A Conversation with Music Therapist Cat Stiles (World Mental Health Day)

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We love a Freytag’s triangle. There is comfort in its rise and fall, in the promise that tension will eventually yield to resolution. We are equally susceptible to the deus ex machina, that old theatrical sleight of hand in which something arrives at precisely the right moment and changes the course of events. It is hardly surprising, then, that we borrow the same shape when trying to make sense of more difficult things: a crisis; an intervention; a recovery. The trouble is that mental health rarely arranges itself so neatly. Treatment can matter enormously, and recovery can be real. But progress may still loop, stall, return in another form, or refuse to behave like a plot.

Life, inconveniently, has never shown much respect for narrative theory.

Some experiences improve, some recur, and others shift so often that the very idea of a final act begins to feel optimistic. Yet we remain hungry for the intervention that makes sense of what came before, the deus ex machina lowered from the rafters with impeccable timing. Something arrives; something works; somebody gets better. We recognise the story because we have been telling versions of it forever.

Childhood, when we look back on it, seems to operate by almost opposite rules. We played without needing a result and made noise without wondering whether it counted as music. A table became a drum because it was there. A song could consist of three invented words repeated until an adult begged for mercy. We didn’t need to be proficient to take part; in fact, proficiency mattered little to the pleasure of it. Later, music acquired standards, while mental health acquired outcomes. Some people became musicians; the rest, listeners. Somewhere along the way, we began to treat feeling better as the only proof that something had helped.

But what happens when there is no neat third act? What can music offer someone living with a long-term or fluctuating mental health condition, or simply facing difficulties that resist the idea of being neatly ‘fixed’? More pertinently, what if music’s value lies not in curing the difficulty, but in staying available while the difficulty persists?

This is what I wanted to investigate with Cat Stiles, a music therapist at Nordoff and Robbins. They are the UK’s largest music therapy charity, which uses music to support people living with life-limiting illness, disability, and social isolation.

My interest was partly personal. Picking up an instrument didn’t make the difficulty disappear; it simply gave me something to return to. Its value wasn’t in curing anything, but in being there when I needed it.

When I put this to Stiles, she understands the distinction immediately. “Music can hold you and be a companion to you, no matter how you’re feeling.” The word ‘companion’ is unusually precise in a field where music is often burdened with grander claims. Music can help people process, connect, and express what they are going through, she adds, but that does not mean ‘You’re suddenly better and everything’s fine’. “It needs to be woven into your life.“

That idea becomes the spine of our conversation. Stiles trained classically, where music meant excellence, preparation, and evaluation. Training with Nordoff and Robbins around nine years ago, ‘Completely flipped on its head what I thought music was, or what it could do for people‘. The shift was from product to process: “There can be such real value in making music for music-making’s sake,” she tells me.

Music therapy also made her listen differently, closely enough for another person’s contribution to alter her own. “It’s not about musical excellence, but musical connection.” At the homeless day centre in Manchester where she works, Stiles remembers one participant who had previously been a classical musician. Their old vocabulary of accuracy and discipline had not disappeared, but something else had begun to sit alongside it: “I’ve realised it’s not always about getting it right, but it’s just about being with people in music, where it’s helped me.“

Getting it right and being with people are very different ambitions. The former is easy to measure; the latter is harder to put on a certificate.

So what does making music with another person bring to therapy? “We’re creating something in real time that neither person could create on their own,” Stiles explains. The client is not simply receiving music from an expert, but ‘Actively shaping, influencing, and bringing it to life in the moment’. Nordoff and Robbins call this ‘meeting someone in music’: following a tempo, answering a phrase, or responding to movement, all with the aim of ‘Valuing, accepting, and celebrating however that person is showing up in that space’.

“The music only becomes meaningful through the client’s contribution.” For someone facing barriers to confidence, communication, or agency, that reciprocity matters.

These questions of participation extend beyond mental health, encompassing disability, access, and belonging. Participation brings its own obstacle: the suspicion that music belongs to people who are good at it. Stiles works against this from the outset. She talks about an ‘inner skin’ and ‘outer skin’ to the work. The inner skin is what happens inside the musical relationship itself; the outer skin is everything surrounding it, from how a session is introduced to the language used to make participation feel possible before anyone makes a sound. “Let’s explore. Let’s be curious.” The intention is that people do not feel ‘Like they have to earn the right to participate’.

“So much of our life is shaped by achievement and performance evaluation,” she observes. Music therapy offers another kind of encounter: “It’s not about becoming better at music. The focus is on the experience, connection, and expression.” A tap, a gesture, or one line can redirect what happens. “It’s just listening, celebrating, and valuing whatever that person is bringing into that space.“

The response itself communicates value. “It’s enough to participate in whatever capacity that person shows up in that space on that day.“

Enough is doing important work there. The contribution does not have to become grander before it matters. “However you show up in that space on that day, we can make music with that.“

This is where the neatness of a linear recovery narrative begins to fray. Stiles returns to music as ‘A tool that you can go back to’. The usefulness survives precisely because you may need it again. She compares this with familiar wellbeing advice: “Go for a run. Eat well. Sleep well. But we don’t talk about music in that way.“

“We are all musical beings,” she argues. “If you can tap into that musicality that exists within all of us through times of real hardship, but also all the time, it can be a consistent thing that can run through.” Consistency, rather than the cure. “Music can hold you in whatever emotion or state you’re in.“

Nor does useful mental health work have to be relentlessly grave. When I ask where enjoyment, humour, and play belong, Stiles calls play ‘Fundamental to human wellbeing’ because, through it, “You explore connection, creativity, expression, relationships, and dynamics”. Humour can indicate ‘Someone’s confidence, or their relationship, or their wellbeing, or their capacity to connect and create and participate’.

The idea of connection becomes more complicated when I ask about one of music’s most familiar propositions: that it is a ‘universal language’. The phrase has been repeated so often that it risks sliding into cliché. Yet it also has genuine significance within the Nordoff and Robbins tradition, and Stiles’ work gives it substance.

At her Manchester group, people come from different cultures and speak different languages. She has watched verbal communication falter, and something else take over. People connect through ‘Rhythm, through shared attention and gesture, and being part of music-making’. In those moments, music can communicate ‘Where words couldn’t’.

What interests me is that Stiles does not use these experiences to flatten difference. Quite the opposite. “Music is not culturally neutral.” A person’s relationship with music is shaped by history, identity, community, and lived experience, as well as the meanings attached to particular sounds and songs. Even the instruments available in the room matter. Simply participating in music together does not mean a therapist can recreate the musical world another person comes from.

Stiles is also acutely aware of her own position as a white therapist trained primarily within a Western classical tradition. “I will never be an expert in music from all cultures.” The answer isn’t to pretend otherwise, but to listen, learn, and make room for people to bring their own musical traditions into the therapy space.

Her distinction is considerably richer than the idea that music means the same thing everywhere: “What is universal is our human capacity for music. That’s the bit that’s universal. The potential for connection is universal, but the musical languages through which people express themselves are really diverse.“

“And also belonging, right?” I ask.

“Yes.“

The universality, then, is not in the music itself but in the capacity to meet through it. Belonging doesn’t require everyone to speak the same musical language.

This is especially important for music therapy in community settings. “The main thing that music therapy has taught me is the importance of meeting people exactly where they are,” Stiles tells me. “We don’t expect people to arrive with the right words, explain their experiences, or share personal details before they come and participate.” Mental health advocacy has rightly encouraged people to talk, but disclosure should not become another entry requirement: “The focus shifts from explaining yourself to simply being part of something.“

Stiles distils the argument to its clearest expression: “You are welcome here exactly as you are, and you don’t need to tell us anything. Just be here, and that is enough.“

The question of public narrative becomes especially interesting when I turn to my own territory: music journalism. “We often treat lyrics as autobiographical, or we assume that a song provides a window into someone’s inner life,” Stiles warns. Music may process difficult experience, but ‘I don’t think that means we should romanticise pain or position mental ill-health as the source of creativity’. She prefers art as ‘A vessel for human experience’ and argues for ‘Curiosity rather than assumption’. “The creativity is theirs, the mental health struggle is theirs, and they also aren’t necessarily the same thing.“

From there, access becomes impossible to ignore. “We often focus on access to interventions, but not enough on access to music-making itself,” Stiles tells me. Financial circumstances, disability-related barriers, geography, confidence, and fear of judgement matter, but the first barrier can arrive earlier: “The belief that music is only for people who are talented, or trained, or already skilled“.

For Nordoff and Robbins, this helps explain why access to music-making can be understood ‘As a human right rather than as a luxury’. Participation can support ‘Connection, expression, identity, and belonging’. A recent social-prescribing project in Salford also enables people to access music therapy in the community, positioning it ‘As not just a response to illness or disability, but also a resource for wellbeing, connection, and participation’. Stiles is particularly interested in its potential ‘As a preventative tool before crisis point hits for mental health’.

Participation can also look different. Therapists are trained ‘To respond musically to however anyone is presenting’, which might mean conventional playing, but equally ‘Someone blinking or someone raising their arm’.

By my final question, the conversation has moved beyond therapy. I ask what Stiles would like Nordoff and Robbins’ relationships across the music industry to achieve beyond fundraising. Her answer is ‘A culture where music-making is recognised as an essential part of health and wellbeing, and not just as entertainment’. Stiles wants more emphasis on participation.

‘The music industry has incredible reach,’ she tells me, ‘And the ability to influence how people think about music and their place within it.’ Nordoff and Robbins have previously worked with Wembley Stadium on a sensory space, and Stiles argues that venues should make musical environments ‘Feel like they belong to everybody as well’.

By the end of our conversation, belonging has surfaced everywhere. In who feels entitled to make music, who is welcomed into the room, and whose contribution is noticed. By comparison, excellence has barely entered the discussion. Stiles keeps returning instead to participation, and to what becomes possible when somebody is met as they are.

Near the end, she describes music as ‘a consistent tool’ somebody can return to throughout life. “Music can hold you in whatever emotion and whatever state that you’re in.“

Perhaps that is enough to recognise the value of music therapy in its own right, without asking it to perform the miracle of fixing everything at once. And beyond therapy, Stiles’ wider point still holds. Whether in a community group or alone with an instrument, music can remain a place to participate, connect, play, and return to; you don’t have to wait until you feel better, or become better at music, before it belongs to you.

To find out more about Nordoff and Robbins, visit their website here or follow them on Instagram, TikTok, and Threads. You can also view previous World Mental Health Day pieces.

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