Influences of music therapists’ worldviews on work in different countries

The Arts in Psychotherapy 37 (2010) 215–227

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The Arts in Psychotherapy

Influences of music therapists’ worldviews on work in different countries夽 Barbara L. Wheeler (Ph.D.) a,∗ , Felicity A. Baker (Ph.D.) b a b

University of Louisville, Music Therapy, School of Music, Louisville, KY 40292, United States University of Queensland, School of Music, Staff House Road, St Lucia, Brisbane 72, Australia

a r t i c l e

i n f o

Keywords: Culture Multicultural Worldview Music therapy Music therapy practice Teaching

a b s t r a c t This research investigated the worldviews that music therapists hold and how these influence their music therapy practice and teaching. Information was gathered from 12 participants who had lived and worked in 16 different countries, all of whom had experience as both music therapy clinicians and teachers. Participants were asked, “What views do you hold that are a part of your culture that you believe may influence your music therapy or teaching of music therapy?” The researchers performed an inductive analysis of the data using principles of grounded theory methods. Four themes were found to represent the main influences of culture relevant to music therapy as understood and described by the participants: the influence of culture in shaping worldviews, on clinical practice, on teaching, and on perception and thinking about the therapeutic process. These themes and constructs that constitute each are presented, along with sample quotations from participants to illustrate each. Participants’ views of culture and worldview are also presented. Implications of this research for the teaching and practice of music therapy in a multicultural world are discussed. © 2010 Elsevier Inc. All rights reserved.

A person’s worldview is his or her way of constructing meaning in the world. This “includes the various beliefs, values, and biases an individual develops as a result of cultural conditioning” (Ivey, D’Andrea, Ivey, & Simek-Morgan, 2002, p. 4). A person’s worldview is thus shaped by his or her culture. While in the past, those in helping professions may not have paid attention to how their own biases and cultural beliefs influence their work with clients, this has changed, and culture is very much a part of our awareness as we work with others. As the editors of a music therapy book on this subject say, “In early days only a handful of scholars included culture as a construct. No more” (Kenny & Stige, 2002, p. 2). In the Preface to Stige’s (2002) book, Culture-Centered Music Therapy, Bruscia labels culture-centeredness as the “fifth force in music therapy,” saying, “This will be the force that reminds us that all of our work, whether it be theory, practice, or research, takes place within very specific and unique contexts—contexts that not only shape the work itself, but also predispose us to attach our own idiographic meanings to it” (Bruscia, 2002, p. xv). Stige (2002) suggests that culture is “ways of relating to the world, consciously and unconsciously, with and through others” (p. 2). Stige hopes to “make all music therapists more culture-centered in their work and thinking, not by labelling their work as such but by

夽 The authors wish to thank Clare O’Callaghan, Carolyn Kenny, and Kenneth Bruscia, as well as the participants in this study, for their assistance. In-person collaboration on the study was made possible by a University of Queensland Travel Award for International Collaborative Research. ∗ Corresponding author. Tel.: +1 502 852 2316; fax: +1 502 852 0520. 0197-4556/$ – see front matter © 2010 Elsevier Inc. All rights reserved. doi:10.1016/j.aip.2010.04.006

integrating cultural perspectives in their thinking” (p. 5). He goes on to address the question to music therapists: “What is the relationship between the music therapy session and the context it belongs to?” (p. 5). Considerable theory and study of multicultural issues have come from the fields of counselling and psychology (Ivey et al., 2002; Ponterotto, Casas, Suzuki, & Alexander, 2001; Sue & Sue, 2003), and the music therapy literature often refers to and builds upon this. A definition from counselling and therapy is: Multicultural counselling and therapy can be defined as both a helping role and process that uses modalities and defines goals consistent with the life experiences and cultural values of clients, recognizes client identities to include individual, group, and universal dimensions, advocates the use of universal and culture-specific strategies and roles in the healing process, and balances the importance of individualism and collectivism in the assessment, diagnosis, and treatment of client and client systems. (Sue & Torino, 2005, p. 6) Sue and Sue (2003) suggest that a culturally competent healer works to: (a) actively become aware of his or her own assumptions about “human behavior, values, biases, preconceived notions, personal limitations, and so forth” (p. 18); (b) actively attempt to understand the worldview of culturally different clients; (c) actively develop and practice intervention strategies and skills for working with culturally different clients. It is clear that being a culturally competent healer requires effort and active involvement.

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Although this article focuses on multicultural issues in music therapy, the other creative arts therapies are also concerned with similar issues. This is illustrated by a special issue of The Arts in Psychotherapy that focused on this topic (Lewis, 1997). This issue covered aspects of multiculturalism, globalism, cultural identity, and ethics, and brought perspectives from creative arts therapists working in several different cultures. Kenny (1994, 2006) suggested that music therapy programs that integrated a creative arts therapies approach had already developed an interdisciplinary dialogue and thus could serve as a model for the discursive processes necessary to cultural pluralism. The impact of culture on the work of music therapists has been studied and written about for many years, with the amount of study and writing increasing in recent years. Moreno (1988) suggested many years ago that music therapists needed to be more aware of the music and customs of other cultures. Kenny (1994/2006) asked practical questions for music therapy training programs regarding issues of culture and suggested the following characteristics as necessary for a successful multicultural therapist: “awareness and knowledge of one’s own cultural identity, a wide range of experience in different cultures, a high tolerance for paradox, a capacity to embrace ambiguity, and resourcefulness and a good imagination (1994, pp. 12–13).” Kenny (1994/2006) explored the influence of culture in music therapy education, including qualitative data from educators around the world. Cole (2003) wrote The Multicultural Music Therapy Handbook, which provides a cultural literacy model and includes sections helping readers to examine themselves, learn about culture, and adapt their clinical practice to multicultural issues. The ethical implications of multicultural practice have also been explored. Bradt (1997) explored ethical issues in multicultural music therapy, emphasizing that music therapists need to be aware not only of the music of other cultures but also of the meaning of music in other cultures. Dileo (2000) devoted a chapter of her book on ethics in music therapy to multicultural and gender perspectives. She suggests that the ethical implications of working with multicultural clients involve two primary issues. The first is the protection of clients’ rights, since clients of various cultures may be vulnerable and have been oppressed, thus requiring special protection. The second is the competence of the therapist, because working with people from other cultures requires particular selfawareness of biases as well as multicultural awareness. Supervision of people from different backgrounds is one area of concern. Estrella (2001) addresses multicultural issues in supervising music therapy students, reviewing multicultural approaches to supervision from other disciplines and considering racial issues as one aspect of multicultural supervision. She also reviews several stage models of multicultural supervision and suggests that instituting them could eliminate some basic problems that occur in multicultural supervision. Kim (2008) conducted a phenomenological study of the supervisee’s experience in cross-cultural supervision. She wanted to understand the supervisee’s experiences of being misunderstood and understood in cross-cultural supervision. She interviewed seven participants and analyzed the data using a phenomenological framework. Kim presents and discusses the supervisee’s experiences of being misunderstood and of being understood in cross-cultural supervision, makes recommendations of factors to consider in cross-cultural music therapy supervision, and suggests implications of her study for music therapy supervision theory. Two surveys of multicultural practices in music therapy were done in the 1990s. Toppozada (1995) surveyed 298 professional music therapists and concluded that music therapists found culture to be a relevant issue in music therapy, but that most multicultural training was taking place at the professional level. She suggested that it would be helpful for music therapy students to take more

coursework in ethnomusicology, multicultural counselling, or ethnic studies. Based on recommendations by Toppozada, Darrow and Molloy (1998) reviewed program requirements of the National Association for Music Therapy (NAMT) and professional literature and national conference programs concerning multicultural issues and also surveyed music therapists practicing in culturally diverse areas of the U.S. In response to one of their research questions, What attention has been given to multicultural issues in the music therapy literature and by the profession at large?, they found that relatively little attention had been paid to multicultural issues in the music therapy literature compared with that in music education. They did find that sessions on this topic at NAMT conferences seemed to be increasing in recent years. In response to the question about the training that music therapists receive in multicultural education or multicultural music, they found that NAMT-approved programs gave attention to training in multicultural education primarily through general education classes and electives. Most survey respondents reported receiving training in multicultural education and/or music as practicing professionals, primarily through work experiences and workshops. And finally, the survey that they sent addressed the question, What are the multicultural experiences, practices, and concerns of music therapists in the major metropolitan areas of the United States? Of 219 NAMT members whose addresses indicated that they lived or practiced in a major metropolitan area, 62% felt that coursework in multicultural music was either “very necessary” or “somewhat necessary.” Only 13% felt that their university training adequately prepared them to incorporate multicultural music or practice with clients from other cultures. In spite of their lack of university training, almost 75% of the respondents felt that they were quite familiar with multicultural music in general and that they were more familiar with the music of the clients with whom they worked. This might suggest that professional music therapists actively seek out relevant multicultural music, but whether they understand and are sensitized to the ways this music is incorporated into practice is open for debate. Both of the survey studies cited (Darrow & Molloy, 1998; Toppozada, 1995) suggest that the education of music therapy students should include more information on multicultural music therapy. These studies were completed more than a decade ago. Curricula of schools approved by the American Music Therapy Association (AMTA) are now competency-based, and the Professional Competencies of AMTA (2008) include competencies that relate to cultural and multicultural perspectives: 14.5

16.4 16.5

22.9 22.11

Demonstrate awareness of one’s cultural heritage and socio-economic background and how these influence the perception of the therapeutic process. Select and implement effective culturally based methods for assessing the client’s assets, and problems through music. Select and implement effective culturally based methods for assessing the client’s musical preferences and level of musical functioning or development. Demonstrate knowledge of and respect for diverse cultural backgrounds. Demonstrate skill in working with culturally diverse populations.

Although it appears that more attention may now be being paid to developing multicultural perspectives than in the past, a recent study examining the extent to which multicultural issues are addressed in the supervision of music therapy internships in the U.S. and Canada (Young, 2009) suggests that things have not changed very much. In this study, 104 internship supervisors were surveyed on several issues concerning multicultural issues in their internships. The researcher found that, although most of the supervisors had supervised interns from various cultural backgrounds, many had little or no formal training in multicultural music therapy. She also found that multicultural issues were not being consistently addressed in internship supervision.

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Brown (2001) provided guidance for music therapists to work towards a culturally centered music therapy practice, based on her work as a music therapist in Canada. Among her suggestions is that music therapists must become familiar with clients’ worldviews, including their values and beliefs and the cultural teachings that they have experienced, and then examine how these teachings might affect their music therapy practices. From an Israeli perspective, Yehuda (2002) looked at some important questions about culture and musicians, therapists, and clients. The main question of her research was: “How meaningful and restrictive are the limitations of the musical culture of the client and the therapist, and how much are performing musicians, therapists and clients being affected by their personal–cultural–musical background in their encounters?” She was interested in investigating the experiences of the musicians and the therapists. She was also interested in the cultural questions that therapists face, how they confront cultural questions and deal with these questions in therapy, and whether they experienced any difficulties in regard to cultural issues. She presented her results in the following categories: (a) different reactions of therapists to music of a different culture, (b) the effects of non-musical elements on music therapists and musicians who approach foreign music, (c) reactions of musicians of eastern origins to classical western music, (d) the ways Jewish therapists deal with Arab music, (e) difficulties in dealing with Jewish ultra-orthodox population, (f) ideas about performing foreign music and composing music that is combined of different styles, and (g) therapeutic attitudes and techniques with clients from different cultures. She discussed the results in relation to intersubjective theory and emphasized that two people with different worlds are present in therapy and that these influence the therapy. A symposium sponsored by the Commission on Education, Training and Accreditation of the World Federation of Music Therapy (held prior to the 11th World Congress of Music Therapy in Brisbane, Australia, in 2005) attempted to build a picture of multicultural perspectives as perceived by music therapists from a range of cultural backgrounds (Nöcker-Ribaupierre et al., 2005). This symposium brought together 35 delegates from Australia, Austria, Brazil, Canada, Germany, Italy, Japan, Korea, New Zealand, South Africa, the United Kingdom, and the United States. Presenters discussed the language-culture barrier that exists in Quebec (Isenberg-Grzeda), working with minority students within a dominant culture in the U.S. (York), Asian cultural issues in music therapy training and education from a Japanese perspective (Okazaki-Sakaue), the culture of experiential training in Germany (Nöcker-Ribaupierre), and designing research training for music therapists in the UK (Watson and Darnley-Smith). The summary from the symposium provides some indication of the diverse viewpoints and issues in multicultural music therapy: In the course of this seminar it became clear that most of the topics under discussion were connected specifically to the particular situation in each country: the problems which arise when different languages are used within one country and the subsequent difficulty of finding appropriate literature in translation which can cover the curriculum and theoretical perspective of that country; the difficulties experienced by minorities and the need for offering psychological support through self-experience. Least familiar, but perhaps most interesting for the authors, were the differences in the expectations, learning, and cultural support experienced by trainees from Asia and from Western cultures. The lively discussion among all participants, which followed the presentations, revealed very clearly that music therapists, as practitioners and educators, have to be aware and responsive to all the different challenges presented by cultural issues.

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Valentino (2006) measured empathy in cross-cultural music therapy. She aimed to determine whether music therapists have sufficient knowledge and insight into the issues of cross-cultural therapy to provide appropriate services to their clients. She achieved this by surveying 200 music therapists, with equal numbers from Australia and the U.S. She received responses from 79 people, 45 from Australia and 33 from the U.S. She found that, with cross-cultural training, music therapists obtained significantly higher empathy scores than those who had not had such training. Vaillancourt (2007) researched multicultural music therapy as an instrument for leadership. She suggests that music therapy is a particularly appropriate way to address multicultural perspectives, since music is itself a multicultural phenomenon. She presents arguments for employing proactive multicultural music therapy to achieve social justice and describes several programs where music therapy has been used in multicultural settings to work towards social justice. Gilboa, Yehuda, and Amir (2009) formed a multicultural group of students that comprised immigrants and Israeli-born students and focused on enhancing communication among these students. Further, they found that the project enabled most of the students to identify more with their own cultural roots as well as with the Israeli culture. They found that music was a key ingredient in helping the students to express more acceptance and openness towards those of other cultures. This innovative teaching approach allowed students to be aware of the music of other cultures and the meaning of this music, and may provide the foundation for more culturally sensitive practice in their professional lives. It is clear from what has been written and researched about multicultural music therapy that further investigations are called for to understand how best to practice in a multiculturally sensitive way. The areas described earlier—becoming aware of one’s own assumptions, understanding the worldview of culturally different clients, and developing and practicing intervention strategies and skills for working with culturally different clients (Sue & Sue, 2003)—are some of the important issues that need to be examined in order to understand how to work with clients of different backgrounds than the therapist. This study aimed to explore these issues further. Culture, for this project, was defined by the researchers as “the behaviors and beliefs characteristic of a particular social, ethnic, or age group” (Dictionary.com, no date). However, these definitions were left quite open for participants so that they would reflect their views. Respondent’s personal definitions of culture and worldview are presented as part of the Results of the study. This study focused on the worldviews that music therapists hold and how these influence their music therapy practice and consequently the teaching of music therapy. The research question was: What are the worldviews that determine how music therapists in different countries work? The research project is intended to contribute to music therapists’ and others’ understanding of culture and its role in their work.

Method Stance of the researchers Author 1 was interested in the subject because of experiences with students from other cultures that she had had over many years of teaching, although her academic teaching has occurred in only one country. She had often been aware that differences in expectations of different cultures translated to learning differences in the classroom that neither the student nor the professor necessarily related back to cultural differences or expectations. She had also had numerous experiences teaching through workshops and semi-

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nars in other countries, many of which had highlighted differences in cultural expectations. Author 2 approached the study with a degree of subjectivity which is unavoidable in qualitative research (Guba & Lincoln, 1994). Like the participants in this study, she had experienced teaching and practice in two countries which had noticeable differences in approaches to socio-cultural practices, different contexts (teaching in a rural area versus in a large city), and theory about music therapy practice. Although these differences were not extreme, she did experience somewhat of a “culture shock.” Her ways of relating to people in her home country were modified and she continuously monitored and adjusted her interactive style in the new cultural context in order to be more culturally sensitive. She needed to consider how her beliefs and approaches to music therapy practice would or would not “fit” in this foreign country, which ultimately influenced how she taught music therapy. Through these experiences, she developed a greater self-awareness which now influence her current thinking and approach despite returning and working in her homeland. Design This study followed the general principles of qualitative research within the framework of grounded theory. We employed an emergent design. This meant that the design was subject to change based on the information that emerged and what the researchers learned during the research process. The emergent design allows the researcher to pursue new areas as they emerge so that the research evolves, taking advantage of what is learned in its earlier stages. We also adopted purposeful sampling, selecting research participants because of what their study may bring to the research question, not because they are necessarily typical of the group being studied (Wheeler & Kenny, 2005). Participants Music therapists were selected for inclusion based on the following characteristics: (a) serve as both clinician and educator; (b) have taught in more than one country; (c) able to communicate in English; and (d) able to correspond by email. A total of 12 people participated in the process; an additional three who were asked declined to participate for various reasons. They were told in the initial email contact the general nature of the study. Those who agreed to participate were given an informed consent document that included additional information and, of course, given the opportunity to ask questions before signing. Participants represented 16 countries: Australia, Brazil, Canada, Denmark, Germany, Ireland, Israel, Italy, Japan, New Zealand, Norway, South Africa, Spain, Taiwan, the United Kingdom, and the United States. Several had also taught rather extensively in additional countries. All except one had taught in at least two very different parts of the world. Ages of the participants ranged from 37 to 66, with a mean of 51.3 (SD = 9.6). They had from 12 to 40 years of experience as a music therapist, with a mean of 25.8 years (SD = 9.9), and from 5 to 33 years experience as a music therapy educator, with a mean of 17.6 years (SD = 10.6). Procedures The research was approved through the Institutional Review Board (IRB)/Ethics Committee in both the University of Louisville and the University of Queensland. The study was considered to be primarily through the University of Louisville, so the Ethics Board of the University of Queensland accepted the decisions of the University of Louisville IRB.

In an email to each participant, the researchers posed an open question “What views do you hold that are a part of your culture that you believe may influence your music therapy or teaching of music therapy?” Raw data were generated by asking participants to reflect upon their experiences and then to write these down. Participants varied in the length of time taken to reflect and respond—some responded in a matter of days, others responded after some months. Some participants engaged in a three-way email correspondence, with the two researchers posing further probing questions as they tried to tease out the issues around “worldviews” and “culture.” One participant chose to have part of the interview done over the telephone. Written responses ranged from 2 to 12 single-spaced pages. Data analysis An inductive analysis of the interview data was undertaken by the researchers using grounded theory methods, with data being managed by qualitative software MAXQDA (Kuckartz, 1988/2007). MAXQDA assists the researcher to systematically evaluate and interpret texts and is regarded as a powerful tool for developing theories and testing the theoretical conclusions of the analysis (Corbin & Strauss, 2008). The researchers implemented the following steps: 1. Participant interview transcripts were equally divided between the two researchers who then independently assigned inductively derived codes to sections of the text. 2. The researchers met face-to-face to review each others’ coding and discussed the meaning and appropriateness of code-labels. Some codes were renamed, and some smaller sections of texts were merged with surrounding texts and given a single code. 3. The researchers independently grouped the coded text into similar concepts. For example the following codes were grouped under the construct “experiential learning”: (a) experiential education → influenced by indigenous teachers; (b) received funding for a co-mentoring project → working together; (c) uses experiences in teaching → making information relevant/memorable; and (d) co-mentoring project brought team together → reinforced team work. 4. The researchers met face-to-face to review the grouping of codes into constructs and some were reassigned to another construct. Following discussion, some constructs were renamed. 5. During several intensive face-to-face meetings over 3 weeks, the researchers then grouped the constructs into larger themes. 6. The themes, including the statements comprising them, were sent to the participants for their feedback and clarification, when necessary. Changes were made based on participants’ input. 7. The themes were then plotted in diagrams displaying the various relationships to provide a visual overview of the themes and main constructs. 8. After a draft of the article was written, it was sent to participants with two requests: (a) that they insure the accuracy of both their statements and the interpretations of the researchers in categorizing them into constructs and themes; and (b) that they be sure that they are comfortable with statements that will be published, since in some cases the information given will make it possible for readers to recognize the identities of participants. Alterations were made based on this input. Results Before presenting the main themes that emerged from the interviews, some information on participants’ views of culture and worldview will be presented and the breadth of these perspec-

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Fig. 1. Worldviews of participants.

tives summarized in Fig. 1. Since the question that participants were asked, “What views do you hold that are a part of your culture that you believe may influence your music therapy or teaching of music therapy?” did not specifically ask participants about their worldview, not everyone spoke directly of this. One participant specifically addressed what her culture meant, while others referred to their worldviews, although they did not necessarily refer to them in that way. Some common threads emerged as the researchers analyzed the interview transcripts. One person spoke of culture as including her “perceptions, ideas, values and belief system” and also related to her “theoretical orientation, professional and personal experience.” Another stated that her worldview did not match the behavioral focus of training that was taught at the time. Worldviews were considered by one as “the sum of all life experiences, and my ongoing reflections on these.” This person described worldviews as a “dynamic, endlessly unfolding notion of how ‘things’ and experiences have meaning. This is both stable and shifting/flexible: stable in the sense of having a longitudinal narrative over time, and flexible, in terms of ongoing life experiences and ongoing reflections on these. It is not necessarily cumulative: Aspects get discarded depending on time and place.” The same participant, continuing the explication of her worldview, spoke of “reflective, responsive and responsible living” by explaining that she is “responsible for what I do, how I do it, for what purpose—and part of my personal ethos is to ensure a responsible and balanced engagement with the life energy and social forces around us. . .” She considers that to enact her worldview is to “live and do work that is life-enhancing.” Two of the participants spoke of their belief in equality, and that differences are to be examined. “The equality of human beings irrespective of age, race, color or religion and “difference is not “something to be avoided or ignored; it is to be explored and acknowledged as part of human and social diversity.” The former participant also expressed her belief that “people should have freedom of expression.”The value of music and musical skills as applied in active music therapy was communicated by one person who said, “I look at almost everything in music therapy—clinical practice, education and research, through my musician’s eyes, even

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Fig. 2. Influence of culture on the work of music therapists.

though I am also influenced by my clinical background, research understanding and political views. Music therapy is really about the power and effect of music to create change.” This person went on to say, “Musical technique and skill, when applied in active music therapy—makes all the difference” and “My first and fundamental view is the incredible importance of musical skill and ability in all areas of music therapy—clinical, educational, research.” Four themes were inductively created to represent the main influences of culture as understood and described by the participants in this study (Fig. 2) and comprise the influence of culture in shaping worldviews, on clinical practice, on teaching, and on perception and thinking about the therapeutic process. One participant emphasized a point that is relevant to all: The perceptions and views of these participants do not necessarily represent those of others from their culture. Each is an individual who has had his or her own personal influences in addition to those of the culture. Each of the four themes comprised a number of constructs. Details of these constructs and examples of text illustrating each are included in the tables. Theme 1: cultural influences in shaping worldviews The factors affecting the development of participants’ worldviews include personal experience and societal influences from where they lived (see Table 1). Perhaps most commonly reported was the impact that engaging in multiple cultures had on their worldviews, with bi-cultural experiences shaping views about the need to make an effort to learn the cultural beliefs of those from a different culture. One participant commented that he actively seeks out experiences from other countries since having resided in a different country than his homeland. Ancestry was an influencing factor in how they viewed the world, particularly for participants with indigenous roots and those with Jewish/Israeli heritage. Childhood musical experiences affected people’s relationship to music and their worldview about its power as a therapeutic medium, particularly in relation to music making. Similarly, family and generational factors such as being a child of the ‘60s where free expression was valued, childhood memories of faith healing and magic, and being a descendent of holocaust victims and

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Table 1 Cultural influences in shaping worldviews. Construct

Examples of text relating to constructa

Engaging in multiple cultures

Living, studying and working in New York. (P4)b Getting to know other cultures, religions and traditions more closely enriched my life and gave me deeper understanding of other people’s lives. (P4) It has been great to be exposed to bi-cultural learning (interface between Maori and white pakeha understanding), because this is a strong part of health and education here. (P8) My perspectives as a music therapist have definitely been influenced by my experiences traveling and living abroad, especially the 2 years I spent in New Zealand teaching and working as a clinician. (P12)

Ancestry

Undoubtedly, the strongest cultural influence in my music therapy practice and teaching has been my indigenous roots . . . Another principle coming from an indigenous worldview is the tendency to see things in wholes instead of parts and to acknowledge the interconnection between all things. (P1) Being Jewish and an Israeli who has been living in Israel most of my life has shaped my identity and contributed to my value system and to the way I view myself and the world. Tradition is very important for me. (P4)

Childhood musical experiences

My education in piano studies and composition at the Royal Academy of Music in London as a young child was with a teacher of Welsh and Latvian parents, who was brought up in Zimbabwe and later studied with Nadia Boulanger in Paris and Harold Craxton in London. (P10) Starting to learn instruments from an early age (4) and the process of learning to mess about in my own time on the piano (and later violin and voice) provided a huge music therapy influence. Music ‘occupying my time’ and stopping me getting bored was the first thing. (P8) I love singing Norwegian songs and listen to Norwegian classical music that has direct connection to my childhood. (P3)

Family and generational factors

Remembering old memories of faith healing and legends of magic from my childhood together with my experience in a materially extensive neurosurgical rehabilitation clinic, there is something about the body and the rest of being human which has been a constant element of my awareness in the cultures I have lived. (P10) Another strong cultural influence would be that I was a child of the ‘60s who came to value expression as one of the key elements of my approach to music therapy. This is also cultural. (P1)

Traumas

Traumas caused by the holocaust, wars and terrorist attacks have been a major influence throughout my life. Knowing that almost all of my father’s family and some of my mother’s family were killed by the Nazis during the holocaust influenced my way of growing up and has later shaped my work. My whole identity has been shaped by these traumas. (P4)

Societal and governmental policies

One aspect of this was the existence of the National Health Service in my country: i.e., free medical service for everyone. (I think many English people are very proud of this part of our culture.) I notice this having moved countries in the last 5 years, to a new culture where users pay much more directly for primary health care and music therapy is having quite a hard time establishing more than a few sessions in hospital settings. (P8) I have lived half of my adult life in Canada. Several elements from this culture have influenced my work. Probably the strongest influence has been socialism. In Canada, social justice has always been at the top of the list of values. I always felt that music therapy was an initiative of social justice. I felt that human beings had a right to health and free expression, no matter what their conditions. The Canadian government funded a lot of my clinical work in Canada. (P1) For me, space is important. Since we live in such a small land, we have to respect our space each other. Otherwise, we can go crazy! (P9)

Spirituality

Opening ourselves to the mysterious qualities of life and music therapy. Respecting and trusting the unknown Respecting and trusting intuition Musicking: listening, playing and creating music can open the way to spiritual experiences Musicking can create peak experiences and allow for transformation to take place (P4)

Feminism

As a woman therapist, I view feminism as my duty to try to remove all barriers that limit my clients’ personal, social, political, economic, creative, sexual and spiritual potential. It is about improving, fulfilling and empowering women’s and men’s lives. Women need to tell their stories in order for them to be heard and read. Sharing our journeys results in many possibilities to regain power in our societies and revitalize human beings’ feminine side. (P4) Most of my clients, students, and supervisees are women. Power is one of the central issues that is constantly being raised and dealt with in my practice. Most, if not all, women who come to me for music therapy have experienced power in negative ways—loss of power, misused power, false and negative power. My women clients were being raised in cultures where women are being dominated by men. They come from patriarchic families where fathers and even older brothers consider themselves to be more important than women; families where they were raised up with men’s specific stereotyped expectations of wives, mothers and daughters concerning rights, duties, household tasks and certain behaviors (in regard to how to dress, how to talk and how to behave, etc.). All these usually result in women’s low self-esteem, poor self-image, confusion in regard to who they are and what are their values, needs and wants and denial of their right to live their lives according to their beliefs and what they stand for. (P4) In my practice I try to help women to reconnect with their healthy, instinctual, intuitive place of wisdom and to regain power via talking and music. There are special moments in my music therapy practice, when I and my client experience our female psyche vibrates and radiant while playing or listening to music. (P4)

Philosophies and beliefs

Later, when I began to “study” in a serious way, the Eastern philosophies seemed to resonate so entirely with the indigenous worldview that I was attracted to these as well. (P1) When I was traveling in the north of China with my Indian mother, we visited an ancient Banpo archeological museum in a remote area (not too far from Xi’ian). There we were stunned with the similarity between the arts and artifacts of these ancient peoples and our own Native peoples. This is a moment I’ll never forget! (P1) Therapy is a very important way of understanding oneself. Before one becomes a therapist and works with others’ inner worlds, one has to get to know oneself and be a client in therapy, preferably music therapy. (P4) Human beings are cultural beings—human beings are musical beings. Both culture and music play an important role in building and strengthening cultural self-identity. (P4) It is my commitment to finding, rediscovering and strengthening human characteristics such as the ability to feel, to express, to share, to support, to care, to nurture, to hold, to contain, to intuit, to understand with, without and between words. (P4) Humanism fits this set of beliefs very well because it combines empathy and respect and it also suggests that the therapist is only human too. (P5) My biography has led me to see personal narratives as a group phenomenon. This means, as a group we construct personal narratives and it is the weave of these narratives that gives content and form to society. I have been brought to see experience in narrative form, with a beginning, middle and end, and many further variations of temporal elements. (P10)

a b

Spelling and other aspects of style used in the U.S. are used in the quotations. All statements in the tables have been attributed to the participants who made them, labeled P1 to P12.

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survivors shaped worldviews. Further, identity and worldviews are shaped by traumas such as terrorism and the holocaust. Being exposed to different aspects of societal and governmental policies has shaped people’s worldviews about whether healthcare should be free or a service that is paid for by consumers. Concepts such as social justice, altruism, and openness were factors influencing worldviews. The geographical limitation of “space” in Japan has led to reflections and worldviews about what space means in a therapeutic context. Beliefs about spirituality such as intuition, peak experiences, and transformation contribute to shaping worldviews. Feminism is an influence and guides the participant toward removing barriers that keep both women and men clients reaching their potential. Being disempowered due to living in a patriarchal society has also shaped views about the need to empower women. Finally, philosophies and beliefs influence worldviews. One participant experienced that Eastern philosophies resonate with Native American culture. The importance of personal therapy, preferably music therapy, was expressed. The influence of humanism and the value of personal narratives as a group phenomenon were identified as influencing clinical practice and teaching. Theme 2: cultural influences on clinical practice The researchers identified five main constructs that best describe how culture influences clinical practice (Table 2 ). The data showed that local music traditions influenced how clients’ rhythmic patterns could be interpreted (or misinterpreted), depending upon whether one is considering analyzing the music according to western or African musical styles. Similarly, attitudes towards atonality in Northern Europe suggest that it is considered the ideal medium for free expression. Countries that have a strong tradition of music making (including singing) may find it easy and natural to engage people in music therapy. However there is not a strong culture of amateur music making in Denmark and Southern European countries. In some cultures, music is used in therapy while in others, music is used as therapy. Music is viewed as recreation, not therapy in some cultures. Several parts of participants’ texts described global music traditions that influence clinical practice. For example, the way that one plays is important to “being, creating identity.” A number of participants across several cultural groups acknowledged that listening was the most significant aspect of learning music. The varied roles that music plays in different cultures were also noted by participants. The impact of clients’ and therapist’s backgrounds on process was a construct regularly discussed by participants. In some cases, participants’ struggled to understand and be understood by clients from different cultural backgrounds. One music therapist expressed feelings of inadequacy when she felt she did not have all the tools to understand her client. Early experiences of people and places on clinical work was another influence. Attitudes and approaches of a number of professional people (not music therapists) have left strong imprints on the participants and have contributed to views about interdisciplinary team work, understandings about learned musicality, and views about supervision. Not surprisingly, cultural influences on therapeutic interaction were raised by many participants. In Chinese cultures, Nin-Gen means human + space between, where space is identified as being close to silence and necessary in interactions. Listening, modesty, and respect are relevant to Asian cultures as well as the Yin Yang where balance is important and one person compensates for the shortfalls of the other to make the unit more complete or balanced. Indigenous cultures lead to clinicians being more “permissive.” In some Asian cultures, each person intuitively sings a Hokkaido rather than following some predetermined score. Further, in the

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Asian culture, the hierarchy of elders being talked up to may be challenging for the clinician, since the elders are the ones that “make the decisions.” This hierarchy presents further challenges for working with children when the therapist attempts to meet them at “their level.” One participant indicated that, as a woman therapist in a culture where women’s place in society differs from men’s, she needs to reflect on and analyze the situation before she responds. Theme 3: cultural influences on teaching The researchers derived six constructs from the data that represented the influence of culture on teaching. Early experiences with people and places influenced people’s teaching approaches. One participant discussed how her work environment promoted experimentation with ideas which she now finds influences her teaching approaches. Peer-learning as a student led one educator to develop a strong appreciation for this approach in her own teaching. Styles of and philosophies of educator–student interaction were identified. For example, educators’ own cultural experiences led to more cultural sensitivity in working with their own students. Another construct was the influence of teaching multicultural communities. Working in a multicultural society can be complex, and, when there are mixed cultures within a group, the therapist’s worldview of equality works to encourage acceptance and understanding of difference. Culture influences teacher–student interaction, and these issues were addressed by several participants. These included “westernized” influences on adopting a supportive role with students, a teaching style not thought to be used in Eastern cultures. Influences of philosophy on teaching practice were related to culture and were coded ranging from encouraging students to discover their true nature, putting one’s own views aside as an educator, “walking beside [students], offering a hand,” and a belief that musical tradition helps to formulate and build identity and enhances a sense of belonging.” Cultural influences on teaching strategies were seen in participants’ use of experiential learning (influenced by indigenous views, team-work approaches, and funding) and collaborative learning, “listening” carefully, focusing on students’ strengths and being permissive, assisting students to go deeper into their questions, teaching students to develop healthy habits (to combat the culture of “work until you drop”). Some educators made observations and comparisons of cultures and the differences that these made in teaching. For example, students in one culture were considered to have personalities that were stronger, with more depth, than those from another culture (Table 3). Theme 4: cultural influences on perception and thinking about the therapeutic process Culture has undoubtedly influenced participants’ perception and thinking about the therapeutic process. The data indicate that culture influences identity and values such as respecting other people’s cultural biography, acknowledging the role that music therapy plays in the context of an economic and political context. Participants’ responses revealed that worldview is dynamic and unfolds over time as they were exposed to other cultures. Some were more stable. While several participants’ shifts in their culture depend upon their context, this was particularly the case for participants who had lived in more than one country during their childhood. One participant commented that music therapy practice and worldviews were involved in a mutual, reciprocal engagement—each one impacting the other. Worldviews and culture were perceived as enriching but also limiting work as a music therapist.

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Table 2 Cultural influences on clinical practice. Construct

Examples of text relating to construct

Local music traditions

Israeli folk songs are an integral part of Israeli and Jewish tradition. I believe that musical tradition helps formulate and build identity and enhances a sense of belonging. (P4) I think that the concept of music as therapy is very strong in southern Europe, and this is a cultural thing. They use music for strong and overt emotional experiences. (P11) I sometimes find the attitude to music making rather singular in the south. For example, in the north of Europe, we count free, atonal improvisation as the ideal medium to allow people to freely express themselves. In the south, they are much more oriented towards group rhythmic playing, often with unified beats such as - -. . - (P11) In Denmark, people are quite used to singing—good for MT. (P11) Southern African indigenous music making can be characterized (from a Western frame) as consisting of fairly short musical phrases that are repeated. Since music making is generally not separate from collective dancing/movement, these dances can go on for a very long time. As western musicians we may hear that “the musical phrases”’ are repeated over and over, with some variations and elaborations in terms of volume and harmony. Generally, though, there is little development of a melody or rhythmic pattern, as there would be in Western music. If we engage in music therapy co-improvisation with people from indigenous musical traditions, then our distinctive musical norms need re-visioning and negotiating. Someone from one of the indigenous musical traditions would become rather overwhelmed as a client, improvising with a music therapist who could only improvise according to Western musical traditions. This would feel uncomfortable and “difficult.” In addition, the “Western trained”’ music therapist working with a person from such a tradition would then need to consider how to make clinical interpretations on this basis. Thus, for example, in the Nordoff–Robbins assessment scales, the word “perseveration” usually refers to repeated playing, which limits the co-improvisation between therapist and client. This has the connotation of a more limited relationship, and has a lower score in terms of musical relationship. However, this is not an appropriate gauge when working with clients whose indigenous traditions are precisely those of ongoing repetition. (P6) Music is one of the most prominent elements of the various forms of cultural expression in Brazil. People sing, dance or play popular songs and the presence and importance of these activities can be felt in clinical practice. Also, lullabies from our cultural roots—Portuguese, Indian, and Negroes—which are used by mothers with her babies, are employed as a music therapy technique with premature babies (in neonatology). Besides that, it is very common that the patients sing songs from childhood in the music therapy sessions. (P7) However, they also may regard it primarily as a recreational activity, and therefore music therapy as a recreational therapy – bad for MT where we want them to perceive it as a serious therapy. Perhaps that is why the concept of Community Music Therapy—and musicking emerged in the UK—a way of attaching to the recreational and casual form of music making with a sort of music therapy wrapper around it. Also not good for the serious credibility of MT. (P11) For example, Esashi-Oiwake, a folk ballad that is still sung by so many people in Hokkaido, has no music sheet. Each person gets in touch with his/her here-and-now intuition to sing. Therefore, Esashi-Oiwake was never the same. (P9)

Global music traditions

The way we “play” has been a leading characteristic throughout all the geographic sites in which I have been a part of culture and no matter whether listening to a Bach Cantata or a steel pan band, the way someone plays has always been seen as a unique, personal and social way of being, of creating identity and being an individual. (P10) My formal music education has taken place on an Atlantic island (Bermuda), two islands in Europe (England and the Republic of Ireland) and on “mainland” Europe (Germany). In all of these geographical settings, listening has been emphasised as the foremost most significant aspect of learning music. (P10) Sometimes the specific music of the culture is the common ground between the music therapist and the patient, thus allowing an easy connection between the two and facilitating the therapeutic relationship. This may function as a way of creating and/maintaining the link between patient and reality, mainly when they are in psychiatric hospitals. (P7) The cultures in which I have generated worldviews have very different roles which are allocated to music within society. Where in one geographical location (Bermuda and to some extent in Ireland), music is permanent, a clearly referential phenomena as a part of everyday life like cooking or physical recreation, in another location it has been temporary (England and Germany), more restricted to performance sites, concert halls, stages, something that is put on at specific times. (P10)

Clients’ and therapist’s backgrounds

My worldview greatly affects my work in how I respond to and interact with clients and students from countries and cultures which are different from my own. I now approach and interact with students and clients from other cultures in a much more open and proactive way, taking care to try to be empathic to how they might be experiencing their therapy or education as a non-Western student or client. (P12) The absolutely first strong feeling that I encountered upon returning to Israel was: “I really can understand my clients, their speech and body language, their customs.” It was more than the Hebrew language; it was my feelings towards the genuine warmth I felt towards the people I worked with. I felt understood and understood them. I did quickly translate many of the wonderful children’s songs I had learnt in the USA, but felt that I was singing it for different ears. I and my music had become more free, flexible and open and of course the clients responded accordingly. (P3) I believe we have to listen to our clients when we work and I am not sure I have all the tools to be able to listen to the ‘whole’ person when working with a client. I could probably understand him but maybe not fully “feel” him/her. (P3) One aspect of this was the existence of the National Health Service in my country: i.e., free medical service for everyone. (I think many English people are very proud of this part of our culture.) . . . I notice this having moved countries in the last five years, to a new culture where users pay much more directly for primary health care and music therapy is having quite a hard time establishing more than a few sessions in hospital settings. (P8)

Early experiences of people and places

A very musical speech therapist, with whom I collaborated on stimulation of communication on many levels with autistic and other children (and then co-worked with a private neurological patient) taught me about the importance of professional collaboration between colleagues and the value of bringing together music therapy and speech and language therapy goals. (P8)

Cultural influences on therapeutic interaction

I could see myself acting (more or less) according to the hierarchical expectation in Asian culture when I was working with the elderly, that is, you always “talk-up” to people older than you are, and they are allowed to make the decision—although I would have to help them sometimes (in Asia, the elderly supposes to be the decision). The emphasis of hierarchy in the Asian culture (therapists are considered authoritative figure-like teachers), on the other hand, is what I have to be cautious especially when working with younger and more vulnerable patients. (P2) We have a Japanese word written by Chinese character “Nin-Gen” that means human. Nin indicates “a person.” Gen indicates “space between.” So, space is very important for humans. (P9)

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Table 2 (Continued ) Construct

Examples of text relating to construct Here is the two in one: As two people start communicating with each other, the circle revolves faster and the boundary becomes ambiguous. It can go to a moment where you do not really know if it is me or you, or it is me and you . . . Then eventually, our spin slows down towards the end of the process of music therapy and I am more aware of the boundary between us but the two are never completely separated from each other, or even from the whole. As I think of a music therapy session with a client, this description immediately felt at home to me. (P9) Although I do not agree that females do not have a voice, it “conditions” me to listen and analyze first before I “dare to” respond—not necessarily a bad thing. (P2) An overall approach in my clinical work and my teaching that has its roots in the indigenous approach is a tendency to be very permissive with both clients and students. Though I can give critical feedback to students, I usually work in a modified Socratic method in which I keep delving deeper and deeper into their own questions. (P1) The work ethics, the emphasis on listening skills/modesty, etc. may be more Asian than western to me in terms of cultural orientation. (P2) I felt that the meaning of the self and individuality was clear among the people in Canada. People always say “I” at the beginning of any sentence. People seem to be independent physically, psychologically and economically. I was freshly and deeply impressed by learning how differently women live their lives. There seems to be a clear difference between “I” and “You.” I could picture separate circles and point each circle saying “I” and “You.” However, somehow, I did not feel at home. I rather thought of the being of two people as an oval with two centers. When I came back to Japan, one of the researchers in phenomenology described two people as Chi. (P9)

Participants who had worked in both Western and Asian cultures provided rich data on how thinking and therapeutic processes differ. Several subcategories emerged. Aesthetics as a concept that there is beauty in everything was highlighted, similarly “optimism” in Asian cultures featured in the data. With respect to the concept of therapy, Eastern culture emphasizes the preventative rather than the curative, and balance (ying-yang). The ambiguity as a feature of Japanese culture may influence interpretation of communication which is typically indirect with the use of metaphors that may contain multiple meanings. Their music is also typically ambiguous in sound, rhythm, tempo—music in the moment. Some participants were influenced by indigenous cultures. These included the concept that the “process is the product,” and that things are perceived as interconnecting wholes. Culture influenced participants’ views that there is a need to understand/defer to the client’s perspective. Specifically, local norms and values concerning illness, health, and music impact on music therapy practice, that is, music therapy needs to take place within the context. A person’s theory of music therapy is influenced by culture. For example, in Canada, there was respect for ecology which permeates the clinical work (Table 4 ). Discussion Being aware of one’s own assumptions, understanding the worldview of clients from different cultures, and developing culturally sensitive intervention strategies and skills (Sue & Sue, 2003) are regarded as important by those in the field of counselling. These were “sensitizing concepts” and guided the researchers in their analysis of responses (Bowen, 2006). A growing body of music therapy literature points to similar concerns that the authors sought to contribute to through uncovering the worldviews that impact on how music therapists work in other countries. There were a number of interesting aspects of the study. First was the areas in which culture was found to influence music therapy. Second was how varied the participants’ perspectives on these issues were. Third was how different the actual responses were from what the authors had anticipated. These will be discussed along with the implications of these findings for how music therapy students are educated and for music therapists working increasingly in multicultural societies. The areas in which culture was found to influence music therapy—in shaping worldviews, on clinical practice, on teaching, and on perception and thinking about the therapeutic process—illustrate the breadth of the impact of culture and thus of the implications of this study.

People’s worldviews were quite different depending upon their backgrounds and other factors. Engaging in multiple cultures was often reported to affect participants’ worldviews and as societies become increasingly more multicultural, the importance of understanding how such exposure and engagement shapes worldviews is becoming more relevant and critical for the profession. It was also striking how many different things seem to have influenced people’s worldviews—as varied as childhood musical experiences, societal and governmental policies, and traumas. Influences on clinical practice were varied. Cultural influences on therapeutic interaction were raised by many participants, with very different examples from Asian and indigenous cultures. Local music traditions were often found to have an impact. This included the interpretation of rhythmic patterns, how atonality is viewed in music therapy, the role of singing in music therapy, whether music is viewed as recreation or therapy, and whether music in therapy or music as therapy dominates the clinical practice. Influences on teaching included striking and varied influences on teaching strategies. They included (a) belief that the educator’s role involved the creation of space for the exploration of the student’s systems of belief and construing; (b) awareness of the importance of students’ experiences within written or oral traditions has significant effects on the student’s oral and visualization abilities when listening to music; (c) a tendency to be very permissive with both clients and students; (d) awareness of the need to be able to put personal beliefs aside and to try to understand the views of the other; (e) the use of experiential education; and (f) helping students to develop healthy habits. The data showed that teaching strategies were clearly connected to the (multi)cultural experiences and traditions of the music therapy educators and the societies in which they were teaching. Influences on perception and thinking about the therapeutic process also came from a wide variety of cultural sources. These ranged from an acknowledgment of economic and political contexts and their influence on the role of music therapy. Participants who had worked in both western and Asian cultures or western and indigenous cultures provided rich data on how thinking and therapeutic processes differ. Participants’ perspectives on these issues were quite different. This is reasonable given their different cultural backgrounds and, of course, examining these differences is the point of the study. Since the researchers chose to ask a general question and thus be open to various responses, there was ample opportunity for people to make their own interpretations of the topic. Given the different cultural backgrounds of the participants, it is not surprising that viewpoints were so different. The very fact that they would be so

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Table 3 Cultural influences on teaching. Construct

Examples of text relating to construct

Early experiences with people and places

The influence of working so long at a music conservatoire (10 years as a part-time tutor and placement supervisor and 13 as program director) did of course have a big impact on my values in music therapy and as an educator. It was a flexible setting to develop things—not always very organized or efficient in my early years there, which had its frustrations!—but it meant that artistic values and ideas could be experimented with. So the idea of the training program being a place to experiment and learn was easy to foster. Teachers and I could try out ways of teaching and learning, and it was easy to allow new staff to develop and adapt the curriculum to suit new ideas and their particular strengths. (P8) I remember emphasizing to students how important was the learning from your peers and the value of music in group therapeutic process. (P8)

Teaching multicultural communities

I have taught very religious students (with right-winged political views) who worked with children of terrorists. This has raised many cultural and ethical issues that I could only tackle as a result of being secure about my own culture. (P3) I have learnt that it can be extremely enriching to have a mixture of students where we can share our cultural beliefs with one another, accept each other even though there can be many cultural differences. (P3) In sympathy with this multicultural, multi-dimensional position, I have tried to be very open to listen to as many different perspectives on research as I can, and be respectful to the genuine passion so many generate and communicate. So the visitors to our university—our guest teachers—that I have invited over so many years really are very representative of a wide range of [international] excellence. (P11)

Culture influences teacher–student interaction

When addressing my students’ concerns, I enjoy being a more supportive role, sometimes even as a “big sister,” which is considered as more “Westernized.” (P2) Sometimes I think this is a bit of a “woosy” approach. Since I don’t believe that “I” can help, only that I might be of some help to the person, I also can’t fail. (P5) Many students describe my teaching as “sword made of clouds”, which comes from a Martial Arts movement. . .. He explained to me that “sword made of clouds” was a move in martial arts that is very hard to do. He interpreted my teaching style as one that seemed soft and illusive on the surface. But in reality, it was cutting to the chase, and quickly, without students awareness, cutting away all of the nonessentials. (P1) Consequently, the effect on me as a teacher, in both northern Europe and the south, is that I have found I try and redress the balance in both situations. In the south, I demand they spend more time with free improvisation, atonality, losing the pulse and listening. In the north, I demand they offer more music structure, give clear harmony and tonality to support the client, and don’t always assume that free improvisation is fit for all. (P11)

Influences of philosophy on teaching practice

I’ll do everything I can to make opportunities for growth/healing/pleasure, but I don’t take responsibility. It is not my life. That’s a whole other story. (P5) I’m sure this is true of all people in all cultures, but what I mean by respect is that I don’t really assume that I will be able to help them, I prefer the idea of walking beside, offering a hand, being there for the people with whom I work. (P5) I have to say that my teaching approach/clinical approach came more out of the influences of my Native American mother and her relatives because this approach just seemed to come so naturally. (P1) Israeli folk songs are an integral part of Israeli and Jewish tradition. I believe that musical tradition helps formulate and build identity and enhances a sense of belonging. (P4)

Influences on teaching strategies

As an educator, I feel that my role also involves that creation of space for the exploration of the student’s systems of belief and construing. The educational journey is more orientated to the students’ process of uncovering their constructs and interpretations. I like to think about it using this phrase: “It is not the world, but it is your eyes in their context which you are seeing.” (P10) In an educational setting, the relation for the student between their experience within written or oral traditions is an important consideration. Each tradition has significant effects on the student’s oral and visualization abilities when listening to music. Both situations provide the student and teacher with unique opportunities to explore how music is perceived both from a cultural perspective and also a neuropsychological perspective. (P10) An overall approach in my clinical work and my teaching that has its roots in the indigenous approach is a tendency to be very permissive with both clients and students. Though I can give critical feedback to students, I usually work in a modified Socratic method in which I keep delving deeper and deeper into their own questions. (P1) I believe that as therapists or educators we need to be able to put our own beliefs and views aside (as the example I gave about treating the child of a terrorist) and try to understand the other side’s views even though they may be very different than mine. (P3) In terms of teaching, there is also a strong tendency for me to follow the pedagogy of indigenous teachers, which is one of experiential education. You know when you do. In my many years of teaching, I have always valued experiential education above any other pedagogy. (P1) Although not necessarily culturally unique, the Asian has been educated to “work until you drop.” Learning to address the psychological and physical needs to maintain healthy working habits was a bit foreign to me, but I enjoy preaching the importance to my students now. (P2)

Observations and comparisons of cultures

I find myself relating more and more to my Israeli culture when I teach, think, write . . . than to any other culture I have lived in. I bring clinical examples from Israel. I teach the students Israeli dances and songs but find it is difficult to teach Norwegian musical activities. I love singing Norwegian songs and listen to Norwegian classical music that has direct connection to my childhood. Then something emotionally is turned on which I find too personal to share with others. (P3) On reflection away from the setting in New Zealand, this looks like an amazing luxury—as I have to encourage ongoing music making and learning in much more serendipitous ways amongst current students. There is neither the money nor the time to fit in such practice. Maybe it somehow took students on the wrong journey with their music sometimes . . . it depended on the teachers I suppose—perhaps leaving them less time to do applied work with their music? I am not sure really—I think I miss, in my current setting, that I can’t enforce spending a lot of time with their music making—though I suspect other things are gained. (P8)

different suggests part of the reason that this topic is so important and also so difficult to deal with. The areas that participants presented were quite different from what was originally expected. The original proposal made by the authors said, “We will attempt to uncover assumptions that guide people’s views of music therapy but that may not have been exam-

ined previously” and suggested that questions (and thus responses) might address therapy, including the value given to therapy and expectations of a client from a therapist; spirituality; the role of the therapist; and the relationship to music. Although specific questions were not posed to participants, no response actually addressed the value given to therapy or the expectations of the

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Table 4 Cultural influences on perception and thinking about the therapeutic process. Construct

Examples of text relating to construct

Culture influences identity and values

I can enjoy this now because I feel very strong about my own cultural identity. This in turn makes me open to others without losing myself (as I did in the US). (P3) Respect of, and an authentic interest in the cultural biography of others But what does this mean? I think my interest in the cultural biography of others belongs to a system of values which I have learned from the places in which I have lived (Bermuda, England, Germany and the Republic of Ireland), this seems to be something that is common to individuals who have lived in different geographic locations during their lifespan. (P10) I believe that we are able to make choices. In terms of health care and the role of music therapy, I have a variety of experiences that has led me to think that simple choices can be used to create health care policy and that there is a need to differentiate between economic issues, physical viability and the culture of care which we choose to create. This is political. (P10)

Worldview is dynamic and unfolds over time

To summarize, I had adapted to the American culture extremely well, but my heart must have been in Israel. I felt differently when I sang Chanuka or Passover songs in Israel than when I sang X-Mass songs in the USA. (P3) However, I definitely thought of music therapy as a United States profession, and really saw music therapy through “American” eyes. This remained the case for many years (until 2002), when I moved to New Zealand to teach and work, returning to the US in 2004. It is interesting that my US perspective was not really affected by short-term international experiences like attending a World MT Congress (1999 in Washington, DC) or visiting England twice in the 1980s to observe British music therapists. These trips led to an article in Arts in Psychotherapy I wrote titled “Hands across the water: Impressions of music therapy in England.” Even though I was greatly impacted by those trips (enough to write an article), I think that I was still “US-centric” in my core music therapy values. I also recall responding positively and strongly to international music therapists whom I visited in the US (e.g., Clive Robbins at NYU), or whose sessions I attended at US music therapy conferences (e.g., Claus Bang). However, I again do not recall these experiences really affecting my core views. (P12) I would say that all of these have shaped my worldview(s) and I don’t have a single, coherent “culture”: rather a shifting one depending on whether I am with family and friends in South Africa, Continental Europe or the UK. (P6) Cultural music therapy values in a new place—New Zealand. I find it a bit hard to know what my cultural views/beliefs are here because I am immersed in the middle of it! (P8) My views and relationship to my culture have changed with the years and as a result have influenced my clinical work and teaching accordingly. (P3) This is a dynamic, endlessly unfolding notion of how “things” and experiences have meaning. This is both stable and shifting/flexible: stable in the sense of having a longitudinal narrative over time—and flexible, in terms of ongoing life experiences and ongoing reflections on these. It is not necessarily cumulative: aspects get discarded depending on time and place. (P3) I would like to say that I don’t see this as a one-way street: yes worldviews impact on MT work (i.e., clinical work and teaching), but at the same time, the other way holds true: that my MT work has also shaped my worldviews; I would prefer to explore the link between the two; and in fact, part of my worldview is that I would hesitate to separate them in terms of the living experience of MT. (P6)

Asian cultures

I believe that “aesthetics” to Japanese (me) has a great deal to do with a sense of what we call “Wabi-Sabi.” . . . I can also say that it means “a true being and/or essence that is actually very simple.” So, what aesthetics really means is the importance of our heart that can feel/sense “beauty” in everything. Basically, a sense of beauty can be felt by individual’s sensitivity and it cannot be decided as a single definition. (P9) The Eastern medical practice indeed emphasizes more the preventive than curative treatment. (P2) This client-centered approach is not traditional to most of Asian cultural practices, which seem to emphasize the importance of hierarchy and authority. (P2) The Eastern culture emphasizes the concept of balance (“ying-yang”), which keeps my “optimism” in the therapeutic treatment design (“whatever is not happening does not mean that it will not happen; regression may be necessary for taking the next step”). (P2) Ambiguity is everywhere in Japan. I can see ambiguity in our language, attitude, communication, arts (including music, of course), the concept of the self. Ambiguity is not the same as “unclear,” “vague”’ or “noncommittal.” It is rather “certain but cannot be explained,” “having a multiplicity truth,”’ so I would say “yes, this is black and also white . . . however, I do not mean gray.” (P9) And of course, we often talk indirectly. People from a different continent may feel confused because it is not clear enough what and how to behave. However, having rich metaphors in own culture, we somehow know what it may mean (meaning can be multiple, not single) without clarifying it (but it does not work often recently, I am afraid, because our education system became really poor and superficial so that we are losing such sense). (P9)

Indigenous cultures

Undoubtedly, the strongest cultural influence in my music therapy practice and teaching has been my indigenous roots. These influences are reflected in my theoretical approach to clinical work, which is called “the Field of Play.” The seven elements in this theoretical model are the aesthetic, the musical space, the field of play, ritual, power, a particular state of consciousness, and creative process. A general informing principle of this theoretical approach is that the process is the product, which is apparent in all healthy Native ways of life. Another principle coming from an indigenous worldview is the tendency to see things in wholes instead of parts and to acknowledge the interconnection between all things. (P1) In music therapy this has been a rather fine thing . . . because Maori practice is much more holistic. For example, Whare tapawha (the four cornered house, where physical, mental, spiritual and family health are all equal cornerstones to be considered), articulated by psychiatrist Mason Durie, is used as a model in many mental health units here, and waiata (or song) is used regularly and significantly in this approach. (P8) Rather, MT needs to engage fully with these contexts, discern the contextual values and attitudes in order to become a socially-relevant and culturally responsive practice. As a MT practitioner and teacher in South Africa, this translates into clarifying and making sense of local norms and values, which may at times differ from the values and norms of the global narratives on illness, health, and music; and may well differ from music therapy professional narrative. (P6)

Need to understand/defer to the client’s perspective

As an Australian music therapist, I think I have an essential code of respect for the people with whom I work. (P5) I believe that as therapists or educators we need to be able to put our own beliefs and views aside (as the example I gave about treating the child of a terrorist) and try to understand the other side’s views even though they may be very different than mine. (P3)

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Table 4 (Continued ) Construct

Examples of text relating to construct My fundamental worldview in relation to MT work is that MT happens in time and place that is hugely diverse, and where values and attitudes are not a given. Rather, MT needs to engage fully with these contexts, discern the contextual values and attitudes in order to become a socially-relevant and culturally responsive practice. (P6)

Theory of music therapy is influenced by culture

Another Canadian value that resonated with me, as a Native person, was the respect for the natural environment. I have found this to be much more prevalent in Canada than in the United States. My clinical work often incorporated images of nature and my theoretical approach is decidedly “ecological.” (P1)

therapist, as had been anticipated. And spirituality, an area that was expected to generate considerable information from different cultures, was mentioned only occasionally, and none of what was said was in great detail. The role of the therapist was not addressed, although the practice of the therapist was. The relationship to music was the one area that had been expected and that several participants did speak of, including the importance of childhood musical experiences and that local music traditions affected their relationship to music. It may not be so much that the responses were different from what was expected as that there was a great deal of material in addition to what had been anticipated. This is logical and very much in line with the topic of this study: Because the researchers have their own cultural beliefs and perspectives on the matter, and they are different from those of the participants, the responses of the participants were quite different from those expected by the researchers. At two points in the research process, participants were given an opportunity to correct or clarify their statements and how the researchers had categorized them. The researchers and participants worked with any concerns until all were comfortable with how the statements were categorized. In most instances, particularly on the second reading, participants felt that the researchers had represented their statements and their intent accurately, although in one case several interactions about how the responses had been categorized were needed to come to agreement. The construct of Feminism was added as a result of this discussion. The addition of this important construct—and the fact that the researchers did not find it to be a construct initially—is an example of how people’s backgrounds and beliefs influence the outcomes of qualitative research. Its addition late in the process, though, also illustrates the value of receiving feedback from participants in a qualitative study and how it adds to the trustworthiness of the findings (see Aigen, 1995; Amir, 2005; Lincoln & Guba, 1985, for discussions of trustworthiness). It can be seen from this study that many different factors affect people’s worldviews and subsequently the way they think about music therapy. This emphasizes the need to be respectful of other music therapy approaches when educating students, given that they are practiced within a different context. For example, improvisation in Denmark uses atonality, which is different from the Australian context of using songs. Is this based on different cultures rather than necessarily different beliefs about what music can offer? Of course, there would be other examples in which different techniques may come from different cultures rather than (or in addition to) different beliefs. Other implications of the findings of this study have to do with music therapists working cross-culturally in a world where traditionally mono-cultural countries are becoming increasingly multicultural. As the world becomes increasingly multicultural, music therapists who have previously not experienced working with people from other cultures will find that they need understanding of other cultures and skills for working with people from these cultures. The findings of this study provide a beginning in how to approach this broadening of cultural understanding.

We return to the points made by Kenny (1994, 2006), who suggested that a successful multicultural therapist needed “awareness and knowledge of one’s own cultural identity, a wide range of experience in different cultures, a high tolerance for paradox, a capacity to embrace ambiguity, and resourcefulness and a good imagination (1994, pp. 12–13).” This study can provide insights into some of the areas needed to develop “awareness and knowledge of one’s own cultural identity.” There are limitations to this study. One is in the number of music therapists interviewed and the countries and cultures that they represent. Many countries were not included; it is likely that music therapists from those countries would bring different perspectives. And, of course, other music therapists from the countries from which these participants came would also have their own perspectives. This point was emphasized earlier and was evident among this sample when two music therapists from the same country had very different perspectives. Another limitation is that the participants may have held back on sharing certain viewpoints because they realized that they could be identified by them. It is not possible to insure anonymity in this type of study, and the researchers and the participants were all aware of this. Near the end of the study, participants were asked to be sure that they were comfortable with what would be published, since some of it might lead to their identification. All were comfortable with what was written in the final version in terms of the possibility of being identified from what they had said. A final limitation is that the two researchers brought their own perspectives to all aspects of the study. While representing different countries and also making every attempt to understand the views of the participants in all aspects of the study, they of course bring their own cultural views. Related research by people from other countries will broaden the perspectives that have been gained here. The findings of this study, based on the experiences of 12 music therapist educators/clinicians, provide insight into some of the complexity of working in multicultural settings. The participants, representing 16 countries, were all experienced therapists and teachers and presumably had a fairly high level of awareness of these issues. Expanding the findings to apply to a broader range of therapists, including other cultures and countries, will be valuable for music therapists seeking to work in a more culturally sensitive manner. Further, given that the researchers interviewed music therapy educators who had worked in at least two countries, there was an assumption made that such experiences would influence their worldviews and approaches to practice and teaching. To better understand how worldviews and practice are shaped, it would be useful for researchers to track the experiences of clinicians and/or educators over time as they leave one country and begin to practice in a different country. References Aigen, K. (1995). Principles of qualitative research. In B. L. Wheeler (Ed.), Music therapy research: Quantitative and qualitative perspectives (pp. 283–326). Gilsum, NH: Barcelona Publishers. American Music Therapy Association. (2008). AMTA professional competencies. http://www.musictherapy.org/competencies.html

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