Book Review: Barbara L Wheeler (ed.),Music Therapy Handbook

This book is, without doubt, a must for any library as it is a vital resource for anyone interested in music therapy. Barbara Wheeler has, yet again, provided a book full of key issues that are currently occupying the field of music therapy. It is a thorough and very methodically constructed handbook that is intended to appeal to ‘music therapists, allied mental health practitioners or students in play therapy or the creative arts’ (p. xiv). Certainly this book would be a valuable asset to all students and provides very good and relevant introductory information.

Despite the amount of information gathered in this book, the structure Wheeler has provided allows the reader to access the material efficiently because she has structured the book so clearly. Thus, the book is divided into three parts: Part 1: Overview and Issues; Part 2: Orientations and Approaches; and Part 3: Clinical Applications. This final part is divided into three sections: Section A: Music Therapy for Children and Adolescents; Section B: Music Therapy for Adults; and Section C: Medical Music Therapy.

In total, there are 54 contributors – all but 11 are from the United States. Six come from Australia, one each from Sweden, Norway and Denmark and two from Montreal. Each author is clearly a highly experienced expert in their field, and Wheeler has done an extraordinary job of pulling together such a gifted group of writers. Given that this is heavily weighted towards US music therapists, I wondered whether there might be a clear orientation towards US work. Occasionally this was apparent – most particularly in the chapters on clinical applications where some country-specific legislation was considered, but on the whole this book provides information about music therapy in a non-culture specific manner.

While the personality of each writer is evident, it is also apparent that Wheeler has been an attentive and thorough editor. The uniform quality of the book is apparent in the length of each part and each chapter. Almost all the chapters are 10–15 pages long with the same sub-titles used in each chapter. In Part 2: Orientations and Approaches, almost all the chapters have the sub-titles ‘History’, ‘Theoretical Tenets’ and ‘Conclusions’. Similarly in Part 3: Clinical Applications, almost all the chapters have a section on ‘Applications to Other Disciplines’. This final sub-title suggests one way of collaborating within teams but I wonder whether greater variety of sub-titles would have allowed for reflection on more diverse considerations.

Each chapter has been written independently so Wheeler’s clear overviews at the beginning of each part are vital. In fact I would have liked her to have made more links between each of the topics so that a thread develops and the reader is encouraged to understand deeper connections between the chapters. However, I recognize that this book may not be intended to be read sequentially and each chapter stands alone and provides good introductions to the areas covered. Thus, the rest of my book review will consider each part in turn to address as much of the material as possible.

Part 1 (Overview and Issues) covers some fundamental issues within the field. I found myself interested and challenged by some of the comments made in Chapter 3 (Aesthetic Foundations of Music Therapy: Music and Emotion). Hiller clearly distinguishes between affect, emotion, feelings and expressions but I felt more could have been written about what is meant by aesthetics. Meanwhile, I realized that I knew very little about Music Therapy and the Brain (Chapter 4) by Concetta M. Tomaino and that I would need to revisit this chapter many times to support my work with each client. Music Therapy and Cultural Diversity (Chapter 5) by Seung-A Kim and Annette Whitehead-Pleaux provides some clear, short vignettes but, given the brevity of the chapter, it was not possible to go into any significant depth or detail. Meanwhile Ethics in Music Therapy (Chapter 6) by Debbie Bates draws the reader into a conversation by asking them to consider questions and ethical dilemmas. I rather like this refreshing style as it challenged me to consider what I feel and how I might react to the scenarios provided.

Chapter 9 focused on Evidence-Based Practice in Music Therapy. Again, this is a clear and thorough overview of a complex topic that could initially overwhelm someone new to the field. I was relieved to note that Baker recognizes the controversy of the application of Evidence-Based Practice (EBP) as she cites Abrams and recognizes that ‘music therapists are not only scientists but also artists …’ and that ‘… different forms of evidence, all with specific roles to play’ are important (p. 111). The table provided on p. 107 offered a thumbnail overview, and I noted that the authors included within this table are mostly from the Cochrane Database of Systematic Reviews. There is much emphasis on music therapy used for medical issues, for example, surgery, cardiology/intensive care unit (ICU), colonoscopies.

The final chapter of Part 1 (Music Therapy Methods by Susan Garstrom and Suzanne Sorel) seems to offer a segue into the next section. This chapter introduces the idea of different methods and considers four types: receptive, composition, improvisation and re-creative (or performance) which originate from Bruscia’s work (from Bruscia, Defining Music Therapy, 2014). The content of the chapter is uneven with the receptive method given significantly more consideration than the compositional methods. I found the comments that introduce the concept of improvisation (p. 124) to be a bit simplistic in a book that has already introduced the reader to some more sophisticated concepts.

This chapter focuses more on methods within the United States and the examples might be unfamiliar to some music therapists (e.g. p. 120 has a music therapist offering a dance group within Physical Education classes to support gross motor skills). There is no space to compare and contrast these four methods, and I wondered whether some of the current debates about the relationship between them could have been included.

In the introduction to Part 2 (Orientations and Approaches), Wheeler notes that there are other orientations which might have been considered and provide references for eight of these. I would have liked to know how she chose the 10 that were included. Also, perhaps there might have been space to provide a little more information about those that were not. The firm structure of this book did not seem to allow for the expansion of this discussion.

Understandably, the content of some chapters will necessitate a different writing style and the reader will feel more affiliated to some chapters than others. For example, as a music therapist from England (recently moved to the United States) with a background in a psychodynamic approach, I am beginning to realize that Neurologic Music Therapy is an approach more frequently used in the United States. Similarly, I found some phrases in Chapter 13 (Cognitive-Behavioural Approaches) a bit confusing but again I recognize this is because of my own limited knowledge. There is some duplication of approaches across chapters. However, overall I felt that each chapter provided clear information and I appreciated a good mixture of case studies, vignettes, tables, lists and references. It is possible to gain a grounded sense of all the approaches whatever background the reader comes from.

For Part 3, Wheeler has written another clear introduction. The first section considers music therapy with children and adolescents and focuses almost exclusively on issues around physical and intellectual disabilities. The second section (working with adults) deals with mental health issues. Thus, there is not a sense of the mental health issues that can affect children and adolescents or of specific issues for adults with disabilities. Wheeler explained that ‘[e]very area in which children may benefit from music therapy can also be applied to adults with the same disabilities …’ and although she wrote that ‘of course some of the issues will be different’ (p. 261), I felt that some fundamental points may be skated over. This is explained in terms of limitations due to the length of the book, but I felt a short explanation for some issues that are missing would have been welcome. For example, issues for adolescents were a key area that could have been explored in more depth.

The first chapters of clinical work in Part 3 did have a more American feel. Chapter 21 (Music Therapy for Developmental Issues in Early Childhood) contained issues pertaining to US federal law with a clear focus on approaches to music therapy that are more prevalent in the United States. Throughout Part 3, quite a lot of the emphasis is on goal-oriented work. For example, in Chapter 24 (Music Therapy for Children with Speech and Language Disorders), the author stated, ‘Note that stuttering is primarily a motor speech disorder and not a psychological one. Use relaxation as adjunctive to the primary treatment’ (p. 310). Hanser cited a survey from 2007 (which I am presuming was conducted in the United States) that revealed that 83.1% of music therapists working in psychiatric practice would use behavioural approaches but fewer than 14% would use psychodynamic approaches (p. 165). I wonder whether more links between Parts 2 and 3 might help the reader orientate how the clinical work links with the theoretical tenets.

Chapter 26 has a different slant as it focuses more on the school contexts within which music therapists can work rather than the techniques and methods used with certain client groups. I am aware that there is limited space in this book to consider the cultural and clinical contexts in which music therapists find themselves working and so I was grateful that Katrina Skewes McFerran provided this insightful overview from American, Australian and British perspectives.

Chapter 27 (Music Therapy for Adults with Mental Illness) opens the section for work with adults. It provides plenty of clinical work, and there is a clear sense of the author’s passion. The issue of post traumatic stress disorder (PTSD) is a key theme throughout this section of the book and is noted by Elizabeth York and Sandra L. Curtis in Chapter 30 on Music Therapy for Women Survivors of Domestic Violence. Given that it is not a widely practised clinical area, I again wondered how Wheeler chose to include some approaches or clinical areas over others.

The final section of this book is entitled ‘Medical Music Therapy’. Once again, the methodical nature of this book is demonstrated in the construction of this section. It moves through from Music Therapy in the Neonatal Intensive Care Unit (Chapter 33) through working with children, adults, adults with traumatic brain injury and other neurological disorders to a final chapter on Music Therapy at the End of Life. Each one is packed with thoroughly researched information. The structure of each of these chapters follows those of the previous section with a focus on the clinical examples. Perhaps these chapters are separated from the other sections because the work is primarily based within medical or hospital environments. Certainly there is no doubt that there is a neat logic to placing them together.

Overall, it is clear that the authors of each chapter are experts in their field and many have included quite a few of their own works. Naturally some chapters have more and others fewer references. I appreciated the chapter on Music Therapy for Older Adults that also includes a section on literature, and the references at the end provide sources from different countries. This is a chapter that more overtly integrates a sense of why a certain approach might be appropriate, and how clinical work is addressed.