PRIMUM NIL NOCERE (ABOVE ALL, DO NO HARM): A Direction for the Development of Music Therapy1/ PRIMUM NIL NOCERE (D'ABORD, NE NUIRE EN RIEN): Une Voie Pour le Développement De la Musicothérapie

It was thirty-seven years ago this past June2 that I began my training in music therapy. I remember the excitement and trepidation I experienced when confronted with my first patient. I couldn't believe that I was supposed to be doing therapy, without experience, without knowledge, certainly without confidence, and without a belief that I could be helpful. And so I did the only thing I could do under the circumstances - I plunged in feet first and, to my amazement, both the patient and I survived. The director of music therapy at the American university at which I studied had warned us that we would be scared. He instructed us to do the best we could, to feel free to explore with our patients, safe in the knowledge that if things didn't go that well, the worst we could do would be to not be helpfal. Using music, he said, we would not cause harm. Those latter words, although comforting in the moment, echoed in my mind for a long time, raising questions about the underlying intention of the statement, about its meaning, its accuracy, its validity. Those words still echo within me, and the questions remain. Giving voice to those questions is what I intend to do in this paper.Over the years since I trained, we have witnessed an impressive evolution in the field of music therapy. As clinicians we have been working with an ever widening variety of patient populations, using an ever expanding scope of clinical methods. Our work has been supported by ever deepening theoretical formulations and validated by ever more sophisticated research paradigms. As a profession, we have been moving increasingly out into the larger professional community, struggling to create and then to take our place as full members of this community, full members of the community of health professionals. It is this latter aspect of our development and its relation to the concept of doing no harm that will serve as the specific focus of this paper.When we speak about finding our place within the community of health professionals, we are speaking about the professionalization of music therapy, an issue that has preoccupied me throughout my career. An examination of my areas of interest, as manifested in presentations and publications, reveals that whereas I have ostensibly looked at what might appear to be different areas, the meta-concern that seems to underlie most of my professional endeavours as a music therapist relates to this notion of professionalization. I am referring to the attainment of a professional status that is commensurate with our skills, with our knowledge base, and with the complexity and the richness of our clinical practice and the theoretical bases upon which this practice is founded - a professional status that would allow us to have recognition at each level of training, that would see us garnering the degree of respect from fellow professionals that we would like to have, and that could result in us serving as consultants to other health professionals if we so choose.Let us examine two fictitious scenarios, the first presented at the 1989 annual conference of the Canadian Association for Music Therapy.Dr. Brown hurried into his office, slipped off his hat and coat and hastily began to leaf through the pile of reports and evaluations left on his desk by his secretary. He would have preferred to review these reports in a more leisurely fashion, but his schedule had been upset by the late arrival of the children's school bus. The bus had had a flat tire and had consequently arrived at the house twenty minutes later than usual, throwing off his schedule.... The loss of time didn't send Dr. Brown into a panic since he had already reviewed these files a couple of times and simply wanted to refresh his memory before heading to the courthouse. Dr. Brown had been summoned to court to testify in relation to an adolescent patient. His testimony would determine whether or not Timmy was to remain with his nuclear family or be sent to a foster home. …

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