Is music therapy functional all the way down?
Well? Is it?
Recently, on the Music Therapy Conversations podcast (https://jazztoad.libsyn.com/ep-110-ben-richardson) Luke Annesley asked me, after discussing relational frame theory and music therapy, a rather frank question, which I have to admit put me on the spot. He asked me if I was saying that music therapy was functional all the way down. This question shouldn’t really have been a surprise, and I should have prepared for it. However, in the moment, I felt the sudden pressure need to ‘pick a side’ as it were. As a habitual fence-sitter, it didn’t strike me as much good to occupy this particular fence.
I told him yes - I think I have to hold that line and be stubborn about it. But the question is so interesting to me, that I felt I really wanted to explore it more, here.
At its core, it’s a rather simple question, requiring just ‘yes’ or ‘no’. In a field that is dominated by relational practice - here, relational meaning the intersubjectivity and interpersonal dynamics and relationships that take place in music therapy, rather than the relational frame theory intended meaning of relational - I felt that there was a subquestion here of ‘and if it’s functional, does that mean it’s not 'relational’’? It speaks not to anything that was said during the interview, but to an underlying feeling that I have that music therapists are under this pressure from quite early on to pick which ‘type’ of music therapist they will be. For instance, there is clear delineation between the music therapy philosophy of the modern Nordoff-Robbins training programme compared to Guildhall, where I studied. There is a tugging at the back of my mind around psychodynamic theory in music therapy - it’s helpful, but are community music therapists onto something when they say that “the therapy is in the music”? That perhaps, it is right to assert that to borrow from existing theory is to water down our own?
This choice is presented to us as early as initial applications to train in the form of where they choose to go - and it’s a choice that many applicants may not know is in the field at the point of applying. I don’t know how many music therapists would name it as such, but I certainly feel there are strong undercurrents of factionalism in the field within the UK and for a field which is not the first-line of treatment as often as it could be, this factionalism risks getting in all of our ways. It is perhaps curious, then, that in answering the question ‘is music therapy functional all the way down’ with ‘yes’ I am possibly contributing to that division. However, to say that music therapy is functional is not the same as saying that it isn’t relational, or that the therapy isn’t in the music. Rather, I believe that if music therapy is functional then it sheds light on the false dichotomy of the field. That we have been choosing between two different methods of delivering therapy, which ultimately both achieve the same thing. And if that’s true, then why on earth should we be bothered by how one another delivers therapy?
At this point, it is worth defining functional, or rather, how you would define a functional definition of a concept, as it isn’t strictly correct to just define music therapy as functional. A functional definition describes a concept by its purpose, use, or the role it plays within a system. It tells you what something does or how it works in practice. This is where music therapy can be talking at odds with itself to various degrees, as it confuses the definitions of approaches as being functional definitions, but those approaches are often based in feelings, rather than actually describing how it is working and what it is doing for someone.
Put it this way; a brief Google tells me that there are three different, named methods of creating a french omelette. The Jacques Pépin style, the Omelette Mère Poulard, and the Thomas Keller method. Different chefs may pick these methods for a variety of reasons; they might believe one to be superior to the other, or they might have been taught one way rather than the other. Alternatively, they may find that one is just more reliable when they do it, compared to their chef colleagues. The result, though, is a french omelette that satisfies hunger and gives the consumer what they wanted. When they have eaten it and feel satisfied and full - do they really care which method was used to make it? Either way, the omelette functions to satiate hunger. But neither does this mean that I want my chefs to be robots - I like that even producing a simple omelette may be a source of joy for a chef, whether the moment that matters to them is the relationship they have with the food themselves, or with my relationship with the food. Either way, it matters to me that it matters to them.
This not-so-subtle metaphor may be a bit overly simplistic. However, I think that it gets to the heart that of the matter that in all things between two people, it often matters that the ‘thing’ (whether that’s music-making or cooking) matters. Therefore, to focus on the function is not to say that the shared ‘mattering’ no longer… matters. It may be the defining feature that brings you back to the restaurant, time and time again.
We can go further, though, than just having a functional definition. Contextual behavioural sciences, a modern psychological school of thought in America, advocates for functional contextualism. This is the question of what purpose does this concept serve in its specific environment, rather than in general terms?
So, if music therapy is functional all the way down, the therapy is not innately in the music or in the relationship, but rather in what those things function to do for the client. It is in the way the music interacts with history, context, and current psychological processes, which are displayed and evidenced in continuations and/or changes in behavioural responses to the music.
That’s the thesis, and the basis of why I believe that yes, whilst music therapy is functional all the way down, that this doesn’t mean that it no longer matters if the clinician picks up on psychodynamic or sociological phenomena; these are still the weather masts that we use to understand what is going on.
The contextual part
The bit that I think is so fascinating, is the ways in which function depends on context. We see this in so many ways with young people. In a parent training recently, one parent said to me that whilst they find it hard to get their young person to do anything, that their teacher could get them to do whatever and they wouldn’t even need to ask twice. What is it, that’s going on here? Why is a request or a demand in one context not leading to the same result in another? A parent is a natural authority figure whose requests often carry the weight of necessity and immediate wellbeing. A teacher, however, often presents requests within a framework of curiosity and learning. The exact same request - 'please sit down' - has entirely different functions based on who delivers it. If a simple verbal request changes function based on the adult delivering it, imagine how wildly the function of a musical intervention changes based on the context of the therapy room.
Human behaviour, responding, and meaning-making, is absolutely contextual. The function of the things that we do, or the things that others do to us, is different depending on the environment that it happens in. This isn’t true for all things; a loud bang will spark us to look around for it, primarily due to deeply engrained behavioural responding to ‘loud noise’ and ‘danger’. However, for something like a demand, or musical responding, where we are experiencing it matters.
If we take this thesis - and accept it - that music therapy is contextually functional, then it highlights that the focus on the music itself within music therapy - or even the relationship between the client and the therapist - risks leading us down a garden path. Because, if function is entirely contextual, then the topography (e.g., shape, volume, texture) of the intervention is theoretically bankrupt. What the therapist might consider as a “grounding” beat may well be for one client, but function as an ominous sense of dread for another. Equally, the therapeutic relationship cannot be the cure in and of itself. A functional perspective implies that the therapeutic relationship is necessary (and the shared music-making, with it) simply because it is the context in which the behavioural and psychological responses are carried out and tested. In relational frame talk, this is called the Cfunc - the functional context, or circumstances in which a response is observed.
This context is everything, as it is the first clue that things are not a simple, binary choice between ‘does’ or ‘does not’, or whether the therapy is in the relationship, or the music. The context may be different every single time, based on what is being played, what kind of day the client has had, what kind of day you have had. We cannot take for granted that a musical response in one session, in one hour, in one day, will repeat itself. It might well do, but watching for what is played is another example of this particular garden path. Functional context teaches us that what we do in the therapy room may very well be unique because it happens within a music therapy space - a place quite unlike any other therapeutic (or otherwise) environment. It is a novel context in which our clients can explore new ways of relating, being, and responding, and the musical and interpersonal relationship functions as the delivery mechanism for this exploration.
What I think is interesting, is that this feels initially cognitively dissonant. However, very few music therapists would say that a “good” session is defined by the aesthetic quality of the improvisation, or the perceived depth of the musical connection. We are taught to attend to the individual and the music without judgement - with unconditional positive regard - and suspend the notion of “good” and “bad” music. To me, this is an implicit agreement that we are being trained and taught to pay attention to what the music is functioning to do for the client, as opposed to what music the client is playing. It is defined strictly by observable changes in the client’s behavioural responses to the music, and I believe we’ve simply used different borrowed language within our factions in order to describe this observable change, primarily in the form of felt shifts in relational or musical dynamics.
Another definition
This is what prompts me to give another definition to Luke in the interview. The definitions of music therapy - for me - have often felt… sticky. They feel too specific to the factions in which they come from. I don’t agree with UK community music therapist Simon Proctor's assessment that music therapy is not a psychological intervention, however I don’t think he’s entirely wrong - it does feel like it’s slightly different from a psychological intervention, or that labelling it solely as such is entirely right. The functional contextualist definition of music therapy I shared seeks to address this; it broadens the scope without making it more vague, and gives honour to the interpersonal and inter musical relationships that take place in our work to which we have to hold on to.
I’ll put it here again, and we can pull it a part. I would wholeheartedly encourage questions around this definition.
“Music therapy is the strategic use of musical interaction as a symbolic language to target and alter the core psychological and social processes that shape how a person functions.
It can bypass internal, linguistic rules, and therefore circumvent behaviours people carry out in response to those rules, and generalises new responses to stimuli through the use of a novel and highly motivating context - music making.”
If sticking my proverbial flag in the ground and being rigorously proven wrong is what it takes to get a definition we all agree on, then sign me up. But for now, this is the best way I feel that I can describe music therapy in a way which is a) non-factionalist, b) global, and c) modern. And here’s why:
When I say 'strategic use of musical interaction,' I am trying to define the therapist’s role as intentional and context-shaping. This is distinct from the incredibly valuable work of community or clinical musicians, whose primary function is often to directly improve the aesthetic environment and bring about soothing. That is a profound skill in its own right. In therapy, however, our goal is deliberately designing an interaction in which you can observe, interact with, and functionally alter behaviour. By labelling this use of it as “a symbolic language”, I am directly asserting that music is not just sound. It operates through networks of derived relational responding in which we create meaning, understanding, or experiences. It is arbitrary because, as Pavlicevic (Music Therapy in Context, 1997) states when discussing symbolism in music, it does not actually resemble the object it represents. A chord or rhythm functions symbolically based on our unique learning history.
To move us away from a diagnostic protocol (e.g., music therapy for autism) as well as acknowledging both sides of the dichotomy, I specifically believe that what we do targets and alters both the “core psychological and social processes” in a client. These are the things which mean that people can function in the day-to-day, as best as they can with their intrinsic qualities (e.g., somebody with a learning disability may have a different level of functioning that we can expect). By working with those processes, rather than trying to work with the psychology or sociology itself, we can change people’s way of relating to the world around them in a way which - hopefully - makes life easier, or improves it in some other manner for them. This is why I say that these processes “shape how a person functions.” If we work with a teenager who is struggling to go outside, then by targeting the processes of that behavioural response through the use of musical interaction, we may well support them to make a change in their life, and begin to function differently to the context of 'outside’.
The second half is where - I admit - I get a little bold. This is the part where I really lean into relational frame theory, and my belief that music therapy works because it bypasses linguistic rules which trap ourselves within our own minds. In contextual behavioural sciences, this is their understanding of human suffering. What I think is remarkable about music therapy, though is how it can support people with their relational network who don’t have language. This means we can support those who are trapped by rule-governed behaviour, as well as those who are trapped by more contextual relational networks which are not as specific as rules like ‘I can’t speak my mind’. I would argue that because music therapy circumvents this strict, linguistic framing, it allows clients to experience their environment without getting tangled in their usual traps. And finally, this is where I think the last bit is so important. If it “generalises new responses to stimuli through the use of a novel and highly motivating context - music making” then that means that the music itself is not the cure, but the context in which the healing can take place. It is a safe, motivating, and novel environment in which new behaviours (e.g., perspective-taking) can take place. And then, if it can take place in one context, perhaps it can take place in another, and then another, before those behaviours have transferred out into the client’s daily lives.
The question I would put to anybody who isn’t sure about this; how is that not beautiful? How is the ability to use a symbolic language as profound as music to speak to the inner core of a person’s being - which in contextual behavioural science we would understand to be their relational network - not something for us to cherish? Not something which mirrors the beauty of art itself?
Behaviourism and functional contextualism do not dismiss the work that music therapists do. To me, it highlights what we do and how deeply entrenched music is within a person’s relational network, even without knowing it. A functional definition of music therapy is not to reduce it to behavioural observations - it still requires the therapeutic context which we have spent years building with our clients, each in our own unique way. Rather, it puts to bed the notion that the therapy is anywhere other than in the minds and the body of the person receiving it; it is not in the music or the relationship, it is through the music and the relationship.
A functional invitation
If this all feels a little conceptually jarring, or if you understandably fear that viewing our work through a functional lens strips away the meaning and feeling, I want to offer a simple invitation.
In the spirit of Acceptance and Commitment Therapy (ACT), I want to invite you to accept the discomfort and to pick a choice of action anyway. In your next clinical session, I challenge you to try on this functional contextualist hat. If appropriate for your client, let’s track one observable, behavioural loop, completely stripping away any subjective interpretation of why it is happening.
Introduce a sudden shift in playing, perhaps stabbing a chord or a note just at the start of a bar, twice. Watch to see how the client responds - how many times do you play it before they either play along with you (coordinate), fill in the gaps only, or do they persist with what they are doing, regardless of your musical offering?
For a moment, don’t call it ‘attunement’ or ‘meeting’ - instead, look at it with unapologetic objectivity. Watch their hands, their posture, and the space between their notes. What you are seeing is an antecedent-behaviour-consequence loop happening in real-time. You are watching yourself alter the core processes that dictate social functioning, namely deictic framing. You can measure, either in beats or time, how long it took for the client to notice you. If it took a while, then the follow-up question could be - is this a lack of confidence, or is it a processing speed? So do it again, on a new instrument. And again, with a longer time frame. You can begin to test the hypothesis in a way which is grounded within the musical relationship - altering the environmental context to see if the client alters their response. We can begin to stop waiting for these felt moments, and begin targeting and training the processes which make those moments possible.
When the session is over, ask yourself honestly; did tracking the function make the session feel any less meaningful? Did it diminish the profound interpersonal connection you shared?
I suspect you will find that it does the exact opposite. Recognising that you are strategically using a symbolic language to help a client to build new, flexible ways of being, illuminates exactly why the art matters so much.