Some thoughts about teaching what you know about
I am writing this article because there are more and more CMPs who are using what they learned in the MHTP Program to teach other musicians about singing or playing in healthcare institutions. These CMPs are teaching short sessions, perhaps an hour workshop or 3 hour workshop, maybe even a 6 hour workshop. Perhaps they are teaching at the request of the hospice or hospital where they work as a CMP, at a local community event, at a Conference or perhaps for their own profit. They may be teaching with the intention that their students will volunteer to "bring more music into places that really need music" – a noble intention - or perhaps because they think there is a need in their community where there are no other certified therapeutic musicians other then themselves within many miles. Or, they may be teaching fellow professional musicians because these musicians want to get "another kind of gig."
Why is teaching classes about therapeutic music in order to give other musicians a smattering of knowledge so that they can go out and play in healthcare institutions as a paid gig or as a volunteer a concern to those of us administering Programs that train therapeutic musicians? Why is the statement made to me recently that "any competent harpist can play at the bedside; extensive training isn’t really needed" just plain wrong?
Far beyond the copyright issues concerning intellectual property, issues that have to do with principles of ethics and legal rights, there are much larger and more important issues that I’d like to try and articulate. They are at the crux of concern for those of us who are working hard to bring into reality a vision. The vision is: A trained, professional, paid, therapeutic musician serving ill and dying people as a respected part of the healthcare team in every hospital, hospice and nursing home.
One avenue to an understanding of our concern is to ask and answer the following three questions. These questions and answers define the parameters we must work within to fulfill our vision:
As therapeutic musicians:
- What community are we seeking to work within?
- What does it take to become a respected professional member of that community?
- Who are we serving?
1. What community of people are we seeking to work within?
The community in which Therapeutic Music lives is the healthcare community, which has very defined and quite rigid parameters of performance. The people who work in that community are all credentialed in one way or another, are paid accordingly, and the institutions spend time and money making sure that the professional staff is properly credentialed. The supervising entities reinforce this focus on credentialing via their oversight. From the MDs, RNs, Respiratory Therapists, Social Workers and Chaplains, to the Certified Nursing Assistants, and house-keeping staff, every paid person is expected to have some kind of training in order to be paid, and is expected to continue learning in some way, even if that simply means monthly in-services about new hazardous materials or HIPAA regulations. Within this community there are certain underlying themes that give it form: For example, Standards of Care, appropriate protocol and infection control, dependence and respect for scientific research, concern about liability issues, reimbursement issues, and patients’ rights.
2. What does it take to become a respected, paid professional member of this particular community and what is most valued?
First, it takes having a credential, i.e.: training, in what you do so that you are not a liability risk for the institution or other team members, but an asset. You are demonstrating respect, knowledge and competence in the protocols of the institution, showing comprehension and superior expertise in the Scope of Practice of your profession, understanding and respecting patient’s rights, understanding your relationship to all of the team members (other professionals and staff) and working in the appropriate manner within that team so that you are a supportive team-member in the delivery of care and services.
3. Who are we serving?
As therapeutic musicians we are serving the most vulnerable: ill and/or dying people. These are people who may be vulnerable physically, mentally, emotionally and/or spiritually. They are people who may not be fully conscious, who might be experiencing unusual states of consciousness and sense-perception because of illness or medications, who may be in pain, who may be full of fear and anxiety, who may be faced with losing everything that is dear to them and who may be on the thresh hold of death. They are people whose individuality and sense of self may be undermined by the very fact of being ill and in a hospital or nursing home.
If you reflect on these questions and their answers, I hope that you will see and understand that in order to fulfill our vision fully, therapeutic musicians must know how to work competently within the requirements and limitations of the first 2 questions, and must always keep foremost in mind the 3rd.. : the therapeutic musician’s responsibility to the individual patient being served.
Concerning the workshop “trained” musician: With just a few hours of conceptual training and no required internship experience, there is a very high likelihood that such a musician, no matter how technically competent they are as a musician, will perform poorly on all 3 levels. The rare exception may be an accomplished musician who is a good improviser, has an intuitive understanding that “less is more” for most ill people, is already an experienced healthcare worker and very good at patient assessment, and who is also inherently intuitive and sensitive. This is because working as a therapeutic musician is not so much about the skills needed for performing, perfecting virtuosity and technique, being a great sight-reader, or playing and/or singing demanding music perfectly. It calls for other very different and additional skills that cannot be taught in a workshop or in a day. The more musicians out there that are un-trained or half-trained presenting themselves to healthcare institutions, the less likely it will be for the profession to ever be fully respected, and the less likely it will be in the future for trained, credentialed, competent therapeutic musicians to assume that they will be paid like any other healthcare professional. The more untrained or minimally trained musicians there are playing at the bedside, the higher chance that negative or even harmful outcomes with patients and institutional protocol will occur.
Giving musicians a few hours of knowledge and encouraging them to go out and practice as a therapeutic musician effectively undermines the possibility that our vision will come to fruition. It also undermines the possibility that our profession will be considered seriously, and that your colleagues seeking work and recognition as professional therapeutic musicians will be able to find good employment.