Melbourne Conservatorium of Music - Theses
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ItemMusical Care: Exploring a person-centered caregiver singing protocol in dementia care in South Africa( 2023-10)This thesis includes three studies which aimed to explore the role of a formal caregiver-led singing training protocol in the delivery of person-centered care for people living with dementia, and how this might support caregivers in South Africa. A systematic mixed studies review was conducted to examine literature relating to formal caregiver training in live music for use in one-on-one caring contexts. Nine English, peer-reviewed studies adhered to the inclusion criteria. Integration of thematic analysis and narrative synthesis findings indicated that training caregivers in live music applied during care situations may contribute to significant reductions in dementia symptoms, resistiveness, and elicit mutual experiences of wellbeing and relationship between formal caregivers and residents. This benefitted person-centered care by supporting communication, easing care, and capacitating caregivers to meet the needs of people with dementia. Findings encouraged caregiver training but illustrated gaps in training component details and the lack of music therapists’ involvement. The action research qualitative study aimed to co-design and refine a person-centered caregiver singing (PCCS) protocol. PCCS is defined as singing in a manner that employs various prosodic and empathic musical elements to aid communication and promote feelings of connection, safety, validation and that aims to enhance the delivery of person-centered care. Ten caregivers from two care homes participated in four iterative cycles of: ‘workshop, interview, and amendment;’ an observation phase; and one-on-one interviews. This process culminated in the final version of the PCCS workshop. Thematic analysis findings suggested that PCCS was a helpful, relevant and easy-to-implement resource for caregivers. The Person-Centered Caregiver Singing Model illustrated the interplay between benefits to caregiver capabilities (including self-efficacy); mutual wellbeing; relational mutuality and reciprocity; the environment; and positive caregiving experience. PCCS implementation was not always successful due to residents’ unpredictable moods and caregivers’ perception of their own music skills. The sharing of music therapy-informed skills contribute to the caregivers’ safe and effective application of attuned singing, which may help them better attune to and meet residents’ needs. The third study was a mixed methods study exploring caregivers’ experiences and acceptability of the PCCS protocol. Forty-one formal caregivers from seven care homes attended one PCCS workshop and completed a questionnaire containing a Likert scale and space for written reflections. Findings were integrated inductively using seven components of acceptability. These illustrated the caregivers’ positive caregiving experiences and enhanced capabilities, improvements in residents’ observed wellbeing, empathic connections, and extension of PCCS benefits beyond the one-one-one care situation. Implementation challenges included limited song repertoire and residents’ unpredictability. Nonetheless, PCCS was considered useful, effective, and highly acceptable. Overarching findings suggest that person-centered caregiver singing is a helpful, relevant, highly acceptable resource that may contribute to caregivers’ delivery of person-centered care. PCCS may promote positive aspects of caregiving and highlights the value of caregivers’ own personhood as essential to quality care provision. Findings affirm the significance of inter-disciplinary skills-sharing by music therapists and support the application of PCCS within care homes in South Africa and similar contexts. Recommendations include booster workshops to support appropriate and sustainable application and the inclusion of family members and other staff in PCCS training. Further research could offer insight into cost-effectiveness of PCCS, test PCCS in similar and other contexts, further develop the PCCS questionnaire, and explore outcomes relating to caregiver self-efficacy and PCCS with family caregivers.
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Item“With music, you feel it more”: A narrative inquiry into an online music therapy project for adults living with mental health challenges related to adverse life experiences( 2023-09)This thesis sought to explore the experiences of adults living with mental health challenges related to adverse life experiences who participated in an online community music therapy program. Previous research into music therapy and psychological trauma in adults has largely focussed on the perspectives of music therapists (Landis-Shack et al., 2017; Stewart, 2010; Sutton, 2002). This project takes an up an expanded definition of trauma that privileges participant self-identification over trauma-based diagnoses to attend to the lived perspectives of participants. Three interconnected studies, two qualitative meta-syntheses and a narrative inquiry project, comprise the thesis. The first study presents a critical interpretive synthesis, exploring recently published music therapy literature looking at music therapy and mental health challenges related to psychological trauma in adults. This study primarily highlighted the underrepresentation of participant perspectives in the literature, and the privileging of clinical discourses of trauma. The second literature synthesis further explored the presence of participant voice in extant music therapy literature related to adult mental health and trauma through a qualitative ethnographic meta-synthesis. Its findings illuminated a number of strengths-based recovery outcomes congruent with previous research into participant perspectives of recovery-oriented music therapy in mental health (McCaffrey, 2018; Solli et al., 2013; Solli & Rolvsjord, 2015), as well as some experiences more specific to the context of trauma-related mental health challenges. The third study yielded the central findings of the thesis. This study was a narrative inquiry into the experiences of participants in an online community music therapy project for adults who identify as living with mental health challenges related to adverse life experiences. Five adults were recruited via community and community mental health channels across Naarm/ Melbourne. An online group was co-facilitated with a mental health peer worker for five sessions, after which the format of the project altered in response to feedback and participation decisions from participants. After a seven-week group process, three participants chose to continue with individual music therapy sessions within the data collection period. Narrative inquiry (Connelly & Clandinin, 1990; Kim, 2015), a methodology centred around narrating stories of experience, was chosen to pursue the data analysis and presentation of findings. Five narratives are thus presented as the results of the thesis in Chapter Six. An additional dialogical narrative reflecting on the experience of co-facilitation between the mental health peer worker and myself, is presented in Chapter Five. The presentation of individual narratives is interspersed with theoretical discussion in Chapter Six, and further exploration of resonant, or shared threads of narrative experience in the second discussion chapter, Chapter Seven. Practice implications are then discussed, exploring differentiated music-centred experiences, considering the need for different levels of engagement, and developing approaches towards collaborative approaches to working alongside with people with lived experience. I then explore the alignment of narrative therapy approaches with anti-oppressive theoretical approaches that may bring a critical lens to exploring adverse experiences. I finish with a model expanding the notion of a musical asylum (DeNora, 2016) toward an assemblage of interconnected musical opportunities within a musical recovery community.
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ItemExploring How Music Therapists Describe Constructing Safety with Young People with Adverse or Traumatic Experiences( 2023-05)Abstract This thesis is an investigation of safety and music therapy in the context of trauma. Herman (2015) describes safety as one of the critical and foremost elements in trauma care. However, there exists little research exploring the importance of safety and inspecting the role of music and music therapy in assisting the creation of safety, as evidenced from the results of the Critical Interpretive Synthesis (CIS). It highlights the need for empirical research into strategies that music therapists engage to create safety. The present qualitative study engaged hermeneutic phenomenology to reveal insights from eighteen experienced music therapists from eleven countries volunteering to participate in the project. Each of the participants have had between 7 and 35 years of experience working with diverse scenarios within the field of trauma. Online zoom interviews were conducted to capture participants' perspectives on safety and their experiences of providing safety in their programs. An Interpretative Phenomenological Analysis (IPA) (Smith et al., 2009) was used to process the interview transcriptions. Participants shared their detailed and insightful knowledge into music therapy and creating safety, which resulted in identifying five emergent themes: safety space, semi-structured program, gentle and respectful facilitation strategies, regular supervision and self-care, and methods used in the program. Safety seems to be a concept that promotes containment and connection through offering control and choice making, negotiation and communication, and providing opportunities for self-expression and self-exploration. Incorporating these findings with relevant literature, I have constructed the concept of a music therapy container, to help music therapists working with traumatised young people to understand how to provide safety in the program. The container includes the five refined components: a safe room; familiarity and predictability; choice-making and control; the therapist's personal qualities; and musical affordances. Each of the components contribute to the creation of physical, environmental, and psychological safety in the program. Importantly, music therapy facilitated with caution affords a space without judgement, a sense of equality and safety for individual expression even within such a complex and unpredictable context. Without forcing individuals, nor focusing only on trauma, the creation of safety in music therapy sessions seems to afford young trauma survivors and therapists alike a container for being and responding. The participants shared similar views on a few crucial elements that promote this connection: being flexible, going with the flow, and taking a client-centred approach. The flexibility that the participants provide creates room for self-exploration and feelings of safety by the individuals. Music therapy can offer a space of respite, relaxation and security, coupled with experiences that may enable individuals to have a broader container for their trauma and assist in self-regulation. Therefore, gaining fundamental tools to assist the therapists connect and engage with individuals can increase the feeling of calmness and perhaps feeling more stable and safer in the program and beyond.
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ItemExploring the rehabilitative potential of familiar song for paediatric patients presenting with an acute disorder of consciousness( 2023)This thesis includes four studies that contribute to the exploration of the rehabilitative potential of familiar song for children presenting with an acute disorder of consciousness (DoC) following severe acquired brain injury (ABI). A DoC is common sequelae of severe ABI in children, and is the result of a sudden interruption in the complex interplay of arousal and awareness. While evidence supporting the use of music in the assessment and treatment of adults presenting with a DoC continues to emerge, the unique developmental context of paediatric ABI necessitates child specific research. Four discrete studies are included in thesis and contribute to the research agenda of describing the behavioural and neural responses to familiar song of children presenting with an acute DoC. The systematic review ‘The Neurophysiological Processing of Music in Children: A Systematic Review with Narrative Synthesis and Considerations for Clinical Practice in Music Therapy’ included 46 neuroimaging studies describing music processing in neurotypical children aged 0-18 years. The narrative synthesis yielded a timeline of significant developments of musical processing. Further, comprehensive considerations for clinical practice for music therapists working with paediatric neurologic population were developed. The results of the systematic review provide a theoretical foundation for the use of familiar song to support consciousness recovery in children presenting with a DoC. When developing the study to empirically describe the neural and behavioural responses to familiar song of children presenting with an acute DoC, it was necessary to first develop a tool to objectively describe behavioural responses. The Music Interventions in Paediatric DoC Behaviour Observation Record (MBR) was developed and piloted. Results of the pilot established that the MBR has content validity, and sufficient inter-rater-reliability to objectively capture the subtle and idiosyncratic responses of children presenting with a DoC during a music therapy intervention. Subsequent to the completion of the pilot, the MBR was utilised in the collection of behavioural data in the case study of a child presenting with an acute DoC The use of EEG in music therapy research with children presenting with a DoC affords the opportunity to describe responses even in the absence of an observable behaviour. To pilot the use of EEG with children, a feasibility study (n = 4) was undertaken using data pragmatically collected within the acute hospital setting. Unique changes in the underlying frequency components of the EEG were recorded during the song condition that were not observed in either the comparative speech or noise conditions. The study showed feasibility of a uniquely hypothesis driven method of multivariate EEG analysis, and added to the current knowledge base by describing the EEG signal in response to whole song as an ecologically valid music stimulus. The piloting of the MBR and multivariate method of EEG analysis ultimately supported the development of multiple baseline crossover case study, of an 11-year old presenting with an acute DoC, in which the behavioural and neural responses to song were described. For this child, familiar song was found to stimulate a greater behavioural and neural response, indicative of an increase in arousal and awareness, than comparative speech or noise conditions. This study provides foundational evidence supporting the use of familiar song to increase consciousness in children presenting with an acute DoC following severe ABI
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ItemMusic for Classroom Wellbeing Professional Learning: The Exploration of a Music Therapist Teacher Support Program( 2020)This emergent qualitative research project explored new music therapy practices for supporting teachers in the current neoliberal education climate. For over twenty years, authors have described diverse school-based music therapist teacher support programs in which the practising music therapist has intended to support teachers (Rickson, 2010b). However, it has also been acknowledged that teachers have found it difficult to sustain practices and benefits from such programs after the music therapist has left the school setting (McFerran, Crooke, & Bolger, 2017; McFerran, Thompson, & Bolger, 2015; Rickson & Twyford, 2011). A Critical Interpretive Synthesis of forty publications pertaining to music therapist teacher support programs allowed the identification of a lack of focus on the needs and resources of teachers in the music therapy teacher support programs described. This thesis attempts to address this realisation through the exploration of alternative practices of music therapist teacher support that maximise the possibility that teachers sustain benefits and practices long after the program has ceased. Within this project, ethnographically informed research methods were used to develop understandings of the practice of supporting six participating teachers. A need for supporting teachers to strengthen classroom wellbeing was identified. Teachers then engaged in a music therapist led program named “Music for Classroom Wellbeing Professional Learning”. Findings revealed that through focusing directly on teachers, teacher participants were supported to enrich their musicality, develop their use of teaching practices, and foster self-care. Teachers’ growth in these three interconnected domains appeared to allow them to strengthen the wellbeing of all members of the classroom. Furthermore, teachers were enabled to engage in practices that countered the performative pressures of the current neoliberal school context. Through positioning as an enabler of sharing, the music therapist encouraged teachers to share music, knowledge and aspects of their personal self within and beyond the school setting in a manner that continued after the program had ceased. Based on these findings, this thesis concludes with a series of provocations to music therapists considering future music therapist professional and caregiver support programs across contexts. Music therapists are encouraged to consider the ways in which they may similarly position as an enabler of sharing and support professionals and caregivers in other settings. Enacting the shifts in practice described within this thesis has the potential for supporting others to use music to transform the lives of themselves and the people they are caring for without a music therapist present.
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ItemCollaborative songwriting with children experiencing homelessness and family violence to understand their resources( 2018)This thesis uses a range of creative and inductive scholarly approaches to highlight the creative resources that children bring to research, as well as the range of resources that they draw upon in the face of adversity. Children’s voices are central to this research and their contributions will be used to inform future music therapy practice, the homelessness and family violence system, and child welfare research. The majority of the literature about children experiencing homelessness and family violence focuses on reporting the perceived ‘problems’ and ‘challenges’ faced by children, with little acknowledgement of children’s personal resources and capacities in times of crisis (Fairchild, McFerran & Thompson, 2017). As a result, children are represented through the lens of risk which in turn impacts the ways that they are viewed, understood and responded to by professionals, researchers and the service system. Drawing upon participatory, resource-oriented and arts-based approaches, this research seeks to balance the representation of children in this context by exploring their resources and what helps them to ‘do well’ throughout their experiences of homelessness and family violence. Songwriting was used as a collaborative research method to co-construct knowledge with children through group and individual interviews. The children were engaged as co-researchers in generating and interpreting the data, and in representing the results. The group interviews focused on what music means to children in this context and through group songwriting the children identified that music offers an escape from the outside world and provides hope that the future will be better. The individual songwriting interviews were used to expand the breadth of this examination of resources and the children described a range of supports, such as friends, family, sport, pets, journaling, hope and creativity. Six identified themes explore the role that these resources play in children’s lives: seeking refuge, wanting to feel safe, hoping for a better future, feeling cared for, being self determined, and protecting self and others. In order to reflect further on the results of the collaborative song writing projects, two additional reflexive projects sought to provide further depth and integration of knowledge. The first was a collaborative article written with an 11-year-old child (‘Malakai Mraz’) who believed that learning to play the drums in music therapy changed his life. The process of writing the article provided an avenue for reflecting upon our experiences of engaging in music therapy together. In the final reflexive project I used songwriting as an arts-based method to explore my own experience of being involved in this research. I used concepts of vicarious trauma and vicarious resilience to discuss how arts-based approaches might also support other researchers to process their own experiences of becoming immersed in deeply personal research data.
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ItemMusical recovery: the role of group singing in regaining healthy relationships with music to promote mental health recovery( 2016)This thesis describes an emergent project which investigates the role of group singing in inpatient and community mental health settings. Music therapy has previously been identified as a way to foster processes of mental health recovery (Hense, McFerran & McGorry, 2014; McCaffrey, Edwards, & Fannon, 2011; Solli, Rolvsjord, & Borg, 2013). However, little is known about the specific factors apparent in group singing which promote recovery. This project aimed to address this gap by exploring the role of group singing in promoting recovery through a small mixed methods study and a larger grounded theory study. Adults aged between 18 and 72 years who were in mental health recovery participated in this research and were recruited from a number of different inpatient and community contexts around Melbourne. Key principles of recovery-oriented philosophy (Slade, 2009) and resource-oriented music therapy (Rolvsjord, 2010) were adopted. An initial mixed methods study was conducted which aimed to both explore experiences of group singing and measure outcomes of belonging before, during and after a 10 week community group singing program (Bibb, Baker, Tamplin & McFerran, under review). The qualitative analysis revealed that being with others, being heard, having a sense of purpose, achieving something and group size and setting contributed to participants experiences of the group. However, little could be concluded from the quantitative data, since for individual reasons, each of the four participants reported difficulty completing the measures. This led to a change in focus of the study to include an additional interview question asking participants to specifically reflect on their experience of completing the self-report outcome measures (Bibb & McFerran, under review). In addition, a need to critically examine the measures used in mental health research and the assumptions surrounding their ‘reliability’ was identified. A method of Critical Interpretive Synthesis was used to interrogate the most commonly used self-report outcome measures in mental health research in the last ten years (Bibb, Baker & McFerran, 2016). The results of the critical synthesis indicated that many of the measures most commonly used in mental health research do not align with the contemporary recovery-oriented philosophy of mental health care. The second study of this thesis adopted a grounded theory approach to explore the conditional and contextual factors involved in group singing. Collaborative interviews allowed for the participant and the interviewer to be active in making meaning of the participant’s experience (Holstein & Gubrium, 1995). The findings of this study, after 29 interviews, impelled the development of a new term, ‘musical recovery’ which depicts a process of regaining healthy relationships with music to promote mental health recovery. A number of factors are identified as promoting and interfering with musical recovery within a group singing context. The musical recovery framework illustrates how music therapy practice can be a process of recovery in itself.