Use Of and Instruction In Clinical Improvisation

ABSTRACT: Board-certified music therapists were surveyed about their use of clinical improvisation and the improvisation instruction they had received in undergraduate/equivalency programs in the United States. A distinction was made between music improvisation and clinical improvisation. The survey sought responses regarding client populations, goals, theoretical orientations, influential models of improvisational music therapy, and musical media that are relevant to MT-BCs' use of improvisation in therapy. Further issues addressed include whether clinical improvisation instruction was received in undergraduate/equivalency programs and/or during internships and how this instruction was received as well as perceptions regarding level of preparedness to use clinical improvisation. Results from 559 respondents indicate that improvisation is widely used by MT-BCs but that instruction in the method at the undergraduate/equivalency level is neither widespread nor consistent in programs across the United States. The adequacy of improvisation-based competencies and guidelines established by AMTA, CBMT, and NASM for instruction in effective and ethical use of clinical improvisation is questioned. The various ways through which music therapists engage clients in music are called methods. Bruscia (1998) delineated four distinct methods as follows: (1) Re-creative, in which clients are engaged in the process of re-creating or performing music already in existence by singing or playing instruments; (2) Receptive, in which clients listen to live or recorded music and respond through an often predetermined modality such as discussion, movement, imagery, or reminiscence; (3) Compositional, wherein clients contribute to the generative process of creating some aspect of a new musical/ sound piece (e.g., composing lyrics or a melody); and (4) Improvisational, in which clients and therapist relate to one another through the process of extemporaneous music-making with voice, instruments, or other media. The knowledge and skills required of music therapists in designing, implementing, and evaluating these music experiences comprise many of the competencies required of all board-certified music therapists (MT-BCs). Among such competencies are those related to improvisation, which is the focus of the present study. This report is based on a study of MT-BCs use of and instruction in improvisation. One delineation relevant to this study is the difference between clinical improvisation and music improvisation. Clinical improvisation is the process whereby therapist and client improvise together for purposes of therapeutic assessment, treatment, and/or evaluation (Bruscia, 1991). In clinical improvisation, client and therapist relate to one another through the music. Sometimes the improvisation results in a musical product of aesthetic value, however, this is neither a requirement nor is it often an essential aim. Music improvisation, on the other hand, is the process whereby musicians extemporaneously create a musical product that is most often intended to have aesthetic value. In music improvisation, the individuals do not relate to one another within a client-therapist relationship, and the purpose is not intended to be therapeutic in any way, although players may find the experience of improvising to be therapeutic in the general sense of the term. These delineations were provided in the survey tool used for this study. Accordingly, while some fundamental musical processes and skills are inherent to both clinical and music improvisation (e.g., listening and responding in the moment), the procedures, techniques, and attitudes essential to achieving the distinct aims of each are different. Research by Brown and Pavlicevic (1996) revealed fundamental differences in the experiences of improvisers as musicians versus as music therapists. Their findings indicate that in clinical improvisation it is the interpersonal dimension that is primary rather than the musical dimension, as in music improvisation. …