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.
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ItemMusical identities of young people recovering from mental illness( 2015)This thesis details a Participatory project investigating how and why promoting young people’s musical identities can facilitate their recovery from mental illness. Studies describe how young people use music listening for managing aspects of their mental health across community-based (McFerran & Saarikallio, 2014; Saarikallio & Erkkila, 2007) and mental health settings (Cheong-Clinch, 2013). Music therapy is also articulated as a way to facilitate processes of recovery from mental illness (McCaffrey, Edwards, & Fannon, 2011; Solli, Rolvsjord, & Borg, 2013). Despite growing awareness of the potential of music to support recovery from mental illness, little is known about what conditions actually facilitate growth of musical identity in ways that foster recovery processes. This project aimed to address this gap by investigating what is needed in order to promote young people’s musical identities in ways that facilitate their recovery from mental illness. The intention was to understand both the processes involved and the resources required to facilitate recovery. A Participatory orientation (Minkler & Wallerstein, 2008) was chosen to align with the recovery approach (Davidson, Row, Tandora, O'Connell, & Lawless, 2009; Slade, 2009b) of the youth mental health service where this study took place. The Participatory philosophy was also seen as appropriate to the social agenda of the study in seeking to address young people’s access to musical resources to promote their recovery. Eleven young people currently attending the music therapy program at the youth mental health service chose to participate across two emergent cycles of action and reflection. In the first cycle, young people participated in collaborative qualitative interviews exploring how their musical identities changed with experiences of mental illness and recovery. A critical interpretation of Constructivist Grounded Theory was used to gather and analyse the data. The finding from this cycle was a constructed grounded theory that detailed young people’s recovery of musical identity. A second cycle of research emerged from this theory, to explore what community-based resources are needed to further facilitate recovery. This cycle involved mapping young people’s musical needs compared to what was available and possible in the local community. Findings from this study were an identified set of musical needs of young people, and the initiation of the Youth Music Action Group to begin addressing the meeting of these needs through community partnerships and advocacy. Findings from this study indicate that promoting musical identity can facilitate young people’s recovery from mental illness by: contributing to a health-based identity, facilitating meaning-making, and supporting social participation. However, the findings indicate a number of conditions are necessary to facilitate these processes. First, the music therapy theory through which to construct these processes needs to accommodate both the pathology of young people’s expression of musical symptoms as well as acknowledgement of the resource of musical identity for recovery. Second, music therapy needs to be available to support young people’s recovery of musical identity during early stages. Third, community-based music resources need to be available and appropriate to young people immediately following their experience of music therapy. Fourth, modes of research need to expand in order to promote greater democratic participation of young people in ways that promote their equal citizenship. These findings contribute to music therapy and youth mental health knowledge, and can inform future service design.
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ItemCritical reflections on how research design and the attributes of a music program can affect investigations of the psychosocial wellbeing benefits of musical participation in mainstream schools( 2015)This project explores the challenges of investigating the psychosocial wellbeing benefits of musical participation in mainstream schools. For a decade, Australian policy literature has claimed these benefits are to be expected outcomes of all students’ participation in school music programs (Australian Government, 2005). Despite these claims, there is little to no consistent evidence supporting a link between musical participation and psychosocial wellbeing in this context (Grimmett, Rickard, Gill, & Murphy, 2010; Rickard, Bambrick, & Gill, 2012). The reason for this inconsistency has been linked to both the research designs and methods used (Knox Anderson & Rickard, 2007), as well as the nature of musical participation investigated (Darrow, Novak, Swedberg, Horton, & Rice, 2009). Despite the identification of these limitations, researchers have continued to use designs that contain them. This can be attributed to a lack of critical engagement with approaches to research in this field, including assumptions about the efficacy of certain research methods, and the capacity for generic school music programs to promote wellbeing. This lack of critical engagement appears to account for the enduring inconsistency of findings in this area. This thesis aims to address this lack of engagement by critically appraising the research approaches used in two small studies that aimed to demonstrate the psychosocial wellbeing benefits of school-based music programs. This was achieved by undertaking two critical reflection analyses on the methods, designs, and contexts of each study, as well as the attributes of the music programs investigated. The first of these identified a number of important research challenges related to the research methods and designs used. Among other things, these findings challenge the assumption that self-report surveys are a valid way of collecting data from students. The second analysis identified a number of music program attributes that are likely to inhibit the reporting of positive results. For example, findings suggest music education programs are unsuited to promoting psychosocial wellbeing. Based on these findings, this dissertation makes a number of recommendations for the design of future studies in this area. It is argued that research following these recommendations is crucial for this field. This is both to develop a richer understanding of the relationship between music in schools and psychosocial wellbeing, and to produce reliable evidence that is better placed to inform relevant policy. It is further argued that without such evidence, policymakers may continue to make uninformed claims regarding the link between music in schools and psychosocial wellbeing. In turn, this has the potential to destabilise policy support for music in Australian schools. Finally, this thesis calls on researchers in this field, and others, to critically engage with the way that knowledge is created. It is maintained that such engagement is the responsibility of all researchers in the social sciences, and that only when this occurs can we claim the knowledge we generate is meaningful, and serving the communities we investigate.
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ItemYou light up my life: a phenomenological study of interpersonal relationships between music therapists and adults with profound intellectual and multiple disabilities( 2014)This research is an investigation of the lived experiences of music therapists who have established meaningful interpersonal relationships with adult clients with Profound Intellectual and Multiple Disabilities (PIMD). Although music therapists in clinical practice observe the benefits of music therapy for this group of clients, there has only been four research studies conducted since 1990 (Agrotou, 1998; Lee & McFerran, 2012; Oldfield & Adams, 1995; Wigram, 1997). This presents a need to conduct an empirical research study that examines and understands the non-verbal interactions and meaningful interpersonal relationships between music therapists and their adult clients who have PIMD. This qualitative study was informed by phenomenology whereby five pairs of music therapists-clients were invited to participate. Each music therapist was interviewed and asked to describe his/her experience of building the interpersonal relationship with the client. The study also included a video recording of a single music therapy session of each pair. In the last part of the interview, the music therapist watched the video footage with the researcher and identified a meaningful moment. To analyse the interviews, a descriptive phenomenological microanalysis method (McFerran & Grocke, 2007) was used. The results of the interview analysis then informed a subsequent analysis of video footage. Interpretative Phenomenological Analysis (IPA) (Smith, Flowers, & Larkin, 2009) was used for video analysis, which further resulted in the development of a new video microanalysis method, Interpretative Phenomenological Video Analysis (IPVA). The interview analysis resulted in five distilled essences of individual experiences and a final global essence. The process of establishing interpersonal relationships with an adult with PIMD was described as requiring mutual efforts over time with the context impacting on the quality of relationship. The music therapist’s role in improving psychosocial wellbeing of the client was thought to be significant. The video analysis resulted in five thick descriptions of meaningful moments. A further interpretive analysis was conducted to discover the implicit meanings of each moment to the music therapist, the client, and the pair as were seen and perceived by their music therapists. The classification of meaningful moments suggested by Amir (1992) were utilised for this process. The results indicate that three clients experienced moments of joy and ecstasy, and two clients experienced moments of completion and accomplishment. Three music therapists experienced moments of completion and accomplishment, and two music therapists experienced moments of surprise. On the interpersonal levels, three pairs experienced moments of physical closeness, and two pairs experienced moments of musical intimacy. The findings of the current study provide a fresh perspective about the processes of music therapy with adults with PIMD. The types of moments identified also provide insights into the meaningful moments that lead to psychosocial wellbeing in a long term. Moreover, the current study incorporates descriptions of contemporary practice, that challenge some of the assumptions associated with more conventional approaches to practice with adults with PIMD. Based on these findings, the future direction of music therapy with adults with PIMD is discussed. Improving work conditions of music therapists working in community settings is highlighted as important, and Community Music Therapy is proposed as one approach that might actualise the true meaning of social inclusion and meaningful participation in community for adults with PIMD.
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ItemMusic therapy performances with pre-adolescent children and families living in crisis: an interpretative phenomenological analysis( 2014)Living in crisis due to homelessness and family violence is associated with feelings of fear, chaos and uncertainty, yet little is known about how music therapy may assist children and families at this immensely challenging time of their lives. The development of community music therapy as a theoretical framework has drawn attention to the potential value of including performance in community programs. However, the majority of research focusses on adult and adolescent populations, rather than children. Considering family members and supportive networks are likely to be audience members at children’s performances, the inclusion of performance in music therapy with children presents different challenges as well as opportunities. This qualitative project explored the experience and meaning of a music therapy performance for pre-adolescent children and their families living in crisis due to homelessness and family violence. Three children aged 11 and 12 participated in a 14-week music therapy group that culminated in the sharing of a musical performance with their families. After the performance, semi-structured interviews were conducted with the children who participated in the performance, as well as their parents. This project sought to understand the phenomenon of the performance itself, rather than the process leading up to it. The performance was a multifaceted experience for the children and their families. An interpretative phenomenological analysis (Smith, Flowers and Larkin, 2009) uncovered some of the positive and negative aspects of the performance, and these were explored in detail at an individual and family level. A cross case analysis explored some of the similarities and differences in participants’ experiences and identified three recurrent themes: the children experienced intense, but mixed emotions; the performance connected the children to their family and peers; and the audience played an active role in the performance. Adopting flow as a theoretical lens provided a possible explanation for the children’s internal and external responses that contributed to their experience of the performance. At an internal level, the children described intense emotions that were similar to flow experiences. At an external level, the children’s parents and the entire audience played an integral role in supporting the children and provided some of the conditions for flow to occur. The findings from this project may help music therapists to understand the potential therapeutic outcomes for the inclusion of performance with children and families living in crisis. However, further research focussing on the ways that music therapists and families might support children’s complex needs throughout the performance experience is required.
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ItemThe effect and experience of therapeutic songwriting on adult cancer patients’ quality of life, mood, distress levels and satisfaction with hospital stay( 2014)This mixed methods multi-site waitlisted randomized controlled trial addressed the overarching research question ‘What is the effect of a specific music therapy songwriting protocol, Guided Original Lyrics and Music (GOLM) on adult cancer patients’ quality of life, mood, distress levels and satisfaction with hospital stay; and how is songwriting experienced?’ This study was conducted at two sites and was open to all adult cancer patients being treated as inpatients or outpatients at both sites. The protocol was for three sessions completed over a maximum of 2 weeks. The control condition of ‘Befriending’ was a standardized talking and support protocol chosen to control for the therapist’s presence and attention. There were 50 participants in this study. An embedded mixed methods design was used in which the qualitative data was embedded within the quantitative data of this study (n=50). Nine participants were interviewed about their experience of songwriting using GOLM. Participants in the therapeutic songwriting group showed significantly higher ratings on quality of life (QOL) (p=0.019) and physical wellbeing (p=0.037) than participants in the waitlist control. There were no significant differences on physical symptoms (p=0.73), psychological wellbeing (p=0.87), existential wellbeing (p=0.15) or the total calculated score for the QOL (p=0.22), although the effect size calculations indicated there was a medium clinical effect. Participants in the therapeutic songwriting group demonstrated a significant reduction in overall Total Mood Disturbance (p =0.027) and significant decreases in tension (p=0.008), depression (p=0.38), and confusion (p=0.017) compared to the waitlist control. There were no significant differences in ratings of anger (p=0.21), vigor (p= 0.40) and fatigue (p= 0.10) however the effect size of 0.49 demonstrated a medium clinical effect in reduction of fatigue. Participants in the therapeutic songwriting group rated their mood significantly higher from baseline to immediately after writing the song (p=0.003) and overall (p<0.0005), than participants in the waitlist control. These findings were supported by the large effect size of 1.37. There was however no significant increase in mood post session 2 to post session 3 (p=0.54). There were no significant differences in distress between the participants in the therapeutic songwriting group when compared to the waitlist control (p=0.083), however there was a medium effect size. There was no significant difference in the means of the hospital satisfaction rating between groups. Overall no significant results were sustained at 2-week follow up. Nine participants’ experience of songwriting was explored in qualitative interviews, and 15 composite themes emerged concluding with the final global essence of the ‘lived experience’. The lived experience of writing an original song in music therapy using the therapeutic songwriting method GOLM was “a dynamic process across an emotional continuum, with challenging aspects of trepidation and excitement, and consequent rewards of feelings of pride and happiness.” Embedding the results in the mixed methodology framework enabled a deeper understanding of the phenomena and its impact on adult cancer patients’ quality of life, mood, and distress levels.
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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.