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Creativity in Decision Making
Carol Ann Blank, MMT, MT-BC
Blog Post #1 OCMT 2015

In this blog post, I’d like to discuss a bit about what I am studying in my dissertation research at Drexel University (Philadelphia, PA).  Music therapists’ clinical decision making when working with parent-child dyads hasn’t received as much attention as I believe it should.  There may be several reasons for this.

Music therapy is an inherently creative process that sometimes defies explanation.  Some practitioners may feel at a loss putting into words what happened in a session with a child and her parent.  How can shaking some eggs, singing songs, or waving scarves provide the necessary elements for supporting a child’s growth?  I suspect there is great variability in music therapists’ degree of comfort with providing clear information about why we engage in these (and other) musical experiences during the session.  Knowing why we do what we do generally in music therapy with young children[1] and their parents is something we know a lot about.  Please check out Music, Therapy, and Early Childhood: A Developmental ApproachBright Start Music: A Developmental Program for Music Therapists, Parents, and Teachers of Young Children, or Family Favorites Songbook for Teachers for some excellent resources for working with young children and their parents, caregivers, and teachers.

What I’m after, though, is a better understanding of clinical decision making:  how music therapists make the decisions we do in the moment during a therapy session with a parent-child dyad[2].  Why did I choose to offer the shaker just then?  What did I expect would happen?  What did I see in the parent’s eyes that made me extend the song just a bit longer?  How did the child’s reaction to the sound of the piano inform the next notes I played? It may be difficult to pinpoint exactly what happened in the session that precipitated a moment of change, yet that ineffable experience of love, connection, and healing experienced by the parent and child is often the culmination of many clinical decisions that we make.

In this post, I am going to focus on creativity as a factor in clinical decision making.

Creativity in Music Therapy

Bruscia (2014) asserts that the presence of music affects the therapy process, and that, because of this, music therapy is different from other forms of therapy.  What sets music therapy apart is the presence of indigenous elements in music therapy that do not exist in other forms of therapy: sound, beauty, creativity, and relationship (Kindle Locations 1456-1459).  Since music therapy is creativity –centered, it’s important, then to look at how each member of the therapeutic triad (clinician, child, and parent) perceives their role in the creation and reception of the creative musical expression. The way sounds become beautiful and meaningful is through the creative process. When a client listens to or makes music, he or she is being creative with sounds, exploring different ways the sounds can be arranged, perceived, and interpreted. Thus, we can say that the client’s very participation in music therapy requires the creative process (Kindle Locations 1487-1490).

Defining Creativity

We cannot go any further in this discussion of the role of creativity in music therapy clinical decision making until we define creativity.  Social theorist Csikszentmihalyi wrote in Creativity that creativity can be viewed as a system with three interrelated parts:  domain, field, and the individual person. The articulated conventions of singing songs, playing instruments, and movement to music might constitute some of the domain of music therapy in early childhood.  These are the conventions that appear generally accepted by practitioners of music therapy, which makes music therapy the field associated with the domain of interventions practiced by music therapists who work with parent child dyads.  The individual person (i.e. the music therapist) uses techniques or interventions (Csikzentmihalyi calls these symbols and procedures) within a parent-child dyadic music therapy session.  The ways in which these interventions are implemented is brought before the members of the field (other music therapists) who act as gatekeepers for the field).  If the gatekeepers agree (and it doesn’t have to be unanimous) the domain (the ways in which we implement music therapy with parent-child dyads) is changed.  This act of changing the domain (how we work) is creativity.

According to Csikszentmihalyi (2007), Creativity is any act, idea, or product that changes an existing domain, or that transforms an existing domain into a new one. And the definition of a creative person is: someone whose thoughts or actions change a domain, or establish a new domain. It is important to remember, however, that a domain cannot be changed without the explicit or implicit consent of a field responsible for it. (p. 29).

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The implications for being aware of the clinical decisions we make in a music therapy session with a parent-child dyad extend further than a single family.  When we are able to articulate our rationale for choosing this experience or instrument over another, we establish a body of evidence that others in the profession, and beyond it, can react to.  Articulating your clinical decisions through case notes, clinical rounds, practice journal articles, or other venues involves risk taking.  Someone might not agree with your choice.  In order for the field to grow, we have to be both aware of the choices we can make and the choices we did make and be ready to engage in dialog about them.  When we engage in these discussions with our colleagues, we promote creativity and serve as gatekeepers for our profession.

Although I have only mentioned one field here (music therapy), there are also other fields that are have gatekeeping responsibility as well.  For example, developmental psychology, early childhood music, and wider community of parents of children with special needs can (and should) weigh in with their opinions.  Research and policy making bodies such as the Council for Exceptional Children and Zero to Three may also choose to contribute to the discussion.  I have framed the discussion regarding clinical decision making from the perspective of the individual music therapist and the field of music therapy.  This is a conscious decision given the OCMT 2015 audience.  However, I encourage music therapists from all areas of practice and levels of education to consider what fields might have gatekeeping responsibilities for the work that we do.  It is important to both broaden and deepen the discussion about clinical decision making.
I look forward to your thoughts!  See you in February, 2015!

If you are interested in learning about creativity in other disciplines, the American Creativity Association has several MOOCS you can participate in.
Portions of this post were presented by the author at the American Creativity Association 2014 annual conference in Philadelphia, PA.


Bruscia, K. (2014). Defining Music Therapy [Kindle Version]. Retrieved from www.amazon.com

Csiksentmihalyi, M. (2007). Creativity: Flow and the Psychology of Discovery and Invention. New York: Harper Perennial

Guilmartin, K. K., & Levinowitz, L. M. (2009). Music Together family favorites songbook for teachers. Princeton, NJ: Music Together LLC.

Schwartz, E. (2008). Music, Therapy, and Early Childhood: A Developmental Approach. Gilsum, NH: Barcelona Publishers.

Walworth, D. (2013). Bright Start: A developmental program for music therapists, parents, and teachers of young children. Silver Spring, MD: American Music Therapy Association, Inc.

[1] For the purposes of this, and all future discussions of parent-child dyads, it is to be understood that the child is aged 0-8 years old.
[2] Please check out this podcast for some of my thoughts on clinical decision making.

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