‘Were they better today?’ Valuing a client’s individual therapeutic process within an institution’s expectation of positive progress and predictable outcomes

Abstract

The broad context for this article is the provision of music therapy for children and adults with learning disabilities within the current social, political and economic context. The article explores themes regarding internal and external pressures experienced by the music therapist both inside and outside the therapy room. The external pressures are identified and discussed through literature, with the focus being on the commissioning institution's expectations of the value music therapy will add and how this value can be measured and predicted. The internal pressures the music therapists can experience concerning their desire to know and understand the client are explored through literature in relation to their professional role and their personal desires when relating to others. The anxieties that these pressures can create, and the impact that they can have on the therapist's thinking around the work, are considered in detail through a case study with particular reference to the music therapist's capacity to work fully with not knowing and regression.

Developing a research approach to explore therapeutic relationships with children and young people with complex needs: A critical reflection

“…'From a disability studies perspective, the dominant discourse on families of children with disabilities is strongly influenced by the medical model and based on assumptions of grief and tragedy' (Metell, 2019: 5). I recognise my previous thinking (Roman, 2016) in this quotation, which is a painful realisation to acknowledge and own.…”

“…A previous publication in the British Journal of Music Therapy (Roman, 2016) provides a summary of my approach to understanding therapeutic work prior to starting this research. I recognise that, in this article, I was not aware of the normative frameworks that I was working and thinking within.…”

What Did You Expect?

“…This desire can lead to the therapist being invited to "keep (the child) all day" or to address specific problems in sessions (p. 42). Roman (2016) explores the challenges faced by a therapist working in a school when "positive progress and […] predictable outcomes" are expected (p. 20). For example, she describes how such expectations can affect how actual outcomes are perceived.…”

“…This can be a problematic issue, particularly if good communication between the referrer and me is not established early on. Roman (2016) describes her process of understanding what might be happening for a client, but identifies the difficulties communicating this to the referrer. She describes how the referrer's understanding of the client's behaviour (in this case, the client refusing to come to the session), is different from her own understanding.…”

“…Since the work I did with the clients in these case studies, in order to ensure we have a structure and a rationale to the assessment process, the team of music therapists working for the service provider that I work for make use of outcomes tools. Although tools can have limitations, such as providing a simplified picture of the progress made and failing to explain the circumstances of set-backs, (see Roman, 2016), I find these can help to provide clarity about what the therapy is for and this can help to dispel misconceptions.…”