Understanding music therapy from a cultural lens

One Monday morning, I led a music therapy group in an inpatient psychiatric unit. Five patients showed up and were willing to participate in group improvisation. Sitting there, I noticed that the group was comprised of one white Caucasian male, one African American male, one African American female, one American-born Asian female, and one Chinese male who immigrated to the US two years ago with English as his second language. As I started the group check-in, I noticed they all mentioned a common problem: how to get through the day and cope with the stress of hospitalization. We then started the first round of group improvisation, which was disorganized and scattered. The patients wanted to improve their group improvisation so they talked about ways to achieve this and found they needed someone to provide a beat for everyone to follow. The next round of group improvisation was more structured and connected. Towards the end of the meeting, the patients said it was as if they shared the same space to communicate, to express, and to support one another in this particular group music therapy session.

This was an ordinary group music therapy session. Most of the time, patients can be led to explore their issues and their connection with others, and, in the end, create a kumbaya moment. This improvisational group music therapy session is a method I learned from my master’s program and I am very familiar with it. When it comes to the discourse of multiculturalism, and looking at the multicultural layers of this particular group modality, I find that culture is a topic we don’t usually focus on during group music therapy sessions or other group therapy sessions. Patients often express their frustration at being in hospital in these group sessions, and talk about the stress of hospitalization and how much they want to be discharged. Cultural issues do not seem to matter to the patients and the therapist.

However, thinking about this aforementioned session, the patients clearly came from diverse ethnic and cultural backgrounds, and were of mixed gender, so there had to be cultural factors we had overlooked that had influenced group dynamics. When I think about it further, I find that playing music actually carries meanings and stories patients would like to convey to others. Such meanings and stories have different but significant cultural appeal to patients, but these meanings and stories do not seem to lead to a cultural discussion. Patients and the therapist seem to avoid talking about cultural issues, as if this discussion would offend some, since bias, stereotypical labeling, and misunderstanding of minorities are common. As Knight, Roosa, and Umana-Taylor, A. J. (2009) indicated, “with the dramatic demographic shift now occurring in the United States, research on ethnic minority populations is bound to grow in the coming decades” (p.96). Unfortunately, an open discourse on culture and ethnicity did not take place in my session or even in my workplace, an inpatient psychiatric care facility. Currently, due to an increase in patient turnover on admission and discharge, and the speed with which it occurs, treatment tends to focus on patients’ symptoms and discharge planning. Furthermore, in the creative arts therapists’ groups, we seem to focus only on the development of patients’ insights and coping skills.

The hospital I work for is a public facility in a metropolitan area in the northeast of the US. During the eight years I have worked there, large numbers of my patients have belonged to minority ethnic groups – Blacks, Hispanics, Asians, and new immigrants. Many of them come from socioeconomically disadvantaged backgrounds. Snowden and Chueng (1990) pointed out, “Because of their greater earnings and likelihood of having health insurance, Whites have greater access than Black, Hispanic, and Native Americans to private inpatient care” (p.348). Accordingly, I have asked myself if what I learned from school can really address their needs and whether cultural and ethnic factors can affect patients’ treatment and even their diagnosis. As I recalled my time in my master’s program in music therapy, I realized most teachers are white Caucasians.

I have thought about whether knowledge, including the method of improvisational music therapy I have learned, can be applied successfully in Asia. Sue and Sue (2013) indicated, “Traditional counseling and psychotherapy were Western European constructions that were oftentimes inappropriately applied to racial/ ethnic minorities” (p.23).

At my work, I sometimes encounter patients who are new immigrants from China. In my group improvisation, some patients with this background would abruptly leave or politely express their resistance, saying that playing this music was only for children and that they didn’t believe it could help them. I then asked myself whether this method of music therapy was an appropriate way to help these patients. Sue and Sue (2013) also pointed out that “without awareness and knowledge of race, culture, and ethnicity, counselors and other helping professionals could unwittingly engage in cultural oppression (p.23). In light of this, I thought about what I had done in the aforementioned ordinary group session, and I wondered if a lack of focus on cultural factors in the context of my workplace would have re-traumatized patients who belong to a minority group and are socioeconomically disadvantaged.

Moreover, dominant narratives are still strongly rooted in the treatment process. Hadley (2013) posited that “we must acknowledge that we live in an ableist society. Ableism points to the practices and dominant attitudes in society that devalue and limit the potential of people with disabilities” (p.376). The way the treatment team addresses their treatment plans to the patients, now that I think about it, is quite authoritarian. When it comes to the concern of multiculturalism, I wonder if these treatment plans are appropriate in addressing the needs of the patients we work with. Brown and Strega (2005) said that “knowledge production has long been organized, as have assessments of the ways producing knowledge can be “legitimate,” so that only certain information, generated by certain people in certain ways, is accepted or can qualify as “truth” (p. 7). The staff members in my workplace seem to be people who are in charge of the truth and tell patients what to do; or are we really the ones that should do so? Who gives us this privilege? Or if this is a privilege, how can we use it to help people in need?

That said, I think open dialogue is very necessary in this context of multiculturalism, but that it is still difficult to do it in the context of inpatient psychiatric care with rapid turnover. Pavlicevic (2005) pointed out that “the need for a transparent common language demands enormous acuity and presence of mind from all” (355). Indeed, we need the efforts of all the parties concerned to have this dialogue. Although there is still a long way to go to raise most people’s awareness of multicultural issues, I believe we will get there eventually. All in all, it is pivotal for me to know where I can locate myself in this context of my clinical work and multiculturalism so I can help my patients let their voices be heard, which I think is the essence of this discourse on multiculturalism.

References

Brown, L. & Strega, S. (2005). Research as resistance: Critical, Indigenous, and anti- oppressive approaches. Toronto: Canadian Scholars’ Press/Women’s Press

Hadley, S. (2013). Dominant narratives: Complicity and the need for vigilance in the creative arts therapies. Arts in Psychotherapy, 40 (4), 373-381.

Knight, G. P., Roosa, M. W., & Umana-Taylor, A. J. (2009). Studying ethnic minority and economically disadvantaged populations. Washington, D.C.: American Psychological Association.

Pavlicevic, M. (2005). Towards straight talking: Multiple narratives in multicultural and multidisciplinary work (or, first I shot the dog, then I shot my mother). Arts in Psychotherapy, 32 (5), 346-357.

Snowden, L. & Cheung, F. (1990). Use of inpatient mental health services by members of ethnic minority groups. American Psychologist, 45, 347-355.

Sue, D. & Sue, D. (2013). Counseling the culturally diverse: Theory and practice. Hoboken, NJ: John Wiley & Sons.

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