Simon Procter (2024). Music Therapy as a Profession and Practice. The shifting Interrelationship of Precarity and Entrepreneurialism. I Rainer Prokop og Rosa Reitsamer (red.) Higher Music Education and Employability in a Neoliberal World. Bloomsbury Academic 2024. Open access.
The British music therapist Simon Procter, who leads the music therapy program at the Nordoff-Robbins Center in London, has written a thought-provoking book chapter about the working conditions for British music therapists. The chapter is found in a recently published anthology edited by two Austrian sociologists associated with the University of Music and Performing Arts in Vienna. Across fifteen book chapters, the anthology discusses how neoliberal ideology influences and shapes music education institutions through curricula and learning cultures. Particular attention is given to the transition to the workforce and a job market characterized by great uncertainty—something that particularly affects today's generation of newly graduated musicians. I have only read Procter's chapter, but I can see that the other chapters should be of great interest to anyone concerned with the well-being of musicians, music education, economics, and careers.
First, neoliberalism, or as defined by the Store Norske Leksikon, is "a collective term for economic and political ideologies and theories, which share the belief that society should largely be organized according to market economic principles."
A British Story
The narrative Procter sketches is primarily focused on the working conditions for British music therapists. Norwegian music therapists generally have good and well-organized working conditions. However, there is reason to be vigilant regarding a changing job market and what might happen if market forces are unleashed in the healthcare field. There are several parallels between British and Norwegian music therapy, not least in education, as a master's degree is required for British music therapists to be recognized by health authorities.
British music therapists received their authorization, or state recognition, in 1999 and are considered by the Health and Care Profession Council (HCPC) as a profession on par with, for example, physiotherapists and occupational therapists. Today, there are eight accredited programs for music therapists in the UK. Since all are based on awarding a master's degree, this creates challenges for students, as a student loan for master's studies has unfortunate long-term financial consequences. This can also have negative effects in terms of social recruitment imbalances in the profession.
From Optimism to Professional Struggles
British music therapy was well-established by the mid-1990s, and many were satisfied with the state recognition. There was a good job market, and music therapists found work in schools, care centers, hospitals, etc., often combining such jobs with other music-related engagements, as not all secured full-time positions as music therapists. There was anticipation that Labour's 1997 investment in healthcare would make it possible to gain full-time positions in the National Health Service (NHS) as full-fledged members of multidisciplinary teams.
In hindsight, Procter writes, this trend towards becoming a new paramedical profession also had a downside. By emphasizing medical or clinical rhetoric, the professional role became narrower. British music therapists had strong clinical and psychodynamic traditions focusing on individual work, referencing medical literature and theory, and downplaying the social and collaborative aspects of music-making, such as musical performance. Music therapy had strong curative and transformative ambitions, which could easily overlook work related to care and community. Within this clinical tradition, music therapists working with performance and concerts were frowned upon, as it was considered unethical.
Community Music Therapy
It's not surprising that Community Music Therapy became a strong counterforce to this development, led by Gary Ansdell and Mercedes Pavlicevic, well supported by Norwegian music therapists, with Brynjulf Stige as a leading example. The focus now was on not viewing individuals in isolation, but as part of a larger community. In the UK, this was seen as an "anti-model," opposing attempts to limit music therapy to medical or psychotherapeutic regimes. In Norway, we know, the introduction of community music therapy was less dramatic. Here, the ideology fit into an already established critical and systemic tradition. We had not developed strong psychodynamic traditions and were able to shape a profession broad enough to include various professional roles and identities.
The Entrepreneurs
The situation in the UK led many music therapists to respond by addressing the need in society to create musical meeting places where people could thrive and develop. This required music therapists to develop new formats, musical meeting places, and working methods that could meet the needs of the local community or specific user groups. This entrepreneurship, often driven by idealism, creative and flexible adaptations, stood in stark contrast to the clinical tradition many music therapists had settled into and which was protected by the new authorization. It’s not surprising that the level of conflict among British music therapists increased during this time. Many music therapists felt that the new community music therapy undermined the professional role they had developed over decades, which had led to their authorization.
I dare to believe that this entrepreneurship has been well preserved here in Norway. Not least by music therapy students who chose a guided self-practice in a new and unexplored field of music therapy. Another aspect of Norwegian music therapy that contributed to creating a broad professional understanding was that we early on developed an understanding of cultural factors, identity issues, and included sociological perspectives in the understanding of health and therapy.
Uncertainty and a New Therapeutic Industry
Anyone following the development of British politics and society is aware of the ongoing crisis, particularly within healthcare. The social contract designed in the post-war era has increasingly been undermined by neoliberal politics and the commercial exploitation of the National Health Service (NHS). The situation changed significantly, especially after 2010, when Labour had to give up power to the Conservative-Liberal Democrat alliance.
Procter writes:
"Whereas proponents of Community Music Therapy committed themselves to a view of their work as psychosocial, valuing the individual in the context of the communal, something to be offered in order to make society better and in particular to benefit the most vulnerable in society, a new wave of business-minded people began to carve out opportunities for monetizing the growth of music therapy."
This development led to the growth of music therapy within the national health system disappearing. Increasingly, health services are put out to tender and left to private companies. Here, music therapists could be engaged on a project basis, often by young and creative entrepreneurs. The pay might be reasonable in the short term, even though the companies take a percentage. But the work is uncertain, dependent on new projects, and the contract often does not cover working with the environments and groups surrounding the individuals receiving music therapy services.
For example: A music therapist is assigned to follow up with a student at a school. Within this project-based assignment, the student will receive music therapy, but the therapy is individualized and privatized, turning it into treatment. A music therapist employed at the student’s school, however, could work much more broadly with both the student and the environment. A music therapist working on a project basis often has to travel long distances and between multiple workplaces. Teamwork and multidisciplinary follow-up can become difficult. One ends up alone with the risks and responsibilities, degraded compared to those with permanent employment, and the result is often a decline in the quality of the work.
The Precariat
Such working conditions characterize the situation for many workers under neoliberalism. What is now called a "gig economy"—a labor market characterized by short-term contracts and freelance work—threatens to take over and create economic uncertainty for music therapists. It is still the case that those music therapists in the UK who are employed within the national health system earn well and have permanent positions. But such positions are becoming increasingly scarce. Music therapists are otherwise (poorly) paid as assistants in schools or within various pay scales. Additionally, there are some charitable organizations that employ music therapists on a permanent basis and offer good conditions. Among these is, notably, the Nordoff-Robbins Institute, which is a significant fundraiser.
Procter writes that the British Association for Music Therapy (BAMT) once functioned as a sort of trade union. Now, they have allied with the new agents within private health companies, even though they also lament the disappearance of permanent jobs in the NHS. For some music therapists, this development creates uncertainty, becoming a new precariat. Some, perhaps younger ones without much financial responsibility, seem to handle this challenge as an incentive to live as entrepreneurs. For others, the motivation to become a music therapist was about social solidarity, a belief in the role of music in society, and a desire to live a financially secure life based on music. Some are now disillusioned and leave the profession. The lack of a stable, secure job will also deter musicians who want to switch to music and health-related work from taking this risk.
An Important Four-Party Collaboration
This story should remind us of how important it is for music therapists to have a strong foundation in union work. The four-party collaboration in Norway, including CREO, the Norwegian Association for Music Therapy, and the two educational institutions, is an important way to ensure good education, salary, and working conditions for music therapists, permanent positions, and regulated salary scales through negotiations. Here in Norway, we must continue working to maintain a broad professional role that encompasses both clinical, (special) pedagogical, and community music therapy work, develop new entrepreneurship, and preserve flexible and creative forms of music and health work in collaboration with musicians, music educators, and healthcare workers.
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