Gender and Clinical Practices

As part of the study about culture and music therapy practices, I held two focus groups with music therapists that work in a variety of settings.  One of the groups had three males and two female music therapists as participants.  This is a unique combination in a field that predominantly female.   Not only is the field predominantly female, but music therapists also work in places such as early childhood settings, schools for individuals with disabilities, and facilities that serve older adults; all of which tend to be female dominated.

The unique composition of this group brought out some very interesting conversation about gender and music therapy practices.  The male participants described how they may have to face the perceptions of other people who are suspect of males working with young children or the challenges of people who think that a male might not know about how to interact effectively with young children.  

As the conversation continued, some of the female members of the group spoke about interactions with male clients.  One clinician brought up the social convention of males complimenting the appearance of a female and how complicated it can be when those social conventions cross into the therapeutic relationship.  It is important for the clinician to set appropriate boundaries, while not creating a tone of disrespect.

Both of these examples bring up some interesting ideas about gender role schema, or the expectations that we have about behavior based on socialized notions of gender.   We need to be conscious of not only our own beliefs about gender, but also the belief s of our co-workers, clients and client’s families in order to create understanding and avoid limitations.

The Language of a Group: Implications for Clinical Music Therapy Practices

I am currently working on a study to explore the implications of family and institutional practices of different groups of clinical music therapy practice.  These practices make up the local culture.  While some music therapists are employed by one agency and strictly serve one type of clientele, many music therapists provide contractual services for multiple agencies or work within institutions that such as hospitals or community agencies that provide services for people from a wide range of backgrounds and experiences.

An important component of culture is the language that a group uses.  I am not referring to just the type of language spoken (i.e. English, Spanish, etc.), but also the specific vocabulary and social intent that is connected with the group or institution.   Each group tends to have its own jargon.  For example, if you work in special education, you need to be familiar with concepts like IEPs, benchmarks and goals, and scaffolding.  Clinicians who work in hospitals need to understand the names of procedures and the labels and roles of different members of the team.  One study participant commented how parents were re-identified.  She indicated how the parent of a child in the hospital typically became known as “mom” or “dad”—identified by their role as opposed to their name or individual identity. 

As with all elements of culture, language shows us something about the beliefs and values of the group or setting.  For example, special education is very much driven by the need to use legal frameworks and guides such as the Individualized Education Program (IEP) to establish educational and therapeutic programming for children with special needs.  In the hospital setting, however, there is a team that surrounds the sick child and each member of that team has a role.  In both examples, the music therapist must develop an understanding of the culture of the institution and how to best work within that system.  One study participant indicated, “There are many things that are not spoken.”  It is therefore up to the clinician to take time to not only learn the vocabulary of the group, but also be a careful observer about the communicative intent in order to best understand the role of music therapy within that structure.  The study participant above reflected on her transition from a special education type of setting to a hospital setting when she indicated, “I found that I really had to tie into my humanness and my intuition and my sensitivities as a person more than a set of tools or songs or concrete things.”  She had to learn the expectations of the new group through their language.  She had to re-learn her way of being as a clinician. 

Studying Cultural Behaviors: Insights into Development and Learning

I find myself in the midst of a few very different qualitative research studies.  One study is examining the implications of family and institutional culture on music therapy practices.  Another study is examining how families interact with a local institution of informal learning.  The third study is looking at how individuals, as informed by their contexts, are navigating a new context.  While the populations are very different for these three studies (music therapists, families/ caregivers with young children, and college students), the central question that threads through all of the studies is the idea of how an individual’s local context shapes their experiences, transitions, and learning. 

Overall, these studies represent an exploration of cultural variables on a more micro level.  Rather than examining culture related to larger ethnic or geographic variables, these studies are an attempt to examine culture for day to day experiences.  In a previous entry, I shared Spradley’s definition that culture is the knowledge that allows us to interpret and engage in social behavior.  Each of these studies therefore attempts to examine the nature of the cultural knowledge and how that knowledge guides behaviors and learning.

What is the value of this sort of examination?  Why is it beneficial to examine the everyday lived experience?  In a recent conversation with a research colleague, we were discussing the perception of a researcher from the hard sciences who claimed that examining the everyday occurrences is just looking at what is common knowledge.  The researcher did not see the value in studying what is known.  Last night, I was reading a passage by Geertz in which he was talking about the nature of studying culture.   He was describing the importance of theoretical formulations in the interpretation of cultural behaviors.  Geertz claims that, “stated independently of their applications, they seem either commonplace or vacant” (p. 25).

So, what is the value of studying the common place?  I believe it’s about really seeing what is right in front of us.  I just finished teaching a child development course.  Students in the class were required to complete a child observation paper which included 4-5 hours of direct observation of a child or group of children.  Typically, students will select children that are familiar to them (i.e. cousins, friend’s children or even younger siblings) out of convenience.  By the end of the project, students often report seeing things in the child that they never noticed before.  In some cases, the transformation in their perception of the child is so significant.  They shift from seeing the child just as this loud, obnoxious child to really seeing how their behaviors are shaped by numerous factors.   The students use developmental theory to guide their interpretations of the children’s behaviors so the commonplace becomes a point of insight and understanding.

Careful examination of everyday behaviors as guided by theoretical formulations allows for deeper interpretation and understanding.  This process can drastically alter the way that we understand others and how we interact with them.  I believe this is the value of the commonplace. 

Geertz, C. (1973).  The Interpretation of Cultures.  New York, NY: Basic Books. 

Knowledge is Indeed Precious

Last week, PBS aired a film entitled Precious Knowledge.  This film highlighted a program in ethnic studies in the Tucson, AZ high schools which focused on Latino students and their rich histories.  The curriculum program was born out the need to support students with historically high drop-out rates who have been failed by standard educational programming. 

The film features bright, articulate students who talk about a sense of finding their identity.  The students were empowered to believe that they could shape their own destiny rather than being controlled by stereotypes and limitations.

 Unfortunately, the story took a bitter turn when the classes were swept up into the politics of a state that appears to be bent on controlling populations of people through scare tactics and legislation.  In 2011, the Arizona lawmakers passed legislation that effectively abolished the ethnic studies classes.   The more faculty and students tried to express their voices, the more there were labeled as radicals who were intent on overthrowing the government.

This poignant story underscores the importance of examining public institutions and policies that try to control parts of the population for their own good.  It is imperative that we look closely at our own lens and think about how our individual reactions shape the experiences of all of the individuals we work with whether they are students, clients or co-workers.  Are we creating a place for people find their voice or are we part of the efforts to control?

One of the courses that I regularly teach is an introduction to special education course.  Students who enroll in the course plan to become teachers in special education, elementary education, early childhood education or related human service fields.  At the end of the course, I challenge students by encouraging them to think about how they can become advocates for persons with disabilities.  I explain how advocacy can range from monitoring our own language and using language that is culturally and contextually sensitive, to learning more about different groups through active inquiry, to volunteering our time to serve others, to speaking up on the behalf of others. 

Watching Precious Knowledge brought the message of advocacy right home.  We can all be advocates.  We can all take a stand through our behaviors, beliefs and attitudes.  Most importantly, we can open our minds to knowledge from the world around us which can be truly precious. 

 Precious Knowledge. PBS Video. Retrieve from http://www.pbs.org/independentlens/precious-knowledge/

The Autism Community: Coming Together for Change

According to the Centers for Disease Control and Prevention, approximately 1 in 88 children will be diagnosed with an autism spectrum disorder.  The increased incidence of autism and related disorders is astounding.  When I started working as a music therapist in the early 90s, the prevalence figures were much less.  There were fewer supports for individuals with autism and their families.  More families had a sense of isolation.

With the increase of the incidence of autism, there is also an increase in the number of individuals and families impacted by this lifelong disability.  Early this morning, I volunteered for the Autism Speaks walk in Chicago.  Hundreds of volunteers, numerous organizations, and thousands of individuals with autism and their families and friends all convened at Soldier Field in Chicago to respond to the need to bring attention and dollars to this very important cause. 

As with many charity walks, people form teams.  The teams make t-shirts and carry signs in support of their friend of family member with autism.  Some of the teams were 50+ members strong.  It was wonderful seeing so many people rally around individuals and their families.  Families that many years ago would likely have felt very much alone are now surrounded with their friends and family.  Families are now surrounded by organizations and a promise for resources that will lead to on-going research and support.

There has been a dramatic change in the autism community over the years that is representative of the larger changes in disability culture.  There is a tone of empowerment and a demand for continued change.  The people that will see the benefit of this cultural shift are the many individuals with autism spectrum disorders.

Autism Speaks.  www.autismspeaks.org

New Data on Autism Spectrum Disorders. (March 29, 2012).  Centers for Disease Control and Prevention.  Retrieved from http://www.cdc.gov/Features/CountingAutism/

Race and Culture

In one of my classes we recently watched the HBO Documentary, Little Rock Central: 50 Years Later (2007).  This powerful documentary juxtaposes the school’s history with current challenges.  Over 50 years ago, this school was the focus on tremendous conflict because of the forced segregation of nine African American students during the height of the Civil Rights Movement.  The segregation was representative of the conflict of long standing racial beliefs and demands for change.   Fifty years later, things have changed and yet they have stayed the same.  The documentary shows that although the African American population is now the majority group at the school students of color continue to be marginalized in many ways.  Students and teachers talk about the barriers for African American students to be involved in advanced placement classes or other achievement oriented school activities.   African American students at Little Rock Central are more likely to be in remedial education or struggling with multiple socio-economic and family challenges.

One of the most compelling scenes of the film is when one of the Little Rock Nine,  Minnijean Brown, speaks to a group of current students.  Ms. Brown talks with the group of students about their own self-segregation within the classroom.  Several students claim that they are just sitting by people they know or one person cannot truly make a difference.  Ms. Brown tells the students that they are not making choices.  Their behaviors demonstrate a set of societal standards.  This scene is striking because we see a woman who engaged in such a courageous act as a teenager confront students who live under an assumption that they don’t have the power to change anything.

The documentary is interesting and provocative on many levels.  The story shows how the culture of the local institution is shaped in such a dramatic manner by larger social and legal issues.  The film also shows in dramatic fashion how culture leads to patterns of thinking that are very ingrained into individual beliefs. 

Minnijean Brown reminds us that one person can make a difference.  Her story demonstrates the importance of breaking out of stereotypes.  Her story reminds us all to examine our own belief systems.  Are we just playing out long standing societal patterns?  Are we aware of our own cultural context?

Little Rock Central: 50 Years Later. (2007). HBO Films

Scene: Minnijean Brown talks to a group of current students http://www.youtube.com/watch?v=d8Or8OBrMzg

Changing Cultural Practices: Music Therapy and Autism Spectrum Disorders

I was delighted to attend the Great Lakes Region of AMTA Music Therapy Conference this weekend.  I shared a presentation entitled, “Examining Cultural Practices and Contexts of Development: Implications for Clinical Music Therapy Practices”.  The presentation highlighted many of the ideas that I have been sharing in this blog and explored how ideas about culture and development shape clinical practices. 

I shared Bronfenbrenner’s Ecological Model of development as a guiding framework for the presentation.  His model emphasizes how each individual’s development is shaped by multiple layers of influence.  In short, we are never working with a client in isolation.  Each client is uniquely shaped by his or her family, community, prior experiences, ethnic identity, and larger social and political issues of the day.  Even the time at which an individual develops shapes his or her developmental trajectory.

 I worked with individuals with autism spectrum disorders throughout my career as a music therapist.  When I first entered the field there was very limited information available and the prevalence figures seemed to be a few individuals in 1,000.  The Centers for Disease Control and Prevention recently released updated prevalence figures that indicate that 1 in 88 children are diagnosed with an autism spectrum disorder.  These numbers are absolutely shocking.  In addition to the increased numbers, there is also a dramatic increase in the information available about autism and approaches for treatment and support.

Knowledge and beliefs change over time.  It is more likely now, that children with autism spectrum disorders will be accurately diagnosed and connected with appropriate services.     Music therapists and other clinicians can access a wealth of research and first person narratives to better understand how to best serve a client with autism.  Living at this time creates a unique set of circumstances which will impact the development of each person. 

Changes in the autism community represent one example of changes in culture.  These changes have tremendous implications for families, schools, communities, health care, legal systems, and larger social structures.  Additionally, these changes have tremendous implications for music therapists and other clinicians.

Bronfenbrenner, U. (1979). The Ecology of Human Development.   Harvard University Press.

“New Data on Autism Spectrum Disorders”. ( March 29, 2012). Centers for Disease Control and Prevention. Retrieved from: http://www.cdc.gov/Features/CountingAutism/.