Music Therapy and Cultural Diversity

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Music Therapy and Cultural Diversity Music Therapy and Cultural Diversity

Seung-A Kim Ph.D., L.C.A.T., MT-BC

Molloy College

, skim@molloy.edu

Annette Whitehead-Pleaux

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n the preface to Stige’s (2002) Culture-

Centered Music Therapy, Bruscia states that

the culture- centeredness perspective is re-

garded as the fifth force in music therapy.

For music therapists, culture has a particu-

larly significant meaning because the work

entails understanding the self and the cli-

ent. The main modality in music therapy

is music—the representation of a specific

culture, or more aptly, the self and the so-

ciety to which the individual belongs. In ad-

dition, cultural misunderstanding can take

place any time during the course of music

therapy— during assessment, treatment, or

termination (Estrella, 2001). Misunderstand-

ing can adversely affect the development of

a therapeutic relationship and the establish-

ment of an effective treatment plan.

Culture refers to “those beliefs, actions

and behaviors associated with sex, age, lo-

cation of residence, educational status, so-

cial economic status, history, formal and

informal affiliations, nationality, ethnic

group, language, race, religion, disabil-

ity, illness, developmental handicap, life-

style, and sexual orientation” (Dileo, 2000,

p. 149). To date, statistics on the number

of clients of different cultures that receive

music therapy services have been unavail-

able to us. However, as the demographics

of the U.S. population become increasingly

diverse, it is likely that music therapists will

work with more diverse populations. For

example, population projections show a

significant change in the racial and ethnic

profile of Americans. In 2050, European

Americans will no longer maintain their

majority status, with the number of Hispan-

ics rising from 42 million to 128 million,

and of Asians from 14 million to 41 million

(Population Reference Bureau, 2008). On

the other hand, the American Music Ther-

apy Association (AMTA, 2013a) reports

that music therapists and students in the

United States are predominantly European

American and female. This discrepancy

CHAPTER 5

Music Therapy

and Cultural Diversity

Seung‑A Kim

Annette Whitehead‑Pleaux

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52 OVERVIEW AND ISSUES

further heightens the need for discussion

of cultural diversity in music therapy.

Historical Perspectives

As the world became increasingly global-

ized, music therapy was making a timely

entrance on the global stage as a profes-

sion seeking a more articulate and unified

effort. In the 1970s, there was an increas-

ing interest in dialoguing about music

therapy among professionals from around

the world; they began to exchange ideas

about music therapy and trainings, and a

few international gatherings were orga-

nized for this purpose. The First Interna-

tional Music Therapy Congress took place

in Paris in 1974 (Wheeler, 2008), followed

by other international conferences. Later,

two noteworthy symposia were held: the

International Symposium of Music Therapy

Training, held in Herdecke, Germany, in

1978 (Wheeler, 2003), and an international

symposium, Music in the Life of Man, held

at New York University in 1982. At the

time, international communication rarely

occurred among music therapists, so, fol-

lowing the New York symposium, Kenneth

Bruscia (1983) initiated the International

Newsletter of Music Therapy, writing, “I sin-

cerely hope that as the newsletter develops

and improves, it will serve an important

communication function in the world com-

munity of music therapists” (p. 3). These

events and others began the communica-

tion that eventually led to a broader inter-

national perspective and consideration of

cultural issues (Barbara L. Wheeler, per-

sonal communication, February 12, 2013).

Although progress was slow initially, a col-

lective effort paved the way for a discussion

of cultural issues that has become an inte-

gral component of music therapy. There has

been steadfast effort by music therapists and

scholars to bring this topic to light (Chase,

2003a). Some of the relevant topics that ap-

pear in music therapy literature include the

importance of multicultural competencies

and ethics (Dileo, 2000); music therapists’

worldviews (Wheeler & Baker, 2010); work

with diverse clients (Whitehead- Pleaux &

Clark, 2009); the impact of music thera-

pists’ religious beliefs (Elwafi, 2011); ethnic

music in music therapy (Moreno, 1988) and

training (Shapiro, 2005); community music

therapy (Pavlicevic & Ansdell, 2004; Stige &

Leif, 2012); international music therapy stu-

dents and acculturative stress (Kim, 2011);

ethnicity and race (Hadley, 2013; Kenny,

2006); feminist perspectives (Curtis, 2013b;

Hadley, 2006); sexual orientation and gen-

der identity (Whitehead- Pleaux et al., 2012,

2013); and cross- cultural supervision (Kim,

2008; Young, 2009). As the work of music

therapists gained momentum and a more

concerted effort, further information and

discourse were disseminated through insti-

tutes for multicultural music therapy at the

AMTA conferences (Kim, 2012; Whitehead-

Pleaux, 2012); the first international con-

ference on gender, health, and the creative

arts therapies in Montreal, Canada, in

2012 (Curtis, 2013a); the World Congress

of Music Therapy conferences, held tri-

ennially around the world; and through

Voices: A World Forum for Music Therapy, an

electronic journal. Furthermore, in 2011,

AMTA formed a diversity committee to ad-

dress cultural issues in the music therapy

profession in a more systemic and orga-

nized way. As a result of the cumulative ef-

forts of music therapy professionals from

around the world, the World Congress of

Music Therapy has been held every 3 years,

and carries the overarching theme of “cul-

tural diversity in music therapy, practice,

research, and education.”

Music: Universal and/or Relative?

Music therapy and culture are intrinsically

connected and are topics of significant in-

terest to music therapists (Stige, 2002). The

interconnection of these two leaves us with

many questions. For example, what type

of music and music therapy interventions

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Music Therapy and Cultural Diversity 53

would be more effective in treating clients

from diverse cultures? Western classical

music is usually used in guided imagery and

music (GIM) and has proven to be an effec-

tive medium (Burns, 2000). Would this be

the case when working with a client coming

from Latin America, Asia, or Africa as well?

We can also examine improvisation, one

of the main music experiences that the

music therapist employs in sessions. Would

the meaning of improvisation be the same

to a client who is not accustomed to West-

ern European and American music and

improvisation? Westerners are accustomed

to diatonic scales and harmonic structures,

and to them, music from a variety of cul-

tures may seem out of tune. As a matter of

fact, the banding sound often used in music

from a variety of cultures does not even exist

in Western scales. While practicing music

therapy in Africa, Pavlicevic (2004) noted

that she experienced the Africans’ musick-

ing as going “on, and on and on—often with

not too much variation in tempo, phrasing,

melody or harmony and with slow build-ups

of intensity over time” (p. 46), because she

was accustomed to the “Western- trained

musical mind.” She proposed that this re-

sponse may have been influenced by her

expectations about improvisation: “Is this

a compromise of our western heritage of

improvisation in music therapy— where the

client’s music may well lead us to the edge

of our being?” (p. 182). More specifically,

would Western European and American

music provide the same results to a client

from India who has just arrived in Amer-

ica? Can you imagine a client who has never

heard the piano in his or her own country

being asked to improvise on the piano for

the first time in a music therapy session?

Moreover, how uncomfortable would it be

for a client, raised within a structured so-

ciety, to be asked to make something up

freely in music? Such a client would expect

the therapist to display full command and

supply comprehensive instruction. He or

she may interpret this approach as a sign of

weakness or a lack of preparation.

On the other hand, an Indian immi-

grant who has lived in the United States

for more than 20 years may enjoy jazz more

than ragas (Indian traditional improvised

music). Still another consideration: Music

and dance are inseparable for some cul-

tures. Some people may feel more natural

making improvised movements through

their body with music rather than just im-

provising solely on musical instruments.

For them, it is natural to use their body as

the main instrument.

Stereotyping and Ethnocentrism

in the Use of Music

Although music is culture- specific, some

musical elements found in other countries

can also be found in America, and vice

versa. For example, some Western classical

composers, such as Debussy and Schönberg,

integrated Asian and Spanish musical ele-

ments into their compositions. In addition,

modern technology and globalization have

influenced music. Many children around

the world grew up with Disney films, which

are riddled with stereotypes. Most Disney

movies are based on white characters and

tend to display strong stereotypical patri-

archal/gender roles (e.g., the bad lion in

The Lion King had many stereotypical gay

male traits). Non- Westerners may perceive

Western cultures in a certain way because

their only exposure to Western cultures has

occurred through movies. It is noteworthy

that individual differences among mem-

bers of the same cultural groups also need

to be considered.

As Moreno (1988) pointed out, “American

music therapists tend to be more ethnocen-

tric and to use music in therapy that primar-

ily derives from western- oriented classical,

popular, and folk traditions” (p. 18). He em-

phasized that music from a variety of cul-

tures is not only a tool for contacting clients

from these other cultures but also a vehicle

from which Western- based music therapy

clients could benefit. The purpose of using

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54 OVERVIEW AND ISSUES

music from a variety of cultures is to build

clients’ identities and increase their feelings

of self-worth ( Shapiro, 2005). Music thera-

pists should consider music from other cul-

tures based on the traditions and cultural

practices of their cultures.

Culturally Informed

Therapeutic Relationship

Music therapists have explored effective

ways of establishing therapeutic relation-

ships with clients from diverse cultures

(Dileo & Magill, 2005; Kim, 2013b). An

effective therapeutic relationship is essen-

tial to bringing about positive outcomes.

Without a cultural understanding of their

clients, therapists would have a hard time

empathizing with many situations. For this

crucial reason, Dileo and Magill (2005) em-

phasize the following:

Music therapists must: commit themselves to

learning about the [client’s] various cultural

needs and musical preferences; examine

their own personal cultural values and how

they may be in conflict with those of the [cli-

ent]; and develop authentic skills in multicul-

tural empathy. (p. 228)

Current music therapy theories and

methods of therapy are also oriented pri-

marily toward European American mid-

dle- to upper-class populations. Westerners

value separation– individuation, autonomy,

self- assertiveness, and verbal articulateness.

These values are culturally encapsulated in

our therapy orientations. How, then, can

we possibly apply these values to the cli-

ents who come from collectivist societies?

In Eastern collectivist- oriented countries,

key figures in the community assume the

role of the therapist— family members, rela-

tives, close friends, and religious leaders.

Such figures do not easily discuss personal

issues outside of the family. Delving into

the personal lives of others is regarded as

shameful for the entire family, especially

if an individual has had a troubled past.

If the client’s values and belief systems

differ from our own, then therapy treat-

ment plans— including goals, assessments,

and evaluations— should all be revised ac-

cording to the individual’s cultural values.

Given that all therapists (ideally) strive for

the betterment of the client within the

value system of that individual, the reality

of diversity has profound implications for

therapy. It means that the definition of a

better life is a culturally subjective determi-

nation. How well do our current methods

of therapy work for non- Westerners? What

type of therapeutic approaches would be ef-

fective? Would individual therapy help cli-

ents from different cultures open up to per-

sonal issues? Another complication: Music

therapists are finding that more and more

clients do not speak English as a first lan-

guage. When verbal communication does

not work well, how can we build a therapeu-

tic relationship effectively?

To answer these questions, alternative ap-

proaches to music therapy have been pro-

posed (Chase, 2003b; Stige, 2002). Stige

(2002) developed a culture- centered theory,

and Stige and others have developed com-

munity music therapy (CoMT; Pavlicevic &

Ansdell, 2004; Stige, Ansdell, Elefant, &

Pavlicevic, 2010; Stige & Leif, 2012). CoMT

emphasizes that music therapy always takes

place in context. Thus, individuals can be

understood fully only within a context and

culture as an “individual– communal con-

tinuum” (Pavlicevic & Ansdell, 2004, p. 23).

Stige (2002) explained:

It is quite possible that other music thera-

pists may see it differently. . . . I can only tell

you what Community Music Therapy is for

me, and perhaps for some other people in

the hope that this will help you work it out

for yourself. In an effort to bridge the gap

between client and community, community

music therapists made the profession rethink

and resituate the traditional definitions of

music therapy and ethical considerations.

Community music therapists are “musicking

community workers” in order to bring out

“social and cultural change.” (pp. 92–93)

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Music Therapy and Cultural Diversity 55

As reviewed above, a cultural under-

standing of all clients, an assessment of

musical and nonmusical characteristics

incorporating their acculturation history,

and a shift in our methods to accommo-

date their worldviews must be taken into

consideration for effective treatment. It is

important that music therapists approach

their work in a way that integrates the cli-

ents into the music therapy process, rather

than dictating what is best for clients based

on the dominant culture. In essence, we

are describing a Culturally Informed Music

Therapy (CIMT) (Kim, 2010). Through hu-

mility (Whitehead- Pleaux, 2012), seeking

information, and learning about the culture

of each client, music therapists can create

music therapy treatment that is relevant to

each client’s worldview and life. The goals

and interventions of music therapy should

incorporate clients’ cultural music so that

each individual’s therapy is tailored to his

or her background and needs. In the next

section, music therapy methods of address-

ing cultural diversity issues are described.

Culturally Informed Music Therapy

CIMT is a music therapy approach designed

for clients who have experience with two or

more cultures and addresses clients’ cul-

tural well-being through music (Kim, 2010).

Flexibility when applying therapy principles

and techniques is a cornerstone of CIMT.

To better understand the CIMT approach,

AMTA (2013c) delineated several steps in

the Standards of Clinical Practice: assess-

ment, treatment planning, implementation,

documentation and evaluation, and termi-

nation. In addition, recommendations for

best practices in culturally informed clini-

cal music therapy are explored. The AMTA

Standards of Clinical Practice state: “The

music therapy assessment will explore the

client’s culture. This can include but is not

limited to race, ethnicity, language, reli-

gion/spirituality, social class, family expe-

riences, sexual orientation, gender identity,

and social organizations” (2.2). Similarly,

AMTA Professional Competencies (AMTA,

2013b) state that the music therapist is to

select and implement effective culturally

based methods for assessing the client’s assets

and problems through music. (16.4)

Select and implement effective culturally

based methods for assessing the client’s musi-

cal preferences and level of musical function-

ing or development. (16.5)

When assessing a client, it is essential for

the music therapist to engage in culturally

informed practices. The assessment is not

only a time to learn more about the client’s

clinical needs, but also to learn about his or

her culture. The following case example il-

lustrates a culturally informed assessment.

Assessment

As I (Annette Whitehead- Pleaux) was clean-

ing my instruments one afternoon a few years

ago, my coworker, a nurse, came into the of-

fice and told me about a new admission. She

was a 4-year-old girl from Senegal who was in-

jured a year prior. She spoke Wolof and knew

very little English. My coworker felt that music

therapy would be a good match for her, as she

was exhibiting signs of trauma and was very

anxious with all medical personnel.

I grabbed my guitar and cautiously stepped

into her room. I saw a tiny child curled up in

a bed, crying with the covers pulled up to her

chin. Her father sat next to her looking very

haggard, while the interpreter looked anx-

ious and uncomfortable. I was immediately

struck with the realization that my assistance

would be limited, as I knew nothing about

Senegalese music, Senegalese culture, the so-

cial norms and mores of the culture, and the

role music plays in the Senegalese culture. I

had no idea what a Senegalese children’s

song might sound like. How could I introduce

music therapy to this father and his daughter

in a way that would be both pertinent to her

needs and effective for her treatment? How

could I fully explain the basis for music ther-

apy with no knowledge of their background

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56 OVERVIEW AND ISSUES

in music? It would be a daunting task to en-

courage them to embrace music. I stood silent

and still for a moment, as I tried to figure out

what was I going to do to help this child and

her father feel more at ease.

I began by introducing myself and explain-

ing the basics of music therapy. I told the fa-

ther and daughter that I would like to help her

feel better through music, but I did not know

anything about the culture of Senegal, or if

there were any specific rules within their cul-

ture about music. I asked if they could please

tell me more about Senegal, their music (es-

pecially the music the child enjoyed), their

beliefs about music, and their lives before the

accident.

Clinicians can gain information about

the client and his or her culture(s) in a

variety of ways. The first is to talk openly

with the client and the family about the

culture(s) that influence the client’s life.

Another is to do research, either in the

library or on the Internet. It is important

to use credible sources to learn accurate

cultural information. A third way to learn

about the client’s culture is to contact com-

munity organizations associated with that

culture. Ethnomusicology departments of

local universities or colleges can also be a

resource through which to learn about the

music of the client’s culture. Finally, if the

therapist works with an interpreter, the in-

terpreter’s job is not only to aid in the ther-

apist’s communication with the client but

also to serve as a cultural ambassador. We

recommend that prior to the session, the

therapist take the time to talk with the in-

terpreter to explain what he or she is going

to be doing with the client. The interpreter

can provide cultural references that can

help the therapist frame the conversation

appropriately. By pairing these resources

with a primary source (the client and his

or her family and caregivers), the music

therapist can learn more about the client’s

culture(s) and how to best serve him or her

in music therapy.

As discussed earlier, a variety of cultural

influences within a client’s life affect his or

her music preferences and identity. Some

broad categories to consider are culture of

heritage, culture of religion, culture of genera-

tion, culture of location, and culture of iden-

tity (Whitehead- Pleaux & Clark, 2009). It is

not uncommon for a client to identify with

many different cultures at one time and for

these differing cultures to create some dis-

cord or confusion within the client. Music is

deeply ingrained within most of these cul-

tures. The client may experience a culture

of heritage based on his or her race, country

of origin, or ethnicity. As the client and the

therapist speak about the client’s culture of

heritage, it is important to learn about the

music of that culture as well as the social

norms and mores regarding music. Despite

being from a specific culture, some clients

may not identify with that culture. Within

the assessment, the music therapist needs

to discover how much the client identifies

with his or his culture of heritage. Finally, it

is important to learn how and if the client

expresses his or her culture musically. Con-

sider this case example:

Dmitry was a teen from Russia, being treated

for burn injuries. When he was first admitted,

he was able to identify some popular Russian

musicians to whom he liked to listen. I (An-

nette Whitehead- Pleaux) incorporated these

songs into his sessions. But as the months of

his hospitalization progressed, Dmitry shared

other genres of music he enjoyed, including

Iranian house music; bands from the United

States, including the Eagles and Michael Jack-

son; and Eastern European trance music.

The client may also have cultural influ-

ences from his or her religion. The role re-

ligion plays in a client’s life and his or her

level of engagement are important factors

for the music therapist to consider when

designing the specific interventions to use

with a client. If the client is highly engaged

in his or her faith, it is essential to learn the

norms and mores of the religion, especially

with regards to music.

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Music Therapy and Cultural Diversity 57

Chiamaka was an 18-year-old woman from

Nigeria admitted for a series of reconstruc-

tive surgeries. Over months of treatment,

Chiamaka often requested to sing songs from

her church. She taught me these songs by

dictating the lyrics and then teaching me the

melodies. One day, I (Annette Whitehead-

Pleaux) came to our scheduled session to find

her and her mother weeping. Her beloved

grandmother had passed away in Nigeria.

Both Chiamaka and her mother were greatly

disturbed that they could not be present for

the funeral proceedings. Chiamaka’s mother

stated, “Until I see her placed in the ground,

I cannot truly know she is dead.” Chiamaka

and her mother continued to explain that it is

their responsibilities, as daughter and grand-

daughter, to be a part of the funeral prepara-

tions and proceedings. However, Chiamaka’s

recent surgery would prevent her from travel-

ing for a number of months.

Mother and daughter did not know how to

grieve, being so separated from their commu-

nity. After asking them about the rituals and

practices around the death of a family mem-

ber in their culture, I offered to help them

write a song for the grandmother to honor

her memory. I acknowledged the songwriting

was something different from their cultural

practices, but that some people find that it

helps to ease their grief. Chiamaka and her

mom quickly agreed, and together, we wrote

the song Nnuki Mummi (Big Mommy). We

sang that song together every session for

months as they grieved the loss of a beloved

grandmother.

The influences of a client’s generation

must also be considered. A generation is

not limited to periodic references such as

baby boomers or generation X. It can also refer

to a client’s identity regarding immigration

history (e.g., first- generation American).

With each generation come different world-

views, beliefs, music, and traditions. These

can be at odds with the other cultural in-

fluences within the client’s life. Addition-

ally, the client’s generational culture may

be at odds with those of his or her par-

ents or other elder family and community

members. These conflicts can create both

internal and external sources of stress for

the client. A music therapist needs to as-

sess clients’ identifications with the music,

norms, worldviews, and beliefs of their gen-

erations:

When Maria, an 11-year-old girl from Bolivia,

was admitted to the hospital, she was intu-

bated and sedated, so I (Annette Whitehead-

Pleaux) spoke with her mother, Juanita, about

the music to which Maria likes to listen. Juan-

ita told me that Maria likes an artist named

José José. Weeks later, when Maria was awake

and alert, she told me that she did not like the

music that I was playing for her; she likes reg-

gaeton. As we spoke further, I discovered that

Juanita preferred José José and disapproved

of the reggaeton genre.

Learning to what extent the client iden-

tifies with the culture of where he or she

resides is another component that can assist

the music therapist in designing a treatment

plan and interventions. A case example that

illustrates the role of the culture of location

can be observed in a patient named Bolin.

Bolin was born in China, but when he was

5, his family immigrated to Mexico. When

I (Annette Whitehead- Pleaux) worked with

Bolin, he was 11 and identified more with

the music of northern Mexico, Norteña, than

with the music of China that his parents en-

joyed. At the time, my music therapy intern

was from Taiwan. As my intern and I de-

signed the music therapy interventions for his

sessions, we initially used Norteña, but, as the

session progressed, my intern began to incor-

porate traditional Chinese children’s songs.

These songs allowed Bolin to connect with

his culture of heritage as he had not before.

However, we continued to incorporate popu-

lar Norteña songs into the sessions, allowing

Bolin to integrate these different aspects of

his history together.

The cultural identity of the client needs

to be explored in sessions. This may be a

culture that is not initially apparent, es-

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58 OVERVIEW AND ISSUES

pecially when the music therapist focuses

on the music culture with which the client

identifies. Learning the client’s cultural

identity is crucial in the assessment because

he or she may not identify with the music

culture of his or her heritage and actually

find that music offensive.

Juan, a teenage boy, was admitted to the hos-

pital at 8

P.M. Friday, after my shift had ended.

I (Annette Whitehead- Pleaux) was not return-

ing until the following Monday, so I wanted to

leave some CDs in his room to aid in his transi-

tion to the hospital. From his chart, I learned

that he was from Honduras. I left a variety of

CDs that reflected many of the popular Latin

genres of music, such as salsa, reggaeton, ro-

mantica, and ranchera. Monday morning I

went to Juan’s room and introduced myself.

Immediately he told me how someone had

left a bunch of music in his room that he did

not like at all, and that I was to take it away

this instant. He preferred Michael Jackson

and Justin Bieber. As I gathered up the CDs,

I apologized for guessing incorrectly what

music he likes, saying it was not included in

his medical chart from the Honduran hospi-

tal. He began to laugh, and we joked about

other information that may not be included

in the chart, including his sister’s name and

how many chickens his family owns.

Expanding the assessment to include cul-

ture not only increases the music therapist’s

understanding of the client, but also affects

the rest of the music therapy process from

treatment planning to intervention design

to evaluation of progress. The extra time

spent learning more about the client cre-

ates an environment (1) wherein the client

feels valued for who he or she is, (2) that

builds the therapeutic relationship faster,

and (3) that creates a greater rapport be-

tween the music therapist and the client.

In addition to the music therapy goals that

address the universal domains, the CIMT

goals include therapists’ development of

increased cultural awareness; acknowledg-

ment of own cultural identity; resolution of

cultural conflicts within the context of the

client’s culture; formulation of needed cop-

ing skills for the client; management of cli-

ent’s acculturative stress; and development

of preventive methods (Kim, 2010).

Treatment Plan

Once the assessment is completed, the treat-

ment plan must be created. Through a thor-

ough synthesis of the information collected

during the assessment, the music therapist

identifies the client’s needs, strengths, in-

terests, and music preferences. This infor-

mation helps the music therapist to craft

the goals, objectives, and interventions for

future sessions. Although not articulated

specifically, AMTA Professional Competen-

cies (AMTA, 2013b) states that music thera-

pists must select and adapt musical instru-

ments and equipment consistent with the

strengths and needs of the client:

Select and adapt musical instruments and

equipment consistent with strengths and

needs of the client. (17.7)

Select and implement effective culturally

based methods for assessing the client’s musi-

cal preferences and level of musical function-

ing or development. (16.5)

When these competencies are interpreted

through a CIMT lens, the idea of music

preferences and musical instruments can

become the music and instruments of the

client’s culture(s), which then can be inter-

woven through the interventions. The music

therapist can learn the melodies, songs,

or musical idioms of the client’s preferred

musical genres. Recorded music from that

culture can be incorporated into the ses-

sions. Instruments from the culture or simi-

lar sounding instruments can be utilized

as well. Handheld electronic music devices

such as tablets or MP3 players that use apps

are an easy way to bring the sounds of in-

struments from other cultures to the session

at a minimal cost (Whitehead- Pleaux, 2012).

In addition to music and instrument se-

lection, the music therapist must also work

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Music Therapy and Cultural Diversity 59

closely with clients from less dominant cul-

tures to ensure that practices are conducted

in a culturally sensitive manner. In the les-

bian, gay, bisexual, transgender, and ques-

tioning (LGBTQ) best practices, for exam-

ple, Whitehead- Pleaux et al. (2012) describe

culturally sensitive behaviors that include

creating a safe space where hate speech is not

allowed, avoiding assumptions about the cli-

ent, treating “all diverse clients, family mem-

bers, and support people equally and with

respect” (p. 160), being “open and affirming

to LGBTQ clients” (p. 160), and practicing

culturally appropriate language in speech

and writing. When working with individu-

als from cultures that have experienced

oppression and discrimination, the clini-

cian must understand that different terms

have different meanings to these individu-

als based on historical events, generational

factors, and cultural associations. Thus, the

therapist should always ask the client what

terms he or she should use when discussing

issues related to the client’s cultural identity

(Whitehead- Pleaux et. al., 2012). This final

point is especially relevant if the music ther-

apist is either a member of, or perceived to

be a member of, the dominant culture. The

history of domination and oppression runs

deep through many cultures and, as thera-

pists, we must be aware of these histories

through not just the view of our own cul-

tural lens but also through that of individu-

als from these oppressed cultures.

Openness and Humility:

The Qualities of the Culturally

Informed Music Therapist

It is vital that the music therapist get to

know the client fully, for it is human con-

nection and trust that allow for the great-

est growth and well-being. A culturally in-

formed music therapist is “a kind of culture

bearer, a person who learned their songs

and some of their languages, archived, and

elicited this material, when appropriate”

(Shapiro, 2005, p. 31).

Approaching the client with openness,

humility, and a genuine interest in know-

ing who he or she is helps to strip away the

power inequity, allowing for the strengths,

knowledge, and worldview of the client

to enter into the sessions. Through this

deeper understanding of the client, the

music therapist can better serve and meet

the client’s clinical needs. With these prin-

ciples in mind, it is important for music

therapists to design intake forms and as-

sessments that give voice to the diversity of

all cultures other than the dominant cul-

ture.

The best practices for LGBTQ recom-

mend that all music therapists “develop

intakes, assessments, consents, releases,

and other documents that provide for

optional self- identification regarding

gender identity; sexual orientation; and

marital, partnership, and family status”

(Whitehead- Pleaux et al., 2012, p. 160).

This best- practice principle can be applied

to a larger cultural view that also includes

race, ethnicity, religion/spirituality, socio-

economic class, family experiences, ability,

and social organizations. Changing these

important forms will help to set the tone

with the client that this therapeutic process

is one that seeks to validate who he or she

is, rather than limit his or her expression

to that which is acceptable to the dominant

culture. The music therapy space must be a

space that is safe for all clients.

Self-Awareness

One aspect of CIMT practice that is not

always discussed is that of self- exploration

and the learning of cultural competencies.

Moreno (1988) emphasized that ethnic

music was not only a tool for contacting cli-

ents from other cultures but also a vehicle

through which mainstream music therapy

clients could also benefit.

As we are profoundly influenced by the

culture surrounding us, much of what

we see, hear, and feel is imprinted in our

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60 OVERVIEW AND ISSUES

minds. It is through this cultural lens that

we view our world. Unfortunately, some of

these messages with which we interpret the

world contain biases, and we carry them

into our sessions with our clients. To prac-

tice CIMT, we must embark on a journey of

self- exploration to uncover these biases and

work through them (Chase, 2003b). This

journey is one that is best taken on with a

supervisor who is well trained in this area.

Supervision is a must for music therapists

who work with clients from cultures other

than their own (Estrella, 2001). The three-

fold approach of open communication with

the client, information seeking, and super-

vision will aid the music therapist in pro-

viding the highest quality of care for clients

from different cultures.

Ethical Considerations

Since 1982, the American Counseling Asso-

ciation and the American Psychological As-

sociation have mandated multicultural edu-

cation in their training. These mandates

include awareness of personal beliefs and/

or attitudes about culturally diverse clients,

knowledge of diverse cultures, and the abil-

ity to use intervention skills or techniques

that are culturally appropriate. (The Amer-

ican Psychological Association [2003] also

documented “Guidelines on Multicultural

Education, Training, Research, Practice,

and Organizational Change for Psycholo-

gists” in 2003).

There has been an effort to increase sen-

sitivity to ethical issues in music therapy

(Dileo, 2000). However, AMTA Professional

Competencies (AMTA, 2013b) should include