Melbourne Conservatorium of Music - Theses
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ItemNo Preview AvailableAccessible therapeutic music-making for stroke survivors with significant arm and hand weakness: A mixed-methods study( 2022)This thesis with publication presents the results of the mixed methods study exploring a novel music therapy intervention for stroke survivors with significant weakness to their arm and hand. Using a mixed methods experimental design, with an explanatory sequential core, this randomised controlled trial sought to examine the holistic impact of a 4-week intervention protocol using functional electrical stimulation (FES) together with an iPad-based instrument (ThumbJam) on stroke survivors’ upper limb function and wellbeing outcomes. Recognising the need for more accessible approaches to music-making with this subset of stroke survivors, the intervention protocol was developed using collaborative processes drawing on knowledge from the disciplines of physiotherapy, occupational therapy and music therapy. After securing ethics clearances, recruitment commenced across five hospitals in Sydney, Australia, aiming to recruit a target sample of 40. Fourteen participants were recruited and randomised to receive usual treatment (n=8) or the daily FES+iPad-based music therapy intervention as an addition to usual treatment (n=6) for four weeks (20 sessions). Masked assessors administered the standardised measures of upper limb function and self-report wellbeing questionnaires at three time points (pre- and post- the intervention period, and at three months follow up). All participants were also interviewed at the post-intervention period regarding their perception of how their received treatment supported their overall recovery. The Motor Assessment Scale (MAS-UL) was the primary outcome for arm/hand function. The other measures of arm/hand function included the Manual Muscle Test (MMT-UL), 9-hole-peg test (9HPT) and grip dynamometry. The Depression Anxiety and Stress Scale (DASS-21), and the Stroke Self-efficacy Questionnaire (SSEQ) were used to measure wellbeing. As this study was underpowered, mean change scores, confidence intervals and effect sizes (Hedges’ g) were calculated and reported. The intervention group showed greater improvements than control on all upper limb measures, with between group differences on the MAS-UL change score of 2.08 (95% CI -2.08, 6.96; g = 0.5), 0.05 for the 9HPT (95% CI -0.13, 0.23; g = 0.32), 3.33 for the MMT-UL (95% CI -1.26, 7.93; g = 0.85), and 3.68 for grip dynamometer (95% CI -0.70, 8.07; g = 0.99). The intervention group also showed greater decreases in anxiety (between group difference: -1.83; 95% CI -7.63, 3.97; g = 0.37), but lesser reductions in depression (2.25; 95% CI -7.71, 12.21, g = 0.27). There were no notable differences between groups for stress and self-efficacy. Reflexive thematic analysis of the qualitative interview data revealed different reflections about the treatment received by each group, with intervention participant themes focusing on their perceived improvement in upper limb function and strength, as well as the motivating and relaxing aspects of musical engagement. These integrated findings suggest that FES+iPad-based music therapy has the potential to simultaneously improve post-stroke upper limb function and wellbeing. Therefore, this pilot study supports the need for future research that is adequately powered for efficacy testing.
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ItemBeyond barriers: Creating a space for deeper connection between individuals from diverse religious traditions through a dialogic group music therapy process( 2021)This project has emerged in response to a community need to create further platforms for interfaith dialogue in Bendigo, a regional city in Victoria, Australia. Community tensions about a new mosque highlighted a need to build stronger relationships amongst the interfaith and wider community. These tensions were at odds with my experiences of creating musical spaces for the expression and exploration of diverse spiritual and religious identity as a music therapist at the local hospital. In these spaces, listening and respect mattered. My close proximity to people with diverse religious perspectives helped me to be more aware of diverse others in the community and of the current tensions. I wanted to see how music could help. An ethnographic approach captured the journey from the institutional context out into the community to engage in a community-based research project, a collaboration with the interfaith community in Bendigo. A cyclic, emergent action research process evolved into a series of focus groups where individual lived experiences of religion and religious rituals were shared, using music as a focus and a support for communication. Eleven collaborators from six different religious traditions in Bendigo came together to take part in a dialogic group music therapy process – musical presentation (Amir, 2012). This process offers a model for listening and engaging in a group. From this process, music playlists, drawings, focus group dialogue and phone interview feedback were generated. This material revealed the strong sense of connection that collaborators felt with others in the group and their enjoyment of coming together to share diverse faith identities in this creative space. The process also highlighted that the vulnerability and challenges that come from engaging in creative processes were valuable and brought new perspectives and growth. The vitality of music as a mode of communication, through which identity, feelings, memory and culture can be explored was highlighted. Collaborators commented on the depth of the experience and the connection to others within a short space of time. Despite the different associations collaborators each had with music, they saw it as helpful in communicating religious identity. Music supported the group to remove some of the usual barriers that existed between them in this new creative space. One of the key statements developed through collaborator feedback was that “This process has the potential to increase understanding, knowledge, and connection in our community”. The project highlights the importance of creating spaces for the exploration and sharing of diverse religious identity. Possibilities for music therapists as advocates, negotiators and community-builders in these kinds of processes are also raised. Engaging in a dialogic group music process highlighted a form of ‘attunement’ between collaborators that related to musical concepts and processes. Music’s capacity to re-conceptualise broader processes and relationships was also highlighted through connecting this project to the concept of ‘community as a harmonic landscape’, as a way of sharing the project with the wider community. Collaborators felt that the process they experienced could act as a ‘stepping stone’ into further creative community action.
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ItemMusico-relational competencies: Examining the convergence of musical and relational competencies in improvisational group music therapy for people with borderline personality disorder( 2020)This thesis details an emergent, qualitative study on music therapy process resulting in the new concept of musico-relational competence. The project began with an exploration of music processes in the context of outpatient adult psychiatry. Seven participants, a cofacilitator and a music therapist (also the researcher) took part in an improvisationally based group music therapy program over eight weeks. All sessions were recorded on video and analysed to explore how music process influenced therapeutic process. The emergent design allowed for discovery and adjustments along the way. This led to taking an ethnographic and ethnomusicological approach to the analysis of the video data (including music analysis), focusing on the meaning making process of participants in the study. There are a few studies suggesting that music therapy is of benefit to people who experience Borderline Personality Disorder (BPD) (Hannibal, 2014; Plitt, 2014; Schmidt, 2002; Strehlow & Lindner, 2015), yet very little written on music process, or music therapy with groups of people who live with BPD. Therefore, this study utilised an emergent methodology with the aim of beginning to understand music therapy processes in this context. Findings from this study are presented as five perspectives on musical competence orientation. They include Musical Structure, Musical Language Competencies, Musical Interaction Competencies, Knowledge and Experience of Group Improvisation, and Changes in Feeling States that Accompany Improvisation. A new theory on competency orientation was developed to explain the phenomena examined in this study complemented by the existing theories of group process (Tuckman, 1965; Yalom, 2005), alliance rupture and repair (Safran, Crocker, McMain, & Murray, 1990; Safran & Kraus, 2014) and implicit relational knowing (Bruschweiler-Stern et al., 2010; Trondalen, 2016). The main finding that emerged from the analysis were the musico-relational competency orientation of participants and the influence of this orientation on relational cycles in group improvisation. The relational cycle in improvisational music therapy is enacted via musical connection, disconnection and reconnection as experienced in musical ‘limbo’ periods. Over time, via repeated experience and changing competency orientation, negative emotionality experienced by participants decreased, contributing to therapeutic process in sessions. The main therapeutic process enacted was tolerating the dynamics of implicit relational knowing during group improvisation. The implications of this finding are relevant to music therapists practicing group music therapy in adult psychiatry, and potentially in other contexts. The importance of the musico-relational competency orientation, in addition to working with limbo phases of improvisation can influence program design, evaluation and interpretation of music therapy process. With further investigation of this phenomena, I hope that group methodologies utilising these principles will become more widely practiced in music therapy.