Nordic Journal of Music Therapy

ISSN: 0809-8131 (Print) 1944-8260 (Online) Journal homepage: http://www.tandfonline.com/loi/rnjm20

Blind spots in music therapy. Toward a critical

notion of participation in context of children with
visual impairment
Maren Metell & Brynjulf Stige
To cite this article: Maren Metell & Brynjulf Stige (2016) Blind spots in music therapy. Toward a
critical notion of participation in context of children with visual impairment, Nordic Journal of
Music Therapy, 25:4, 300-318, DOI: 10.1080/08098131.2015.1081265
To link to this article: http://dx.doi.org/10.1080/08098131.2015.1081265

Published online: 14 Sep 2015.

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Date: 12 December 2016, At: 04:05

Nordic Journal of Music Therapy, 2016

Vol. 25, No. 4, 300318, http://dx.doi.org/10.1080/08098131.2015.1081265

Blind spots in music therapy. Toward a critical notion of

participation in context of children with visual impairment
Maren Metell* and Brynjulf Stige
GAMUT The Grieg Academy, Department of Music, University of Bergen,
Bergen, Norway
(Received 11 May 2013; accepted 4 August 2015)
Visual impairment results in a different way of perceiving the world.
The consequences of the absence of vision in early childhood determine
individual capacities for participation in a sighted world, but, at the
same time, possibilities for participation are determined by society. The
purpose of this theoretical paper is to explore and develop a critical
notion of participation within the context of music therapy and children
with visual impairment, and to examine theoretical ideas that are relevant for practice, research, and further theoretical discussion. Music
therapy with children with visual impairment appears to be an underdeveloped field where the focus has been on the individual. The frameworks of community music therapy and disability studies provide a
theoretical background to link individual capacities such as
protomusicality and musicianship with the social and cultural dimension
of music. In discussing possibilities and barriers for participation for
children with visual impairment, we argue that a values-based and
resource-oriented approach to health musicking might allow for mutual
participation with context-transforming potential, by providing a space
that is shaped by the universal design of instruments, activities, and
environments.
Keywords: visual impairment; community music therapy; participation;
disability studies

Introduction
In spite of overall international goals to attain full participation and equality (United Nations, 2006), children with visual impairment often experience exclusion (Vision 2020, 2007; World Health Organization, 2012).1

*Corresponding author. Email: Maren.Metell@uib.no

1
Vision 2020 is a global initiative of the WHO (World Health Organization) in cooperation with the IAPB (International Agency for the Prevention of Blindness). The objective
of Vision 2020 is to eliminate avoidable blindness.

2015 GAMUT The Grieg Academy Music Therapy Research Centre

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Consequences of the absence of vision in early childhood determine

individual capacities for participation within a sighted world, but, at the
same time, possibilities are determined by society. Visual impairment2 has a
societal dimension; there are barriers for participation due to negative
attitudes and a lack of accessibility.
To take part in relationships and social contexts such as family, kindergarten, school, and leisure time means to be an active member of society.
Participation involves potential for companionship, mutual recognition, and
freedom. From a disability studies perspective, the notion of participation
links to societal conditions. As the Union of the Physically Impaired
Against Segregation (UPIAS) stated already in 1976, In our view it is
society which disables physically impaired people. Disability is something
imposed on top of our impairments by the way we are unnecessarily isolated
and excluded from full participation in society. A child with visual
impairment who can access all buildings, does not meet negative attitudes,
gets access to books in Braille, and can fully participate in all activities in
the community does not experience disability. Different theorists over the
past few decades have shared this view and they do not look at the physical
impairment, but look at the subsequent social isolation as a disability. The
opportunity for participation, as the dialectic opposite of social isolation
(Jantzen, 1976), is what decides a persons disability. Becks (2009)
approach is similar; she refers to participation as the positive opposite of
marginalization.
As of yet, there is not much literature on music therapy and vision, or
even visual impairment in general, and even less literature that takes the
societal dimension of participation into account. To find relevant literature,
we searched the databases RILM, Bibsys, ERIC, and Google Scholars, and
also Music Therapy World, Voices, NJMT, Musiktherapeutische Umschau,
Journal of Music Therapy, British Journal of Music Therapy, and Revista
Brasileira de Musicoterapia. The database search was carried out using the
following keywords: blind, visual impairment, music, music therapy
and participation in English, German, Spanish, Portuguese, and
Norwegian. We chose to exclude articles that are on topics or have foci
not relevant for this paper (e.g., the article by Aepkers & Stark, 2005).
Thus, we do not provide a comprehensive review of the literature in its
entirety, but a literature review of 12 publications relevant to the focus of
this article.

2
We choose to rely on terminological suggestions proposed by the UN (2006). This entails
not using the term blind children. Since children with blindness is not in use, the term
children with visual impairment is employed. Visual impairment is an umbrella term
including low vision and blindness. The focus in this paper is on children that cannot use
their vision in everyday life.

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In the included literature, two case studies have been identified: one conducted by Orff (1982) and the other by Salas and Gonzalez (1991). Orffs (1982)
study is about a 3-year-old girl named Antonia. Orff (1982) describes that
Antonia, during the music therapy process, develops relationships with both a
therapist and instruments and a sense of agency. The case study of Salas and
Gonzalez (1991) describes Gabriela, a 4-year-old girl with visual impairment and
multiple disabilities. The main therapeutic approach is clinical improvisation,
giving a response to all of the expressions and initiatives that Gabriela showed.
They describe the process as going from isolation to participation (Salas &
Gonzalez, 1991). Both Orff (1982) and Salas and Gonzalez (1991) work from
a humanistic, client-centered approach.
In contrast, the next two empirical studies are from a more behavioristic
approach and consist of studies by Kern and Wolery (2001, 2002) as well as by
Robb (2003). Kern and Wolery (2001, 2002) carried out a study on the interactive participation of a 3-year-old boy by adapting a playground in a musical
way. The researchers added musical stations, connected them with a soundpath,
and carried out staff training. Robb (2003) focuses her study on attentive
behavior in both play-based and music sessions and on the participation of
groups in the different forms of sessions. Her study includes 12 children between
4 and 6 years of age who were enrolled in an early intervention program due to
their visual impairment.
Another interesting contribution to the field of music therapy and children
with visual impairment is the work of Codding. Coddings (2000) literature
review includes 27 studies and 17 case studies and argues how music is used
in relation to musical and nonmusical aims. Kern (2006) did an interview with
Codding, addressing mainly early intervention with children with visual impairment. Codding (Kern, 2006) highlights here the impact music therapy has on
development, especially in terms of sensory stimulation, motor development,
orienting, and normalizing. She looks at music as a natural tool to promote the
exploration of the environment. Music can further reduce the isolation of the
child and the family. Gourgey (1998) and Decker-Voigt (1994) mention similar
topics in their articles. Gourgey (1998) reviewed literature from the field of
psychology on children with visual impairment. He suggests three areas of
importance: exploration of the environment, modification of blindisms,3 and
socialization (Gourgey, 1998). Decker-Voigt (1994) mostly focuses on the effect
of music on the brain and on music therapy in general, but topics of importance
related to people with visual impairment include the different perception of the
world, isolation, and the potential of music in this context. Wrogemann-Becker
(2010) explores the ego development in children with visual impairment. She
worked for 2 years with six children with visual impairment between 3 and 7
years old and explores the development of a relationship between herself and the
children from a psychoanalytical approach.
3

Stereotype behaviour.

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The two last articles we want to present are mainly descriptions of work
settings. Bertolami and Martino (2002) describe methods and activities in their
article, such as songwriting, which they use in their work. They emphasize the
value of working interdisciplinary and the possibility of providing co-therapy
with professionals from other disciplines. Silva (2006), in his conference poster,
evaluates the implementation of music therapy in a rehabilitation center for
children with visual and multiple impairments. He describes the inclusion in
terms of the family, school, and social environment of children with visual and/or
multiple impairments as the overall goal of the center.
In spite of occasional references to social processes such as inclusion, the
music therapy literature reviewed earlier, to a large degree presents an individualized view of disability.4 Participation is conceptualized as individual conduct
rather than as something relational that has to do with both the individual and
community. The notion of participation, as used by Robb (2003) and Kern and
Wolery (2001), appears to be more of a behavioral category than a societal ideal
and process. Most of the articles are from a behavioral (Codding, Kern &
Wolery) or psychoanalytical (Decker-Voigt, Wrogemann-Becker) music therapy
tradition and do not include a societal perspective. However, the literature
reviewed clearly testifies to the importance of music therapy for the development
of relationships and interaction, and of skills such as orientation and mobility.
The difficulties of children with visual impairment are highly dependent on
their environment (Brambring, 2006; Tellevik, 2008). It would be natural, then,
to work not only with the child individually, but also with the childs environment. However, this does not emerge as a main approach in the music therapy
literature reviewed. In order to look at the societal dimension which is missing in
this literature, we need to look at participation from different theoretical perspectives and examine theoretical ideas that are relevant for practice, research, and
further theoretical discussion.

Theoretical framework
Our research approach in this study is a theoretical one; we focus on critical
theorizing and conceptual elaboration. We want to develop a theoretical understanding of the notion of participation in the context of visual impairment, and
we want to discuss childrens possibilities for participation in and through music
therapy. In order to develop theoretical ideas that are relevant for practice,
research, and further theoretical discussion in the field, we explore links between
these notions.
Drawing theories from different fields requires an approach that is reflexive
(Alvesson & Skldberg, 2000/2009). In order to explore different notions and
4

This claim is made here specifically in relation to visual impairment, but as discussed in
Vol 14 No 3 of Voices in a special issue on music therapy and disability studies this
might characterize music therapy more broadly, also.

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theories and to use our own experience and understanding to reflect on differences and similarities, we find it necessary to situate ourselves in a hermeneutic
research tradition. Our approach is informed by the pre-understanding that
participation not only has an individual dimension to it, but also a social and
political dimension. This requires a theoretical framework that takes these
dimensions into account. The framework we employ emerges from critical
theory and fields that are informed by critical theory, such as community
music therapy, critical special education, and disability studies.
The term critical theory is used in different ways. We refer to how the term
is used by the Frankfurt School, a Neo-Marxist academic tradition that traces
back to the Institut fr Sozialforschung, founded in 1923. A main task for critical
theory based on Marxist theory is to uncover an ideology in established modes of
thinking in a society [Ideologiekritik]. The basic assumption is that there is a
connection between peoples ideas and theories and the social and economic
structures of a society. Through the systematic uncovering of the dependency of
ideology, the aim is to criticize and help overcome social structures that maintain
unequal societal conditions.
The separation of individual and society, through which the individual accepts the
limits of their activity as natural, is relativized in critical theory5 (Horkheimer,
1937/1970, p. 28)

In our interpretation, Horkheimer provides the possibility to look at an activity

(such as participation) and its restriction in a different way. Critical theory
challenges the structures of class society, especially the distribution of power
regarding the means of production, which is often hidden to the individual. This
is relevant, for instance, in relation to issues such as the unemployment of people
with visual impairment and general processes of exclusion in society.
Critical theory provides a background to discuss structures of power and has
influenced many disciplines, including critical special education, disability studies, and community music therapy. Community music therapy provides a
perspective that goes beyond the dyad of a music therapist and client in a
music therapy room. It is sensitive to context and culture; it challenges structures
in society; and it explores the relationship between societies, individuals, music,
and health (Ansdell, 2002; Pavlicevic & Ansdell, 2004; Stige, 2003/2012, 2010;
Stige & Aar, 2012). This approach opens the possibility of looking at both
individual and societal preconditions of participation.

Methodological considerations
Compared to methods in empirical research, building theory through theoretical
research tends to be freer and more open for creative imagination and critical
5

Our translation.

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reflection. Developing theory through synthesizing literature from different

angles is a common approach in the humanities, and we relate this paper to
this tradition of reflexive theory development. The framework of critical theory
asks for the critical and reflective use of literature and theory. It emphasizes
reflection on the production and use of knowledge, the dimension of power, and
the relational view of both disability and the individual in society. The approach
is shaped by analysis, critique, and the elaboration of aspects relevant for this
paper (Alvesson & Skldberg, 2000/2009).
Examples of reflexive theory development in music therapy literature include
Ruud (1987), Kenny (1989) and Stige (2003/2012). It can be similar to what
Bruscia (2005) calls a reflective synthesis in his overview of the most common
methods to develop theory in music therapy. Bruscia describes it as follows:
A theory is developed by reflecting on ones own experiences with a phenomenon,
relating the reflection to existing ideas or perspectives of other theorists, looking at
research, and intuitively synthesizing all the sources of insight into an original theory
or vision. The theory may start from any of the sources. (Bruscia, 2005, p. 545)

Some might argue that a reflective synthesis lacks the rigor of theorizing
based on empirical research. We will argue that for complex practices such as
music therapy, it is extremely important to allow for theoretical research methods
based on constructive speculation and critical reflection, in order to encourage
the development of new or more nuanced perspectives (for a related argument,
see e.g., Weick, 1995).
In writing this article, we selected literature that would contribute to the
discussion of a critical notion of participation, both in general and in the context
of children with visual impairment in particular. Looking for similarities and
differences and evaluating the ideas presented in literature, we then synthesized
the emerging ideas by using our pre-understanding and overarching theoretical
framework as resources. As suggested earlier, reflexivity is a core component of
this method, developing knowledge through participant observation of the field,
dialogue, examination of literature, and reflection.
We will approach the theoretical examination by first examining the notion of
participation more generally, exploring the use of the notion in different fields
that provide a background for the discussion of a critical notion of participation.
Then, we explore participation as an individual capacity related to the need for
companionship and development. In the next section, the focus is on participation as a human right and democratic value for children with visual impairment.
Through synthesizing arguments, we elaborate on the conditions that allow
musicking as an activity to afford the potential of a space for mutual participation
that promotes individual and communal resources for children with visual
impairment.

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The notion of participation

Participation is an umbrella term used in different contexts, both in everyday
language and in academic discourse, and it has a variety of meanings that are
often not specified. The social notion of participation that we employ is closely
related to other notions such as integration, inclusion, and empowerment, with
conceptual contrasts such as exclusion and marginalization. In the first authors
mother tongue of German, there are two different words for participation.
Teilnahme means joining into something. Teilhabe addresses the political dimension of taking part in society and the structures that hinder participation. The
main difference is the dimension of power. Teilhaben, taking part, requires a
mutual relationship, while teilnehmen is possible in any hierarchical or nonhierarchical constellation (Metell, 2011). In the context of this paper, we emphasize a
notion of participation that is related to Teilhabe.
Originally, the English term participation comes from the Latin terminology
partem carpere, which means to take something from someone. This demonstrates a certain dimension of power in the notion of participation and allows for
the political use of the notion. The notion of participation is widely used by the
United Nations, and it is described as a necessary condition for democracy to
develop. Participation is a human right according to the UN, but it remains
unclear what impact this has on the reality of people with disabilities. Barnes and
Sheldon (2010) argue that the UN initiatives still build on an individualistic,
medical notion of disability and that these initiatives do not challenge the
systems that safeguard the benefits of privileged people and places.
Since 1999, the notion of participation has been part of WHOs International
Classification of Functioning, Disability, and Health (ICF; 2001)6 and it is
defined as involvement in a life situation. Disability can then be seen as modified
and reduced participation due to individual defect and activity limitation.
The change in terms undertaken in 1999 emphasizes the societal dimension of
disability, but there is no consensus among theorists if the WHO succeeded in
terms of describing and categorizing that dimension. One objection is that
participation can be understood as a solution for everything. For instance,
Prosetzky (2009) criticizes the ICF for offering a solution that is actually part
of the problem: Because the given societal structures for participation are not
only able to compensate disability, but in the first place to produce disability7
(Prosetzky, 2009, p. 90). Prosetzky (2009, p. 91) further warns against using the
notion as something positive and morally romanticized without challenging it.
For him, the notion is closely related to power and must have an impact on the
distribution of power. Jantzen (2000/2004) describes the change in terms as
euphemism, and Hirschberg (2007) criticizes that participation is still

6
The terms impairment, disability and handicap from the version of 1980 have been
substituted by impairment, activity and participation.
7
Our translation.

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underrepresented in the ICF and the emphasis still lies on the individual, rather
than on the environment.
Stige (2006) reviewed and discussed music therapy literature on participation
in order to stimulate systematic reflection on the notion and developed the
following definition to provide a platform for discussion:
Participation is a process of communal experience and mutual recognition where
individuals collaborate in a socially and culturally organized structure (a community), create goods indigenous to this structure, develop relationships to the activities, artifacts, agents, arenas and agendas involved, and negotiate on values that
may reproduce or transform the community. (Stige, 2006, p. 134)

Other music therapists who stress the relevance of participation in terms of social
participation in music therapy include Frohne-Hagemann (2001), Krger and
Stige (2014), Procter (2004, 2011), Rolvsjord (2010), Ruud (1998), Schwabe and
Haase (1998), and Aasgaard (2002). Pavlicevic (1997), Rolvsjord (2002, 2010),
Solli (2008), and Trondalen (2008), among others, emphasize the experience of
mutuality in interaction in the context of music therapy. For Ruud (2010),
participation is the missing link between health and culture. As Gary Ansdell
points out, Music is seldom just a private pleasure it is always already social
participation (Ansdell, 2004, p. 68). In the growing body of community music
therapy literature, the notion of participation is crucial.
Other fields of music study that can inform the discussion of participation of
people with disabilities include the emerging fields of ethnomusicology of
disability and music and disability studies/cultural disability studies (Lerner &
Straus, 2006; Lubet, 2004, 2011; Straus, 2011). Researchers in these fields look
into the relationships between disability and music. As Lubet (2011) states,
participation in music is a human right and, therefore, also a disability right.
The literature reviewed illuminates participation as individual capacity and
need, as well as a social ideal, process, and a human right. In the following
sections of this paper, we want to elaborate further on these aspects of the notion
and relate them to the reality of children with visual impairment.

Participation as individual capacity and need

The emphasis of this paper is on the societal dimension of participation.
However, we want to give a short overview of arguments that show how
participation as individual capacity is related to a social interaction. Research
on early infant interaction has shown that children are born to be sociable, to
communicate, and to share meaning (Trevarthen & Malloch, 2000). Trevarthen
and Aitken point out that a human being is born with what they call a system for
intrinsic motive formation (IMF), a system that seeks inter-subjectivity and
makes cultural learning in companionship possible (Trevarthen & Aitken,
1994, 2001). This research supports philosophical arguments suggesting that

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human beings are social in nature and that they need companionship for development (e.g., Buber, 1923/1965). Feuser (2000) describes isolation as something
that must be overcome and dialogue as something that needs to be established.
For Feuser, the inner perspective of participation is dialogue.
Early interaction between a child and caregivers is considered crucial for
social and emotional development. In relationship to children with visual impairment, the focus in literature is often on the challenges. It is emphasized that
vision plays an important role in early interaction between caregivers and
children and promotes attachment and joint attention (e.g., Schore, 1994; Stern,
1985). Daniel Stern (1985) describes vision as being crucial for joint attention,
and Selma Fraiberg (1979) suggests that vision affords an elementary form of
initiative in human partnership long before there can be intention (Fraiberg,
1979, p. 156). The focus on the childs limitations represents able-bodied
perspectives and says perhaps more about the difficulty of the caregivers to
adapt to the childs signals than about relational possibilities. As Cutter (2007, p.
13), an early childhood specialist for orientation and mobility, emphasizes,
differences arent deficits. The studies of both Bigelow (1995) and Preisler
(1991, 2005) show that interaction and communication works if caregivers adjust
themselves to the child with visual impairment and use touch and voice to
establish a relationship. Preisler (1991) links this to amodal perception, the
capacity to process and translate a sensory impression across modalities (Stern,
1985). To illustrate this, we want to refer to an example given by Trevarthen.
Trevarthen (1999) analyzed a video of a mother and her 5-month-old daughter
who has congenital blindness and uses it to explain the notion of amodal
perception. The video shows the mother singing songs accompanied by the
gestures of her daughter. According to Trevarthen (1999), the daughter is acting
like a trained conductor, accentuating high notes, and closing her hands on the
end of the phrases. Trevarthen (1999) considers the baby and mother as equally
competent partners in this performance. This example does not only illustrate
psychobiological capacities as well as the importance of amodal perception, but
it also illustrates an arena where musical knowledge is appropriated. According
to Pavlicevic and Ansdell (2009, p. 362), musicianship is a cultivated facility of
musicality-in-action within sociocultural contexts. It involves the skillful coupling of musicality to specific musical cultures, traditions, games, techniques and
artifacts. For them, musicianship is linked to affordances offered by situated
musics8 and characterized as the process of communicating and generating
musical knowing through musical doing (Pavlicevic & Ansdell, 2009, p. 362).
Musicianship can be understood as our personal musical history, as appropriated
musical knowledge in social contexts. Musicianship is then a resource for
The notion of musics traces back to ethnomusicology and refers to the many various
traditions of music and music making in various societies. The notion has been adopted by
Stige, who relates it to processes of meaning making and the possibility of recontextualizing objects and practices (Stige, 2002, p. 94).

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participation that all humans possess, but, in contrast to protomusicality, it

develops during the lifespan.

Participation as human right and societal need

There are several layers of preconditions for participation in community and
society. The range spans from prevalent attitudes toward disability to the accessibility of buildings and public transport and services () How is societal
belonging produced and experienced and how much inequality is accepted by
society?9 asks Bartelheimer (2007). Both questions are highly relevant in the
context of children with visual impairment and will be addressed in this section.
The notion of participation appears in several documents by the UN on
accessibility and participation, for example, The Standard Rules on the
Equalization of Opportunities for Persons with Disabilities, a text that includes
22 rules, including preconditions for participation and target areas for participation (UN, 1993). These rules are not binding in juridical terms but reflect a
moral and political commitment. The Convention on Rights of Persons with
Disabilities (UN, 2006) includes, among others, the right to education and
employment. On a superordinate political level, participation, equality, and
accessibility are thus recognized as highly pertinent values and goals.
However, 90% of all children with visual impairment in the world do not receive
schooling (Vision 2020, 2007) and according to the American Foundation for the
Blind, 75% of adults are unemployed (http://www.lighthouse.org/research/statis
tics-on-vision-impairment/employment-status/). Disability tends to correlate with
poverty and misery, and represents a labor of lower quality in a capitalist system
(Jantzen, 1976). As Soldatic and Meekosha (2012), two social scientists, point
out, neoliberal regimes entrench poverty and marginalization. Participation is
therefore inseparably linked to the societal system in which children with visual
impairment live.
However, it is not only politics on an institutional level, but also the people
living in the society that determine participation. People have certain attitudes
and a particular social reaction to people with a disability. Hollins (1989)
research showed both a correlation between attitudes toward blind people and
attitudes toward minorities in general, and that society has many misconceptions
regarding blindness and people with visual impairment.
Participation in music is related to the accessibility of music in society, the
educational system, and the music culture. One important notion linked to accessibility is the concept of universal design, coined by Ron Mace in the 1970s.
Universal design refers to the idea that design, products, environments, and services
should be usable by all people to the greatest extent possible, without adaption, but
not excluding the use of special solutions where this is needed (Mace, 1985; UN,
2006). While universal design was initially related to architecture and product
9

Our translation.

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design, today it is adapted to other contexts such as learning (e.g., Bowe, 1999) and
disability studies (e.g., Wendell, 1996). DSouza (2004) argues that universal
design can be seen in a critical theory paradigm in terms of knowledge generation
and as linked to emancipatory attitudes. In our view, the concept of universal design
can be valuable to music therapy, especially for the discussion of participation. An
interesting example in this context is the sensory friendly concerts (Shiloh &
LaGasse, 2014). These concerts are facilitated by community music therapists,
based on the premises of the autistic community.
In addition to the idea of universal design, an elaboration of the notion of
health musicking can help clarify the notion of participation in relation to music
therapy. The notion of health musicking was developed in music therapy theory
by Stige (2002, 2003/2012), building on Smalls concept of musicking (1998)
and DeNoras notions of affordance and appropriation (2000, 2007), as well as
the praxeology of Wittgenstein (1953/1967) and others. The concept clarifies
how health-related meanings and effects of musical engagement depend on
situations of human action and interaction, and the notion has been discussed
by both music therapists (Bonde, 2011) and music sociologists (Batt-Rawden,
Trythall, & DeNora, 2007; DeNora, 2007).
It is crucial to note that music is not per se facilitating mutual participation.
Lubet (2004) argues that Western classical music presents formidable impediments
to full participation, most notably to the vision-impaired (Lubet, 2004, p. 134). He
highlights Western classical musics dependence on notation, which provides a
clear barrier for participation for people with visual impairment. Contrasting this, or
rather describing an exception, Lubet (2011) describes the Al Nour Wal Amal
(Light and Hope) Orchestra of Cairo. All members are females who have a visual
impairment. Lubet (2011), with reference to Smalls (1998) study on symphony
orchestra concerts, criticizes its Eurocentrism, androcentrism, totalitarian structure,
and exemplification of the industrial capitalist factory model of production (Lubet,
2011, p. 77). Nevertheless, for Lubet (2011), this orchestra, which is in a country
where girls and women with visual impairment do not have many opportunities for
participation, is an example of the liberatory impact of a foreign music in
transcending social norms (Lubet, 2011, p. 69).
Both Lubet (2004) and DeNora (2007) refer to Marthas Vineyard, an island
that had an unusually high percentage of people with a hearing impairment.
Deafness was considered a normal variation and not a disability or impairment.
Lubet uses the example to show that impairment can be culturally contingent
(Lubet, 2004, p. 134). DeNora (2007) uses it somewhat similarly, but relates it to
the performance of health.
We want to argue that the practice of community music therapy can create
spaces comparable to Marthas Vineyard; spaces where variety is the standard
and where barriers for participation for children with visual impairment are
reduced. This leads back to the question of how music therapy can create
possibilities for participation.

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Health musicking as the realization of mutual participation

We claim that participation in the activity of health musicking can afford the
development of individual and communal resources. In this section, we will
outline how health musicking can be characterized for children with visual
impairment and their families in an early intervention context. The choice of
an early intervention context is partly influenced not only by the work experiences of the authors, but also by the fact that early childhood is an interesting
arena when working for social change.
Music therapy for children with visual impairment would, ideally, involve
different arenas in order to promote inclusive structures that facilitate participation and counteract barriers. In the context of early intervention, this could
involve working directly with a child with visual impairment, providing a
space for mutual participation, and promoting individual capacities for participation as well. This work would then be complemented by working with the
caretakers and the broader community context, providing inclusive music spaces.
Promoting early communication and attachment aims at providing a space where
both children and caretakers are competent partners. A music therapy project in
an early childhood program (Metell, 2015) indicates that music therapy affords
happiness and joy and the improvement of bonding patterns, as well as empowerment of both children and caretakers. Empowerment is a central category, as
families with children with disabilities often experience marginalization
(Brambring, 2006; Goodley & McLaughlin, 2008). A music therapist can provide information and support regarding how music can be used to create spaces
for mutual participation in everyday life, developing songs and activities in
collaboration with the family.
Furthermore, this work would include collaboration with kindergartens and
preschools, providing, for instance, supervision on musical activities. The focus
here would be on the universal design of activities, not only in terms of design of
instruments and environment, but also in terms of offering activities in which
children with and without visual impairment can participate. The concept of
universal design provides us with a framework for the creation of inclusive
spaces. Ideally, the instruments would have a universal design that would help
to meet individual needs (e.g., carefully designed surface qualities that afford
differentiation of instruments). One objection to the concept of universal design
is that one design cannot meet the needs of people with all different types of
visual impairment (Imrie, 2004). This applies not only to the design of instruments, but also to the design of activities. It is, therefore, important to adapt the
design to every group and setting.
When musicking provides a place with qualities similar to those of Marthas
Vineyard, the space affords experiences of belonging where different perception
styles do not matter. According to Cloerkes (2007), until the age of 7 or 8,
children are open to all differences; whereas, around the age of 7 to 8, they
already show massive prejudices. Therefore, kindergarten and preschool seem to

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be an important place to create spaces where children experience friendship and

diversity. Hence, kindergarten and preschool are important arenas for values and
attitudes.
From a community music therapy perspective, music therapy affords change
in terms of altering existing arenas for participation and creating new ones by
negotiation of structures, values, and attitudes. Prosetzky (2009) highlights the
need to counteract the structures in society that create disability. Public arenas of
music therapy practice could be where the attitudes toward diversity and visual
impairment are redefined. This leads to a notion of participation as political
action (Stige, 2006) and to a process that would involve the negotiation of
structures that determine participation. Examples for such processes would be
community performances that take principles of universal design into account
and which might encourage people to rethink their constructs of disability.
Applying Prosetzkys (2009) critique of the notion of participation, the negotiation of structures has to involve discussions of the relationships between the
structures that determine possibilities for participation and the structures that
determine disability. It is, therefore, important to look at the broader social and
political context and to work with structures that determine access to music for
children with visual impairment.
Conclusion
We have argued that a value-based and resource-oriented approach to health
musicking can allow for mutual participation with context-transforming potential. Space for participation is shaped by the universal design of instruments,
activities, and environments. We have suggested a space comparable to Marthas
Vineyard, a space where variety such as visual impairment, and differing degrees
of such, is normal. Such a space for children with visual impairment can be
created in different arenas within individual therapy, in a family context, in
groups, and in public arenas. Engaging in this space is made possible by the
psychobiological capacity of protomusicality and through appropriation of the
affordances of agendas, activities, and artifacts.
Health musicking, as the realization of participation, is always linked to a
situation and has the potential to interact with various contexts. The space of
mutual participation offers, through its affordances, a potential for individual
development for children with visual impairment, as well as for community
development through the negotiation of structures and relationships. How
would playing music with blind toddlers change the world? might be a legitimate objection. Even though it might not be possible to counteract all oppressive
structures and practices, it seems crucial to be aware of them. A focus on the
societal dimension of participation can stimulate music therapeutic practice that
contributes to the development of inclusive structures in society. Enhancing early
communication between parents and a child with visual impairment, or offering a
music group in kindergarten, might not change the world at large, but it can

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make a difference for the child, the family, and the community. A critical notion
of participation moves the focus away from the individual only and toward our
understanding of community, music, and health. Consequently, it may stimulate
critical awareness and further discussion of the structures we practice and
practice within.

Notes on contributors
Maren Metell studied music and special education in Berlin, trained as a music therapist at
the University in Bergen and holds also a Masters degree in visual impairment pedagogy.
She is interested in the links between disability and social and musical participation and
works currently at Statped Southeast, Department for Visual Impairment and at the Grieg
Academy, University of Bergen, Norway.
Brynjulf Stige is Professor of Music Therapy at the University of Bergen (UiB) and Head
of Research at GAMUT The Grieg Academy Music Therapy Research Centre, UiB and
Uni Research Health. Stige has published books and articles on culture-centred music
therapy, community music therapy, and music therapy theory. He was founding editor of
Nordic Journal of Music Therapy from 1992 to 2006 and is founding co-editor of Voices:
A World Forum for Music Therapy.

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