A Dialogical Perspective
Garred, 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.

• References
  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.

This bookreview was released January 16, 2007 ©2007 Nordic Journal of Music Therapy

BOOK REVIEW FOR BJMT (Sept 2006)

Music as Therapy: A Dialogical Perspective
By Rudy Garred (Barcelona Publishers 2006)
Reviewed by Dr Gary Ansdell, Co-Head of Research, Nordoff-Robbins Music Therapy Centre, London.

Substantial contributions to music therapy theory have been rather like London buses recently: having waited many years, four books have arrived in quick succession. Brynjulf Stige’s Culture Centered Music Therapy in 2002 was followed by Henk Smeijsters’ Sounding the Self: Analogy in Improvisational Music Therapy (2005), Kenneth Aigen’s Music Centered Music Therapy (2005), and now Rudi Garred’s Music as Therapy: A Dialogical Perspective. Apart from all being written by men (and published by Barcelona Publishers), what these four books have in common is their offering a contribution to an envisaged ‘general theory’ of music therapy, a possible synthesizing perspective that could offer shape and form to an ever-diversifying field. “See it this way” these authors are saying – the first three touting culture, music-centredness and analogy as their chosen synoptic viewpoint. Whilst all borrow interdisciplinary material, there is also a welcome sense of intra-disciplinary theoretical development – of what Aigen calls ‘indigenous theory’.

Garred’s contribution adds a theory of ‘dialogue’ to this theory-building. More specifically the ‘dialogical principle’ – a philosophical perspective that grew throughout19th and 20th century philosophy and psychology, but perhaps most powerfully and poetically expressed by the Jewish social philosopher Martin Buber (especially in his famous book I & Thou). Many music therapists have been inspired by Buber’s confirmation that “All real living is meeting”. Many of us found how closely his ideas fitted with how we experience what ‘happens’ when two or more people “meet” in music – where the relational quality of that meeting is sometimes quite unlike that experienced in ‘everyday’ life – and can be existentially and therapeutically transformative. From this has come the deceptively simple image of the music therapist’s task as eliciting and helping develop ‘musical conversations’. Garred has been inspired enough by Buber’s perspective to elaborate a whole music therapy perspective from dialogical theory – and he is the first to do so in such detail, and with such breadth and rigour of discussion. His book is an intellectually courageous project, clearly bearing witness to a strongly-felt belief in this viewpoint. I found my response to it, however, unusually contradictory – I was by turns inspired, frustrated, illuminated and confused. I’ll try to outline some of the problems I had with Garred’s ideas here - but the following discussion should be taken as an example of what level of serious thinking this book occasions (an author can ask no more!).

The structure of the book takes us neatly through the argument for a ‘dialogical perspective’ on music therapy. Firstly Garred has a useful chapter called ‘Frame and Picture’ which situates his thesis within current debates within the music therapy discipline. What Garred wants to do is build a philosophically grounded defense of therapy in music in distinction to music in therapy (using Bruscia’s distinction). He sees this as related to (but not identical to) ‘music-centred music therapy’ (eg Aigen 2005), and as based on the heritage of the Nordoff-Robbins tradition (within which Garred loosely works). The chapter sketches its frame against both the infamous discussions of the 1990s (Streeter’s article & its replies) and also the culture and community debates of recent years. Garred wants to provide a rationale (and defense) of ‘therapy in music’ based on the ‘dialogical principle’, so the following chapter presents the essence of Buber’s theory of dialogue. This is based on the fundamental distinction of two different ‘stances’ of possible relationship: the ‘I-It’ type, where you relate in an objective, abstract and instrumental way to things and people, and the ‘I-Thou’ (or I-You), where there’s a direct, unmediated, and potentially transformative encounter. A ‘dialogical perspective’ develops from everything that flows from this central insight, and Garred argues in the rest of the book that this can serve as a philosophical ‘grounded theory’ for practicing ‘music as therapy’, as a transformative, experiential approach.

Garred suggests that, just as we can form a potentially I-Thou encounter with people, so too we can with music itself. He thus offers a model called the ‘music therapy triad’ which shows the various possible relationships between music, therapist and client (imagine a triangle with each of these on a point and the various sides expressing the relationships between them). This image has been a staple one for music therapy for many years, but Garred is more specific in his theoretical use of it. What it suggests to him is that each of the three ‘sides’ of the triangle (ie the key relationships) needs a precise theoretical anchor. Chapter 4 thus presents a theory of the interpersonal relationship between therapist and client (using early interaction theory and the ‘later Stern’ on ‘implicit relational knowing’). Chapter 5 then presents a theory of relating to music itself, with Chapter 7 shoring this up with a version of Buber’s theory of art, and Chapter 6 presenting a comparative analysis of Nordoff-Robbins and Analytical Music Therapy to try out these various ideas. The theoretical task Garred then sets himself (and tries to resolve in Chapters 8 & 9 in terms of a general rationale and implications for practice) is just how to relate the interpersonal and the musical (in terms of how he has set out this dichotomy). I’ll let Garred summarise this thesis so far in his own words:

The theoretical position is that in music as therapy there is an interrelation between two relational dimensions, the interpersonal and the musical. The premise is that change in therapy may come about through change in implicit relational knowing, leading to a change in the sense of self. The argument that is developed emphasizes that in music therapy this may happen both through the interpersonal relation and through the relation to music. And that one may enhance the other. It is a process of change across two different, but interrelated, mutually enhancing spheres.

The main characteristic of this form of therapy is that is does not use the medium of verbal language for dealing with issues of declarative knowledge for the development of insight, but instead relies on an intensifies relational process brought about through the dynamics of relation between these two sides of the musical and the interpersonal. Music as a therapy entails an encounter with and through music. (p.147, emphasis in original)

I need to declare an interest in this book now before going further in this review. Not only am I sympathetic with Garred’s overall project, but (amongst other colleagues) Garred makes fairly extensive, sometimes critical use of my writings on music therapy. Nearly four pages are devoted to a critique of my concept of the ‘musical between’ in Music for Life (itself adapted from Buber). Though it’s not conventional to make a response to such a critique within a review, I will do just that now, for the purpose of I hope clarifying what I think is mistaken in Garred’s basic thesis (as sketched in the previous paragraphs) in a more global sense.

We have ascertained so far that Garred wants two modes of relationship in his theory – the interpersonal and the musical – which interrelate and enhance each other but remain distinct. What Garred objects to is that I suggest almost the opposite of this. I remember coming across Buber’s notion of “the between” with particular excitement – it expressed that place which was no-place of the music between us, from where the special quality of ‘musical-personal’ relationship seemed to flow in some sessions. What I called the ‘musical between’ seemed key to my music therapy encounters. Garred takes me to task for this term, and my description of it:

The insistence on the relationship residing within the music seems to be conceptually based on the equation of music within the “Between”. Music is the “Between”, or the “Between” is music in some sense. Music seems this way to be positioned somewhere within the “Between”, according to Ansdell’s constructs here. […] A problem with “containing” the relationship “within the music” is that the various aspects of each line of relation, interrelated with the other two, may not be brought out clearly. The “Between” is not some fused entity. It is no “thing” at all, it is the space in which relation is opened for. (p.99/100, emphasis in original)

In contrast, Garred defends his triangle model of separate but interrelated spheres of relationship (the interpersonal and the musical). I’m happy to plead guilty to my possible misunderstandings of Buber (I claimed only Buber as an inspiration), but I’d like to argue the wider point involved here concerning the relationship between the musical and the personal within music therapy. As I’ve said before, Garred is generally describing a personal version of Nordoff-Robbins music therapy, and he critiques in another section of the book Aigen’s (2005) statement of a core music-centred/Nordoff-Robbins axiom: that a change in a client’s music is normally a personal (and usually therapeutic) change. What we might call the ‘musical-personal’ realm is probably the key insight of music-centred practice. To sloganise, “The musical is the personal”. And yet Garred writes this:

It is too simple to say that musical change is personal change. Change in the music may be indicative of change in the relation to music on the side of the client. What to look for is the quality of the engagement in the music, which may be reflected in the music, but not in any mechanical way. The focus has to be on the client’s relation to the music. (p.245, emphasis in original)

But is it really ‘too simple’? What Nordoff & Robbins emphasized was how ‘the music’ in music therapy was indeed a unique fusion of the musical-personal. The ‘child’s music’ was how the child was able to play (their musical flexibility, creativity etc) with others (ie their interpersonal flexibility, creativity) in relation to their limitations. In the famous formulation, Nordoff & Robbins described how a child initially presented a ‘musical portrait’ of their limitations and potential, saying in music “This is me; I can (only) do this”. Therapeutic progress was mirrored by musical progress in terms of how the qualities and tendencies of their music changed against the backcloth of their limitations and unfolding potential. At the same time the therapist is of course playing with her limitations – so the ‘musical between’ is quite naturally a jointly negotiated musical-personal realm – paradoxically both fused and separate. It is to my understanding not the interaction of two realms, but the creation of a third: the ‘musical-personal’. This is what musicing does best – and how music-centred practice works.

This all may sound like splitting hairs with Garred (and to be fair, Garred does discuss some of these complexities in regard to how music relates to ‘musicing’). But the paradoxes of what I’ve just described (alongside many others) led me, when reading this book, to ask myself why often I felt Garred’s global thesis somehow often misses the point.

Garred presents his methodology as a philosophical one (his empirical material is slight, cases are used only as illustrative of ideas, the main approach being to revisit key literature in the light of his central dialogical thesis). Given this I feel it not unfair to offer a philosophically-oriented critique. For me, a disadvantage to the choice of Buber as a singular guiding light may be two-fold. Firstly, that his key terminology (I-It/I-Thou) tends to encourage so-called ‘binary logic’ – where arguments and models are constructed out of constructed opposites (‘this’ versus ‘that’). Secondly, Buber tends to recommend ontological arguments (eg music is ‘really’ this or that; people are ‘really’ this, etc), rather than phenomenological ones (eg ‘our experience of music seems like this, but could be otherwise’), or indeed ‘ecological’ ones (eg ‘within this situation and environment music and people relate like this…’). My reading of Garred’s thesis is that he is drawn by these philosophical commitments to sometimes reify both ‘music’ and ‘people’ in rather limiting and static ways, and to separate out binary this/that pairings of things – for example: music/people, work/play, music-oriented/conflict-oriented music therapy. There is admittedly some unfairness here in my judgement, in that (as Buber does) the relationship-between is also constantly stressed by Garred. It’s just that (for this reader at least) the separation of things dominates in the end – and the seemingly overriding need to neatly place things within the model-under-construction perhaps gives a false sense of intellectual security, and potentially misrepresents the complex and ‘messy’ phenomenon of ‘people and music’ within and without music therapy.

Do I have an alternative? Certainly not an alternative model, but perhaps an alternative methodology. One branch of our discipline is currently questioning the status of therapist-constructed knowledge and context-free models (of music, people and ‘therapy’). To put it baldly: do our clients really experience what we think they experience? How does this relate to our models? How does ‘music therapy’ relate to their wider experience of ‘music’s help’ in their everyday life? These kinds of questions can only be answered by a more flexible, ethnographic-style method – one which stands to challenge the music therapist’s theoretical monologue. So we might question Garred’s conclusions in relation to his methodology – that is, his (mostly virtual) dialogues with other music therapists through their written texts. What would other types of conversations have opened up for him? (eg with clients, carers, places where music therapy actually happens)?

A concluding question in relation to Garred’s book might come from his own dialogical perspective: What kind of conversations could his text open up for others now? Certainly for this reader it afforded detailed re-thinking about the areas he tackles and a critical and intellectually rich opportunity for meditation, response and critique. I’m wondering however how much the overall theoretical foreclosing of the argument in this text might inhibit more open-ended and creative conversations. Like any book, it will now take its own life in the “It” world and await dialogue partners.