Things to Look for in a Referral

A social worker posted the following query on Twitter the other day:

My music therapist folx.. what do you look for in referrals? (what makes a good referral?)

Something that I regret not having more familiarity with is working collaboratively with music therapists. I have such a deep appreciation for your work 1/2

— Jesse Dice, LCSW (@Brbhealth) January 15, 2021

The music therapy tweeting community was quick to respond, sharing who typically provides referrals and what NOT to refer for. (Please don’t tell us it’s because that person “likes music.” Just…no.)

These recommendations came in short, Twitter-appropriate sound bites. But it’s an important question and one not commonly addressed. So how might we answer this more fully?

When discussing referrals, music therapists commonly speak to who is making the referral (another therapy, medical, or education professional, the client themselves, or a family member) and/or they highlight that the client being referral does not actually need to be a musician to benefit from music therapy (so true).

When it comes to the reason for a referral, well that’s often site-specific. A patient in a medical facility may be referred for procedural support or to help with pain and anxiety management. A young child may be referred for assistance in speech and language development. Or perhaps the music therapist works at a facility where all the clients are on their caseload—no referral necessary. 

If you’re looking for research on this topic (because c’mon, who doesn’t love a good research article?), well, there’s not much to choose from. There’s this, this, and this, for example. But by and large these again focus on site-specific considerations (or reimbursement-related in one case).

Probably one of the clearest overviews I’ve read outlining reasons to refer clients to music therapy was published in the third edition of Hanser’s The new music therapists’s handbook, published in 2018. In a chapter dedicated solely to the referral process, Hanser lists and describes 11 criteria that generally indicate someone is a potential candidate for music therapy. These include when clients:

1. Would benefit from a multisensory approach to therapeutic (or educational or developmental) learning 
2. Demonstrate some responsiveness to sound (or music)
3. Have limited mobility or cognitive capacity (Hanser lists these as two separate criteria)
4. Would benefit from a non-invasive, non-confrontational approach to therapy (note this does not mention “safe”)
5. May struggle engaging in other therapies (and perhaps might be more motivated by music)
6. Find it difficulty to verbally communicate or express their thoughts, feelings, or ideas
7. Find it difficult to get along with others 
8. Have limited self-awareness
9. Are no longer benefiting from other therapeutic or treatment approaches (or when such approaches are contraindicated); or
10. Are seeking personal or spiritual meaning

But this still doesn’t really answer the question does it? There’s a difference between why a potential client is referred for music therapy and what we ultimately are looking for when we move from referral to assessment to treatment.

So then…what exactly is it that we music therapists look for in referrals?

Well, there’s no clearcut answer. In fact, I’d wager for most of us the answer is based on clinical experience, making it a bit idiosyncratic. So in that spirit—here’s how I would answer this question: 

When deciding whether or not to refer a client for music therapy, have a clear reason for that referral. This reason should be genuine and thoughtful. It should be based on your desire or attempt to improve the client’s life in a meaningful way way. As long as you follow these general principles, that to me is a “good” referral.

Cause here’s the thing—what also matters is what we music therapists do after receiving your referral. For those of us in the US (and I imagine other countries have similar documents), it is clearly indicated here and here that it’s our professional responsibility to consider and evaluate the appropriateness of a referral and prioritize them. (We also consider contraindications as part of this evaluation process. Yes music can be contraindicated). So the onus, then, is on us as the music therapy professional to accept your referral and determine whether or not music therapy is warranted.

Thus, to answer your question, Jesse, what I look for in a referral is something thoughtful, with the client’s best interest at heart. You can’t go wrong with that.

References

American Music Therapy Association, & Certification Board for Music Therapists. (2015). Scope of music therapy practice. https://www.cbmt.org/wp-content/uploads/2019/10/CBMT-AMTA-Scope-of-Music-Therapy-Practice.pdf

Certification Board for Music Therapists. (2020). Music therapy board certification: Board certification domains—2020. https://www.cbmt.org/wp-content/uploads/2020/03/CBMT_Board_Certification_Domains_2020.pdf

Hanser, S. B. (2018). The new music therapist’s handbook (3rd ed.) Berklee Press.