Melbourne Conservatorium of Music - Theses

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    An exploration of people with dementia and their family care partners’ experiences of shared home-based music
    McMahon, Katherine Jean Meredith ( 2023-06)
    This dissertation describes an emergent project exploring how people living with dementia and their family care partners experience shared musical activities. With an increasing number of people with dementia residing in the community, family members play a key role in providing support for daily living as family care partners. There is, therefore, a recognised need to support the wellbeing of both people living with dementia and their family care partners. Music interventions uniquely support mood, memory and communication for people with dementia. However, little is known about how sharing music might support people with dementia and their family care partners as dyads. This thesis sought to address this gap through two qualitative studies: a thematic synthesis of the literature and a hermeneutic phenomenological study. This research was situated within a larger study examining a 12-week home-based music intervention (HOMESIDE), where I played dual roles as a researcher and music therapist. The thematic synthesis was conducted first to inform later stages of the research. My thematic synthesis explored how dyads experience shared musical activities across a range of contexts, including community settings, residential aged care, and the home. An analysis of 13 qualitative studies found that shared musical activities supported the individual and collective wellbeing of dyads through fostering connection. The findings informed the development of the Contextual Connection Model of Health Musicking for People Living with Dementia and Their Family Care Partners. This model captured the relationship between dyads’ contexts, their experiences of sharing music, and their wellbeing. In my second study, I conducted a hermeneutic phenomenological exploration of the shared musical experiences of six dyads participating in HOMESIDE. I recruited dyads I had worked with as a music therapist to utilise the rapport we had developed. Data was collected through music-based interviews to capture dyads’ musical and non-verbal experiences in the moment. Additional data was collected from the HOMESIDE study including dyads’ intervention diaries and semi-structured interviews. To explore and build on the Contextual Connection Model, this data was analysed using an abductive and relational-centred approach to hermeneutic phenomenological analysis. Through this analysis, I developed fifteen themes to capture dyads’ experiences of shared home-based musicking. These fifteen themes were organised into three global themes: 1) Experiences were shaped by complex influences; 2) A connected musical ecosystem; and 3) Music was a resource for wellbeing. These findings added depth, nuance and novelty to the Contextual Connection Model, leading to the development of the Revised Contextual Connection Model of Musicking for People Living with Dementia and Their Family Care Partners. This revised model conceptualises dyads’ experiences of musicking as cyclical and ecological, with nuanced outcomes including supported wellbeing, changed relationships to music, and challenging experiences. This study also provided insights into dyads’ process of learning to use music as a resource. This thesis provides theoretical and practical insights into dyads’ experiences of sharing music in the home and broader contexts. My research highlights the complexity of dyads’ shared musical experiences, and the central role of connection through musicking in supporting their wellbeing. It also locates the unique role of music therapy within the evolving landscape of music in dementia care. These understandings may support future development and refinement of therapeutic music interventions for dyads.
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    Accessible therapeutic music-making for stroke survivors with significant arm and hand weakness: A mixed-methods study
    Silveira, Tanya Marie ( 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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    Beyond barriers: Creating a space for deeper connection between individuals from diverse religious traditions through a dialogic group music therapy process
    Notarangelo, Astrid Danielle ( 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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    Musico-relational competencies: Examining the convergence of musical and relational competencies in improvisational group music therapy for people with borderline personality disorder
    Kenner, Jason Ronald ( 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.
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    How does a critical analysis of the literature inform recommendations for writing about mindfulness in music therapy practice?
    Tanhane, Anja Franziska ( 2019)
    Mindfulness Based Therapies have become widespread in clinical work, but so far the literature on integrating mindfulness into music therapy has been limited. The thesis presents the results of a critical interpretive synthesis (CIS) investigating the use of mindfulness in music therapy. The CIS of eight published articles examines how music therapists describe the use of mindfulness in their clinical work. A critical examination of the literature presented in the CIS finds that the use of mindfulness is described under the categories of mindfulness-based, Buddhist-influenced, or mindfulness, and discusses some of the difficulties in describing music therapy processes in this way. Based on the findings from the CIS, and drawing on research from the mindfulness literature as well as my experience as a mindfulness teacher, practising Buddhist, and registered music therapist, the thesis then offers recommendations for music therapists who are interested in using mindfulness-influenced practices in their clinical work and research. The word ‘mindfulness’ has become widespread, and can describe almost anything from relaxation to in-depth therapeutic work to the path to spiritual enlightenment. This broad use of the term can lead to a lack of clarity in how the use of mindfulness is described. The thesis will explore the use of language, including the challenges of adapting concepts from other cultures and belief systems. Research into the adverse effects of meditation is discussed, and the thesis argues that due to these possible harmful effects, music therapists using mindfulness in their work might consider additional training, ensuring they understand the theoretical basis, the benefits and the contra-indications of mindfulness-based therapies. There are also indications in the current literature on mindfulness and music therapy that music therapy processes can at times cultivate mindful states in both therapist and client. This could be an exciting area for further research, potentially leading to the development of a new theoretical model of mindfulness arising from within the creative processes of music therapy.
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    Music therapy as an anti-oppressive practice: critically exploring gender and power with young people in school
    Scrine, Elly ( 2018)
    This project sought to locate music therapy within broader health, research, and education contexts, as a participatory and anti-oppressive practice for young people in school to explore issues related to gender and power. In parallel, the research aimed to expand music therapy as an anti-oppressive practice (Baines, 2013), specifically focusing on deepening music therapists’ understanding of critical issues related to gender, power, and young people in education settings. Predicated on the notion that schools can be both sites of violence, and microcosms for change-making, the project occurred during a time of significant shifts across education settings worldwide to respond to endemic gender-based violence (Chandra-Mouli et al., 2017). Meanwhile, young people themselves continue to demonstrate new forms of resistance to gender-based violence and dominant gender and sexuality norms (Bragg et al., 2018; Keller et al., 2018). This project responds to a need for approaches that support young people’s autonomy and challenge processes of pathologisation and individualisation; approaches that seek to understand social structures, and the ways in which young people are shaped by their relationships with these social structures, and with each other (Brunila & Rossi, 2018). Framed broadly as a participatory action research project, the study was informed by a series of music-based workshops conducted in the first year, exploring the issues that young people identified as most important in relation to gender. The project then established a music therapy group program in a government school. The school was located in the outer suburbs of Melbourne, with an index of community socio-educational advantage below the national average, and a high percentage of students with a language background other than English. This primary project took the form of a critical ethnography, and generated a wide range of data over nine months. Interviews were conducted with five staff and sixteen of the young people who participated in music therapy groups exploring issues related to gender and power. Discourses of risk and deficit emerged as critical issues to respond to in the project, and became a key focus of the four chapters of results. The research revealed the complex forms of violence that can occur when exploring gender-based violence in a school context, and how these relate to young people’s layered subjectivities and social positioning. The findings demonstrated a need to problematise and expand upon current responses to gender-based violence in the context of Australian education settings, especially where Whiteness and colonial relations remain profoundly underexamined. Chapter Six overviews the five broad, salient themes that emerged in relation to the role of music in creating conditions for young people to explore gender. Chapter Seven outlines the role of music therapists in supporting young people to do so, the unique skillset and critical lens required in this emerging practice, and a new method developed in the project: ‘Insight-Oriented Narrative Songwriting’. Informed by anti-oppressive and decolonial approaches to reframing violence and harm, music therapy is ultimately constructed as a practice congruent with shifting understandings and paradigms related to trauma. Overarchingly, the research exposes the complex conditions of power in schools, and explicates the potential of music therapy within these conditions, to support young people to resist discursive positioning, and rewrite their own subjectivities.
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    An emergent exploration into the musical beginnings of parental identity across the neonatal journey
    McLean, Elizabeth ( 2018)
    This thesis describes an emergent research project exploring the musical beginnings of parental identity in the neonatal unit setting. While scholarship is calling for parentally- inclusive practices that support optimal health and well-being of premature infants and their parents (Benzies, Magill-Evans, Hayden & Ballantyne, 2013), there exists little music therapy research exploring parents’ unique experiences of appropriating music with their baby in this context. Moreover, research highlights the need to foster the process of becoming a parent to a premature baby in the neonatal unit to support the critical development of the parent- infant relationship (Gibbs, Boshoff & Stanley, 2015). However, no studies have examined music therapy’s role in contributing to parental identity constructs in the neonatal unit. This project aimed to respond to this gap through exploring parents’ experiences of musical engagement with their baby in the neonatal unit through a phenomenological inquiry, followed by a grounded theory study. Parents were recruited from across two in-patient, neonatal hospital facilities in Melbourne. An initial inquiry, adopting Interpretative Phenomenological Analysis (Smith, Flowers & Larkin, 2009) methodology explored nine parents’ experiences and perceptions of singing and using their voice with their premature baby in the neonatal unit. Findings emerged across four waves of analysis. Recurrent themes included: the intrinsic role of singing and voice to support the developing identity of parents and act as a fundamental bridge of connection to their premature baby; the supportive role of voice to meet the emotional needs of parents; and act as a self-soothing coping tool. The concept of time across differing stages of the acute neonatal journey and its influence on parents’ experiences and perceptions of voice inductively emerged across cases. Findings also highlighted parents’ singing and voice interactions with their baby as a critical dialogical encounter of perceived connection and recognition. Finally, the role of the music therapist was acknowledged as supportively educating and facilitating parents to ‘find their voice’ and connect with their baby. The second study of this thesis expanded on an interesting aspect of these initial findings that illuminated singing and voice interactions leading to the validation of a parent’s identity through their baby’s perceived recognition of their voice (McLean, 2016a). This grounded theory study explored how parents’ musical engagement with their baby contributed to their parental identity across their neonatal journey. Interviews with nine parents of a premature baby across varying time points in their hospital journey took place. To generate theoretical understandings of this topic, a Constructivist Grounded Theory approach was employed (Charmaz, 2014), with influences from Strauss & Corbin’s (1998) approach to analysis. Findings in the form of a substantive grounded theory illuminated the contribution of parents’ musical engagement on their sense of parental identity. Specifically, the centrality of their baby’s response during musical interactions as influencing these parents’ capacity to engage in musical dialogue with their baby emerged. It was through these early musical encounters, involving their baby’s powerful response, that parents’ emerging sense of identity across their neonatal unit journey was supported. This enabled parents to ‘do something musical’ for their baby and receive an ‘identifying response from their baby’. Specific conditions that acted as both barriers and fosters in parents’ musical engagement across a high- risk pregnancy and hospital admission also emerged.
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    From social connectedness to equitable access: an action research project illuminating the opportunities and the barriers to accessing music for young people with disability transitioning from school to adult life
    Murphy, Melissa Amy Irving ( 2017)
    The action research project described in this thesis emerged from a partnership between the Community Inclusion Team of a large, not-for-profit disability service organisation in Australia (the Organisation) and the National Music Therapy Research Unit at the University of Melbourne (NaMTRU). The project developed following a question from the Organisation about how music could be an engaging part of young people’s lives as they transitioned from school to adult life. Community inclusion team members of the Organisation had identified that young people who accessed their services, many of who live with more complex disabilities, often experienced challenges in establishing a sense of social connectedness during the transition. The Organisation were interested in how involvement in music may play a role in addressing this challenge. As such, the project began with a focus on the role of music in social connectedness for young people. However, as the project unfolded, the focus began to broaden into the more pressing issue of equitable access to music. The project developed amid the backdrop of the introduction of a new disability funding model in Australia, the National Disability Insurance Scheme (NDIS). This change within the disability sector has had a significant influence on many aspects of this inquiry. An action research approach (Reason and Bradbury, 2008) was used for the project within a transformative paradigm (Mertens, 2009) as it relates to issues of social justice and human rights. This framework encompasses the aim of personal and social transformation within communities that experience oppression and discrimination. Grounded in community music therapy theory and disability studies, the project took the form of four cycles of planning, action and reflection. Cycle 1 involved a critical interpretive synthesis of the literature. Cycle 2 involved semi structured interviews with young people accessing the Organisation to learn about their experiences of social connectedness. Cycle 3 involved focus group discussions with facilitators of music programs accessible to young people to begin building a picture of opportunities to access music and finally, cycle 4 involved the establishment of an ongoing, collaborative community music program with a group of young people. Findings indicate that young people with disability lack sufficient opportunities to access music as a resource in their lives. A variety of opportunities exist that offer different ways of participating in music, but barriers to this participation are continually faced. These include limitations on independent access to information about the existence of programs and opportunities, inadequate funding for independent action and a lack of community infrastructure to accommodate people with differing needs. Once an opportunity was made available in this project, young people embraced the chance to work collaboratively to create the music program into what they needed. This included growing the group membership to satisfy social needs, taking on leadership and marketing roles, making group decisions about the music, the venue and performances. The research project outcomes have implications for roles and actions for music therapists and other facilitators of music programs aimed at a structural level to increase opportunities for young people to access music as a resource in their lives.
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    Parents' and music therapists' reflections on the experience of music and home-based music therapy for paediatric palliative care patients and their families, who come from diverse cultural backgrounds
    Forrest, Lucy Christina ( 2017)
    Music can be an important part of many young children’s lives, especially when a child is unwell, or dying. In recent years, the use of music therapy with children in paediatric palliative care (PPC) has become more widespread, across hospice, hospital and home settings. This qualitative inquiry investigated the experience of music, and home-based music therapy for PPC patients and their families, who come from diverse cultural backgrounds. The inquiry employed a constructivist approach and was informed by grounded theory and meta-ethnography. The inquiry examined how children in PPC and their families experience music, and music therapy in PPC, with a focus on how cultural beliefs and practices shape experience. The inquiry also identified barriers to accessing PPC, music, and music therapy for children and families of diverse cultural backgrounds. Four studies were conducted as part of this inquiry. Study One employed a repeated-interview design to interview six parents of children in PPC about their experience of music and music therapy in caring for a child in PPC. Five mothers and one father participated in an initial interview; and three of the mothers also participated in a six-month follow-up interview, to capture in-the-moment experiences and changes over time. Study Two employed a focus group design to interview three music therapists about their experience of providing music therapy for children and families of diverse cultural backgrounds in home-based PPC. Study Three employed an ethnographic approach for the author to reflect on her work in home-based PPC music therapy with 34 children and their families. Twenty themes emerged from the analysis of Studies One to Three, based around three distinct foci: the palliative care journey; the experience of music; and the experience of music therapy. Study Four conducted a meta-ethnography of Studies One to Three. The meta-ethnography provided a rich and detailed description of how children and families from diverse cultural backgrounds experience PPC, music and home-based music therapy; and also identified barriers to access. Key findings included: 1) Migration, length of time in Australia and cultural shaming can impact isolation, coping, and access to support; 2) Families want music therapy for their child, even if music is not part of their culture or family life; 3) Music can support family health and wellbeing, although the presence of multiple stressors in the family’s life can inhibit use of music; 4) Families use music to express their culture and maintain their cultural identity; 5) Music therapy can support families who have few/no family or other supports, reducing carer stress and isolation, and enhancing parental coping; 6) music therapy can uphold and support cultural and community patterns of relationship in the face of life-threatening illness; 7) child and family experiences of palliative care can be transformed in MT, positively impacting parental coping; and 8) the emotional intensity of music therapy in end-of-life-care can be overwhelming, and lead to family disengagement from music therapy. The thesis makes an important contribution to the fields of music therapy and PPC, in developing understanding of how culture impacts family experiences of PPC, music, and music therapy; and also offers insight into the complexities of conducting research with the highly vulnerable population of children in PPC.
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    Effectiveness of SAMONAS Sound Therapy (SST) in improving social engagement of children with Autism Spectrum Disorder
    Pitkola, Suvi Marjatta ( 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.