Response to Rizkallah’s review of the book ‘Integrative health through music therapy: Accompanying the journey from illness to wellness’ — Sundararaj

Πρώτη Ματιά – Letter to the editor (published on 19 July 2020)

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Response to Rizkallah’s review of the book ‘Integrative health through music therapy: Accompanying the journey from illness to wellness’

Mohan Sundararaj

Independent scholar, USA 

Author biography

Mohan Sundararaj, MBBS MPH, is a physician and global health practitioner from India. He also graduated summa cum laude from a music therapy degree programme at Berklee College of Music, Boston, and completed a postdoctoral training in public health at Harvard University, USA. Sundararaj is currently the Director of Public Health Programs at MPact Global Action in Oakland, California. [msundararaj@post.harvard.edu]


I am writing this letter as a response to Marianne Rizkallah’s recent book review published in Approaches (Rizkallah, 2020). The book reviewed is titled ‘Integrative Health Through Music Therapy: Accompanying the Journey From Illness to Wellness’, written by Suzanne Hanser.

Integrative health must be viewed as a set of person-centred principles and approaches to enhance patient care and reduce suffering. It goes “beyond simply combining different forms of medicine and allows for an individualistic approach to patient care that incorporates the mind, spirituality, and sense of community as well as the body” (Gannotta et al., 2018, p. 1). It is intended as a practice that draws from a suite of interventions that meet the holistic needs of the patient. Integrative medicine practitioners do not view the field of integrative health from a dichotomous perspective of eastern versus western medicine but instead as a complementary and synergistic range of solutions that can help alleviate one or more presenting problems or concerns expressed by patients (Bell et al., 2002). A study conducted among resident physicians in the United States revealed that ideological differences and lack of knowledge were the primary barriers to the adoption of integrative medicine, not a lack of evidence (Ziodeen & Misra, 2018). The researchers recommend formal integrative medicine training to be incorporated within the medical education curriculum to overcome these barriers. The National Institute for Complementary and Integrative Health (2020) also advises health providers on how to access the body of evidence-based medicine, including mind-body practices such as music therapy. These conclusions suggest that attitudes and mindset also influence the adoption of integrative medicine, not necessarily the lack of evidence, as suggested by Rizkallah (2020). Further, the building of a robust evidence base is necessary across all integrative medicine practices worldwide.

Integrative medicine also views the patient and the practitioner as partners within the therapeutic process (Maizes et al., 2009). Approaches to the therapeutic relationship can therefore vary depending on the clinical context or length of treatment plans. It is true that there is a power differential between therapist and client, and maintaining a professional relationship requires strict parameters. However, Hanser urges the music therapist to “empower” the client to identify their own inner strength and resources as they enter into the therapeutic relationship. Those who face difficult diagnoses, traumatic treatments, ongoing pain and suffering, and limited lifespans may not always require a deeply psychoanalytic approach. In these individuals, the idea of a “companion” and “muse” as proposed by Hanser would be appropriate, as such an approach is more likely to elicit the intended therapeutic outcome of empowering the individual seeking treatment. Therefore, the terminology of companion does not deny the power dynamic that is inherently present in any therapy, as highlighted in Rizkallah’s book review.

Finally, the emphasis of the book is indeed on the relationship with music. Throughout the book, Hanser explores the relationship between the individual and music therapist as an empowering, open, and more balanced flow throughout the journey to wellness. This may not be the traditional client-therapist relationship, but this approach is what makes the book intriguing. In Chapter Six, Hanser specifically addresses the music therapist’s own journey at many levels of being, including “musical preparation.” 

Hanser’s contribution brings focus and depth to understanding the use of music therapeutically within an integrative medicine context. The evidence base assembled in the book and the strategies suggested by Hanser are an excellent resource for global music therapy practitioners of all experience levels who may want to engage more rigorously with this rich field. Drawing on my own expertise in the field of medicine and music therapy, I would recommend Hanser’s textbook for music therapists and health professionals from all fields to help promote and advance the use of music in integrative medicine. 

As Hanser models for us, the field of music therapy should be open to expanding our collective ability as a professional community to use music therapeutically more effectively. Hanser is to be lauded for departing from a narrower view of music therapy in favour of an innovative integrative healing model. I would invite the global music therapy community to undertake a more open and deeper reflection on the principles of integrative medicine with consideration for a range of needs presented by diverse communities worldwide.

References

Bell, I. R., Caspi, O., Schwartz, G. E., Grant, K. L., Gaudet, T. W., Rychener, D., Maizes, V., & Weil, A. (2002). Integrative medicine and systemic outcomes research. Archives of Internal Medicine, 162(2), 133. https://doi.org/10.1001/archinte.162.2.133

Gannotta, R., Malik, S., Chan, A. Y., Urgun, K., Hsu, F., & Vadera, S. (2018). Integrative medicine as a vital component of patient care. Cureus, 10(8), 1-5.  https://doi.org/10.7759/cureus.3098

Maizes, V., Rakel, D., & Niemiec, C. (2009). Integrative medicine and patient-centered care. Explore, 5(5), 277-289. https://doi.org/10.1016/j.explore.2009.06.008

National Institute for Complementary and Integrative Health (2020). Resources for health care providers. Retrieved from https://www.nccih.nih.gov/health/providers

Rizkallah, M. (2020). Book review “Integrative health through music therapy: Accompanying the journey from illness to wellness” (Hanser). Approaches: An Interdisciplinary Journal of Music Therapy. Advance online publication. Retrieved from http://approaches.gr/rizkallah-br20200203

 Ziodeen, K. A., & Misra, S. M. (2018). Complementary and integrative medicine attitudes and perceived knowledge in a large pediatric residency program. Complementary Therapies in Medicine, 37, 133-135. https://doi.org/10.1016/j.ctim.2018.02.004