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Supportive Eclectic Music Therapy for Grief and Loss. A Practical Handbook for Professionals

br2005_047Bright, Ruth (2002). Supportive Eclectic Music Therapy for Grief and Loss. A Practical Handbook for Professionals. St. Louis: MMB Music, Inc.

Dr. Ruth Bright, a prominent pioneer of music therapy in Australia, a world known author who dedicated her numerous articles and books to the subject of grieving and loss?[1]. From 1960 till her retirement Dr. Bright worked with varied hospitalized patients, developed her own clinical practice, lectured all over the world and contributed energy both to the Australian Association of Music Therapy (presidency 1975-1978) and to the World Federation of Music Therapy (presidency 1991-1994).

Personally, as a music therapist who works with war and terror victims, Dr. Bright’s books and presentations in international conferences enriched my knowledge and touched me emotionally.

In its 12 chapters the book encompasses a broad range of patients’ population, explanations /definitions and clarification of relevant terminology. It embraces an attitude of openness toward a variety of approaches and procedures, planned interventions, contains rich references and more.

Before getting to the content of the chapters, I would like to convey Bright’s words concerning the terminology of the title:

Supportive – the author is talking about “…the supportive nature of all music therapy, which provides comfort, resilience”… and also “when it is inappropriate to take the client too deep into issues of transference, ego strength and weakness” (p.ix-x) than rather brighten the quality of the present life.

Eclectic – “in which the therapist strives to meet the needs of the individual client in a brief series of interventions by drawing on professional knowledge of a wide range of schools… approaches and methods” (p. ix).

Grief – is “a response to any significance loss” (p. vi) not necessarily to death and dying, without judgment of amount and which might express sadness, anger, humiliation, depression, disbelief, relief of tension etc.

Terminal illness – is broadly explained as all the conditions for which there is no remedy and the patient and relatives see him as being at the end of life (p. 75).

Content

  • (Introduction) Music therapy for grief: a personal viewpoint
  • 1. Referral and assessment
  • 2. Meaning in music: the basis for grief-resolution work
  • 3. Methods, techniques, and protocols in music therapy for grief
  • 4. Music therapy for the grief associated with death and terminal illness
  • 5. Music and grief therapy in psychiatry
  • 6. Music therapy in psychiatry: work with forensic patients
  • 7. Music therapy for grief resolution for those who have suffered sexual abuse
  • 8. The grief of disability and long-term losses at all ages
  • 9. Other loss situations
  • 10. Music therapy and counseling in private practice
  • 11. Research, evaluation, and writing
  • 12. Putting it all together: being a therapist
  • (Epilogue) Death through terrorism

Each chapter includes goals and learning objectives, definitions and explanations of relevant terminology, practical issues, approaches, models, therapeutic philosophy, techniques, clinical examples and vignettes.

In her book, Dr. Bright is touching on both practical issues and theoretical-philosophical aspects. Though it claims to be a practical handbook, I found that there is a fair balance between practice and theory, efficient and interesting both to the beginner music therapist and to the experienced one.

Among the theoretical points there are also core questions which occupy many music therapists though sometimes tend to be neglected: Is there universality of meaning in music? What are the influences of the socioeconomic background of the patient and the therapist on their listening and interpretation of music? Different theoretical and practical questions concerning improvised music as the main expressive language in music therapy are discusses as well as others. In dealing with these and other questions, Dr. Bright dwells again and again on issues that have to do with therapeutic ethics and humanity. While so doing, she portrays to us her own insight, considerable experience and therapeutic personality: open-minded, never rushing, carefully progressing from stage to stage weighing every word and sound, sensitive to the patient’s needs and very grounded. From this point of view the book can serve (in a broad sense) a modeling purpose for all therapists, not solely music therapists.

Needless to say, the philosophy of integrative use of approaches requires broad knowledge and skills, as the integration is valid in each stage of the therapeutic setting: intake, therapeutic consideration, therapeutic process, closure and all the intermediate steps. The ability to be eclectic is based on the concept of Therapeutic Alliance which exists in many approaches such as psychodynamic, supportive, counseling, cognitive and more.

As for practical techniques, Bright mentions improvisation, song writing, graphic representation, the empty chair work (known from Gestalt therapy), life-road map or journal and others. All are exemplified clinically according to specific needs. Among other things the author conveys symbolic work which helps saying good-bye to a dead person and discusses final separation. Bright never forgets to mention that there is also a “working through” of the therapist, specifically when treating patients in severe conditions: “Therapists need to have an idea of what may be going on below the surface for the client and others. We also need to understand our own feelings about death and dying, euthanasia, life after death, chronic disability, old age, “timely” and “untimely” death, and any other aspects of terminal illness that may need to be dealt with” (p.75). Indeed, as can be perceived from the content of the chapters, Bright discusses very severe cases which demand a mature and experienced therapist. In order to develop the proper attitudes, the therapist has first to work on himself either through supervision or in therapy or (as is customary in my country) both. In working with the population presented in this book one has to choose the right moments, words, music, approach etc. “We must never attempt to elicit memories until we know the person will have support to deal with what recalled” (p. 86). If a therapist is locked on a specific approach, he might miss this point. For example, a psychoanalytic approach with terminal patients might fill their last days with emotional turmoil instead of creating an atmosphere of tranquility and emphasizing the quality of life. Concerning the right approach, I was very much impressed by the symbolic work Dr. Bright has done in a palliative setting with the mother of a baby who died in the womb. She even takes the trouble to mention the preferable words to be used (p. 88).

Summary

Dr. Ruth Bright’s book fulfills its promises: in a clear systematic way she presents a broad display of population, phenomena, technical approaches, theoretical and spiritual aspects, eclecticism and much more. Her book provides the reader with a wide range of knowledge, and if I may add, educates us music therapists to be humble, permanently searching after relevant knowledge, to be careful with our musical and verbal language, look inside ourselves and always honor the patient and family.

As I have already mentioned, I have personally worked for many years with war and terror victims of all colors of the rainbow: varied socio-cultural-religious-political population. Death and mourning, not to mention the permanent underlying anxiety, is our bread and water. Thus, I dare say that this very experience enables me to bear witness to the quality of Bright’s book, to the comfort, support and spiritual wisdom we can derive out of it.

Notes

[1] To mention some:

(1968) Grieving: A Hand Book for Those Who Care. St Louis: MMB Music, Inc.

(1989) Developing Skills and Competencies in Music Therapy for Palliative and Hospice Care, The Next Step Forward: Music Therapy with the Terminally Ill. Proceedings From a Symposium for Music Therapists Working in Palliative Care. New York: Calvary Hospital, 3-23.

(1996) Grief and Powerlessness. London: Jessica Kingsley.

(1999) Music Therapy for Grief Resolution. Bulletin of Menninger Clinic, 63 (4), 481-498.

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