Tuesday, September 4, 2012

Are you my 'client'?

I have been challenged recently to think more deeply about my rejection of the word 'client'. I’ve been trying not to use the word for a number of years, and frankly, it’s been a hard habit to break.  But I had made a very conscious decision in opposition to what I perceived as the institutionalised power imbalance invoked when the ‘client’ was framed as a recipient of my expert treatment.  The use of the word 'institutionalised' refers to the unconscious use of the word; the fact it was just accepted that people who participate in music therapy in all places and various ways should simply be considered to be one amalgamated whole, rather than the unique, context bound beings that they are.  'Power imbalance' referred to my belief that music therapy, as I practice it, is more of collaborative act than one directed by my superior understanding of a vulnerable person's needs. I use 'recipient' as suggestive of passivity on the part of the people who participate in music therapy, in contrast to the well-documented need for active commitment as fundamental to the success of therapy. 'Expert treatment' refers to the assumed use of a treatment model, which in my opinion is a very specific model involving formal stages of referral, assessment, goal setting, implementation of the planned activity, followed by evaluation of efficacy.

So, I had my issues with the relevance of the word client to the way I practice music therapy and perhaps even the way music therapy is practiced in many contexts informed by contemporary social policy.

Client is a convenient word however, and it is pragmatic to argue that replacing one word with what would potentially be four - person / people participating in music therapy - is both inefficient and confusing. However, I do recall the movement in the 1990s from language where people were described as 'autistic child' to 'child with autism', and at the time the change felt problematic for the same reason.  The importance of putting the person before the diagnosis seemed to make it worthwhile however, and it no longer feels cumbersome at all.

A problem with removing all connotations of power imbalance in music therapy was suggested by a colleague of mine, Jason Kenner, who pointed out that avoiding the reality that we have power in the relationship with our client is irresponsible. We are responsible for the music therapy context and committed to striving for therapeutic outcomes in relationship with our clients.  He suggests that by removing the recognition of this power, we may actually be disempowering ourselves and inadvertently relieving ourselves of responsibility within the therapeutic process. He feels that acknowledging our power helps us to be more responsible to the people we work with.

My own position is to emphasise mutual empowerment.  Perhaps my practice of music therapy is less effective than others, but my experience is that I am not able to take responsibility for the therapeutic outcomes; this is something I am enthusiastic about, and energetic towards, but not responsible for.  This is also in keeping with common factors research into the effectiveness of psychotherapy (Duncan, Miller, & Sparks, 2007).  If people do not wish to sing when I have suggested singing, there is only so much I can do.  If people choose to play, but not to discuss what they have played, I am often unable to convince them to do so.  Their agency is a critical dimension of the therapeutic encounter, combined with my capacity to create the conditions wherein the desire to participate can happen. 

Randi Rolvsjord (2010) elaborates her position on the concept of empowerment in the context of adult mental health, and I have a well-thumbed copy of her contribution to the topic and have commented on it previously (McFerran & Campbell, in-press). It has always confused me that she also likes to use the word client.  I have no doubt that she has been reflexive in considering this language, which reminds me about how important it is to consider the ways that words are used in different contexts.  Another heavily reflexive Norwegian, Brynjulf Stige (2002), points to Wittgenstein’s ideas to explain this contextualized use of language as it has come to be understood in the past century.  Perhaps words do not provide a direct mirror of reality, but rather point to meanings that are co-created in a given social context. Therefore it is easy to see that my use of the word client may be different to Randi and Jason’s use of it.

Another colleague, Grace Thompson, has been instrumental in influencing my own thinking on this topic, informed by her work in the Early Childhood Intervention sector where partnership with families has become the dominant model.   The sector has worked hard to illuminate implicit or explicit assumptions about the helper’s knowledge and resources being ‘superior’ to the local knowledge held by families (Davis, Day, & Bidmead, 2002, p. 47) and ultimately to provide alternative models to the expert helper.  The importance of collaborative relationships has been emphasized, and the use of language that suggests anything other than mutually empowering relationships has been considered detrimental to the success of the collaboration. 

This is obviously not a topic that is restricted to the music therapy profession.  A quick Google search reveals discussion on this topic from a range of fields and Jason Kenner discovered an article in psychiatry where ‘patient’ is reported to be the preferred language according to a sample of users/consumers/patients/clients in the UK (Simmons, Hawley, Gale, & Sivakumaran, 2010).   

My own conclusion is that the word client is convenient, simple and universally used within music therapy.  I continue to struggle with its relevance to my own work and cannot help but associate it with a classic treatment model that I no longer find useful.  However, I acknowledge that it may be the most appropriate term in some contexts.  In private practice, I can see that the word ‘client’ might be the most appropriate word, especially if the individual is paying for therapy.  In hospitals it makes sense that patient would be the preferred term, and I see no reason why a music therapist would introduce the use of the term client in contrast to that.  In education it is helpful to use the word student.  In work with young people in the community or in mental health care, another colleague, Cherry Hense, confirms that ‘young person’ is the preferred language in her institution.  I can see now see that it is just as inappropriate to reject the word ‘client’ as it is to accept it without conscious reflection.  My own issues with the word are local and grounded in my experiences of how that language is used and obviously this is not the same as other people’s experiences.  But I would argue that it requires due consideration and should not be a term that is used without critical reflection.  I guess I still don’t like it.

First Published on www.voices.no
McFerran, Katrina (20012). Who is my "Client" . Voices: A World Forum for Music Therapy. Retrieved September 03, 2012, from http://www.voices.no/?q=fortnightly-columns/2012-who-my-client