A Model for Clinical Decision Making in Music Therapy: Planning and Implementing Improvisational Experiences

Improvisation has been a catchall term in music therapy. It has a specific meaning, yet it is also used to describe experiences that range from highly prepared and structured to unstructured, freeform musical expressions (Wigram, Pedersen, & Bonde, 2002; Wigram, 2004; Aigen, 2005a). A music therapy experience can be completely improvisational in nature, or it may incorporate aspects of improvisation into a planned format. Music therapy offers a very wide range of experience. Music therapists are recognizing the power and value of developing improvisational strategies in their work, yet in my own role as professor of music therapy, I continually noted students' fear of improvisation. When questioned as to the source of this fear, many students responded that it stems from feelings of inadequacy because they did not believe they had the necessary skills to spontaneously create effective improvisations. Before learning clinical applications and concrete techniques, students often viewed improvisation as being extemporaneous and uncontrolled with no preparation or foundation to it. This expository article explores the role of structure in clinical music improvisation and offers guidelines, examples, and suggestions for practice with the aim of helping clinicians expand their own practice.CompetenciesImprovisational skills are taught in music therapy training programs as mandated by the American Music Therapy Association (AMTA) educational competencies (AMTA, 2009). Students are required to be proficient in the following areas before graduating:A. Music Foundations9. Improvisation Skills9.1 Improvise on percussion instruments9.2 Develop original melodies, accompaniments, and short pieces extemporaneously in a variety of moods and styles, vocally and instrumentally9.3 Improvise in small ensembles (AMTA, 2009, p. 30)The AMTA defers to individual music therapy training programs regarding the specifics of how to teach improvisation as long as these basic skills are achieved by all students. However, given the importance musicality and improvisation play in the clinical setting (Groene & Pembrook, 2000; Baker & Wigram, 2005), well-defined tools for teaching effective improvisation need to be continually developed.Before the AMTA developed basic competencies, Gault (1978) found music therapy students consistently said they "felt that the major problem [in their education] was a lack of specific training and application of actual music therapy procedures" (p. 38). In other words, students did not feel they received sufficient education on how to create and implement music therapy experiences. The basic tools necessary to being an effective music therapist were not being taught. A more recent survey (Wheeler, 2000) of 38 undergraduate programs found a continuation of this theme. There was a high degree of educator uniformity in goals for students' needs, assessments, and feedback, yet students reported a lack of training in functional musical skills. Though there may be congruency in educator goals, students believe more could be done to improve their clinical skills.Groene and Pembrook (2000) called for educational emphasis on the development of clinically useful musical skills. They reviewed curricula relevant to AMTA competencies and found a need for more training in practical musical skills and practice in translating these skills to therapeutic situations. They go on to state "considering that music is our entry point into the profession, is what makes us unique, and often reaches our clients when other therapies are less effective, this position seems appropriate" (Groene & Pembrook, 2000, p. 98). Continuous development of new methods to approach the teaching of improvisation and revision of existing methods is important for recognition of music therapy as a sound artistic and therapeutic medium.Guidelines for teaching the creation and analysis of clinical improvisations have been established and can be found in several well-researched music therapy models (Bruscia, 1987, 2001; Aigen, 2001; Wigram, 2004; Nordoff & Robbins, 2007). …