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
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
