Reflecting on relational needs in the context of a global health crisis

While writing this editorial, the World Health Organisation announced that COVID-19 is characterised as a pandemic. Leaders of governments, businesses, schools and health services around the world are putting action plans in place that aim to keep people safe and healthy. One of the easiest ways to stop the spread of infection is to practice social distancing; that is, physically staying away others. Most of us have experience with keeping our distance when we are sick, but what makes the COVID-19 situation more extreme is the scale of people involved and the length of time that social distancing is required. As is often the case, people with more resources available to them will be buffered by the worst effects of isolation.

The need for deep connections between people is highlighted during this time when we are forced to be separated. Maslow’s motivational theory and hierarchy of needs is well known to many, but perhaps the recent developments prompt us to look at this theory in a different light. The original hierarchy places physiological needs as the most basic, followed by safety, and next the need for love and social belonging. However, Maslow did not view the hierarchy as a rigid ladder, and instead considered that the order of needs will be flexible depending on circumstances and individual differences. In fact, we are more likely to have simultaneous rather than sequential needs (Maslow, 1987). Even across diverse regions of the world, positive feelings of wellbeing can be achieved when social needs are met despite the fact that some basic needs may be unfulfilled (Tay & Diener, 2011).

The universal appeal of music as the go-to “feel good” experience in everyday life has been reported by news services covering the personal impact of social distancing and isolation. In China, dance parties have taken place both in make-shift hospitals and online. COVID-19 also has its own hit songs emerging, with tunes written to educate the public about hand washing and hygiene. A public education song from Vietnam evolved into an online dance challenge where people choreographed dance moves to help us wash our hands more effectively. People have created lists of 20-second songs to accompany our handwashing along with lists of “top albums to listen to” while in isolation.

Returning to Maslow’s hierarchy, I was reminded that the original 5-stage model was later revised and increased to an 8-stage model (Maslow, 1970). The addition of “growth needs” were emphasised, and these encompass aesthetic needs that involve an appreciation and search for beauty, balance and form. When considering the fact that Maslow considered we are likely to be multi-motivated by several needs simultaneously, it is fascinating to consider how aesthetic needs and social needs often co-exist.

Music therapists are familiar with this concept of multi-motivation, with aesthetic experiences regularly found to support social inclusion and connectedness in both qualitative and quantitative findings. However, given that many people around the world can and do independently use music to support their own subjective wellbeing, the role that the music therapist plays is important to consider. From a resource-oriented perspective, as music therapists we “take the client’s resources seriously and do whatever we can to nurture the use of those resources so as to foster empowerment” (Rolvsjord, 2010, p. 181). From this stance, music therapy experiences are about people co-constructing a relational and collaborative endeavour, where both the therapist and the client(s) initiate and respond to each other and, together, possibilities for change unfold.

In contrast, if the therapist is considered a helper who provides services to others, then this view might reveal a different underlying assumption about the therapist-client relationship: that it is the therapist who has good health, and the client who has compromised health. The current global health crisis is likely to result in music therapists’ having compromised physical and mental health at some point, and perhaps this will lead some practitioners to question whether they can or should provide services to others, and whether they need to seek therapy for themselves. If we leave aside the obvious concern about contamination, this may be an opportune time to challenge an ableist view of society that presumes that only healthy people can be helpers (Kalenderidis, 2020; Shaw, 2019).

Within this journal issue, many authors have explored the role of the therapist in a variety of contexts and practice approaches. Hernandez-Ruiz (p. 200) presents a detailed conceptual framework for parent coaching, where the role of the music and the music therapist in parent-mediated practices are explored. By deeply considering the theory underpinning family-centred music therapy practice while drawing on the Parent Early Start Denver Model, mechanisms for change are proposed that are yet to be fully explicated by research findings. A reflective commentary on Hernandez-Ruiz’s conceptual framework is provided by Pasiali (p. 288), which highlights the need for music therapists to be aware of their own values and beliefs and how these influence the way practitioners approach their work.

Marom, Gilboa and Bodner (p. 222) report on their findings from a micro-analysis of a music therapist’s response to the echolalic vocalisations of autistic children. Rather than focusing on pathologizing the children, the authors instead reflect on how the music therapist felt and responded to the children’s communication style. The relational and collaborative approach to music therapy is emphasised, since it is the therapist who embarks on a journey of self-awareness in order to question their own ethical position within their practice.

Relational issues continue to be explored by Bensimon (p. 240) in a qualitative study that explicates the perspectives of music therapists working with people who have experienced trauma. The study places the music therapists’ experience in the foreground and describes how the clients’ relational needs are musically addressed in order to enhance the therapeutic process. In addition, music therapists also depend on musical equipment and technologies to support them to facilitate musical experiences. Gilboa and Hakvoort’s article (p. 255) “Buy that instrument” posed a creative challenge to graduating music therapists to spend a basic budget to equip their imaginary music therapy practice. The results show some common choices and also some differences across contexts that may reveal the theoretical emphasis of the students’ training program has in their approach to practice.

Kenner, Baker and Treloyn’s article (p. 271) is the first to explore a group music therapy process for people with borderline personality disorder. Group improvisations were video recorded, with the analysis focused on understanding how music making contributed to therapeutic process in practice. As the participants’ music competencies expanded, the analysis showed a parallel expansion of relational competencies. However, the participants were highly interested in their developing musical competencies. Within this paper, the participants’ perspective is brought forward, and the therapist is challenged to reflect on their own beliefs around musical engagement. Kenner and colleagues reflect on resource-oriented practice perspectives, and here we return to the view that the relational and collaborative nature of the therapeutic relationship might be more pivotal than the notion of a therapist providing an intervention.

This issue concludes with Holck’s book review of “Music therapy and autism across the lifespan: A spectrum of approaches” (p. 292). Holck highlights that many of the chapter authors advocate for collaboration and sharing with parents, teachers, and other professionals. Perhaps greater investment in co-designed projects with people with lived experience, rather than their family members and workers, will further deepen our understanding of the therapeutic potential within collaborative and relationally oriented music therapy practice.