Melbourne Conservatorium of Music - Theses
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ItemEffectiveness of SAMONAS Sound Therapy (SST) in improving social engagement of children with Autism Spectrum Disorder( 2016)Atypical sensory reactivity has been included in the latest diagnostic criteria for Autism Spectrum Disorder (ASD). Compared to typically developing children, children with ASD are more likely to demonstrate atypical sensory responses, such as adverse reactions or indifference to sensations. An increasing body of literature has explored the connections between auditory processing and social engagement. Difficulty orienting towards a parent’s voice has been suggested to have a detrimental impact on a child’s ability to engage with the social world. Severe auditory processing difficulties can be disabling for a child and his or her family. A child with poor auditory filtering might not respond when being called, have difficulty following verbal instructions, and struggle with social engagement and interaction. Treatment options for auditory-based difficulties for children with ASD are, however, limited. For this reason, parents seek other therapies such as sound therapy to help their children. SAMONAS Sound Therapy (SST) is a sound therapy method that involves listening to electronically modified music through headphones over a period of time with the aim of improving listening skills. Evidence of the effectiveness of sound therapies with children with ASD is scarce and limited to studies examining language and behavior. There have not been any studies published on the impact of SST on children with ASD. This Singapore-based study aimed to investigate whether SST impacts social orienting, joint attention, and social interaction of children with ASD. Eleven Asian children between ages four and six years were recruited for the study. All children had severe ASD, difficulty focusing on the voices of their parents, and low cognitive, verbal, and adaptive functioning. Double-blinded randomised controlled trial with repeated measures was employed. The children, randomly allocated into SST and music listening groups, received a combination of clinic- and home-based treatments. Measurements were taken before and after a two-week clinic-based intervention, after an eight-week home program, and at three-month follow-up. Clinician-administered tests were supplemented with parent and teacher questionnaires, parent interviews, and observations of parent–child free play. Statistical analysis of standardized and non-standardised measures indicated a significant effect in favour of SST in some, but not all, clinician-administered measures. SST was more effective than music listening in improving joint attention and reciprocal social interaction in children with ASD. Treatment gains were maintained at three-month follow-up. There were, however, no differences between groups on social orienting. An important finding of this study was that the positive results achieved in the context of therapist–child interaction did not simultaneously generalise to parent–child interaction. Incorporation of parent training is recommended for SST treatment and future trials. These outcomes offer the first indication that SST may be a useful tool for children with severe ASD in particular areas of social engagement.
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ItemMusical intimacy and the negotiation of boundary challenges in contemporary music therapy practice( 2016)This thesis details a grounded theory study that examined the new concept of musical intimacy. This research began with an initial interest in therapeutic boundaries, exploring how they interact with music in music therapy practice. Through a critical interpretive synthesis, examining the prevalence and presentation of traditional boundary ideas, musical intimacy emerged as a new boundary theme. Musical intimacy was an interesting concept that seemed to capture the complexities of musical experiences, and their unique interaction with therapeutic boundaries. It was the discovery of this concept that led me to explore it in more detail. A grounded theory study was conducted, interviewing 20 music therapists from locations in Australia, the USA, Canada, the UK, Denmark and Norway. I used intensive interviewing to explore the music therapists’ experiences and understandings of what musical intimacy could be. Through this, I was also keen to examine how the music therapists were managing musical intimacy, and if they had experienced any boundary challenges within that context. The interviews were conducted in person across a three month period. A grounded theory analysis, influenced by both Charmaz’s constructivist grounded theory (2014) and analytic strategies from Corbin and Strauss (2008), was applied to the interview transcriptions. The analysis process included: 1) data collection and initial analysis, 2) initial coding, 3) focussed coding, and 4) synthesizing to form the theoretical framework. Throughout the analysis process, the grounded theory technique of ‘memoing’ was used, as well as many reflexive strategies to reveal my influence on the emerging findings. This analysis allowed me to move back and forth between data and analysis, involving many streams of analysis, where I returned to the data to expand, confirm or challenge my initial ideas and themes. Through this process, a theoretical framework of musical intimacy and boundaries has emerged. The grounded essence of the musically intimate experience emerged as the core defining feature of musical intimacy. The grounded essence is: the therapist experiences a powerful moment of connection in and around the music that triggers an acute sense of vulnerability and reveals the need for boundaries to keep things safe. There were two main themes that emerged, which contributed to the musically intimate experience for these participants. These were: the ‘interpersonal experiences’ and the ‘intrinsic components of music’. The music therapists described a spectrum of experiences, which were a complex web of powerful moments of connection and challenging experiences. They also described their ‘ways of being and responding’ to the musically intimate experiences, which detailed how they managed boundaries in these moments. The most interesting aspect of this research is the emergence and definition of musical intimacy. Musical intimacy captures a complex aspect of music therapy that was experienced by all 20 of the music therapists involved in this study. Musical intimacy provides a way for music therapists to conceptualise boundaries in their practice. It alludes to powerful moments of connection we can experience, and how there can be challenging moments in and around the music in music therapy. The ‘ways of being and responding’ are the beginnings of developing a new understanding of boundaries in music therapy practice. It is my belief that through this theoretical framework of musical intimacy and boundaries, we can begin to understand the complex nature of music and boundaries in a contemporary approach to music therapy practice.