Fouten in Muziektherapie

Without a chance meetup at a conference on music therapy, the book Breaking Strings: Explorations of Mistakes in Music Therapy might never have seen the light of day. Music therapists Avi Gilboa and Laurien Hakvoort found out they both wanted to explore the topic of mistakes in music therapy, and so they did. After years of hard work, they launched their book on the 20^th of September. The Journal of Trial and Error met up with them for an interview.

Let’s start with a cheeky question. Which mistakes did you yourselves make during the production of this book?
Laurien: “We lost time due to various reasons. I felt insecure about my English and my status in the worldwide community as a music therapist. This is why we really wanted to collaborate with colleagues from the very beginning, but at times we had trouble finding good matches. If we had started with just the two of us from the very beginning, it would have saved us time. But that has been a learning experience.”

Avi: “I would say there weren’t any big mistakes, but that there was a lot of wiggling about. The process was not linear at all. Sometimes we took a 180 degree turn, only to subsequently turn back again. We had different teams working on the book at different times. Some teams were great at one point, but then didn’t work out later on.”

Laurien: “With one team, for instance, we shifted from the idea of making two books, one theoretical and one with case studies, to just one book. Not everybody wanted to be an editor, some just wanted to be a chapter author. And then COVID hit, which was the last nail in the coffin. COVID made it almost impossible to meet physically, something which was really needed to co-author this sensitive topic. So, the composition of our editorial team changed.”

Avi: “In hindsight this was all part of the process, but in the moment itself it felt like a mistake. This ties into the question of: how do you define a mistake? There is always this temporal component; it depends on which point in time you look at an event whether it constitutes a mistake or not. Looking at the present, I don’t know if the book will be a success – I am uncertain about how it will be received by our professional community. We took design decisions which are not conventional and might be considered risky. So, for instance, we use strikethrough like this, for words in parentheses, to give the impression that ideas are there but also not there, perhaps correct, perhaps not. This is a purposeful addition to our layout, but it might cause confusion, and readers might consider it unprofessional. So, maybe our unconventional design decisions will turn out to be a mistake in the future.”

What is the role of responsibility and liability with regards to mistakes themselves, exploring mistakes, and opening up about mistakes?
Laurien: “There were quite a lot of people who were willing to explore their cases with us. They describe one of the mistakes that they made. What we saw with all of them, which is typical for the music therapy community, is that we always feel responsible for our client’s wellbeing. That was a very important part of our concerns as editors, also when we were helping the authors with writing their case material. We had to make sure that even when a client reads about their own case, they should not be able to recognize it. Clients are vulnerable and they should be protected, for example by ensuring their privacy. On the other hand, you can learn from mistakes that you are going to make anyway.

Other mistakes you really can and should prevent. Like going too deep, using music which might trigger suicidal thoughts. The idea that music is harmless is something we wanted to dispel, because that is not the case. And if you think music is only beautiful and harmless, make music for yourself, make music in an orchestra, but don’t use it as a therapeutic intervention. That’s the message we want to bring across, there are boundaries and a music therapist should be informed, and you can be informed by mistakes that others make.”

Avi: “Let me add another point about mistakes and responsibility. If you start celebrating mistakes, you might start to idealize them. Of course you should not aim for mistakes. Mistakes might happen, and then the question becomes what to do with that. There should be a balance between two extremes. On the one hand, some music therapists have this attitude of pushing mistakes aside altogether. Pretending a mistake didn’t really happen, or if it did happen that it was a one-time thing. At this extreme you typically push away your emotions. On the other extreme music therapists have this attitude of just making mistakes and celebrating them. That’s also the wrong attitude because you are not taking responsibility for the mistake. Inside the word responsibility is the word response, so if you want to take responsibility over your mistakes you should give yourself the opportunity to respond to them. Develop the ability to look at the mistake and to respond to the emotions that surround it. Emotions are healthy as long as you don’t block them and they don’t block you.”

Laurien: “One other thing. We didn’t look at what clients felt were mistakes, or what the environment thought was mistakes. We only focused on what the therapists thought were mistakes. We had a lot of debates about what were mistakes. Some people said something wasn’t a mistake because they do it themselves. Well, sometimes that’s still a mistake. In the future, it would be great to have a book from the perspective of the client, or their environment. We chose to look at and present those mistakes that music therapists realized they themselves made. In addition, we didn’t look at mistakes that could have been made in verbal therapy, but at mistakes unique to the music and to music therapy. We wanted to reflect on the uniqueness of music therapy and find those specific cases where the uniqueness that caused the mistake, was shaped by the musical intervention or incorrect musical relations, things like that. So we really look at what is unique in the music therapy realm and how we can bring that to the profession to start discussing mistakes.”

How have the reactions to the book been so far?
Laurien: “We have had very positive reactions. The book is a very needed book, maybe it’s even something that we should have written earlier. Colleagues tell us they want to be in the next book, that they have cases too. Up till now the only criticism we have received is on the unconventional layout.”

Avi: “I think the idea was already out there, people always said someone should organize a conference, or a special issue about failed cases. With the exception of the German Musiktherapeutische Umschau, nobody ever did. But let’s not forget that typically, we would be getting mostly the positive reactions from people and that there may be other, more critical, reactions that – just like mistakes – remain in the shade, so to say.”

That’s an interesting situation which you describe. Why do you think there was such a need for more discussion on mistakes but nobody took it upon themselves to start that discussion?
Laurien: “The nice thing is that both of us have a scientific background, with support from our community. At the same time, we are not the hotshots of the profession, so we have the freedom to experiment, to do what we think is important. Also, Avi and I have a positive chemistry between us, and because we have that, we could convince colleagues to actually contribute. I think we are both people who can put our own ego’s aside, as well, and for this topic that is very important. If you have to be this very high status person, it is sometimes more difficult to acknowledge that you have limitations than if you think: I can learn from mistakes. And for me that’s the baseline. It helped us to be tenacious and continue going.

And also we were aware that we wanted to claim a new field in a sense, so even though there was not a lot of literature on this topic, we were always afraid of someone else publishing before us. We started with this book all the way back in 2016, so we had good reason to be nervous about others publishing before us. And some people did. I had to rewrite a whole chapter on harm because by then publications about harm had already started to come out.”

Avi: “We brought this question about the timing of the book up in our focus groups. We had discussions with our fifteen authors whom we grouped into three focus groups. We discussed each other’s chapters and asked each other questions. One of the questions we asked them was: Is this the right time? Which is the reverse of your questions. And all of them answered “yes, it is time. The subject might seem peculiar or irrelevant to some, but it is time”. As we spoke, we realized that there were already fifteen music therapists who were willing to write a case chapter about their mistakes, so that is definitely an indication of an appropriate timing.

When we asked why it had not happened until now, some of the authors referred to the age and the status of the profession of music therapy in relation to its ‘older siblings’. Psychotherapy, for instance, already has a lot of articles and books on mistakes, failure, and error. So why does psychotherapy already deal with mistakes while music therapy doesn’t? Maybe it is because music therapy is younger and smaller. It is still trying to prove itself. When you’re still trying to prove yourself, you can’t go out and say look at my mistakes. You want to say look at me, and at my success rates!”

What role do emotions play in how we deal with mistakes? What were the cases which moved you?
Avi: “There were many cases which moved us very much. Because the therapists were so open and so courageous about these emotions and how vulnerable they were during or after their mistakes. So of course there were many cases. Because of these emotional dynamics, we decided to have frequent meetings with each of the authors. Though this is unusual for edited books, we understood this was a sensitive issue and we wanted to accompany the authors all along, not leave them alone with their emotions. Some of them were very harsh on themselves. We wanted to let them know it was ok, to experience such emotions. Some authors were circling around the issue, but not touching it. Probably because it was either too painful or because it appeared obvious to them. So we really needed to help them make the idea clearer. We never argued with them about what should be considered a mistake; this was always up to them to decide. Emotionally, we were trying to make it as easy as possible to express the mistake as clearly and communicatively as possible and to take these very difficult emotions and deal with them in a non-judgmental way.”

Laurien: “To add to that, one of the things we did was collect stories about mistakes from colleagues during the first initiatives on mistakes, so during conferences and music therapists’ meetings. One of those colleagues came in immediately the morning after a mistake happened, and was willing to share it with us, right then and right there. This therapist ended up writing about it a year later. So those were very valuable interactions, much more emotional than if we had invited people we had never met by just emailing them. That’s because of the personal connection.

One of the things we came across when investigating mistakes was the role of culture in how we deal with them. We invited people from Colombia, South Africa, China, Japan, Bahrain, and other countries. We got so many different types of mistakes, mixed stories. That’s because music is not really something universal, cultural aspects play a big role. Of course we all know what music is, like we all know what speech is, but the music that is suitable for one culture might not be suitable for another culture. Or the music that is suitable for one situation might not be suitable for another situation. So realizing that also brought a lot of new insights. The idea is not to generalize, but to expose as much diversity as possible.

So for me, the main emotion has been excitement. Of course you resonate with what a person tells, but the main emotion has been the excitement of realizing: wow, there is such a diversity and we have never actually delved into this. So this is really the first attempt and there will be much more to explore in the future.”

Avi: “Again there is this time factor, there is a dynamic to the emotions surrounding mistakes. A mistake can cause an emotional eruption, like a volcano. Admitting a mistake at that point can be very emotional, could lead to being very sad or angry. As time passes, sometimes, the emotional ‘lava’ ‘solidifies’ and cools down, so it can more easily be touched. Many times we had colleagues tell us about mistakes they made ten or twenty years before. These years probably made it easier to talk about the mistakes. So you can imagine it’s very courageous to bring us a case right after it has happened.”

What do you think that your book can bring people from outside your field?
Laurien: “I really hope that the insights from the chapters on harm in music will trickle through into the musician community and the medical community. There are a lot of people who say things like just give surgeons Mozart during surgery and everything will go well. There’s no reason to believe that. I hope our book can make people aware of what music can do and also what music cannot do. Music is not just harmless. If that was the case we wouldn’t need any education or training as music therapists. For me that’s important information that should become more generally known.

Besides that, I hope we can show the diversity of music therapy. We have cases from geriatrics, children with autism, about nonverbal people, on psychiatric clients. There’s such a diversity of fields that we work in. Our book can make people aware of where we as music therapists can help, but again, also were we cannot help. That would be a great advantage outside our music therapy community.”

Avi: “I think it’s a sociological question. It depends on the person who looks at music therapists and what they are seeing. If they look at it in a sociological way, like at another nation or culture, and if they look at it in an open way, I think they can learn a lot. We have similarities with psychotherapy, some similarities with research fields, some with music and the arts, with medicine – some of us work in hospitals, with doctors and physicians. So, it depends on the openness of the person. Some people are very local and they like to look at themselves. For them music therapy and our book won’t say anything.”

What do you think of the tendency to instrumentalize failure and mistakes? Should they always be useful learning experiences or should there be room for mistakes that we cannot learn from?
Laurien: “Again, emotions play a big part in this. Somehow we don’t like to fail. I have worked in forensic psychiatry, and all those patients there have failed in a sense. Have failed society, have failed themselves. And you see different reactions and perspectives. You see people who become angry at themselves, people who become angry at others, people who become depressed, people who ignore the situation, people who avoid the situation, people who flee. You see very different reactions to mistakes, to how to deal with it. Somehow most people want to be good people, they even want to be perfect people. We all make mistakes but we all react differently to them. So I very much recognize this tendency to look for what we can learn from mistakes, to want to prevent them, to want to help others learn from them. It is not something to be ashamed of, but something we can learn from and which can help us set boundaries and limitations. But it’s always something we evaluate in comparison to what is right, to what is perfect, to what success is.”

Avi: “I would use the distinction we made in the first chapter, where we describe three approaches towards mistakes. There is the medical approach, the educational approach, and the explorative approach. The medical approach wants to extinguish mistakes, probably because the consequences are so severe – life and death. As long as this is the case, extinguishing mistakes is probably the best course of action. According to the educational approach, mistakes are considered an integral and necessary part of the process. Like in life, in therapy too, you have to go through mistakes. According to this you are not trying to extinguish mistakes, but you are trying to find them and work with them to better understand the process. If someone I supervise comes to me after a year of treating and continuously says that everything is going fine, I would tell them that something is probably going wrong. I try to tell them that when a mistake happens, we should celebrate. Because it will give you a lot of information. That’s the educational approach. The explorative approach is more neutral; you just look at mistakes from a perspective and try to analyze how they happen, when, and why.”

Do you have any views on how society in general handles mistakes and failures?
Avi:“In general societies are very suspicious of mistakes, they do not really provide much space for them. There are, of course, societies that support ‘mistake culture’, but it seems that the natural starting point is to suspect mistakes and to stay away from them. I would also add that music therapists are a hybrid, of at least two different professions: musicians and therapists, and that these professions have very different ways of looking at mistakes. Therapists usually say that mistakes are part of life – usually, not always – and part of therapy (the ‘educational approach’). With musicians, it depends on the musical culture. Some musical cultures do everything to get rid of mistakes (the ‘medical approach’) to the point where you are supposed to be perfect. Western classical music is such an example. You are supposed to strive for perfect (i.e. no mistakes), especially in the most strenuous situations such as on stage. This can then lead to problems like performance anxiety and stage anxiety. When such musicians come to study music therapy, we spot them very easily, because they really have a difficult time with mistakes, not only with musical mistakes, but also with therapeutic mistakes. With them, part of the process is to give them time to fuse into the ‘educational approach’ to mistakes.”

Is there anything else you’d like to add?
Laurien: “What I really like is the fact that ArtEZ Press allowed us to make mistakes. We got the time to do things incorrectly, and we had flexibility in our collaboration which was very nice. For the layout of the book Amir Avraham designed it from our basic ideas on how we wanted to discuss mistakes. In round tables, with room for mistakes, allowing the time to consider thoughts and mistakes, yet create room for humor and different perspectives. We worked together with students of the illustration department who made the illustrations for us. The whole reason the cover is orange, is that we asked students which color fits music therapy (green) and which color fits mistakes (red). Green and red together becomes brown, which is an ugly color. The color closest to brown was orange according to these students, so it became orange. So we had this flexibility, and because we got the freedom to experiment and to make mistakes, we felt more like we were actually playing with mistakes. I think it’s very important to have these platforms like ArtEZ Press or the Journal of Trial and Error, which is a wonderful platform, that allow people to make mistakes and to discuss mistakes.”

This interview originally appeared on the Journal of Trial and Error website.