If the NHS is training musicians from scratch, the problem is with us.

Another week, another collective sigh of outrage running through the music therapy community.

If you haven’t seen it yet, an NHS job advert has been doing the rounds offering a freelance rate of £300 a day to hire musicians for clinical environments. On top of that lucrative day rate, the trust is funding an outside organisation to teach these musicians basic clinical ethics, psychological boundaries, and reflective practice from scratch.

Predictably, the knee-jerk reaction from our profession has been pure indignation. We look at it and say, "How dare they? Why are we fighting for secure, underpaid posts while public money is spent training non-clinicians from the ground up to do what takes us years of intense study and supervision to master?"

But once the initial heat settles, I am left with a much more uncomfortable, deeply frustrating realisation. This isn’t just a failure of NHS spending oversight; it is an absolute indictment of how we communicate.

I’m going to be blunt, at the risk of rubbing some of my peers up the wrong way: we have a massive problem with entitlement in this field. We seem to think we are automatically owed respect, demand, and secure funding just because we hold a professional registration. We stand on the sidelines, looking around at other allied health professions or well-funded community arts projects, folding our arms and muttering, "But what about us?"

We cannot keep being outraged that we aren’t in demand when we refuse to learn the lessons of why we’re being bypassed. If an NHS trust would sooner invest in building an adjacent workforce from scratch rather than hiring us, the problem isn’t just the trust. The problem is music therapy.

The Traps We Built for Ourselves

We have spent decades trapping ourselves in an insular, defensive posture, and it boils down to two major structural flaws in how we talk about our work.

1. The Vocabulary Trap

For a long time, our professional narrative has leaned heavily into abstract, humanistic language. We talk about ‘holding space’, ‘facilitating expression’, or ‘improving wellbeing’.

While those terms might carry meaning when we’re talking shop with each other, they are completely useless to an NHS commissioner or a service manager reading a business case. To them, ‘facilitating expression’ sounds exactly like what a skilled, empathetic community musician does. If we describe our clinical outcomes in the exact same vague terms as a participatory arts project, we have no right to be surprised when managers treat us as interchangeable.

Respect where it’s due: this is one area that Neurologic Music Therapists (NMT) have absolutely nailed. They brought rigour to their communication. But why on earth should that level of standard and clarity be reserved only for neurology?

2. The Myth of the ‘Black Box’ and the Erasure of Risk

We have treated the therapeutic musical interaction as a mystical ‘black box’, something highly intuitive that cannot possibly be broken down or manualised. By doing that, we’ve completely failed to communicate the actual clinical risk involved in what we do.

Performing music with people in a medical environment is highly unpredictable. It can trigger sudden, intense, and deeply volatile emotional or psychological responses in an instant. Music therapists spend years across multiple clinical placements learning how to read those subtle shifts and manage that real-time risk quickly and safely.

Empathy is a baseline human trait; it is not a clinical qualification. An untrained musician, no matter how talented or well-meaning, is not equipped to handle a patient experiencing acute psychological decompensation on a ward. But because we haven't made that clinical boundary clear, trusts assume a quick top-up course on boundaries is enough to bridge the gap.

Planting the Flag: A Functional Definition

If we want trusts to choose qualified clinicians, we have to stop treating our work as an opaque mystery. We need to stop waiting to be invited to the table and start explicitly defining what we do in ways that make our value undeniable.

So, let's plant the flag. What actually is music therapy when you strip away the fluff?

Music therapy is the strategic use of musical interaction to target core psychological and social processes. By bypassing rigid linguistic rules, and the behaviours that respond to those rules, it leverages the highly motivating context of active music-making to build and generalise entirely new responses to stimuli.

This definition doesn't sit on the fence, and it doesn't pander. It targets the function of the music, not just the aesthetic form.

Traditional talking therapies are forced to work inside the client's existing linguistic architecture. They have to use language to fix language, which means they constantly run into the brick wall of rigid, rule-governed behaviour like rumination, compliance, or experiential avoidance.

Music therapy provides a psychological shortcut. It alters the context without triggering the client's linguistic defence mechanisms.

Whether you practice from a deeply psychoanalytic perspective (tracking internal relational networks and transference) or a community music therapy perspective (breaking down rigid social scripts to build collective empowerment), this functional framework holds up. We aren't just playing songs and hoping for good vibes. We are using a novel, symbolic context to strategically disrupt rigid, unhelpful behavioural patterns and build psychological flexibility.

Moving Past the Moaning

It is time to stop the defensive, passive-aggressive hand-wringing every time an arts-in-health project gets a headline or a high-paying contract.

If we want the healthcare sector to respect us as an essential, process-driven clinical intervention, we have to talk like it. We have to back ourselves, demystify our practice, and clearly articulate the specific mechanisms that keep patients safe and get them moving forward.

Let's stop being outraged that the system doesn't understand us, and start making ourselves impossible to ignore.