Philosophy and Framework

Systemic Interventions, Ecological Practices, and Integral Thinking

I had already made several visits to Birendra* along with Sahitya, who was interning during the summer of 2020. Each visit had varying degrees of hostility from Birendra’s uncle, because we were using a nice shady patch of ground for our sessions. The patch was on his side of the garden. On this visit, the tension was already somewhat tangible for me, and Birendra seemed subdued. Not too long into the session, the tension escalated in to an agrressive face-off between father and son. I knew that we were also at the receiving end of some colourful verbal abuse, but it seemed a matter of time before the aggression would become physical. I got involved, and threw in a threat that if he (the uncle) didn’t behave I would lodge a complaint with the police. I know a few colourful Hindi abuses myself, but not well enough to use them in sentences, so my involvement was in English. I hoped that the ‘sound’ I was making would cause the uncle to back off. It didn’t, he picked up on the word “police,” the frenzy increased.

I decided that taking Birendra to my place would be the best option, as continuing a therapy session in that environment didn’t seem workable, and leaving Arvind in the hands of emotionally charged adults also felt risky. Not that my own involvement in the situation pardons me of poor emotional regulation. After an hour or so at my place, I walked Birendra back to his place. His grandparents had locked their side of the house, and gone to the police station. I had to decide again – do I leave Birendra at his uncle’s house, or do I take him back home? Back to my place again. Half an hour later, I decided to sprint back, this time alone, as walking up and down with Birendra is much slower. The house was still locked. I spoke with the uncle’s son and got a contact number, which would help in me not having to keep shuttling up and down between our places. Back at home, I made lunch for the two of us, and tried to put Birendra to sleep. Didn’t work too well, and by evening I decided to put him on my scooter and take him for a ride. The ride seemed to make him uneasy, the opposite of what I hoped the wind blowing in our faces would do. At 530, the grandparents still hadn’t returned, and with much lack of clarity, I walked Birendra to his place and left him with his cousin. It had been a long day. 

From the onset, I admit to having spent several years not thinking specifically in terms of labelling my work. In retrospect, I seem to approach my work with a “what is needed for this situation and what will get that done” philosophy. This is largely because of my “let’s see where this goes” appraoch to my own therapeutic journey (a little more about this can be read in the Grapefruit Music section). That said, I was keenly aware that my style of operating was at the outer edge of the treasonable, and a stark contrast to the training I underwent. Initially when sharing about my work, I painstakingly made efforts to fit what the context here required and my responses to the demands of the context, within the framework of my training. I knew that something was “off” in spite of the hard work this describing required, but couldn’t quite put my finger on it. To discover eventually, that there were detailed articulations and substantial theoretical foundations around working outside the grid, was most rewarding. As interest around the nature of work in Matli has increased, I am becoming more intentional about cultivating language that puts flesh around the skeleton. For this I am indebted to the writings of Mercedes Pavlicevic, Gary Andsdell, Even Rudd, and Kenneth Bruscia.

Ken Bruscia in his book “Defining Music Therapy,” devotes an entire chapter to what he calls ecological practices. For him this is ‘promoting health within and between various layers (underline mine) of the socio-cultural community and/or physical environment.” He brings more clarity with this helpful paragraph, which has rich implications for working in contexts “outside the grid.”

“This includes all work which focuses on the family, workplace, community, society, culture, or physical environment, either because the health of the ecological unit itself is at risk, and there fore in need of intervention, or because the unit in some way causes or contributes to the health problems of it’s members. Also included are any efforts to form, build, or sustain communities through music therapy. Thus, this area of practice expands the notion of “client” to include a community, environment, ecological context, or individual whose health problem is ecological in nature. Thus helping an individual to become healthier is not viewed as a separate enterprise from improving the health of the ecological context within which the individual lives; conversely, helping any ecological context to become healthier is not a separate enterprise from improving the health of its members; and helping individual and ecology to relate to one another harmoniously makes both healthier.”

While on one hand, there’s nothing really new under the sun, in these definitions I sense it’s the degree to which the layers within a context show up simultaneously, which I appropriate to working in Matli. Here, I may slightly differ with Bruscia’s writings, or even more possible that I’ve not read enough to clearly contextualize his thoughts on how the layers present themselves within a session in my work. In my experience, I often find myself going about networking the client as an individual, their family, community, and at times even the dictates of the socio-cultural milieu, all at once. To flesh this out a bit, take for example good patient history taking. These give insight into the larger ecosystem and the layers involving the client, but the larger multi-layered ecosystem isn’t necessarily present during the session. In conventional therapy and if appropriate, caregivers/family members are present during the session, and in such cases, we find a dual-layer of sorts present. Or when working in a rehab centre, residential care, a school, these settings will intrinsically involve multiple layers, but often within the parameters of even a loosely defined therapeutic space. Further, and while I am open to correction on this, assessment sheets that therapists use for their sessions, often focus predominantly on the client as an individual (one layer), and monitor their progress or lack of, within the treatment room. If the entire ecological context needs an intervention/s, by extension the definitions of client-therapist relationship, treatment room, assessments, treatment plans, goals all require expansion. This is precisely what Bruscia does by calling for systemic interventions. I see these as interventions for each layer in the ecosystem being included in the treatment plan. Another helpful paragraph from Bruscia might be helpful to further clarity: 

‘Ecological practices are quite different from those in other areas, and this has major implications for determining levels. Not only does therapy extend beyond the treatment room, regardless of setting, but it also extends beyond the client-therapist relationship to include many layers of relationship between client and community, therapist and community, members within a community, and communities themselves. Going even further, the work itself is different, sometimes not anything like traditional therapy. Thus, treatment setting, client-therapist relationship, and “process” cannot be used as criteria for determining levels of therapy as they have been in other areas of practice. As a result, the levels of therapy identified heremay seem inconsistent with other areas of practice, and, although a practice is listed under one level, it may easily move to another. Here the criteria of greatest significance are whether the focus is on the individual, the ecology, or both and the degree of change resulting from the interventions.’ 

Much of this ‘hits the spot’ in terms of my own experiences of Matli, and while as a singular therapist with language barriers, having multiple layers (and often layers within layers) present within one session has it’s challenges, it is here where I find meaning in Integral thinking and practice. For this I am indebted to Aurelio Hammer’s life, work, and brainchild project Svaram, in Auroville India, which has greatly enhanced my appreciation of Integral spirituality and yoga, but here I will limit the scope of my sharing to Bruscia’s ideas of Integral practice within the context of music therapy.

“Integral practice is the therapist’s continual adjustment of his own way of thinking about and working with a client, to continually meet the emerging needs presented by the client as therapeutic priorities. An integral therapist stays reflexive at the macro and micro level and thinks the way the client needs him to think, not the way of thinking the therapist has already adopted; similarly, an integral therapist works the way the client needs him to work, not the way the therapist has already decided to work. An integral practitioner stays vigilant and open to responding to whatever client needs unfold as they unfold, creating a continual give-and-take of therapist and client following and leading each other. Likewise, an integral therapist can follow a protocol or model faithfully; modify the protocol to meet emerging client needs; use other relevant protocols if and when necessary; and establish a unique way of working with a client without using protocols. And being able to do all of this depends not only on the therapist’s ability to be reflexive about himself in relation to the client, but also on his mastery of music therapy methods, orientations, and techniques. In common parlance, an integral practitioner is flexible rather than fixed and open-minded rather than single-minded, but in that flexibility it is possible to be fixed sometimes, and in that open-mindedness it is possible to be single-minded sometimes. Integral thinking and working is the oppositeof one-way thinking and working, but includes them. As one begins working with a client, it is important to be reflexive at themacro level—to see the big picture of how and where everyone involved is situated. First, identify who or what is the client. Is the client an individual, an entire family or relationship, and/or the sociocultural or physical environment in which the client lives? Then compare the client’s background and living context with your own. Where are the similarities in and differences between how you and the client view and live in your respective worlds? Next, identify other possible participants and consultants in the therapy process and situate or locate where they are coming from and how their backgrounds and contexts fit with the client’s and your own.”

The story with which opens this write up, is one of many from my work where conventional boundaries don’t and cannot be applied. There can be no easy accommodation of the conventional client-therapist relationship and several layers within the client’s ecological unit are risky, and in need of intervention. This is no easy task given that the notion of therapy does not exist in the socio-cultural milieu here. At times I see myself as a singular agent attempting to intervene within a much larger ecological system, and being a singular point of reference has its own dangers. How far can an intervention go, given that it originates from a singular point of reference, and does it run the risk of  having all the answers and imposing them?

Hence, a trainee/intern, will undoubtedly benefit and simultaneously be immensely challenged by interacting with the layers of the context, and I see this process as better facilitated with borrowings from the South Asian heritage of “gurukul,” (roughly translated, apprentice) where certainly moments of verbal discourse and instruction occur, skill is primarily acquired by daily and intimate association within a context, picking up subtle but absolutely essential things such as timing, rhythm, and touch.

Excerpts from Kenneth Bruscia, “Defining Music Therapy – 3rd Edition,”  Barcelona Publishers, 2014

*Name changed.