Sage Journals: Discover world-class research

Abstract

In this article, I introduce a cultural approach to musical care by situating health, well-being, and music engagement within specific cultural meaning systems. While existing models of health, including biomedical, biopsychosocial, and socioecological models, have informed music therapy and related practices, they often carry universalist assumptions that overlook cultural diversity in health definitions and behaviors. Similarly, theorizing in music therapy has highlighted the importance of cultural humility, cultural empathy, and intercultural competence, yet has largely focused on therapist reflexivity without fully articulating how cultural insights can inform the design and implementation of music interventions. Drawing on cultural-psychological perspectives, I conceptualize culture as comprising both external conditions and internal psychological processes that shape how individuals experience health and well-being, as well as how they engage with music. Using examples of cultural match and mismatch in music therapy research, I argue that alignment between individual psychological processes, culturally grounded music practices, and culturally sanctioned health goals enhances therapeutic outcomes, while mismatches may limit effectiveness. Beyond outcome measures, a cultural approach requires attention to the diversity of ways people engage with music, including consumption, creation, and response, recognizing music's role in constructing identities and shaping understandings of health. I conclude that cultural match offers a promising direction for future research, advancing both theory and practice in musical care, underscoring the need for more robust, culturally responsive, and culturally sustaining research methodologies and interventions.

Keywords

Cross-cultural cultural approach culture music therapy musical care

Since the World Health Organization (WHO) published its scoping review on the role of the arts in improving health and well-being (Fancourt & Finn, 2019), there has been a surge in arts and health initiatives around the world. The rise of music-based interventions, such as music therapy, community music, and music medicine among others, reflects this growing trend (Global Wellness Institute, 2025). For instance, in collaboration with WHO and other institutions, the Jameel Arts and Health Lab was launched in January 2023 to advance scientific research on the effectiveness of the arts in promoting health and well-being. With a particular focus on overlooked and underserved communities, the Lab aims to support the global integration of the arts into clinical and public health settings (Jameel Arts & Health Lab, n.d.). Although a laudable endeavor, it must be noted that the majority of the existing research originates from Western countries, which seemingly reflects Eurocentric paradigms as well as WEIRD (western, educated, industrialized, rich, and democratic) axiologies, epistemologies, and ontologies (cf. Henrich et al., 2010; J. Tang, 2025; Jakubowski et al., 2025). In particular, the Lab is physically based in Denmark, the U.S., and the U.K., but attempts to support initiatives on a global scale. For arts and health to flourish internationally, cultural humility and cultural sensitivity are imperative. Therefore, I propose a cultural approach to the study of arts and health, drawing on cultural-psychological perspectives (Miyamoto et al., 2019).

In this article, I focus specifically on musical care, a subset of arts and health practices that encompasses a wide spectrum of music-related activities, including both private and public music experiences, as well as targeted and everyday music practices to support an individual's health and developmental needs (Spiro & Sanfilippo, 2022). First, I outline different models of health and discuss their influence on musical care practices. Second, I present a theoretical framework for understanding culture and introduce a cultural approach to the study of musical care. Finally, I suggest practical strategies for advancing a cultural approach to musical care and consider the implications of this approach for the future development of musical care and, more broadly, arts and health in the international arena.

My Positionality

Before proceeding, it is essential to reflect on my positionality. By doing so, I acknowledge the limitations of my perspectives while situating my arguments within particular cultural understandings and lived experiences. I was born and raised in postcolonial Singapore and identify as a cisgender, non-disabled, ethnically Chinese male who has benefitted from majority status and, at times, economic privilege. My professional formation has unfolded across multiple cultural contexts: I trained in music therapy in the U.S.; practiced in the U.S., Singapore, and the U.K.; and pursued advanced degrees in English-speaking academic environments. Over the course of these experiences, I have both enacted forms of power and been subject to them, shaped by the intersections of my privileged and marginalized cultural identities. These encounters have sharpened my awareness of power and privilege, as well as the dynamics and tensions between dominant theories and ideologies rooted in different cultural traditions. Collectively, they have informed my identity as a researcher, educator, and music therapist committed to fostering culturally sensitive and reflexive practices and scholarship. The examples presented in the subsequent sections draw on both my clinical experience as a music therapist and my academic engagement as a music and cross-cultural psychologist.

Models of Health and Musical Care

Biomedical Model of Health

The biomedical model of health is perhaps the most widely recognized framework within healthcare disciplines. In this framework, health is defined as the absence of illness or disease, with disease understood as a deviation from biological norms and fully explained by somatic variables. This approach is characterized by eight key features (Willis & Elmer, 2011):
Specific aetiology – all illness and disease are attributed to a specific physiological dysfunction;

Body as a machine – the body is viewed as a “machine” composed of parts that can be fixed by medical professionals;

Mind–body dualism – the mind and body are treated as separate entities that do not influence one another;

Reductionism – a philosophical view that complex phenomena are reduced to a single primary biological principle;

Narrow definition of health – health is understood solely as the absence of a definable illness;

Individualism – causes of ill health are located within the individual rather than in the surrounding environment or social context;

Treatment focus – the primary emphasis is on diagnosing and treating illness rather than preventing it; and

Scientific neutrality – healthcare systems and professionals are assumed to operate as socially and culturally neutral agents.

Some musical care practices align closely with a biomedical approach, such as Neurologic Music Therapy (NMT). NMT is defined as the “therapeutic application of music to cognitive, affective, sensory, language and motor dysfunctions due to disease or injury to the human nervous system” (Thaut & Hoemberg, 2025, p. 2). Its techniques are grounded in neuroscience models of music perception, cognition, and creation, as well as research on how music can influence non-musical brain and behavioral functions. At its core, NMT is structured around a diagnostic treatment goal and the use of music, or specific mechanisms within music perception and production, to achieve that goal. One example is rhythmic auditory stimulation, which employs the physiological effects of auditory rhythm on the motor system to improve gait patterns in patients with significant gait deficits caused by neurological impairment (Thaut & Abiru, 2010).

In line with the biomedical model, NMT conceptualizes illness as stemming from specific physiological dysfunctions (e.g., an injured brain) and involves targeted treatment interventions using specific musical elements (e.g., rhythm and tempo). In the case of rhythmic auditory stimulation, the complexity of music is reduced to a single primary biological principle – an immediate entrainment stimulus providing rhythmic cues to facilitate movement rehabilitation. A major critique of the biomedical model is its reductionist orientation and mind–body distinction, which tends to overlook psychological, social, and environmental factors influencing health. Musical care practices like NMT, by virtue of its biomedical and neuroscientific foundations, are subject to similar critiques.

Biopsychosocial Model of Health

In response to these critiques, Engel (1977) proposed the biopsychosocial model of health, which considers not only the patient but also the social context in which they live and the societal systems designed to address the disruptive effects of illness, namely, the role of the physician and the healthcare system. This model offers an inclusive, systems-oriented perspective, viewing the individual as an integrated whole, interconnected with biological, psychological, and social systems. According to this model, all three levels must be taken into account in every healthcare task, as these systems are in constant interaction and collectively shape overall health.

The literature contains numerous examples of musical care practices that adopt a biopsychosocial approach (e.g., Blichfeldt-Ærø et al., 2019; Daveson, 2008; Lee & Dvorak, 2023; Ullsten et al., 2018). For instance, in palliative care settings, music therapy interventions can be used to promote biological, psychological, and social aspects of health (Ramesh, 2024). Biologically, receptive music experiences (e.g., listening to live music) can provide symptom relief and support pain management. Psychologically, song writing and clinical improvisation can aid in bereavement and grief expression, foster acceptance, help reframe regret, facilitate catharsis, and strengthen confidence and resilience. Socially, recreative music experiences (e.g., singing and instrument playing) can promote feelings of connectedness with loved ones and other significant people in one's life. Unlike the biomedical model, the biopsychosocial framework, when applied to musical care, illustrates how music can support health and well-being in a holistic and integrated manner.

Socioecological Model of Health

Taking a step further, socioecological models of health emphasize the environmental and policy contexts of well-being while also incorporating social and psychological influences (Sallis et al., 2015; Stokols, 1992). Drawing from Bronfenbrenner's (1977) ecological systems theory, the central idea is that health behavior is shaped by multiple levels of influence, including intrapersonal (biological, psychological), interpersonal (social, cultural), organizational, community, physical environment, and policy factors. Socioecological models of health are underpinned by four key factors:
Multiple influences affect specific health behaviors, spanning the intrapersonal, interpersonal, organizational, community, and public policy levels;

Influences on behavior interact across these different levels;

Ecological models should be behavior-specific, identifying the most relevant potential influences at each level; and

Multilevel interventions are most effective in changing behavior.

In short, the aim of socioecological models of health is to guide the development of comprehensive interventions that systematically target mechanisms of change across several levels of influence.

Certain musical care practices embrace a socioecological approach, most notably community music therapy (Pavlicevic & Ansdell, 2004). According to Ansdell (2002):
Community Music Therapy is an approach to working musically with people in context: acknowledging the social and cultural factors of their health, illness, relationships and musics. It reflects the essentially communal reality of musicking and is a response both to overly individualized treatment models and to the isolation people often experience within society. (after Fig 3 in the paper.)
Community music therapy is thereby characterized by seven key features: it is participatory, resource-oriented, ecological, performative, activist, reflective, and ethics-driven. An example of this approach is provided by Stige (2002) in his Upbeat project, which involved a group of adults with learning difficulties who were transitioning into community life. In this case study, traditional group music therapy sessions, initially held within conventional healthcare settings, gradually evolved into the integration of the group into the local musical life through choral and band performances. Another example of a socioecological approach can be found in Smith's (2022) music therapy outreach work with Bear, an underhoused youth musician on unceded Coast Salish and Straight Salish territory. Smith's work challenges the neocolonial assumptions embedded in contemporary therapeutic discourse and supports movements of “becoming-music” that foster new forms of subjectivity and catalyze social change (see The Colonialism and Music Therapy Interlocutors [CAMTI] Collective, 2022, for further discussion).

These examples illustrate how music therapists can operate therapeutically with individuals and groups while also engaging culturally and politically within a broader context. In this sense, therapists act as “action therapists,” seeking to foster attitudinal change within local communities to ensure that people with disabilities have access to, and can actively participate in, cultural life. The examples highlight how musical care practices can traverse fluidly across contexts – from clinical spaces into community and even political arenas – to improve overall health and well-being.

This brief outline is not intended to be exhaustive. Rather, it demonstrates that different models of health have influenced musical care to varying degrees, with some practices aligning more closely with certain frameworks than others. While each of these models offers valid insights, a fundamental assumption requires interrogation: Who determines what counts as health? Although I recognize that some aspects of health may indeed be similar across cultures, the concept of health within these models remains somewhat opaque and appears to carry a universalist undertone, shaped by Western-based axiologies in defining what constitute health behaviors. For instance, one defining feature of community music therapy is that it is ethics-driven. Yet, it is not always clear whether this ethical orientation is grounded in Western moral frameworks or in local, indigenous belief systems (cf. DeWane & Grant-Kels, 2018). This raises important questions about the extent to which cultural perspectives are genuinely acknowledged. Overall, the role of culture in shaping definitions of health and musical care has received relatively limited attention. In this article, I seek to address this gap by proposing a cultural approach to musical care, informed by cultural-psychological perspectives (Miyamoto et al., 2019).

Cultural Approach to Health

To articulate a cultural approach to health, it is first necessary to clarify what is meant by culture. In this article, culture is understood as both explicit and implicit patterns of meaning that have emerged historically and become embedded in institutions, practices, and artefacts (Adams & Markus, 2004). These patterns are not only outcomes of human action but also frameworks that shape future action. From another perspective, culture encompasses both “outside the head” factors, such as daily life situations, institutions, cultural products, and widely shared beliefs, as well as “inside the head” factors, which include psychological processes like emotions, cognitions, motivations, and values (Morling, 2016). Altogether, this implies that culture is not merely a context in which people live (Taras et al., 2016) but is simultaneously expressed in external conditions and internal psychological experiences, influencing even how health and well-being are understood.

A cultural approach to health therefore begins with the recognition that conceptions of health and well-being are rooted in cultural meaning systems (Miyamoto et al., 2019). Cultural beliefs and values about well-being are shaped by long-standing ecological and historical conditions (distal sociocultural processes) and are institutionalized in practices, norms, and products (proximal sociocultural processes). These, in turn, influence and are continuously reshaped by the individuals who participate in them through psychological processes. As individuals repeatedly engage with these notions of health and well-being, they become internalized and natural to them, which further reinforces the cultural meaning system. In other words, a cultural approach to health does not begin with the application of models or theories derived from one context. Instead, it starts from the ground up, by examining how health is defined, experienced, and sustained within each unique cultural meaning system.

Cultural Approaches in Music Therapy

Within the music therapy discipline, efforts have been made to develop cultural approaches, often articulated through concepts such as culturally centered practice (Brown, 2002; Swamy, 2014). One of the earliest comprehensive resources in this area is Cultural Intersections in Music Therapy: Music, Health, and the Person (Whitehead-Pleaux & Tan, 2017), which explores diverse understandings of both health and music across cultural contexts. A more recent contribution, Music Therapy in a Multicultural Context (Belgrave & Kim, 2020), extends this work by examining the implications of cultural diversity for music therapy practice.

Despite these valuable efforts, several limitations persist. First, most theorizing on cultural approaches to music therapy has primarily focused on the therapist (Grimmer & Schwantes, 2018). To support effective work with clients from diverse cultural backgrounds, scholars have advocated that therapists practice cultural empathy (Brown, 2002), cultural humility (Edwards, 2022), multicultural or intercultural musical competence (Hadley & Norris, 2016; J. Tang & Schwantes, 2021; Young, 2016), and sociocultural reflexivity (Hadley, 2021). While these constructs each carry their own nuances, they share a central emphasis on reflexivity; that is, the ongoing, in-depth examination of one's own cultural identity alongside an appreciation of the client's worldview. This critical stance is undoubtedly essential for engaging ethically and effectively with individuals from different cultural contexts.

However, these theoretical frameworks tend to fall short when it comes to articulating concrete next steps. In other words, after acknowledging and respecting a client's experiences, what should therapists do with this understanding? How can such insights be translated into the design and delivery of culturally responsive and sustaining music interventions? At present, these approaches often stop at the level of awareness and reflection coupled with a posture of cultural humility, without fully addressing how cultural knowledge can inform and transform actual music therapy practices.

Second, cross-cultural research in music therapy often adopts a narrow conceptualization of culture, typically operationalizing it through sociodemographic variables such as nationality, race, and ethnicity (e.g., Mondanaro, 2016; Swamy, 2014). As a result, research into cultural approaches in music therapy has been constrained in at least three ways. First, cross-cultural work tends to define cultural diversity almost exclusively in terms of sociodemographic categories (e.g., Mondanaro, 2016; Swamy, 2014). Second, cultural approaches are frequently reduced to repertoire, such that being culturally responsive merely means incorporating music and instruments from the client's presumed culture (e.g., Behrens, 2012; Froman, 2009). Third, even when cultural factors are considered in intervention design, health and well-being outcomes are still assessed using Western epistemological and ontological frameworks (e.g., Bradt, 2012; Mondanaro, 2016; Rodgers-Melnick et al., 2018).

These constraints highlight the need for more robust approaches to theorizing culture in music therapy. As previously defined, culture is not only the context in which people live; it encompasses a complex interplay of external conditions and internal psychological processes. By reducing culture to sociodemographic markers, research risks capturing only distal (and perhaps proximal) sociocultural processes while overlooking the psychological processes through which culture is lived and enacted. Such an approach might have sufficed in the 20th century, when culture was assumed to map neatly onto geographic or demographic categories – presuming within-group homogeneity and between-group heterogeneity. However, this assumption is increasingly untenable in today's globalized world. With international migration, global communication, and transnational cultural flows, boundaries between cultural groups are less distinct, and intra-group diversity may exceed inter-group differences (cf. Talhelm et al., 2014).

For example, consider second-generation Asian Americans, defined here as individuals born in the U.S. to at least one parent who emigrated from an Asian country. Such individuals may grow up immersed in American cultural contexts that valorize individualism and autonomy, while simultaneously being socialized within family environments that emphasize collectivism and social harmony. Should they therefore be considered more Asian or more Western? Such binary distinctions quickly break down in the face of cultural hybridity (Burke, 2009) and bicultural identity (Benet-Martínez & Haritatos, 2005). As sociodemographic variables inevitably remain part of participant recruitment in cross-cultural research, greater specificity regarding which cultural factors are under examination is needed if music therapy is to meaningfully advance cultural approaches (J. Tang, 2025).

A second limitation arises when cultural responsive practice is equated with the use of culturally specific repertoire and instruments. This perspective assumes that the primary way to engage clients from diverse cultural backgrounds is through music associated with their sociocultural identity. Such an assumption is problematic. For better or worse, much of today's music is globally disseminated and influenced by Western musical idioms (Huron, 2008). At the same time, digital technologies and globalization have transformed how music is created, shared, and consumed, leading to cross-pollination of musical styles and the blurring of previously distinct genre categories (Banzon & Leonard, 2023). In this context, definitions of what constitutes “cultural music” are increasingly arbitrary. Returning to the earlier example of Asian Americans, should music therapists employ “Asian” music, “Western” music, or some hybrid form that reflects their lived cultural experience? While musical choices are an important element of practice, they cannot, in isolation, capture the broader complexities of working in a culturally responsive and sustaining manner.

Third, assessing health and well-being outcomes through Western frameworks assumes that these constructs are understood in the same way across cultures. While certain aspects of health may indeed be universal, variation exists in how people define and experience health and well-being (Miyamoto et al., 2019). For example, research on subjective well-being, defined as an individual's personal evaluation of their own life, has demonstrated cultural differences: Chinese participants tend to endorse socially oriented subjective well-being, whereas American participants more often emphasize individual-oriented subjective well-being (Lu & Gilmour, 2006). If such differences emerge in a broad construct like subjective well-being, it is reasonable to expect that cultural variation extends to specific domains of health, such as experiences of pain (Booker & Herr, 2015). These findings underscore the need to account for culturally diverse understandings of health and well-being in both research and clinical practice.

Cultural Approach to Musical Care

Extending from a cultural approach to health, a cultural approach to musical care requires not only an understanding of health and well-being within specific cultural meaning systems but also a recognition of music's role in shaping and facilitating these experiences. In this view, health benefits emerge when there is alignment between individual psychological processes, musical activities, and culturally sanctioned goals. For example, Bradt et al. (2016) investigated a vocal music therapy intervention for chronic pain management with inner-city African Americans. This intervention, delivered through weekly group sessions, resonated strongly with the cultural traditions of community music-making and the central role of group singing within African American churches as a source of social support and resilience (Norris, 2019). After the eight-week intervention, participants reported reductions in pain interference and average weekly pain levels. Although the intervention was originally guided by a biopsychosocial framework, I argue that its effectiveness also reflects a cultural match – where the music intervention aligned with culturally meaningful practices and well-being goals, thereby facilitating positive health outcomes.

In contrast, music interventions that lack cultural congruence may produce weaker or negligible effects. Rodgers-Melnick et al. (2018) compared an electronic music improvisation intervention, recorded music listening, and standard care on pain in adults with sickle cell disease, all of whom identified as Black or African American. The improvisation intervention consisted of individual sessions, focused on improvisation with electronic instruments with a music therapist. Unlike the previous example, this intervention did not draw directly on culturally consonant musical practices or socially embedded forms of music-making. Analyses of covariance revealed no significant differences in pain intensity or pain relief between the intervention and control conditions. In addition, one respondent in the music listening condition stated that “the music was too upbeat and perhaps it made the pain a little worse [and] preferred playing music rather than listening to music” (p. 174). The null quantitative result alongside this qualitative finding suggest a cultural mismatch, where the intervention was less aligned with participants’ cultural practices, individual psychological processes, and culturally sanctioned goals related to health and well-being.

Taken together, these examples illustrate that a cultural approach to musical care rests on the principle of cultural match. Health and well-being are most effectively supported when music interventions are congruent with the cultural meaning systems of the individuals they serve. When musical practices align with culturally valued goals and psychological processes, they can enhance well-being and promote positive health outcomes. Conversely, when music interventions are culturally mismatched, their effectiveness may be diminished. Thus, adopting a cultural approach to musical care requires careful and sensitive consideration of specific cultural meaning systems that shape music engagement as well as how health and well-being are defined, pursued, and experienced.

Discussion and Future Directions

In this article, I have described how different models of health have shaped approaches to musical care, with certain practices aligning more closely with specific frameworks than others. While cultural approaches have been theorized within music therapy, important limitations remain, underscoring the need for more robust ways of conceptualizing cultural approaches to musical care. In this article, I defined culture as encompassing both external conditions and internal psychological processes, each of which shapes not only how individuals engage with music but also how health and well-being are understood. Building on this definition and drawing on cultural-psychological perspectives (Miyamoto et al., 2019), I proposed a cultural approach to musical care. Such an approach requires careful attention to the cultural meaning systems that influence music engagement and experiences of health and well-being.

The first step in advancing a cultural approach to musical care is to recognize the diversity of ways in which health and well-being are defined and experienced across cultures. Whether in research or in practice, this requires adopting a critical stance toward how health outcomes are assessed and evaluated. For example, we should ask: From what cultural lens was a given health measure or tool developed? Does it adequately capture the ways in which the individuals I am working with perceive health and well-being? In research settings specifically, ensuring that outcome measures are meaningful and relevant to target participants is crucial (Fischer & Smith, 2021). This is particularly important in cross-cultural studies, where establishing equivalence goes beyond simply translating validated tools from one language into another (Boehnke, 2022). Rather, it requires attending to emic perspectives, ensuring that the construct under investigation reflects understandings of health and well-being grounded in specific cultural meaning systems. This may involve developing entirely new outcome measures in collaboration with the communities involved. If developing new measures is beyond one's capacity, researchers and practitioners can instead draw on insights from cross-cultural psychology, indigenous psychology, and anthropology to identify more appropriate outcome measures or ways of conceptualizing health-related constructs. For example, if self-esteem is identified as a desired health goal in a music intervention, it is important to acknowledge that self-esteem takes different forms across cultures – such as individual versus collective self-esteem – each of which has distinct implications for well-being (Yamaguchi et al., 2017).

Alternatively, another valuable strategy involves adopting anti-colonial practices (Sauvé et al., 2023), such as participatory action research (Ponterotto, 2010). Participatory and community-based research methods emphasize collaboration, positioning participants and their communities as partners throughout the research process in identifying issues, gathering and analyzing data, and co-developing solutions. This approach elevates the voices of those directly involved, fostering epistemic justice while ensuring that their health priorities and well-being experiences are foregrounded. Importantly, such approaches must be coupled with a posture of cultural humility (Edwards, 2022) and cultural safety (Truasheim, 2014), which entails both intrapersonal reflexivity, through critical self-examination of one's own cultural assumptions, and an interpersonal orientation of respect, openness, and care toward others.

Although recognizing diverse understandings of health is a crucial step, it is equally important to consider the diversity of ways in which people engage with music. A cultural approach to musical care cannot be understood solely in terms of health outcomes; it must also account for the varied practices of music consumption, creation, and response that are embedded in cultural meaning systems. Appreciating these multifaceted forms of music engagement is essential for designing culturally consonant music interventions that effectively promote health and well-being. For example, using participant-preferred music is considered best practice in music therapy (Silverman et al., 2016). While this approach may indeed be effective, I argue that a cultural perspective can enhance its therapeutic potential. Specifically, a cultural approach would consider the functions that individuals ascribe to their preferred music, enabling practitioners to leverage this knowledge in designing more targeted interventions. Research has shown that people use their favorite music for both other-directed and self-directed purposes (W. L. J. Tang, 2025). Depending on how individuals understand health and well-being, practitioners might draw on preferred music that aligns with their specific goals. For instance, when addressing social determinants of health, it may be more effective to use music that individuals associate with connection and relational purposes (other-directed), rather than music used for motivation and emotion regulation (self-directed). In this way, a cultural approach extends beyond understanding health and well-being within a cultural meaning system to tailoring interventions that align culturally grounded forms of music engagement with these well-being goals.

This perspective broadens the scope of musical care to include all forms of music engagement: the ways people listen to music, how they create it, and the behaviors surrounding its consumption. To deepen this understanding, researchers and practitioners can draw on insights from music psychology, cultural studies, and ethnomusicology, all of which offer valuable perspectives on cross-cultural similarities and differences in music engagement. However, one caveat is that research in music psychology has often operationalized culture through sociodemographic variables, reflecting the same limitations outlined earlier (J. Tang, 2025). As in music therapy research, there is a need for more robust conceptualizations of culture that explicitly identify the mechanisms through which culture shapes music behaviors – whether these involve “outside the head” influences such as social norms, institutions, and cultural products, or “inside the head” processes such as emotions, cognitions, motivations, and personal values.

Encouragingly, recent work in music psychology has begun to address these complexities by examining the role of specific cultural mechanisms in affective experiences with music. For example, studies have demonstrated that self-construal – one's sense of self in relation to others, shaped by a cultural emphasis on interdependence or independence – influences the emotions people perceive and feel in their favorite music (J. Tang et al., 2025a, 2025b). Such findings highlight how cultural meaning systems not only shape music preferences but also structure the affective experiences that arise from music engagement, both between and within cultural contexts. Future research should continue to move in this direction, articulating with greater precision the mechanisms by which culture influences how people engage with, interpret, and respond to music.

Returning to my conceptualization of culture in this article, cultural patterns are not only outcomes of human action but also frameworks that shape future action. In other words, culture and individuals are continually and mutually constituting one another (Markus & Kitayama, 2010). Building on this notion, we should also recognize that music, as both a cultural artefact and a social practice, contributes to the construction and maintenance of subject positions and ways of being (Clarke, 2011). Music shapes our sense of identity through the embodied experiences it affords, which in turn allow individuals to situate themselves within broader cultural narratives (Frith, 1996; Windsor & de Bézenac, 2012). More specifically, because music conveys cultural values, it can influence how individuals perceive the world and, consequently, how health and well-being are understood. For example, research has demonstrated that cultural icons presented as visual stimuli can prime individuals to adopt subject positions associated with collectivistic or individualistic cultures, resulting in behaviors aligned with these cultural contexts (Hong et al., 2000). Within the music domain, emerging evidence suggests that music can function in a similar fashion, priming listeners to adopt more individualistic or independent self-perceptions after engaging in certain music experiences (W. L. J. Tang, 2025). The implication of this line of research is significant: It underscores the importance of aligning culturally grounded forms of music engagement with relevant well-being goals within specific cultural meaning systems. In addition, it highlights the complexity of adopting a cultural approach to musical care. The very music that therapists and practitioners employ may inadvertently encourage individuals to adopt ways of being that are contrary to their prevailing sense of self. Therefore, in a cultural approach to musical care, attention to cultural understandings of music engagement must be given equal weight to cultural understandings of health and well-being.

Throughout this article, I have presented a cultural approach to health as distinct from other models of health. However, my intention is not to position it as separate to or incompatible with these models. Rather, I argue that cultural perspectives can and should be integrated with existing frameworks, as cultural factors have too often been overlooked in health research and practice. For example, consider how a cultural approach could complement the biomedical model in the treatment of depression. From a biomedical standpoint, research has identified the short (S) allele of the serotonin transporter gene (5-HTTLPR) as a risk factor for depression and anxiety (Porcelli et al., 2012). Given that this allele is more prevalent among East Asian populations, one might expect higher rates of depression in these groups. However, East Asian populations paradoxically report comparatively lower rates of depression than Western populations (Goldman et al., 2010). This discrepancy suggests that the relationship between genetic risk and mental health outcomes is far more complex than biological predispositions alone. Furthermore, antidepressant medications such as selective serotonin reuptake inhibitors (SSRIs) have been shown to be less effective for individuals with this gene polymorphism, further underscoring the importance of incorporating non-pharmacological approaches and attending to cultural factors in the treatment of mental health.

In this article, I have argued for the necessity of a cultural approach to musical care, one that foregrounds the reciprocal relationship between cultural meaning systems, music engagement, and understandings of health and well-being. While existing models of health and current theorizing within music therapy have provided valuable insights, they often fall short in adequately accounting for cultural diversity in health experiences and musical practices. Drawing on cultural-psychological perspectives, I have proposed that cultural match – where individual psychological processes, culturally grounded musical practices, and culturally sanctioned health goals align – can be a key mechanism through which music supports health and well-being. Conversely, cultural mismatches may hinder the effectiveness of musical care. Recognizing culture as both an external context and an internal psychological process underscores the need for researchers and practitioners to move beyond sociodemographic markers of culture and engage with specific cultural frameworks to elucidate specific cultural elements that shape both music and health. Future research should continue to explore how cultural match operates across contexts and populations, offering a fruitful avenue for advancing both theory and practice in cultural approaches to musical care.

Footnotes

Acknowledgments

I would like to thank the Musical Care International Network, specifically Neta Spiro, Bonnie McConnell, and Katie Rose Sanfilippo, for leading this special collection. I would also like to thank the anonymous peer reviewers for their constructive feedback to improve this manuscript. This publication was supported by the Aubrey Hickman Award from the Society for Education, Music and Psychology Research (SEMPRE).

Action Editor

Bonnie McConnell, Australian National University, School of Music

Peer Review

Jasmine Edwards, New York University Susan Hadley, Slippery Rock University

Data Availability Statement

Data sharing not applicable to this article as no datasets were generated or analyzed during the current study.

Declaration of Conflicting Interests

The author declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Ethical Approval

This research did not require ethics committee or IRB approval. It did not involve the use of personal data; fieldwork; experiments involving human or animal participants; or work with children, vulnerable individuals, or clinical populations.

Funding

The author disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This work was supported by the Society for Education, Music and Psychology Research, (grant number Aubrey Hickman Award).

ORCID iD

Jonathan Tang

References

Adams

Markus

H. R.

(2004). Toward a conception of culture suitable for a social psychology of culture. In Schaller

Crandall

C. S.

(Eds.), The psychological foundations of culture (pp. 335–360). Lawrence Erlbaum Associates Publishers.

Ansdell

(2002). Community music therapy and the winds of change. Voices: A World Forum for Music Therapy, 2(2), Article 2. https://doi.org/10.15845/voices.v2i2.83

Banzon

Leonard

(2023). Genre-bending: A discourse on globalization and culture with implications for music therapy. Music Therapy Perspectives, 41(2), 187–197. https://doi.org/10.1093/mtp/miad004

Behrens

G. A.

(2012). Use of traditional and nontraditional instruments with traumatized children in Bethlehem, West Bank. Music Therapy Perspectives, 30(2), 196–202. https://doi.org/10.1093/mtp/30.2.196

Belgrave

Kim

S.-A.

(Eds.). (2020). Music therapy in a multicultural context: A handbook for music therapy students and professionals. Jessica Kingsley Publishers. http://ebookcentral.proquest.com/lib/sheffield/detail.action?docID=6349486 .

Benet-Martínez

Haritatos

(2005). Bicultural identity integration (BII): Components and psychosocial antecedents. Journal of Personality, 73(4), 1015–1049. https://doi.org/10.1111/j.1467-6494.2005.00337.x

Blichfeldt-Ærø

S. C.

Trondalen

Halvorsen

(2019). Facilitated music listening: Music therapy in an invasive cardiac procedure. British Journal of Music Therapy, 33(1), 27–38. https://doi.org/10.1177/1359457519840131

Boehnke

(2022). Let’s compare apples and oranges! A plea to demystify measurement equivalence. American Psychologist, 77(9), 1160–1168. https://doi.org/10.1037/AMP0001080

Booker

S. S.

Herr

(2015). The state-of-“cultural validity” of self-report pain assessment tools in diverse older adults. Pain Medicine, 16(2), 232–239. https://doi.org/10.1111/pme.12496

10.

Bradt

(2012). Randomized controlled trials in music therapy: Guidelines for design and implementation. Journal of Music Therapy, 49(2), 120–149. https://doi.org/10.1093/jmt/49.2.120

11.

Bradt

Norris

Shim

Gracely

E. J.

Gerrity

(2016). Vocal music therapy for chronic pain management in inner-city African Americans: A mixed methods feasibility study. Journal of Music Therapy, 53(2), 178–206. https://doi.org/10.1093/jmt/thw004

12.

Bronfenbrenner

(1977). Toward an experimental ecology of human development. American Psychologist, 32(7), 513–531. https://doi.org/10.1037/0003-066X.32.7.513

13.

Brown

J. M.

(2002). Towards a culturally centered music therapy practice. Voices: A World Forum for Music Therapy, 2(1). https://doi.org/10.15845/voices.v2i1.72

14.

Burke

(2009). Cultural hybridity. Polity Press.

15.

Clarke

(2011). Music perception and musical consciousness. In Clarke

Clarke

(Eds.), Music and consciousness: Philosophical, psychological, and cultural perspectives (pp. 193–214). Oxford University Press.

16.

The Colonialism and Music Therapy Interlocutors (CAMTI) Collective. (2022). Colonialism and music therapy. Barcelona Publishers.

17.

Daveson

B. A.

(2008). A description of a music therapy meta-model in neuro-disability and neuro-rehabilitation for use with children, adolescents and adults. Australian Journal of Music Therapy, 19, 70–85. https://search.informit.org/doi/10.3316/informit.566473313214827

18.

DeWane

Grant-Kels

J. M.

(2018). The ethics of volunteerism: Whose cultural and ethical norms take precedence? Journal of The American Academy of Dermatology, 78(2), 426–428. https://doi.org/10.1016/j.jaad.2017.05.013

19.

Edwards

(2022). Cultural humility in music therapy practice. In Beer

L. E.

Birnbaum

J. C.

(Eds.), Trauma-informed music therapy: Theory and practice (pp. 28–35). Routledge. https://doi.org/10.4324/9781003200833

20.

Engel

G. L.

(1977). The need for a new medical model: A challenge for biomedicine. Science (New York, N.Y.), 196(4286), 129–136. https://doi.org/10.1126/science.847460

21.

Fancourt

Finn

(2019). What is the evidence on the role of the arts in improving health and well-being? A scoping review. World Health Organization. Regional Office for Europe. https://iris.who.int/handle/10665/329834 .

22.

Fischer

Smith

P. B.

(2021). How far can measurement be culture-free? In Adams

B. G.

Bender

(Eds.), Methods and assessment in culture and psychology (pp. 319–340). Cambridge University Press. https://doi.org/10.1017/9781108675475.016

23.

Frith

(1996). Music and identity. In Hall

du Gay

(Eds.), Questions of cultural identity (pp. 109–127). Sage Publications Ltd.

24.

Froman

R. J.

(2009). Music therapy practice with Jewish people in the United States of America. Music Therapy Perspectives, 27(1), 33–41. https://doi.org/10.1093/mtp/27.1.33

25.

Global Wellness Institute. (2025, April 2). Music for health and wellbeing initiative trends for 2025. Global Wellness Institute. https://globalwellnessinstitute.org/global-wellness-institute-blog/2025/04/02/music-for-health-and-wellbeing-initiative-trends-for-2025/.

26.

Goldman

Glei

D. A.

Lin

Y.-H.

Weinstein

(2010). The serotonin transporter polymorphism (5-HTTLPR): Allelic variation and links with depressive symptoms. Depression and Anxiety, 27(3), 260–269. https://doi.org/10.1002/da.20660

27.

Grimmer

M. S.

Schwantes

(2018). Cross-cultural music therapy: Reflections of American music therapists working internationally. The Arts in Psychotherapy, 61, 21–32. https://doi.org/10.1016/j.aip.2017.07.001

28.

Hadley

(Ed.). (2021). Sociocultural identities in music therapy. Barcelona Publishers.

29.

Hadley

Norris

M. S.

(2016). Musical multicultural competency in music therapy: The first step. Music Therapy Perspectives, 34(2), 129–137. https://doi.org/10.1093/mtp/miv045

30.

Henrich

Heine

S. J.

Norenzayan

(2010). The weirdest people in the world? Behavioral and Brain Sciences, 33(2–3), 61–83. https://doi.org/10.1017/S0140525X0999152X

31.

Hong

Morris

M. W.

Chiu

Benet-Martínez

(2000). Multicultural minds: A dynamic constructivist approach to culture and cognition. American Psychologist, 55(7), 709–720. https://doi.org/10.1037/0003-066X.55.7.709

32.

Huron

(2008). Lost in music. Nature, 453(7194), Article 7194. https://doi.org/10.1038/453456a

33.

Jakubowski

Ahmad

Armitage

Barrett

Edwards

Galbo

Gómez-Cañón

J. S.

Graves

T. A.

Jadzgevičiūtė

Kirts

Lahdelma

Lennie

T. M.

Ramatally

Schlichting

J. L.

Steliou

Vishwanath

Eerola

(2025). Participant and musical diversity in music psychology research. Music & Science, 8, 20592043251317180. https://doi.org/10.1177/20592043251317180

34.

Jameel Arts & Health Lab. (n.d.). About the lab. Jameel Arts & Health Lab. Retrieved August 7, 2025, from https://www.jameelartshealthlab.org/about/our-story.

35.

Lee

S. J.

Dvorak

A. L.

(2023). Therapeutic group singing for individuals with Parkinson’s disease: A conceptual framework. Music Therapy Perspectives, 41(2), 178–186. https://doi.org/10.1093/mtp/miad008

36.

Gilmour

(2006). Individual-oriented and socially oriented cultural conceptions of subjective well-being: Conceptual analysis and scale development. Asian Journal of Social Psychology, 9(1), 36–49. https://doi.org/10.1111/j.1467-839X.2006.00183.x

37.

Markus

H. R.

Kitayama

(2010). Cultures and selves: A cycle of mutual constitution. Perspectives on Psychological Science, 5(4), 420–430. https://doi.org/10.1177/1745691610375557

38.

Miyamoto

Yoo

Wilken

(2019). Well-being and health: A cultural psychology of optimal human functioning. In Cohen

Kitayama

(Eds.), Handbook of cultural psychology (2nd ed, pp. 319–342). Guilford Publications. http://ebookcentral.proquest.com/lib/sheffield/detail.action?docID=5626667 .

39.

Mondanaro

J. F.

(2016). Multiculturally focused medical music psychotherapy in affirming identity to facilitate optimal coping during hospitalization. Music Therapy Perspectives, 34(2), 154–160. https://doi.org/10.1093/mtp/miw019

40.

Morling

(2016). Cultural difference, inside and out. Social and Personality Psychology Compass, 10(12), 693–706. https://doi.org/10.1111/spc3.12294

41.

Norris

M. S.

(2019). Between lines: A critical multimodal discourse analysis of Black aesthetics in a vocal music therapy group for chronic pain [Doctor of Philosophy, Drexel University]. https://doi.org/10.17918/nwe8-qm16

42.

Pavlicevic

Ansdell

(2004). Community music therapy. Jessica Kingsley Publishers.

43.

Ponterotto

J. G.

(2010). Qualitative research in multicultural psychology: Philosophical underpinnings, popular approaches, and ethical considerations. Cultural Diversity & Ethnic Minority Psychology, 16(4), 581–589. https://doi.org/10.1037/a0012051

44.

Porcelli

Fabbri

Serretti

(2012). Meta-analysis of serotonin transporter gene promoter polymorphism (5-HTTLPR) association with antidepressant efficacy. European Neuropsychopharmacology, 22(4), 239–258. https://doi.org/10.1016/j.euroneuro.2011.10.003

45.

Ramesh

(2024). Role of music therapy in palliative care—Methods and techniques. Journal of Palliative Care, 41(1), 08258597241235110. https://doi.org/10.1177/08258597241235110

46.

Rodgers-Melnick

S. N.

Matthie

Jenerette

Griest Pell

T. J.

Lane

Margevicius

Little

J. A.

(2018). The effects of a single electronic music improvisation session on the pain of adults with sickle cell disease: A mixed methods pilot study. Journal of Music Therapy, 55(2), 156–185. https://doi.org/10.1093/jmt/thy004

47.

Sallis

J. F.

Owen

Fisher

E. B.

(2015). Ecological models of health behavior. In Glanz

Rimer

B. K.

Viswanath

(Eds.), Health behavior and health education: Theory, research, and practice (4th ed, pp. 465–485). John Wiley & Sons.

48.

Sauvé

S. A.

Phillips

Schiefelbein

Daikoku

Hegde

Moore

(2023). Anti-colonial strategies in cross-cultural music science research. Music Perception, 40(4), 277–292. https://doi.org/10.1525/mp.2023.40.4.277

49.

Silverman

M. J.

Letwin

Nuehring

(2016). Patient preferred live music with adult medical patients: A systematic review to determine implications for clinical practice and future research. The Arts in Psychotherapy, 49, 1–7. https://doi.org/10.1016/j.aip.2016.05.004

50.

Smith

J. G.

(2022). Becoming-music as a desettlering of music therapy. In The Colonialism and Music Therapy Interlocutors (CAMTI) Collective (Ed.), Colonialism and music therapy (pp. 425–460). Barcelona Publishers.

51.

Spiro

Sanfilippo

K. R. M.

(Eds.). (2022). Collaborative insights: Interdisciplinary perspectives on musical care throughout the life course. Oxford University Press.

52.

Stige

(2002). Culture-centered music therapy. Barcelona Publishers.

53.

Stokols

(1992). Establishing and maintaining healthy environments: Toward a social ecology of health promotion. American Psychologist, 47(1), 6–22. https://doi.org/10.1037/0003-066X.47.1.6

54.

Swamy

(2014). Music therapy in the global age: Three keys to successful culturally centred practice. New Zealand Journal of Music Therapy, 12, 34–57. https://doi.org/10.3316/informit.083852501077631

55.

Talhelm

Zhang

Oishi

Shimin

Duan

Lan

Kitayama

(2014). Large-scale psychological differences within China explained by rice versus wheat agriculture. Science, 344(6184), 603–608. https://doi.org/10.1126/science.1246850

56.

Tang

(2025). The important role of self in cross-cultural investigations of affective experiences with music. Psychology of Music, 53(4), 616–642. https://doi.org/10.1177/03057356241305154

57.

Tang

Schwantes

(2021). International service-learning and intercultural competence of U.S. music therapists: Initial survey findings. Nordic Journal of Music Therapy, 30(4), 377–396. https://doi.org/10.1080/08098131.2020.1841822

58.

Tang

Tan

(2025a). Favorite music expresses socially engaging emotions: The role of self-construal across cultures. Journal of Cross-Cultural Psychology, 56(8), 1042–1074. https://doi.org/10.1177/00220221251355202

59.

Tang

Tan

(2025b). Feeling socially (dis)engaging emotions with favorite music: The role of self-construal across cultures. Psychology of Aesthetics, Creativity, and the Arts. Advance online publication. https://doi.org/10.1037/aca0000807

60.

Tang

W. L. J.

(2025). mUSic or musIc?: Examining the role of self-construal in affective experiences with music across cultures [PhD, University of Sheffield]. https://etheses.whiterose.ac.uk/id/eprint/37051/ .

61.

Taras

Steel

Kirkman

B. L.

(2016). Does country equate with culture? Beyond geography in the search for cultural boundaries. Management International Review, 56(4), 455–487. https://doi.org/10.1007/s11575-016-0283-x

62.

Thaut

M. H.

Abiru

(2010). Rhythmic auditory stimulation in rehabilitation of movement disorders: A review of current research. Music Perception: An Interdisciplinary Journal, 27(4), 263–269. https://doi.org/10.1525/mp.2010.27.4.263

63.

Thaut

M. H.

Hoemberg

(Eds.). (2025). Handbook of neurologic music therapy (2nd ed.). Oxford University Press. https://doi.org/10.1093/oso/9780192844491.001.0001

64.

Truasheim

(2014). Cultural safety for Aboriginal and Torres Strait Islander adults within Australian music therapy practices. Australian Journal of Music Therapy, 25, 135–147. https://doi.org/10.3316/informit.473207068488978

65.

Ullsten

Eriksson

Klässbo

Volgsten

(2018). Singing, sharing, soothing – biopsychosocial rationales for parental infant-directed singing in neonatal pain management: A theoretical approach. Music & Science, 1, 2059204318780841. https://doi.org/10.1177/2059204318780841

66.

Whitehead-Pleaux

Tan

(Eds.). (2017). Cultural intersections in music therapy: Music, health, and the person. Barcelona Publishers.

67.

Willis

Elmer

(2011). Society, culture and health: An introduction to sociology for nurses (2nd ed.). Oxford University Press.

68.

Windsor

W. L.

de Bézenac

(2012). Music and affordances. Musicae Scientiae, 16(1), 102–120. https://doi.org/10.1177/1029864911435734

69.

Yamaguchi

Akutsu

Oshio

Kim

M.-S.

(2017). Effects of cultural orientation, self-esteem, and collective self-esteem on well-being. Psychological Studies, 62(3), 241–249. https://doi.org/10.1007/s12646-017-0413-y

70.

Young

(2016). Multicultural musical competence in music therapy. Music Therapy Perspectives, 34(2), 127–128. https://doi.org/10.1093/mtp/miw016

A Cultural Approach to Musical Care: Theoretical Perspectives and Future Directions

Abstract

Keywords

My Positionality

Models of Health and Musical Care

Biomedical Model of Health

Biopsychosocial Model of Health

Socioecological Model of Health

Cultural Approach to Health

Cultural Approaches in Music Therapy

Cultural Approach to Musical Care

Discussion and Future Directions

Footnotes

Acknowledgments

Action Editor

Peer Review

Data Availability Statement

Declaration of Conflicting Interests

Ethical Approval

Funding

ORCID iD

References