Neurodiversity Paradigm: A Model of Collaborative Possibility

In my journey continuing to read and engage with literature written by neurodivergent authors about the neurodiversity movement and music therapy, I always encounter inspiring stories about the moments that caused people to shift their own perspectives about themselves and others. One of these stories I came across recently was a Ted talk by ethnomusicologist Michael Bakan, who is the founder of ‘ARTISM’ a project inspired by a single musical interaction he once had with a young autistic family member. The young boy was drawn to Bakan’s drumming in the family living room and they began to naturally improvise together. Bakan responded to his family member’s playing and supported him to lead the direction of the music. What Bakan noticed emerging from the boy was a confidence and a way of being that Bakan felt transcended what the rest of his family had ever told him about his abilities, causing him to question the contextual and socially constructed nature of how autism is viewed by others. It became clear to Bakan that the environment was the strongest force of disablement for many neurominorities.

Subsequently he developed ARTISM a music programme that facilitates the enablement of autistic children to reveal and celebrate their own creative, social, playful and musical selves on their own terms whilst also fostering new perceptions of and attitudes about autism and autistic people.

Enjoy the whole Ted talk linked below, especially the last 3 or so minutes where one autistic young person performs an original composition. I found it especially hopeful with regards to the valuable role all ways of being can contribute meaningfully in a single space.

With the neurodiversity paradigm being the grounding trunk on the tree of my changing perceptions, this article represents a branch from that tree on music and music therapy and how it might look shifting into a neurodiversity paradigm.

For a recap of the neurodiversity paradigm and definitions of key concepts refer to my previous blog post.

Today the spotlight is on neurodivergent music therapists; Hilary Davies and Jessica Leza.

Davies explores existing approaches aligned with the neurodiversity paradigm as well as proposing and theorises an emerging approach called ‘neurodiversity-affirming music therapy’

Leza explores the intersections of neurodivergence with other aspects of identity and expands on the work of Dr. Walkers concept of neuroqueering as a tool for embracing neurodiversity in the music therapy space.

These writers are both autistic, I am struggling to find writers who are both music therapists and open about their neurodivergent identity beyond autism. I wonder why this is? Autism is potentially a more socially acceptable form of neurodivergence that being open about does not impact as negatively on an individual’s career prospects (of course it likely still does, as explored in my previous post). Also note that these authors identify as women. Autism presents differently in women compared to men (not to mention the correlation between neurodivergent and gender-diverse identities (Warrier et al., 2020)), with women’s ability to more effectively mask/camouflage autistic traits being a well known phenomenon (Schuck, 2019). This masking of autistic traits (ie. appearing neurotypical in order to live up to society’s expectations) might allow autistic women to be a chameleon long enough to develop a secure personal and professional identity that may offer a safer environment to disclose their neurodivergence to others and think about it in relation to their work.

Hilary Davies: Autism is a way of being

Davies describes her autism as a way of being that is inseparable from how she experiences herself and the world around her (2022). Davies says the extent to which an autistic trait is viewed as positive or negative is highly contextual, Davies refers to the presentation of autism being like a fruit salad of co-existing traits. Autistic adults have described some of these traits as the ability to hyperfocus, attention to detail, good memory, creativity and honesty. Some more clinically defined autistic traits refer to ‘sensory processing differences, executive functioning difficulties and perseverative thinking’.

Minority Stress Model

Davies uses the minority stress model to emphasise the impact being neurodivergent has on a person’s mental health as they exist in a system that is built by and for neurotypical people. Autistic people experience regular discrimination and ostracisation resulting in a warped view of their intrinsic value and belonging in the world. Even those who are able to mask their neurodivergent traits do so with a huge energy and mental cost that neurotypical individuals don’t struggle with in the same way. All these experiences compound and generate a consistent level of stress that results in poorer mental health outcomes for neurominorities.

This model explains the imperative need for change at a systemic level. Addressing this disablement of neurominorities is a social justice issue and requires a cultural shift. Adoption of the neurodiversity paradigm would see neurodiversity being valued and promoted at every level of society and help alleviate the harmful sociocultural attitudes that impact the mental wellbeing of neurodivergent people. This would look like differences between people becoming viewed and engaged with as a natural and normal part of human diversity and valued as sources of immense creative potential. Note that there is still a responsibility to honour the sometimes complex support needs that many neurodivergent people require accomodations for in order to maximise their quality of life.

In the field of music therapy, Davies points to existing approaches as a starting point for how the profession might begin to embrace the neurodiversity paradigm.

Community Music Therapy

Community music therapy (CoMT) is an approach that focuses on participant wellbeing as an interconnected expression of culture and community and therefore gives scope for working much more collaboratively with participants than in traditional clinical environments (Davies, 2022). CoMT requires the therapist to give up a lot of traditionally assumed power. Often the 1:1 therapist in a clinical setting is viewed as the agent of change, offering interventions that fix some perceived deficit. A community music therapist however enters the therapy space as an outsider and it is the community members who are the experts in who they are. The job of the therapist becomes to learn about the culture and context of the community and build relationships that focus on listening and uplifting the voices and aspirations of the community as a whole. The kind of musical experiences that take place are collaboratively decided, e.g a group may gravitate to forming a choir, a drumming circle or a songwriting group. The direction of the therapy journey is constantly negotiated and shaped by the collective aspirations of the community.

Person-Centred Approach

Person-centred approaches are also viewed as having potential to exist within a neurodiversity paradigm as they respect and focus on individual autonomy, self-determination and encouragement of personal growth (Davies, 2022). The participant is again viewed as an expert in who they are and the therapeutic process takes place with the clients personal strengths and aspirations at the centre.

Both these approaches consider the subjective and contextually shaped nature of what ‘wellbeing’ means to each individual person entering the music therapy space. The relationship between music therapist and participant becomes a vehicle for discovery of that unique meaning and the therapeutic process is the attending to a participants wellbeing aspirations through collaboration in musical experiences.

Anti-Oppressive Music Therapy

Anti-oppressive music therapy takes these two approaches one step further by emphasising the responsibility of the therapist to continually analyse the power dynamics that exist within the therapeutic relationship (Davies, 2022). I always think about the intersecting aspects of my identity as a young, neurotypical passing pākeha (of New Zealand, European ancestry) women/non-binary person who is gender diverse but also passes as a women in majority of contexts. The way I appear to others offers me many privileges and I am always thinking about the way participants and their family may perceive me and how this might influence the music therapy space.

Davies has since collaborated with Bakan on a chapter in the recently published book; ‘Music Therapy and Music-based interventions in Neurology’ (2023). Together they challenge approaches, for working with neurodivergent participants, that centre on ‘implementing interventions to ameliorate ‘deficits’ and introduce an alternative collaborative approach that works with neurodivergent participants to identify their own goals that ‘enhance their strengths, coping strategies, self-acceptance and confidence’. All the while music therapy maintains it’s core principle of being a therapeutic process with therapeutic outcomes, this process should be one of reciprocity and learning from another with an attitude of humility and respect for autistic people (and other neurodivergent identities) as the ‘expert in being who they are’.

Jessica Leza: From Patient to Therapist

“Attempting to hide my identity, I was doing a disservice to those people similar to myself” - Jessica Leza in Sociocultural identities in music therapy (2021)

Hiding the minoritised aspects of our identity might keep us safe from the misconceptions of others but ultimately perpetuates the wrongful socially designed conclusion that neurodivergent people might make to undermine and undervalue their own potential. Representation is therefore important in order to dismantle these attitudinal barriers that prevent neurodivergent people from even considering entering a field like music therapy.

An interesting way in which the pathology paradigm is perpetuated currently is in the dichotomy between 1). People who receive therapy and 2). Those that provide therapy. Despite Leza’s qualification and experience as a music therapist, she identifies first as a person who receives therapy and considers herself a ‘trespasser from patient to therapist. The mad are taking over the madhouse’ (2021). Leza appreciates this experience and the blurring of these two identities as a symbol of disability rights activism, the challenges she faces as a practitioner are partly a result of this profession that wasn’t designed for people like her to study and work. She is part of a revolution that is needed in order for the paradigm to shift to valuing neurodiversity within the music therapy profession.

I think about this in relation to my own journey to studying music therapy, which began with a period of personal grief. I found music to be a key vehicle which allowed me to feel what I needed to in order to integrate my experiences and pursue a clearer direction in regards to who I wanted to be. Without over-identifying with my own story, I feel grounded in my practice by my experience as first a person who recieved/s therapy, to understand the therapeutic processes music can facilitate. The profession currently feels dominated by neurotypical perspectives and gives minimal time and space for therapists to be open about whether or not they receive therapy or require accomodations to enable them to carry out their work. The more we can disrupt this pattern to celebrate our belonging to both sides of the therapeutic dichotomy, whilst still setting the necessary boundaries a therapeutic relationship requires, we might potentially achieve a new kind of equality and mutuality that enhances the therapeutic process.

Leza has transferred neuroqueering into the music therapy discourse, an idea first created by Dr. Nick Walker (Metell and Leza, n.d). Neuroqueering emerges out of Queer theory which challenges the notion of the male-female gender binary and heterosexuality being what is natural or normal (Walker, 2021). Walker argues that if it was natural it would not have to be so brutally imposed, highlighting all the work that goes into enforcing heteronormativity in society. Instead Queer theory recognises heteronormativity as a learned performance that we actively participate in, imposed by culture and society and augmented by an innate desire of most people to belong no matter the psychological cost.

This performance can be queered ie. messed with and customised. We can challenge expectation in many ways and in doing so liberate ourselves from heteronormative performance.

Walker proposes that neuronormativity works like heteronormativity where noone is born neurotypical, but rather there is a learned performance of neuronormativity (2021). Imposed on us is a way to think and embody (act), a way that is compatible with the way a majority of people function. 

Neuronormativity being seen as a performance (as opposed to an innate identity) can therefore be queered and this is what Walker and Leza call ‘Neuroqueering’ (Metell and Leza, n.d). Anyone can neuroqueer by abandoning neuronormativity and altering how they think and embody themselves. This might look like insisting on and honouring the embodiments of a neurodivergent person. In music therapy Leza provides the example of a music therapy participant who stimmed by smearing saliva on music instruments. Her commitment to anti-oppressive neuroqueered practice required her to set aside feelings of revulsion or inadequacy in order to support the participant finding a safer way to stim.

Her process in achieving this was based in three self-reflexive assumptions that:

“(i) accommodation is possible;

(ii) this therapy participant is the expert in their own life; and

(iii) the music therapy participant used their behaviour to identify a goal area relevant to their lives”.

This process allowed Leza to think outside the box and identify a clear solution: the fresh leaves of an aloe vera plant. Introducing this into sessions allowed the participant to experience a hygienic substitution that met their needs to stim. Reflecting on this experience she states “It might be in the mundane daily tasks of a therapist that we are provided with the regular opportunity to pursue a neuroqueered anti-oppressive practice as an ongoing liberatory project”.

I’m so inspired by the potential of neuroqueering in music therapy to guide therapeutic decision making. I see so many similarities in thinking to Davies and Bakan’s collaborative model and the person-centred music therapy approaches that many music therapists are familiar with. Neuroqueering gives us permission to question the norms that exist around our field in order to best meet the needs of participants. We can explore and disrupt our own neuronormative performance, through our music making, our thinking about our work and in our acting/embodying in order to support the liberation of our participants and colleagues, paving the way for actively valuing and celebrating different ways of being.

Finally Leza reminds everyone of Music therapy’s radical roots. Our profession was born out of responding creatively to new way of thinking, so why not honour our origins to embrace neuroqueering as a way to shift our work into the neurodiversity paradigm.

References

Davies, H. (2022). ‘Autism is a way of being’: An ‘insider perspective’ on neurodiversity, music therapy and social justice. British Journal of Music Therapy (London, England : 1995), 36(1), 16–26. https://doi.org/10.1177/13594575221090182

Davies, H., Bakan, M.B. (2023). Music Therapy and Music-Based Approaches with Autistic People: A Neurodiversity Paradigm-Informed Perspective. In: Devlin, K., Kang, K., Pantelyat, A. (eds) Music Therapy and Music-Based Interventions in Neurology. Current Clinical Neurology. Humana, Cham. https://doi.org/10.1007/978-3-031-47092-9_15

Metell, M., & Leza, J. (n.d.). Exploring Queer Theories as a Framework for Anti-Oppressive Music Therapy Practice with Neurodivergent Children and Youth. In The Oxford Handbook of Queer and Trans Music Therapy. Oxford University Press. https://doi.org/10.1093/oxfordhb/9780192898364.013.21

Schuck, R. K., Flores, R. E., & Fung, L. K. (2019). Brief Report: Sex/Gender Differences in Symptomology and Camouflaging in Adults with Autism Spectrum Disorder. Journal of autism and developmental disorders, 49(6), 2597–2604. https://doi.org/10.1007/s10803-019-03998-y

Warrier, V., Greenberg, D. M., Weir, E., Buckingham, C., Smith, P., Lai, M.-C., Allison, C., & Baron-Cohen, S. (2020). Elevated rates of autism, other neurodevelopmental and psychiatric diagnoses, and autistic traits in transgender and gender-diverse individuals. Nature Communications, 11(1), 3959–3959. https://doi.org/10.1038/s41467-020-17794-1