Sunday, August 9, 2015

Same Same, but Different

Music therapy looks different in different cultures, just as other forms of healthcare look drastically different in other countries based on cultural norms. In an American hospital, it is common to see individual music therapy sessions happening in patient’s rooms, as well as group sessions in common areas. Thai hospitals operate differently. Many Thai hospital units have rows of beds in one large room without partitions. Because of this, most music therapy on these units is done in group sessions only. Even in Thai units where the patients have private rooms, it would be seen as an invasion of the patient’s privacy for a music therapist to come into the patient’s room.  
            This was a big change for me to process. We were placed into our first sessions with a few Thai students at Siriraj hospital early in the trip. I had no idea what to expect.  At first, the hospital looked very similar to American hospitals I had seen. Seeing the unit for the first time was shocking, and leading a group session with the entire unit was a very strange experience. Even little differences really stuck out to me. The nurses wore uniforms like nurses in America wore in the middle of the 20th century. I was allowed to wear my Birkenstocks as a therapist on the unit. I don’t have any experience in any of these settings, so I didn’t know what I was looking for.  The nurses seemed overjoyed that we had come, but it was harder for me to take data on the patients because I was with a new group each week.
It took me a long time to process my experiences at Siriraj even after we discussed the cultural norms of Thai hospitals in class. The students we were working with were also first year students, who had just begun the music therapy program one month before our arrival.  I finally began to realize that this was an opportunity where we could all learn from each other. Being a farang, I had more clinical experience than the Thai students, but I was clueless about Thai culture, especially in a medical setting. Before my final session at Siriraj, I sat down with one of the Thai students I was working with to plan our session. I asked her questions about the hospital and what her sessions looked like when I wasn’t there. I then suggested ways we could engage the clients more and focus on the intentionality of the music.

This is a picture of my friend Ploy and me talking after our final session at Siriraj.

Another striking difference between Thai and American sessions was emotional expressions. Generally, Americans speak more freely of their emotions than Thais. The Thai people are generally very reserved, and are taught from a young age not to express significant emotion in public. In our final session with older adults recovering from strokes at Sirindorn Rehabilitation Center, these two cultures combined beautifully. The American students teamed up with Susan Dustin and Ron McDiarmid, Laughter Yoga leaders who work with the group weekly (Read more about Laughter Yoga here: At the end of the session, we sang “May the Road Rise to Meet You” to the Thai patients to express our gratitude and well wishes. Many of us were teary-eyed by the end of the song. One woman, a caregiver for her father, was so touched that she led the rest of the Thais to sing a Thai song of encouragement for us. She shared her gratitude for the joy and physical improvements she had seen in her father through our sessions. Previously, this woman had been fairly reserved, only speaking to greet and thank the staff. She told us with tears in her eyes that this was the first time since her father’s stroke that she had seen him sing an entire song. This moment set aside cultural differences and allowed us to relate to each other beyond our nationalities.
Through my clinical work here in Thailand, I have seen how crucial it is to consider one’s culture in a clinical setting. I don’t know the whole story, but I need to be willing to learn in order to be therapeutically effective. I treasure these relationships I have developed with the Thai people. It is so hard to say goodbye to people that have become family, and a culture that has come to feel like home. 

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