Melbourne Conservatorium of Music - Theses
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ItemUnderstanding and articulating the processa and meaning of collaboration in participatory music projects with marginalised young people and their supporting communities( 2013)Participatory approaches are increasingly emphasised in music therapy, advocating collaboration with participants for empowerment and social change. Participatory philosophy underpins Community Music Therapy (CoMT) and is the theoretical framework for the study presented in this thesis. To date, CoMT theorists have advocated strongly for participatory approaches in music therapy to promote health and wellbeing in communities (Stige, Andsell, Elefant & Pavlicevic, 2010; Stige & Aaro, 2012), and a growing number of case study examples offer contextual examples of participatory practice in music therapy. Whilst collaboration is frequently referred to as an underlying principle and feature of participatory music therapy practice, there is a notable lack of literature that practically examines the process of collaboration with communities beyond single case examples, or the meaning of that collaboration for the community participants themselves. Rolvsjord (2010) has identified collaboration in music therapy as a shared, dialogic process of negotiation between music therapist and participants that is characterised by equality, mutuality and active participation in decision-making. In CoMT projects that are, by nature, outwards-facing and ecologically focussed, engaging in a genuinely shared and dialogic collaboration with community participants can be complex and challenging. This thesis describes a study that aimed to describe this challenge. In this thesis I present learnings from an action research project in Melbourne, Australia. Three communities supporting marginalised young people engaged in participatory music projects with a music therapist. In repeating cycles of action and reflection, community participants and I worked together to plan, develop and implement their music projects. Alongside this practical decision-making, we reflected periodically on the process of collaborating together and the meaning of the process for the participants involved. Throughout the process, these reflections with individual communities were combined and shared to develop an overall understanding of collaborative process between the three groups. Comparative analysis of the process of collaboration with the three participating communities focussed on two key areas: to understand and articulate the process of collaboration with communities supporting marginalised young people; and, to understand what aspects of the collaborative process were meaningful for the participants involved. Using these key areas as a frame, learnings were interpreted from the empirical material in this study using an emergent, iterative analysis process. The analysis of empirical material identified that collaboration in participatory music projects has the potential to promote positive growth for participants in the form of strengthened connections with peers, increased self-esteem and confidence and empowerment. Learnings further indicated that this potential for empowerment is mediated by the degree of alignment between the structure of the chosen music project and particular contextual and individual factors, supporting a need for active and engaged collaboration to maximise this alignment, and subsequently the positive growth potential of participatory music projects. Based on the interpretation of empirical material, I propose a structure of collaborative process that accounts for contextual variation between communities. This structure is based on three interpersonal interactions between music therapists and community collaborators, and highlights vital characteristics of collaboration. Critical aspects include the importance of a ‘hangout period’ prior to active collaboration, and the ongoing nature of negotiations within the collaborative process. Implications from these learnings are proposed in the form of a new understanding of collaboration in music therapy - as a positive growth practice. This understanding is based on underlying principles of shared power and mutual responsibility. Particular emphasis is given to the critical and under-explored role that participant investment plays in music therapy collaborations.
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ItemMaking a connection: randomised controlled trial of family centred music therapy for young children with autism spectrum disorder( 2012)Young children with autism spectrum disorder vary greatly in their social and communication skills, from non-verbal and difficult to engage socially, to using some sentences and showing social interest in other people. For those children who are non-verbal and difficult to engage socially, there is minimal evidence to help parents and early childhood intervention service providers determine which interventions will most successfully foster the social communication development of these young children. There is, however, increasing awareness in the literature of the positive impacts a strong parent-child relationship can have on social communication development in both typically developing children and children with ASD. The use of music therapy to assist children with autism to develop social communication skills has a long history, dating back to the 1960s. While the use of music therapy with children who have social communication impairments has been widely described, evidence into the effectiveness of music therapy with children with autism spectrum disorder has primarily taken the form of case studies, small quasi experimental research and small experimental designs. This mixed-methods study aimed to investigate whether family-centred music therapy positively influenced the social communication development of preschool aged children with severe autism spectrum disorder. 23 children between the ages of 3 and 6 years and their families were randomly allocated to either the treatment group or the control; with each participant receiving 16 weeks of family-centred music therapy sessions which took place in the family home. A variety of data was collected including 4 standardised measures, 1 non-standardised measure, a survey of the use of music in the home, and a structured interview with the participating parent. Quantitative analysis showed that children in the treatment group made improvements in the quality of their social interactions in the home and community, as well as their level of engagement within the music therapy sessions. The qualitative and mixed data analysis suggested that there were also improvements in the closeness of the parent-child relationship. Further, parents were able to adapt music activities to support their child in various activities in the home and community. These outcomes provide preliminary support for family-centred music therapy’s effectiveness in promoting developmental change in children’s social communication skills, and fostering greater closeness in the parent-child relationship.
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ItemThe accumulative effects of music therapy on dementia-related speech deficits in a sub-acute hospital setting( 2011)A single blinded randomised control trial was conducted to determine the accumulative effects of Music Therapy on dementia-related speech deficits. The hypotheses to be tested whether a programme of MT will result in greater improvement in dementia-related spontaneous speech deficits (in particular naming), than a programme of DT and 2) whether a programme of either MT or DT will result in a reduction in dementia-related spontaneous speech deficits (in particular naming) compared to a non intervention (control) group. Fifty-one participants with moderate to severe dementia, were randomised into 3 groups, one being the control group, the other two groups receiving either Music Therapy (MT) or Diversional Therapy (DT) (referred to as Recreational Therapy in the USA). The 45 to 60 minute Music Therapy and Diversional Therapy sessions were run concurrently every Monday, Wednesday and Friday morning for 3 weeks by the author, a Registered Music Therapist or a Diversional Therapist. The Music Therapy sessions consisted of MT techniques previously used in Music Therapy dementia-related language studies, which included singing familiar songs, word cueing, instrument playing, music and reminiscence and music and movement. The Diversional Therapy activities were based on cognitive activities, physical stimulation and creative expression through arts and crafts activities. Data was collected at baseline and within 48 hours of the final session by the chief investigator and the research assistant. Data was generated by the following validated and standardised tools for the field of dementia: the Boston Naming Test Short Form (Mack, Freed, Williams, & Henderson, 1992), the Animal Naming Test (Spreen & Strauss, 1998), the Mini Mental State Examination (Folstein, Folstein, & McHugh, 1975), Geriatric Depression Scale, short version (Sheikh, 1986; Yesavage et al., 1983) and the Digit Span Test (Hunsley, Hanson, & Parker, 1988). Using a one-way repeated ANOVA the changes in the scores of the MT group were compared to the DT group (hypothesis 1), and score changes in both the MT and DT group were compared to the non-intervention (NI) group (hypothesis 2). Results of the one way repeated ANOVA did not support the two hypotheses. Changes in the scores of the secondary outcome measures using a one way repeated ANOVA also did not support the two hypotheses. Possible reasons for the null hypotheses are discussed including the research design, choice of research tools, and the challenges faced when conducting research studies within the dementia population. This study, with its large participant numbers and stringent research design significantly contributes to MT research literature. This study is also the first of its kind to define the MT technique of “word cueing”. Recommendations for future MT and dementia-related language deficits are discussed.
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ItemAn investigation of premature infant response to recorded music with maternal involvement versus no maternal involvement: a randomised control trial( 2011)The incidence of premature birth has increased over the past two decades in Australia. While survival rates have improved and stabilised, there has not been a decrease of neuro-developmental and behavioural problems arising from prematurity. Because of this, there is an increasing understanding of the need to address non-medical needs of the premature infant in hospital including the integral role of the family during this time. In a repeated-measures randomised control trial, this study sought to determine the effect of maternal presence on the premature infant’s physiological and behavioural response to recorded music and on infant status overall. Participants were 22 clinically stable premature infants (born at >28 weeks gestation and enrolled at >32 weeks gestation) and their mothers in the NICU. Both Experimental and Control groups were exposed to one session consisting of a baseline of 6 minutes of ambient noise, followed by two alternating 6 minute periods of music and no-music (total 30 minutes). The Experimental group infants had the mother present for the first twelve minutes (baseline and first music period) compared to the Control group without mother present at any time. The auditory stimulus was the NICU ambient noise, and the music stimulus was recorded lullaby music. Physiological monitoring included heart rate and oxygen saturation. The infant's behavioural state was classified using the Six Derived States of Behaviour classifications (Thoman, 1990). A Restricted Maximum Likelihood (REML) model was used to analyse the physiological and behavioural responses. There were no significant effects of maternal presence on physiological or behavioural outcome measures in either group over time. The Experimental group had consistently lower heart rate than the Control group. There was a significant difference in oxygen saturation (p< 0.05) between the Mother Present and Mother Absent periods in the Experimental group and infants responded to music with more Quiet Sleep and higher oxygen saturation in the presence of the mother. Findings from this study suggest that maternal presence had a positive effect on premature infant physiological and behavioural status during music and no music periods and a significant effect on oxygen saturation. This finding is worthy of more substantial investigation.
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ItemThe impact and effect of group music therapy on anxiety, depression, quality of life and coping with women with breast cancer: a mixed methods study( 2011)This mixed method study investigated the impact and effect of group music therapy on anxiety, depression, coping and quality of life, and the experience of music therapy for women with breast cancer. Four groups of women received 6 weekly music therapy sessions that incorporated various music therapy methods. Eighteen women at different stages of the disease trajectory took part in the study. A decision tree was developed to determine the most appropriate intervention to use each session. The pre and post program measures were the Depression Anxiety Stress Scale (DASS), the Coping Orientation to Problems Experienced Inventory (COPE), the European Organisation for Research and Treatment for Cancer Quality of Life Questionnaire (EORTC QLQ-C30) and the European Organisation for Research and Treatment for Cancer Quality of Life Questionnaire Breast Cancer Module (QLQ-B23 (breast cancer). Visual Analogue Scales (VAS) measured mood, anxiety, coping and quality of life, pre and post each session. Qualitative data was gathered through focus group interviews which were held post music therapy program. A statistically significant improvement was found on one item of the EORTC QLQ-B23 (breast cancer) inventory, but there were no other notable changes. There were trends on two items of the COPE inventory, but no other changes, and no detected changes on the DASS. Statistically significant improvement was found on all four items on the VAS across all four groups, indicating that the music therapy sessions had a significant impact during the course of the six week program. The themes emerging from the qualitative analysis evolved from discussions about the music therapy sessions, the group experience and living with breast cancer. These were: a) music was heard and appreciated differently, b) the sessions allowed reflection, c) playing the chord harp was a voyage of discovery, d) songwriting was meaningful, e) listening to songs, singing and song writing were very moving experiences, f) confusion over the questionnaires, g) experiencing challenging moments, h) not enough time in the sessions and there were too few people, i) sharing experiences, j) it was a special space, k) the feeling endured, l) appreciation of the music therapist, m) it was a discrete experience, n) wanting to join a choir, o) the need to discuss the effects of treatment, p) silence of breast cancer, q) the impact on others of the diagnosis, r) seeing the funny side, s) it was a dual process coping with many things, and t) travelling similar but different paths. Individual distilled essences were generated from the focus group data, depicting the women’s distinctive experiences. Group essences were also developed from the data, illustrating the different group experiences. This study is one of only a few to examine a group music therapy model for women with breast cancer. Even though the study was small the findings make an important contribution to the research literature on the effect of group music therapy for women living with breast cancer.
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ItemMusic therapy for a 10-year old child experiencing agitation during posttraumatic amnesia: an intrinsic mixed methods case study( 2010)A mixed methods case study was developed to explore the use of music therapy for children, aged 2-14 years, experiencing agitation during the posttraumatic amnesia phase of recovery following severe traumatic brain injury. The study developed pragmatically within a real world research context, and was undertaken in the Children’s Neuroscience Centre at The Royal Children’s Hospital Melbourne (Australia). The collection of qualitative data was embedded in a quantitative protocol, and data was collected concurrently. During the recruitment phase of the study, only one participant met the full eligibility criteria. The study subsequently evolved as an intrinsic case study. Data collection took place every day (excluding weekends) for the first ten days of posttraumatic amnesia. Data collection included the participant being video recorded pre, during, and post each daily music therapy intervention. The music therapy intervention involved the music therapist-researcher singing familiar songs. The aim of the quantitative data collection and analysis was to measure the effect of music therapy on agitation, and included two independent reviewers viewing the video data and rating the participant’s agitation pre, during, and post each music therapy intervention using the Agitated Behavior Scale (Corrigan, 1989). These ratings were then analysed statistically. The analysis of qualitative data aimed to explore the responses of both the participant and the music therapist-researcher during the music therapy interventions, and was an emergent process undertaken using Morse and Pooler’s (2002) tri-tiered method of analysis for videotaped data. The participant (a 10-year old girl) sustained an extremely severe traumatic brain injury as a result of a transport accident. Severe cognitive impairments and a significantly reduced level of consciousness resulted in the participant presenting with only Islands of Awareness during the music therapy interventions. Analysis of the quantitative data yielded inconclusive results as to the effect of music therapy in reducing agitation during and post each music therapy intervention. Micro-description and analysis of the qualitative data revealed that the participant displayed four distinct categories of behaviours during the music therapy interventions: Neutral, Acceptance, Recruitment and Rejection. The final three categories of participant behaviours were responses to the familiar songs. Further, the music therapist-researcher responded to the participant’s behaviours in four distinct, corresponding ways; Holding, Affirming, Enticing, and Containing. The interpretation of these categories of behaviours and responses was that through offering a consistent musical holding for the participant’s behaviours, and adaptation of the familiar songs in a contingent manner in response to the participant, the music therapist-researcher offered an Environment of Potential to maximise the participant’s Islands of Awareness. The Environment of Potential maximised early stimulation to optimise the participant’s early recovery of consciousness and cognitive abilities.
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ItemMethods used in cross-cultural music therapy in aged care in Australia( 2010)Aged care clients in Australia come from increasingly diverse cultural and linguistic backgrounds. Music therapists are being called upon to work with this changing population, an area in which both training and research are still developing, according to current literature. Music therapists have written about cross-cultural practice; yet most of these studies concern individual clients, not the group approach that is most commonly used in aged care. This study therefore addresses the shortage of research in these areas: 1) cross-cultural music therapy methods, 2) aged CALD clients and 3) group situations. The Australian Music Therapy Association (AMTA) was contacted to circulate an online questionnaire to 88 practising registered music therapists (RMTs) identified as working in aged care. A thirty-three percent response rate (30 respondents) was achieved. Data was gathered on frequently used methods (listening to music, singing and movement to music), music repertoire, genre and styles, and utilisation of cultural specific music idioms. The results suggest that cross-cultural music therapy practice in aged care is influenced by various factors, including personal experience and professional training, as well as the client’s background, abilities, level of acculturation and musical preference. Most respondents were confident in providing music therapy to CALD clients, who enjoyed an equal amount of service as non-CALD clients. However, a number of respondents expressed reservations about the level of preparedness for cross-cultural work provided by university training, preferring to emphasise the importance of personal (rather than professional) experience and interests. This study thus concludes with recommendations for training music therapists in future.