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Thoughts / The craft

In a team, what language does the music therapist speak?

September 17, 2026 · Thoughts / The craft

Tuesday, a quarter past nine, the small meeting room of a service for older adults in Brianza, north of Milan, where I've been working for a few years. Around the table: the doctor, the psychologist, the physiotherapist, the nursing coordinator, two educators and me. Files open, little coffee cups nobody throws away. We go through the people on the second floor one by one and, when we get to the name of the lady I'll call A., everyone speaks in turn: the doctor says blood pressure and sleep, the physiotherapist says walking and fear of falling, the psychologist says mood and a daughter who visits less often. Then the coordinator turns to me: "Paolo, you?"

I'm the only one at the table who has no uniform of any kind. It isn't a pose: I told the story in an old podcast episode, I don't need to see myself in the medical or psychological category to feel that what I do makes sense; I feel like a musician who frequents clinical settings. But that "Paolo, you?" carries its weight. I have a minute, maybe less. And in that minute, every Tuesday, I decide what language to speak.

In July 2026 I asked who tunes the tuner: that was the inner half of a question. This is the outer half. How do I stay in tune when I'm playing in an orchestra where everyone else is reading a different score from mine?

What tempts me, when it's my turn?

Two things, and I know them well because I've fallen into both.

The first is silence dressed up as an answer. "She took part willingly, she was calm, she sang." All true, everyone nods, nobody asks anything else. It's the sentence of someone who chooses to say only what the others already understand; nobody challenges it because there's nothing in it to challenge.

The second is subtler and more flattering: total translation. "We worked on temporal orientation and emotional regulation, with an increase in active participation." This is true too. The doctor takes a note, the psychologist looks at me with a new expression, I go home feeling I've finally been taken seriously. Except that in the minutes, the music has vanished. Nobody will ever know that Mrs A. slowed down and lowered her voice on one precise word.

That's the point. In a team the risk isn't not being accepted: it's being accepted at the price of speaking everyone else's language. When that happens, the service gains one more member of staff who says the same things as everyone else with bulkier instruments, and loses the only person who knew what was going on in the music.

In 2019, in a post, I called us musicimigranti, music-migrants: people destined to wander in search of a land where they can feel at home. And whoever is looking for a land accepts the passport they're offered, even if the name written on it isn't theirs. It isn't a temptation of today: back in 2010 Postacchini and Spaccazocchi were writing that for years the music therapy world "has been working hard to tailor itself an ever more scientific suit" (in my translation). A suit, precisely, and we sew it ourselves: in a document that the Italian Association of Music Therapy Professionals (AIM) filed with the Ministry, music therapy is "an additional complementary resource", to be used "exclusively on the indication and under the responsibility of healthcare personnel" (again in my translation). An article published in September 2026 on palliative care (Iturri and colleagues) argues that these labels, complementary, adjuvant, non-pharmacological, may in certain contexts make our scope of practice ambiguous. The words we use to ask to be let in are the same ones that, once we're inside, make us illegible.

Is it me getting something wrong, or does it happen to everyone?

It happens to everyone, and somebody has measured it.

Alison Ledger followed twelve music therapists who had opened a music therapy service from scratch, the first in their workplace, in five countries. They tell the same stories: isolation, insecurity, a role the others can't quite bring into focus, a bit of resistance from teams that were already well-oiled. Her doctoral thesis is called Am I a founder or am I a fraud?, and anyone who has opened a service from nothing knows what she's talking about. But the reading she gives it with her colleagues is liberating: this is the normal trajectory of every new profession that enters a group that already exists. It isn't a flaw of yours, it's the physics of groups.

Fiore and colleagues, in 2023, asked hospice teams how they see the music therapist. Out of twenty-five tasks, on thirteen they think differently from the music therapists themselves; they value us above all as "a distraction from pain"; and often the music therapist simply isn't at the team meeting at all. The title of the article, A seat at the table, says it all. I do have my seat at the table, and that's precisely why the question of what language to speak there concerns me.

Kantor and colleagues, in 2024, surveyed 439 music therapists in five European countries and Israel: very satisfied with the job, less so with their interactions with the team and with their perceived status. We love what we do and we struggle with the place we occupy. Then again, as far back as 2000 Hills and colleagues had noticed that those who work in teams have a greater sense of accomplishment than the others, and yet still "identified with their profession more than with their multidisciplinary team". That doesn't look like a problem to me. It looks like a bird in a flock, and I'll get to the flock in a minute.

So then, what language do I speak?

My own, as clinical data. It isn't a shortcut, it's the longer road.

That Tuesday I said more or less this: "She sang three verses of Quel mazzolin di fiori (an Alpine folk song) in time, without me dragging her along. In the second verse she slowed down and lowered her voice on the word 'mamma', then looked for my eyes when the tune came back round. She kept time with her left hand on her thigh, the whole way through." The physiotherapist looked up: the left is the hand that, according to her, Mrs A. doesn't use. The psychologist asked about the daughter. The doctor wrote something down. I didn't translate the music into their language: I described the music precisely, and they were the ones who found their own questions inside it.

It's what, in another episode, I called the sound portrait: I tell you what I observe as a musician, and then we share it in an even-handed exchange of specific skills. Observation, not inference. Slowing down, lowering the voice, seeking eye contact, keeping time: these are facts, anyone at the table can pick them up and use them. Orii McDermott, in an editorial in the Nordic Journal of Music Therapy, writes of "our collective responsibilities to articulate our implicit knowledge". I would add: in words other people can use. Articulate, not translate. A translator who erases the original isn't a translator: he's a replacement.

It works the other way round too, though. If I expect my colleagues to learn to read my sound portrait, I have to be able to read theirs: the number on a rating scale in the clinical notes, what the physiotherapist is measuring when she says "walking", what the psychologist means by "mood". I wrote a whole volume about it, Gli strumenti degli altri, other people's tools, and the title already says it all: I'm not the one who administers them, but I have to be able to read them, so as to "take part in the team's clinical reasoning as a professional and not as a guest" (in my translation). The rule I've given myself is simple: in every project, at least one measure that speaks to the setting, and at least one that sees the music. The first I choose among their tools, the second among ours. Neither is enough on its own.

Here I have to declare a conflict of interest, as always: that volume and the manual I'm about to quote I wrote myself, I work in teams and I teach these things at the Verona Conservatory, so I have every interest in believing they work. In the map of competencies, under the heading "interdisciplinary integration", the row on attitudes is a ladder of four rungs. At the bottom, the one who "sees the team as a source of directives to follow" and attends meetings as a listener. Then the one who "shows openness to the reciprocity of skills". Then the one who "promotes a common language, avoids discipline-centred hierarchies". At the top, the one who acts as spokesperson for the person and the family and models a culture of collaboration. And here one thing matters more than the rest: the common language is on the third rung, not the first, and you promote it, you don't adopt it. It isn't everyone else's language learnt in a hurry to get yourself admitted. It's a language you build together, one Tuesday at a time.

The same manual says that the heart of the music therapist's identity lies in clinical-therapeutic competence, the one that turns a musician into a health and education professional. And the podcast in 2020 said I feel like a musician who frequents clinical settings. Am I contradicting myself? No. The musician is who I am; clinical competence is what I bring to the table. If I leave the first at home, I bring nothing to the table the others don't already have.

Also in 2019 I wrote a post in front of a photograph of a flock of birds. It said that we are parts, small portions of a dimension we will never possess as a whole, built for teamwork. And that in a flock nobody collides, but nobody holds hands either: the birds keep the space. The common language is that space, not its erasure. That's why, when a session doesn't go well, the first item on my checklist isn't "what did I play badly" but "did I confer properly with the team that has this person in its care?". Objectives are shared beforehand, otherwise the music stays the inspiration of the moment: beautiful, and useless to the other six at the table.

Does identity need defending?

No. It needs practising.

Defending music therapy tired me out a long time ago: you defend it badly, with a raised voice and hunched shoulders. And besides, I had already written it in 2019: my professional adversary wasn't the head physician or the psychotherapist next door. The team isn't the enemy. It's the place where the music finds ears other than mine, and where I discover a left hand I knew nothing about. Ken Bruscia, the one with the 102 definitions, borrows from Gary Ansdell the expression "definition anxiety": the fear that we "may not feel legitimate enough if we do not have just the right words to represent us professionally". Perhaps the cure is to stop looking for the right word and start describing the real thing well. As for the rest, Law 4/2013, the UNI standard, the recognition that doesn't come, I've already lined it all up in a monograph and I won't go back to it.

Music therapy is there, in spite of everything. It's there every Tuesday at a quarter past nine, when it's my turn and I choose to speak as a musician, precisely.

And you, when it's your turn, what language do you speak? How many times, to make yourself understood, have you left the music outside the door?

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