Music Therapy Clinical Practice Research Articles

Approaches, Goals, and Scientific Integrity in Music Therapy Research with Individuals on the Autism Spectrum: An Integrative Review.

Scientific integrity is fundamental to evidence-based practice (EBP) and essential in music therapy (MT) research and clinical practice. Researchers conducted an integrative review of approaches and interventions employed by music therapists (MTs) with individuals on the autism spectrum in the context of how studies are analyzed by the National Autism Center (NAC) and National Clearinghouse on Autism Evidence and Practice (NCAEP). Researchers identified 880 database records meeting initial search criteria (i.e., autism spectrum disorder, autism, PDD-NOS, MT, and music interventions); 36 studies remained after screening for duplication, topic relevance, and adherence to inclusion criteria. Included studies were published between 1964 and 2021, in English language, in free open-access journals, worldwide; peer reviewed; conducted by MTs; empirical quantitative, qualitative, or mixed-methods design; intervention-based; and presented separate data for participants on the autism spectrum. Content and quantitative analyses identified deficits in scientific integrity and the following gaps in studies reviewed: Motor Skills and Placement (NAC-defined intervention targets), Computer-based and Songwriting and Composition (MT techniques), and Wellness and Bonny Method of Guided Imagery in Music (clinical approaches); no patterns were evident among NAC Interventions with MT techniques and approaches. Analysis of 5-point Scientific Merit Ratings yielded a mean 2.78 rating. A comparison of NAC and NCAEP terminology (i.e., how MT researchers report independent variables) indicated eight titles mention specific non-music interventions, 19 mention MT, 14 include music-based technique descriptors, and two mention both non-music interventions and MT. Researchers offer guidelines regarding identity-inclusive language, scientific integrity, and clarity of EBPs within MT intervention research with individuals on the autism spectrum.

A personal reflection on challenges facing music therapy education, training and clinical practice

Music used in connection with health and wellness is not a new concept. Music therapy is one discipline that uses music and has developed at various speeds internationally. Since the day I first learned about music therapy I have been advocating further understanding of the discipline, and for its inclusion in multiple contexts. I situate myself in the paper with the start of my own journey into music therapy and provide a short personal reflective overview of three overarching issues I see impacting education, training, and clinical practice of music therapy and its continued development. The World Federation of Music Therapy and the International Association for Music and Medicine will be briefly described with respect to their impact as two large international organizations seeking to advance music therapy and music medicine in healthcare. The essay is offered as an opportunity for educators, practitioners, and researchers to consider and reflect on the factors they see impacting our profession to work towards advancing music therapy and actioning the challenges facing the discipline. Some action steps are offered such as ensuring ethical practice, continuing advocacy efforts, increasing opportunities and avenues of knowledge translation, and developing collaborations. It is hoped that reflecting on these experiences will further dialogue to advance different, non-Western perspectives of music therapy, and to learn how to honor multiple ways of supporting therapeutic music and healing experiences without centering Western approaches or perspectives.

A Description of Harmful Events Reported by Music Therapists in Their Everyday Clinical Practice

Abstract Twelve music therapists working in a range of settings throughout the United States were interviewed and asked to recall harmful events they experienced during music therapy sessions. In total, 61 harmful or potentially harmful events were described and subsequently analyzed using procedures consistent with qualitative content analysis. Four categories emerged that characterized these harmful events: (1) emotional harm, (2) physiological harm, (3) physical harm, and (4) relationship harm. Within each of these categories, therapist self-awareness, clinical decision-making, and clinical competence are discussed. The findings suggest a need for increased awareness of the potential for harm in music therapy clinical practice, increased education for students and new professionals entering clinical training/practice, as well as additional research exploring the ways music therapists may define, navigate, and prevent harm.

Comparison Between Neuroscience- and DIRFloortime®-Informed Approaches Within Music Therapy: A Descriptive Case Study

Abstract Music therapists practice from different clinical approaches; however, these approaches have not been compared in a research study. The purpose of this descriptive case study was to examine differences in behaviors for one participant on the autism spectrum and their therapist practicing from two different clinical approaches. We examined five videos where treatment was delivered in a neuroscience-informed approach and five videos in a DIRFloortime®-informed approach. We used observational behavioral coding for three nonmusical social skill behaviors, three musical social skill behaviors, and four therapist behaviors. We also examined the presence of critical elements of each approach within the videos. Results indicated that the therapist overall showed the critical elements for each approach within the examined videos. Targeted participant social behaviors were present in each of the approaches; however, the manner in which they were facilitated was different. Descriptive statistics and visual analysis were used to show similarities and differences between the approaches. Further studies are needed to explore different approaches in music therapy clinical practice.

Considering case formulation and decision-making processes in music therapy assessment and treatment planning

ABSTRACT Introduction Two approaches to assessment and treatment planning, case formulation and decision-making, are presented and compared in order to consider what each bring to music therapy clinical practice. Method Case formulation processes are compared with decision-making processes to illuminate the differences inherent to each approach. Special attention is given to differences related to data collection, use of theory, therapist expertise, client collaboration, context, and power. Results Clear differences in these two assessment and treatment planning processes emerge, particularly in the ways in which the client is understood, the ways in which the client’s needs are contextualized and the ways in which they might be engaged as collaborators in the therapy process. Discussion Considering these two different perspectives offers opportunities for music therapists to reflect on how they position themselves in relation to clients – particularly in terms of the extent to which power, desire, collaboration, and equity are realized within the therapeutic relationship. The context in which therapy takes place is also considered differently in each approach, and this has implications for the way the client’s needs are understood. When considered as a whole, this article invites further discussion about how music therapists conceptualize the personhood of clients, and how this impacts the way therapy unfolds.

Response to Gattino’s review of the book ‘The AQR tool – Assessment of the quality of relationship’

I am writing this letter to add some facts and answers to questions asked in Gattino’s review of ‘The AQR Tool – Assessment of the Quality of Relationship’ which was published in Approaches (Gattino, 2022). The book, ’The AQR Tool – Assessment of the Quality of Relationship. Based on Developmental Psychology’, was authored by three authors. Two of us, Claudine Calvet and I, developed the tool, and Silke Reimer’s role as the third author was very relevant for the revised publication. Reimer added some important ideas, especially for the accompanying DVD. The following themes made in Gattino’s review needed to be commented on: reliability, case study, certification courses, research, and references.
 Reliability: The reliability of the AQR tool was mentioned in the book (see page 10). This reliability could therefore be proven by 84 raters from four different cities (Vienna, Berlin, Munich and Sjövig) who were first trained and then did this work. The result of this examination of reliability, carried out by an independent statistician, showed an Intraclass-Correlation (ICC) higher than 0.74, which meant that the reliability was very good (Stallmann, 2006). The validity has not been done because we could not find a comparative tool for assessing the quality of relationship for the first three years of life. This is perhaps an area that could be addressed in the future.
 Case study: There were two publications (one with DVD) where you could find a case study analysed with the help of the AQR Tool. In German, readers could find a book (Schumacher, 2017). This book was about the three years of work with an autistic boy called Max, which was published in 1994 before the AQR Tool was developed. In 2016, I re-examined the film material from this work with Max and analysed it with the help of the AQR. This book is published again in German, now with a DVD and is entitled Musiktherapie bei Kindern mit Autismus, Musik-Bewegungs- und Sprachspiele zur Behandlung gestörter Sinnes- und Körperwahrnehmung (2017). In English, readers could find another case study in an article (Schumacher, 2014). This article described the application of the AQR Tool in music therapy work with Steven.
 Certification courses: Our training course lasts ninety (90) hours over five weekends and is only for experienced music therapists. Over the past 16 years of running this course, we found that it was necessary to teach practitioners how to use the AQR Tool. Developmental psychology forms the basis of this tool, and it is often not taught in the curriculum of different music therapy training programmes. This knowledge is not only valuable for work with children with social-emotional difficulties, including children with autism, but also for other areas of music therapy clinical practice. In these courses, all participants have to demonstrate how they work and how well they understood the book. To read is one thing, but to show how one practices and explains their interventions indicates if one has understood this tool. The danger of applying this tool without a deep understanding of developmental psychology and supervision is that one might obtain superficial and imprecise results regarding the quality of relationship. Over the last years, I have offered introductions in English and other languages, with the help of translators from many countries including France, Italy, Russia, Ukraine, and Hungary. Colleagues in Japan and Korea were particularly interested, and we have now introduced certification courses in their countries. My impression was and is that we need more time for this complex and important question: Does the therapeutic relationship have a good quality? In other words, does the therapist reach his or her client with their music therapeutic intervention through an appropriate assessment of the state of development? The most common mistake, in my experience, was to expect the capacity for joint attention and the attempt to enter into dialogue with a client who does not have the ability to do so.
 Research: The research work with Karin Mössler showed whether the music therapeutic intervention has reached the patient, that means whether a “shared moment” can be observed. Through the Covid-19 pandemic we stopped our plan to give a course in English, but we will see what is possible in the future. At the moment, we offer courses in Berlin, Munich, Vienna, and Zürich. The newest are in Korea and Japan, where colleagues were very interested to profit from our knowledge and to teach the AQR Tool in their countries.

MusicTeamCare (MTC): Theory and practice of clinical intervention for music therapists offering remote support to clients during emergencies

The COVID-19 pandemic meant that people’s lives and work changed significantly across the world. Governments took measures such as social distancing, lockdowns and quarantine protocols to stem the spread of the pandemic. This had a significant impact on music therapy clinical practice, generating reflections and adaptations among the worldwide music therapy community, with several studies still underway. A number of professional music therapy organisations have explored methods for carrying out remote interventions. MusicTeamCare is an approach developed by three Italian Certified Music Therapists that could offer access to support in emergency and crisis situations. This approach is rooted in receptive music therapy theory, with particular reference to Guided Imagery and Music (GIM). MusicTeamCare was used for the first time in March to April 2020, with healthcare workers in Italy who were treating COVID-19 patients. This article outlines theoretical framework, development and evaluation phases of MusicTeamCare. Detailed explanations are given of the theoretical framework, methods of musical analysis, assessment and evaluation strategies, criteria for constructing the playlists and interactive triangulation between the Music Therapists in the research team.

Using Music to Address Trauma with Refugees: A Systematic Review and Recommendations

Abstract Refugees experience trauma and are more vulnerable than the general population to experiencing mental health conditions. Music may be used to support and enhance the lives of refugees. The purpose of this systematic review was to summarize and describe the uses of music to address trauma for individuals who are refugees. The research questions included (a) What are the characteristics of studies using music to address trauma for people who are refugees? and (b) What are the outcomes of these studies, and how are these outcomes measured? The researchers gathered available literature from PsycInfo, ERIC, Sociological Abstracts, PubMed, Music Index, and Directory of Open Access Journals (DOAJ). Databases were searched using “music” AND “refugee.” Search filters aimed to select articles that were peer-reviewed and published quantitative, qualitative, or mixed-methods studies. Of the 1,318 studies first identified, 11 met the criteria for inclusion. Studies included qualitative and quantitative approaches; the most common research design was case study. The majority of participants were adult refugees from a variety of countries, with approximately a third of the studies conducted in Australia. The majority of interventionists identified as music therapists. Treatment length varied from several days to 18 months, typically occurring once or twice weekly. Music interventions included a combination of methods, with receptive and recreative most common. Outcomes included improvements in behavioral and psychological functioning, with a variety of measurement tools used. Implications and recommendations for music therapy clinical practice are discussed.

Music Therapy for Children with Oncology & Hematological Conditions and Their Families: Advancing the Standards of Psychosocial Care.

Background: Diagnosis and treatment of cancer and blood disorders in childhood, adolescence and young adulthood has a significant impact on patients and families. The Psychosocial Standards of Care project, initiated in 2012, resulted in 15 Psychosocial Standards (PSS) that guide the care patients and families receive throughout treatment. As members of the multidisciplinary psychosocial care team, music therapists play an important role in the advancing the PSS. Most surveys have focused on other commonly provided services (e.g., social work, child life), leaving gaps in our understanding about the availability and use of music therapy services to advance PSS. This paper offers an initial description of how music therapy services contribute to the provision of care under these Standards. Methods: We analyze how music therapy services promote PSS through synthesis of a music therapy clinical practice survey, published literature, and scope of practice documents. A brief overview of music therapy services structure, PSS that music therapy services currently address, and two clinical program descriptions are included. Results: Music therapy services address 9 of the 15 PSS and are well integrated within the larger program of psychosocial care. Findings suggest integration of music therapy services can help ensure personalized, comprehensive care and efficient use of often-limited psychosocial care resources. Discussion: Nurses, as members of the psychosocial and medical teams are uniquely positioned to identify patient and family care needs and refer patients for services. Understanding how music therapy services address PSS and most importantly, the needs of patients and families, will optimize their care.

Defining the Therapeutic Singing Voice: Further Examination of the Everyday Singing Practices of Music Therapists

Abstract Twelve music therapists were observed working clinically in 3 to 5 of their music therapy sessions and subsequently interviewed about their clinical work in order to further examine and define the essential characteristics of therapeutic singing in music therapy clinical practice. Observational and interview data were analyzed separately using procedures consistent with qualitative content analysis and then integrated to provide a comprehensive picture of these singing practices. Analysis of these data revealed 3 interrelated dimensions of therapeutic singing that were integrated into the larger realization of therapeutic singing: (1) foundational vocal skills, (2) vocal engagement, and (3) authenticity. Implications for the education and training of music therapy students, vocal health, and a reevaluation of the American Music Therapy Association’s competencies contextualize these findings for the profession as a whole.

Defining Attachment and Bonding: Overlaps, Differences and Implications for Music Therapy Clinical Practice and Research in the Neonatal Intensive Care Unit (NICU).

Preterm birth and the subsequent hospitalization in the Neonatal Intensive Care Unit (NICU) is a challenging life event for parents and babies. Stress, anxiety, and depressive symptoms, limitations in holding or touching the baby, and medical complications during the NICU stay can negatively affect parental mental health. This can threaten the developing parent-infant relationship and might adversely impact child development. Music therapy in the NICU is an internationally growing field of clinical practice and research and is increasingly applied to promote relationship building between parents and babies. The two most commonly used concepts describing the early parent-infant relationship are ‘attachment’ and ‘bonding’. While frequently used interchangeably in the literature, they are actually not the same and describe distinctive processes of the early relationship formation. Thus, it is important to discuss the overlaps and differences between attachment and bonding and the implications for music therapy clinical practice and research. Whereas providing examples and possible scenarios for music therapists working on either bonding or attachment, the distinction between both concepts is relevant for many health care professionals concerned with early parenting interventions in the NICU. This will hopefully lead to a more precise use of theory, and ultimately, to a more informed clinical practice and research.

Social Skills Instruments for Children with Autism Spectrum Disorder: A Critical Interpretive Synthesis.

Identifying and critically analyzing the most frequently used social skills psychometric instruments (SSPI) for children with autism spectrum disorder (ASD) can inform future music therapy research and clinical practice. Therefore, the initial purpose of this critical interpretive synthesis was to identify the SSPI most frequently used as dependent measures in the Journal of Autism and Developmental Disorders (JADD) for children with ASD from 2012 to 2018. Results indicated that the Social Responsiveness Scale (n = 35), Autism Diagnostic Observation Schedule (n = 19), and Vineland Adaptive Behavior Scales (n = 15) were the most frequently used instruments. Congruent with critical interpretive synthesis methodology, we then identified the psychometric properties and advantages and disadvantages of the 9 most commonly used instruments. To compare these results with the existing music therapy literature, we also identified nonmusical SSPI used as dependent measures in music therapy research for children with ASD in studies published between 2012 and 2018. In comparing the data sets, music therapy researchers used 5 of the 9 SSPI we identified from our JADD review. Understanding frequently used SSPI has applications for consultation and communication with other professionals as well as how future music therapy research is conducted. Implications for clinical practice, limitations of the study, and suggestions for future research are provided.

Expectancy Theory of Motivation and Substance Use Treatment: Implications for Music Therapy

Abstract The existing literature indicates that motivation is an important predictor of treatment outcome for people with substance use disorders (SUD). Although researchers have found that music therapy can positively impact motivation for people with SUD, the music therapy and SUD literature base lack a theoretical understanding of motivation. Vroom’s expectancy theory of motivation (ETM) is an established theoretical framework positing that motivation depends on three relationships: expectancy, instrumentality, and valence. These relationships consist of four variables: effort, performance, reward, and preference. Based on these four variables, motivation depends on the expectation that an increase in effort will lead to improved performance, thus leading to a reward aligned with an individual’s preferences. The purpose of this paper is to apply Vroom’s ETM to music therapy and SUD clinical practice and research. We reviewed the existing literature addressing Vroom’s ETM within SUD treatment and created a model to depict how to apply Vroom’s ETM to music therapy clinical practice for people with SUD. Application of Vroom’s ETM may help music therapists understand and augment motivation for people with SUD, potentially leading to relapse prevention and recovery. Implications for clinical practice, limitations, and suggestions for future research are provided.

Intergenerational Choir: A Qualitative Exploration of Lived Experiences of Older Adults and Student Music Therapists

The purpose of this phenomenological study was to explore the essence of an intergenerational choir experience for older adults and student music therapists. Data were gathered through a series of open-ended individual interviews with older adult participants (n = 10) and student participants (n = 5). Analysis of data revealed four emerging themes common to both older adults and students: mutual learning, social bonding and support, feelings of accomplishment, and appreciation and enjoyment. Emerging themes unique to the older adult community members were that (a) participation challenges came from differences in musical culture; (b) intergenerational choir promoted experience of emotional health and helped maintain an active lifestyle; and (c) community members were passionate about recruiting new members to expand the choir. Emerging themes unique to the student music therapists were that (a) intergenerational choir provided unique ensemble experiences and (b) students reported positive changes in perception of older adults. Implications of intergenerational music engagement for music therapy clinical practice, research, and education are discussed.

Integrating Alternative and Augmentative Communication into Music Therapy Clinical Practice: A Clinician’s Perspective

Abstract This article provides an overview of Alternative and Augmentative Communication (AAC) and discusses ways in which AAC may be integrated into music therapy clinical practice with neurodivergent children and young adults. The article begins with an overview of commonly used AAC modalities and subsequently explores their use in clinical practice through a series of vignettes. This article may be of value to students who wish to understand the myriad ways in which AAC may be integrated into their clinical work and to clinicians interested in developing their clinical practice knowledge in this area.

Making Sense of Self: An Autoethnographic Study of Identity Formation for Adolescents in Music Therapy

Abstract Told through my experiences of working with three teenagers who had mild and moderate developmental disabilities, this autoethnographic study considers identity formation as a core concept in music therapy clinical practice. In doing so, I explored theories of identity formation, including those described by Erikson (1950, Childhood and society, Norton), Marcia and colleagues (1993, Ego identity: A handbook for psychosocial research, Springer), and Crocetti, Rubini, and Meeus (2008, Journal of Adolescence, 31(2), 207–222), relating these concepts to each of the teenagers I worked with. This article, therefore, chronicles the ways in which my clinical thinking shifted from a skills-based approach to one that considers the client’s identity as a whole, leading to suggestions of ways to integrate identity formation theory into clinical practice.

Flow as a mechanism of change in music therapy: Applications to clinical practice

Due to the creative and purposeful applications of music in a therapeutic context, music therapists may be uniquely able to foster flow-based experiences for the people who access their services – herein “users”. As flow has been linked with a number of positive factors, it may be ideal for encouraging and enhancing learning and therapeutic encounters during music therapy. The purpose of this paper is to describe flow and provide contextualisation of flow in music therapy clinical practice and as a possible mechanism of change that might explain outcomes observed in research with users. To integrate the flow-based literature into music therapy research, we discuss flow in receptive and active music therapy interventions and applications of flow in clinical practice and research. We propose flow as a bi-directional construct in music therapy and, based upon the person-activity fit model, offer a figure integrating skill of the therapist with the challenge of the intervention in an attempt to enhance music therapy education and clinical practice. Moreover, flow may represent a positively framed and less invasive method for measuring users’ perceptions of the therapeutic outcomes. Future research utilising all paradigms is warranted to best understand this concept and resultant therapeutic implications.

Needs of Children Experiencing Homelessness who are Living in Shelters: A Qualitative Investigation of Perceptions of Care Workers to Inform Music Therapy Clinical Practice

On a single night in January in 2014 there were 194,000 children living with their families in shelters in the United States (National Center on Family Homelessness, 2015). A typical family experiencing homelessness consists of a single mother with two to three children. Children experiencing homelessness are more likely to face academic, social, and emotional problems compared to children in poverty. As there is currently a dearth of peer reviewed publications related to music therapy with children experiencing homelessness, the purpose of this study was to explore the perceived needs of children living in a homeless shelter through interviews with care workers and apply results to the music therapy clinical practice. Participants were seven staff members employed at a shelter for women and children experiencing homelessness in the Midwestern part of the United States. Data analysis was based upon Braun and Clarke’s (2006) six phases of thematic analysis. Emerging themes included: (a) staff need to be positive role models and provide trusting and affectionate relationships, (b) older children require programming and opportunities for communication and emotional support, (c) wellbeing must be screened and monitored, and (d) routine and expectations are needed to promote a calm living environment. Implications for music therapy clinical practice, limitations, and suggestions for future research concerning music therapy with children experiencing homelessness are provided.

A Musicoterapia e o Transtorno do Espectro do Autismo: uma abordagem informada pelas neurociências para a prática clínica

Resumo:Nos últimos anos, muitos estudos em neurociências têm buscado compreender como o sistema nervoso está estruturado, como funciona em pessoas com desenvolvimento global típico e atípico, e como este sistema nervoso processa a música enquanto estímulo percebido e ação no mundo. A integração destes conhecimentos na prática clínica musicoterapêutica pode fornecer novas explicações sobre o modo pelo qual o uso terapêutico da música promove melhoras da saúde, bem como subsidiar o desenvolvimento de novas abordagens clínicas de tratamento, avaliação diagnóstica e avaliação do processo terapêutico. Este artigo apresenta uma fundamentação nas neurociências para uma prática clínica musicoterapêutica com foco na melhora da comunicação não-verbal e da interação social de crianças e adolescentes com Transtorno do Espectro do Autismo.

Supervisor training: An integration of professional supervision and the use of artistic media

This article fills a gap in knowledge about supervisor training programmes in the field of music therapy in Europe. Sparse research exists which demonstrates evidence of effective professional supervision upon the outcome of music therapy clinical practice. The article has its focus on the experience of an integrated supervisor training programme offered in Aalborg, Denmark in 2009/2010. In this programme general issues of professional supervision and the application of artistic media as a core element in the supervisory process were integrated. It is the hope of the author that this article will inspire other music therapists to develop supervisor training programmes for professional music therapists and also to undertake further research into professional supervision.