and practitioners, as well as professionals who work alongside music therapists. I believe that it is music therapy students and other health care professionals who will benefit most from this publication. Students are provided with a solid introduction to a number of client groups, a range of organisational contexts, and the various ways in which music therapists have worked with other professionals and family members. For health care professionals, the book offers ideas for collaborative work with music therapists and motivates and inspires further collaboration. The clever use of headings and introductions at the start of each section also means that it is not essential to read the book in its entirety. Readers with limited time can extract a chapter or case study that is most relevant to their own work. I discovered this feature during my doctoral research on music therapy service development, when I considered similarities between the strategies needed for collaborative working and the ways in which music therapy services can become successfully established. It was then helpful for me to limit my attention to the “guidelines for good practice” provided at the end of each chapter. Now that I am working in a medical school, I could imagine showing short sections of the book to colleagues to explain how music therapists fit into interprofessional teams.
As an experienced music therapy practitioner and researcher, the honesty of the case studies was refreshing. I appreciated the contributors’ generosity in sharing how their collaborative work was planned and what their experience of team working was like. Many of the contributors described vulnerabilities and uncertainties in working with other professionals. These descriptions resonated with my own experiences and indicated that music therapists are becoming less guarded in discussing their work. The case studies also give a rare insight into other professionals’ experiences of working with music therapists. I was particularly struck by a clinical psychologist’s account of her feelings of anxiety in working with musical instruments for the first time. This account showed that other professionals may be willing and able to collaborate with music therapists if they receive adequate preparation and support.
If I was to make one suggestion, it would be that the contributors could have gone even further in their descriptions of obstacles to collaborative working. Several of the contributors alluded to tensions, hostilities, and competitiveness in their work with other professionals. Claire Miller’s chapter on collaborative working in mental health was especially revealing in terms of the power struggles and rivalries that music therapists have experienced when working in teams. However, the case studies tend to read only as a collection of interprofessional success stories. For experienced clinicians, it would be helpful to read more detailed descriptions of the problems others have experienced and the ways in which interprofessional tensions have been resolved. For example, the broader health care literature indicates that there may be some negative consequences to interprofessional working when professional boundaries become blurred. “Role blurring” has been identified as a potential source of conflict, confusion, and burnout in healthcare teams (Brown, Crawford, & Darongkamas, 2000; Hall, 2005). I would therefore welcome further consideration of the ways in which boundary blurring may challenge music therapy practitioners’ conceptions of what music therapy is and how a music therapist’s identity may become altered through collaborative working. Additionally, I would suggest greater reflection on whether music therapists have played an equal or an adjunct role in their collaborative work. This type of reflection could be a little overwhelming for student readers, but would be useful for practitioners who are grappling with these issues.
The editors concluded with a hope that they will have an opportunity to provide a second volume, to further explore collaborative and transdisciplinary approaches in music therapy. Based on my reading of this pioneering text, I would strongly encourage the publisher and editors to do so. A second volume could include contributions from a wider range of countries and contexts and provide additional examples of ways in which challenges to collaborative work have been addressed.
References:
Atwal, A. (2002). A world apart: How occupational therapists, nurses and care managers perceive each other in acute health care. British Journal of Occupational Therapy, 65(10), 446-452.
Brown, B., Crawford, P., & Darongkamas, J. (2000). Blurred roles and permeable boundaries: the experience of multidisciplinary working in community mental health. Health and Social Care in the Community, 8(6), 425-435.
Hall, P. (2005). Interprofessional teamwork: Professional cultures as barriers. Journal of Interprofessional Care, 19(Supp 1), 188-196.
Kvarnström, S. (2008). Difficulties in collaboration: A critical incident study of interprofessional healthcare teamwork. Journal of Interprofessional Care, 22(2), 191-203.
Suter, E., Arndt, J., Arthur, N., Parboosingh, J., Taylor, E., & Deutschlander, S. (2009). Role understanding and effective communication as core competencies for collaborative practice. Journal of Interprofessional Care, 23(1), 41-51.