Views, overviews & understanding

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Players' and audience members' overlapping understanding of a piano-cello chamber workshop performance

Research team: Michael Schober & Neta Spiro

Organisations involved: The New School for Social Research, New York; in association with Nordoff Robbins

Start date: May 2015

Project outline: Communication with non-music therapists about their work is a daily challenge for Nordoff Robbins practitioners. The question of the extent of shared understanding between those participating in an activity and those observing is not limited to music therapy. Therefore, our study explores audience interpretation of duo musical performance and the extent to which variability in understanding across different audience members can be predicted by prior musical experience. In particular, using a questionnaire the study asks:

  • To what extent do non-performing listeners understand a performance in the same way as the two performers who originally played?
  • To what extent do audience members with different musical backgrounds hear the performance in the same way as each other?
  • When the performers have different interpretations of what happened in the performance, do audience hearings correspond more with one performer’s interpretation than another’s, or are hearings individually variable across all audience members? Are audience members with musical training more likely to agree with performers’ interpretations than audience members without musical training? Are audience members who have played the same instrument as a performer more likely to endorse that performer’s interpretations?
  • Are audience members more likely to agree with claims about the performance that both players endorse than claims that only one performer endorses?

This is one of a series of studies about shared understanding in collaborative music making. We hope that the methods developed and findings identified in these projects will help inform our exploration of the variability of shared understanding in music and music therapy.

To what extent is current Nordoff Robbins music therapy practice in care homes seen to fulfil the goals of the Dementia Strategy, 2009?

Research team: Neta Spiro, Mercédès Pavlicevic & Camilla Farrant

Organisations involved: Nordoff Robbins

Start date: October 2012

Date first published: 2015

Reference 1: Spiro, N., Farrant, C., & Pavlicevic, M. (2015). Between practice, policy and politics: Music therapy and the Dementia Strategy, 2009. Dementia: The International Journal of Social Research and Practice, Advance online publication. DOI: 10.1177/1471301215585465.

Abstract: Does current music therapy practice address the goals encapsulated in the UK Department of Health document, Living well with dementia: a national dementia strategy (the Dementia Strategy) published in 2009? A survey elicited the views of clients, family members, music therapists, care home staff and care home managers, about this question by focusing on the relationship between music therapy and the 17 objectives outlined in the Dementia Strategy. The results showed that the objectives that are related to direct activity of the music therapists (such as care and understanding of the condition) were seen as most fulfilled by music therapy, while those regarding practicalities (such as living within the community) were seen as least fulfilled. Although the responses from the four groups of participants were similar, differences for some questions suggest that people's direct experience of music therapy influences their views. This study suggests that many aspects of the Dementia Strategy are already seen as being achieved. The findings suggest that developments of both music therapy practices and government strategies on dementia care may benefit from being mutually informed.

A research study on monitoring and evaluation (M&E) of music therapy services

Research team: Giorgos Tsiris, Neta Spiro, Mercédès Pavlicevic & Sarah Boyce

Organisations involved: Nordoff Robbins

Start date: September 2013

Project outline: The study aims to build an evidence base which will inform future M&E initiatives, including appropriate collection and analysis methods, report formats and dissemination methods.

Initially, 27 M&E projects which were completed between 2011-2014 by the Nordoff Robbins Research Department were analysed in terms of their methods and main areas of findings. Through this retrospective analysis of evaluation material, a number of ‘impact areas’ of music therapy services were identified.

Since these impact areas and their ratings per client group and settings emerge from a relatively small sample, a follow-up online survey helped to check the extent to which the themes (impact areas) identified were comprehensive. All Nordoff Robbins employed and supported music therapists were invited to respond to the survey which also asked them to rank the given impact areas in order of importance according to the different sites and client groups with whom they have worked with since 2012.

Randomised controlled trials in music therapy: What have we learned so far?

Research team: Neta Spiro, Giorgos Tsiris, Tatiana Sobolewska & Mercédès Pavlicevic

Organisations involved: Nordoff Robbins

Start date: October 2014

Project outline: Randomised controlled trials (RCTs), which often feature in debates regarding hierarchical models of evidence and their methodological assumptions, play a key role in the modern healthcare landscape. Findings from RCTs influence policy-making and shape the image of professional fields nationally and internationally. This holds true for music therapy and the wider field of music and health too.

Despite the increasing number of RCTs conducted in music therapy and other music interventions, the research community is still learning how to carry out and report on such studies. Studies have considered practical guidelines for the design and implementation of RCTs in music, but it is equally important for researchers, and also for research audiences, to develop clear theoretical foundations and understanding of the links between RCTs and the practices that they study.

Through analysis of 25 RCTs on music therapy and music intervention in dementia care, this study provides an overview of the type and format of practices studied in these RCTs, the outcome measures, as well as the relationship between the aims of such practices and foci of RCTs respectively. The patterns, as well as the methodological tensions and ‘gaps’ identified in the study, help us to learn about the connections between practice and outcome, as well as raise questions that have perhaps been overlooked in review studies that emphasise aspects of reliability, validity and generalisability. Looking ahead, the consideration of RCTs alongside other research approaches can enhance mutual understanding and exchange.

What does the past tell us? A content analysis of the first quarter century of the British Journal of Music Therapy

Research team: Giorgos Tsiris, Neta Spiro & Mercédès Pavlicevic

Organisations involved: Nordoff Robbins

Start date: October 2012

Date first published: 2014

Reference 1: Tsiris, G., Spiro, N., & Pavlicevic, M. (2014). What does the past tell us? A content analysis of the first quarter-century of the British Journal of Music Therapy. British Journal of Music Therapy, 28(1), 2-24.

Abstract: Professional journals have a legitimating and sanctioning role in the development of disciplinary knowledge, as well as professional practices and identities. The British Journal of Music Therapy (BJMT) – the only UK-based peer-reviewed music therapy journal – has portrayed research, theory and accounts of practices, reflecting trends and developments in the field of music therapy since 1987. Marking the 25th anniversary of the BJMT and looking into its future development, a content analysis of the journal since its inception (1987–2011) was conducted with the aims of (i) tracing trends and developments of music therapy praxes and professional identities, and (ii) exploring the journal’s engagement with disciplinary discourses and practices alongside and beyond those of music therapy. The study provides an overview of the BJMT in terms of 1) paper types, 2) authorship: numbers and professional titles, 3) countries of project sites and countries of authors, 4) sample conditions, sizes and ages, 5) formats of practices, and 6) models and themes. The results show that the majority of the articles published in the BJMT are theoretical, focus on one-to-one sessions, are single authored by music therapists and are UK-focused in terms of authorship, project site and models. This study brings to the fore questions for the future development of music therapy as profession and discipline.

Why music? Investigating how music-centred music therapy meets the psychosocial needs of adults with learning disabilities and working towards a practice-based discourse (pilot study)

Research team: Mercédès Pavlicevic, Nicky O'Neill, Harriet Powell, Neil Foster, Nicola Dunbar, Oonagh Jones, Ruth Hunston, Susie Arbeid & Ergina Sampathianaki

Organisations involved: Nordoff Robbins

Start date: March 2010

Date first published: 2013

Reference 1: Pavlicevic, M., O’Neil, N., Powell, H., Jones, O., & Sampathianaki, E. (2014). Making music, making friends: Long-term music therapy with young adults with severe learning disabilities. Journal of Intellectual Disabilities, 18(1), 5-19.

Abstract: This collaborative practitioner research study emerged from music therapists’ concerns about the value of improvisational, music-centred music therapy for young adults with severe learning disabilities (SLDs), given the long-term nature of such work. Concerns included the relevance, in this context, of formulating, and reporting on, therapeutic aims, development, change; and working in ‘goal-oriented’ way. Focus groups with the young adults’ families and a range of professionals suggest that, rather than leading to developmental change, long-term shared therapeutic musicking provides young adults with ongoing opportunities for experiencing confidence and self-esteem, with feelings of shared acceptance and success, and also provides young adults and their families with opportunities for developing and sustaining friendships. In addition, families experienced meeting other parents and carers in the communal reception area as supportive and countering their isolation. Focus groups assigned intrapersonal, relational and social values to long-term music therapy for young adults with SLDs.

Music therapy in dementia care residential settings: Stage 1: Music therapy strategies and the Ripple Effect

Research team: Mercédès Pavlicevic, Stuart Wood, Harriet Powell, Janet Graham, Richard Sanderson, Jane Gibson, Rachel Millman & Giorgos Tsiris

Organisations involved: Nordoff Robbins, and care-homes in private and public sector

Start date: March 2010

Date first published: 2013

Reference 1: Pavlicevic, M., Tsiris, G., Wood, S., Powell, H., Graham, J., Sanderson, R., Millman, R., & Gibson, J. (2015). The ‘ripple effect’: Towards researching improvisational music therapy in dementia care-homes. Dementia: The International Journal of Social Research and Practice, 14(5), 659-679.

Abstract: Increased interest in, and demand for, music therapy provision for persons with dementia prompted this study’s exploration of music therapists’ strategies for creating musical communities in dementia care settings, considering the needs and resources of people affected by dementia. Focus group discussions and detailed iterative study of improvisational music therapy work by six experienced practitioners clarify the contextual immediacy and socio-musical complexities of music therapy in dementia care homes. Music therapy’s ‘ripple effect’, with resonances from micro (person-to-person musicking), to meso (musicking beyond ‘session time’) and macro level (within the care home and beyond), implies that all who are part of the dementia care ecology need opportunities for flourishing, shared participation, and for expanded self-identities; beyond ‘staff’, ‘residents’, or ‘being in distress’. On such basis, managers and funders might consider an extended brief for music therapists’ roles, to include generating and maintaining musical wellbeing throughout residential care settings.

The Chelsea community music therapy project: creating and tracking ‘musical pathways’ for people with enduing mental health problems

Research team: Gary Ansdell (PI), Tia DeNora (PI), Mercédès Pavlicevic, John Meehan & Sarah Wilson

Organisations involved: Nordoff Robbins, University of Exeter, and CNWL Mental Health Trust & SMART

Start date: 2006 (pilot project) & 2008 (main project)

Date first published: 2010

Reference 1: Ansdell, G., & Meehan, J. (2010). "Some light at the end of the tunnel": Exploring users' evidence for the effectiveness of music therapy in adult mental health settings. Music and Medicine, 2(1), 29-40.

Abstract: This study responds to the current demand for evidence of the effectiveness of music therapy in adult psychiatric care and rehabilitation. The qualitative, idiographic, and user-based perspective of the study also responds to the growing requirement that ‘‘evidence-based practice’’ take into account patients’ needs, experiences, and evaluations of services. The study is based on verbal data from 19 patients with chronic mental health problems who completed at least 10 individual sessions of professional music therapy in a London mental health unit. In-depth analysis of semistructured interviews using interpretive phenomenological analysis elicits patients’ experiences of the process of music therapy and its varied benefits for them in relation to their symptoms, coping strategies, and overall quality of life. The data suggest how the approach to music therapy taken in this situation often works in relation to users’ long-standing relationship to music, as expressed through their ‘‘music-health-illness narratives.’’ Participation in music therapy has benefits in itself but can also help reestablish patients’ ongoing use of music as a health- promoting resource and coping strategy in their lives.

Reference 2: Stige, B., Ansdell, G., Elefant, C., & Pavlicevic, M. (2010). Where Music Helps: Community Music Therapy In Action & Reflection. Aldershot: Ashgate.

Abstract: This book explores how people may use music in ways that are helpful for them, especially in relation to a sense of wellbeing, belonging and participation. The central premise for the study is that help is not a decontextualized effect that music produces. The book contributes to the current discourse on music, culture and society and it is developed in dialogue with related areas of study, such as music sociology, ethnomusicology, community psychology and health promotion. Where Music Helps describes the emerging movement that has been labelled Community Music Therapy, and it presents ethnographically informed case studies of eight music projects (localized in England, Israel, Norway, and South Africa).

The various chapters of the book portray 'music's help' in action within a broad range of contexts; with individuals, groups and communities – all of whom have been challenged by illness or disability, social and cultural disadvantage or injustice. Music and musicing has helped these people find their voice (literally and metaphorically); to be welcomed and to welcome, to be accepted and to accept, to be together in different and better ways, to project alternative messages about themselves or their community and to connect with others beyond their immediate environment. The overriding theme that is explored is how music comes to afford things in concert with its environments, which may suggest a way of accounting for the role of music in music therapy without reducing music to a secondary role in relation to the 'therapeutic', that is, being 'just' a symbol of psychological states, a stimulus, or a text reflecting socio-cultural content.

Reference 3: Ansdell, G., & DeNora, T. (2012). Musical Flourishing: Community Music Therapy, Controversy, and the Cultivation of Wellbeing. In R. MacDonald, G. Kreutz & L. Mitchell (Eds.), Music, Health & Wellbeing (pp. 97-112). Oxford: Oxford University Press.

Abstract: This chapter reflects on the growing recognition of music's potential as a resource in health and social care. It suggests how a growing interdisciplinary understanding of health and wellbeing as ‘ecological’ phenomena meshes perfectly with a similarly developing ecological understanding of people, music, and context. Together these perspectives show how music can provide a resource for cultivating wellbeing, understood as the positive flourishing of identity, relationship, and community (regardless of ‘objective’ health status). It also highlights some of the dilemmas, controversies, and ironies associated with this current fashionable applause for ‘music and health’.

Reference 4: Ansdell, G. (2014). How Music Helps in Music Therapy and Everyday Life. Farnham: Ashgate.

Abstract: Why is music so important to most of us? How does music help us both in our everyday lives, and in the more specialist context of music therapy? This book suggests a new way of approaching these topical questions, drawing from Ansdell's long experience as a music therapist, and from the latest thinking on music in everyday life. Vibrant and moving examples from music therapy situations are twinned with the stories of 'ordinary' people who describe how music helps them within their everyday lives. Together this complementary material leads Ansdell to present a new interdisciplinary framework showing how musical experiences can help all of us build and negotiate identities, make intimate non-verbal relationships, belong together in community, and find moments of transcendence and meaning.

How Music Helps is not just a book about music therapy. It has the more ambitious aim to promote (from a music therapist's perspective) a better understanding of 'music and change' in our personal and social life. Ansdell's theoretical synthesis links the tradition of Nordoff-Robbins music therapy and its recent developments in Community Music Therapy to contemporary music sociology and music studies.

This book will be relevant to practitioners, academics, and researchers looking for a broad-based theoretical perspective to guide further study and policy in music, well-being, and health.

Reference 5: Ansdell, G., & DeNora, T. (2016). Musical Pathways in Recovery: Community Music Therapy & Mental Wellbeing. Farnham: Ashgate.

Abstract: ‘Music triggered a healing process from within me… I started singing for the joy of singing myself…and it helped me carry my recovery beyond the state I was in before I fell ill nine years ago…to a level of well-being that I haven't had perhaps for thirty years…’. This book explores the experiences of people who took part in a vibrant musical community for people experiencing mental health difficulties, SMART (St Mary Abbotts Rehabilitation and Training). Ansdell (a music therapist/researcher) and DeNora (a music sociologist) describe their long-term ethnographic work with this group, charting the creation and development of a unique music project that won the 2008 Royal Society for Public Health Arts & Health Award. Ansdell and DeNora track the 'musical pathways' of a series of key people within SMART, focusing on changes in health and social status over time in relation to their musical activity. The book includes the voices and perspectives of project members and develops with them a new understanding of how music promotes their health and wellbeing. A contemporary ecological understanding of 'music and change' is outlined, drawing on and further developing theory from music sociology and Community Music Therapy. This innovative book will be of interest to anyone working in the mental health field, but also music therapists, sociologists, musicologists, music educators and ethnomusicologists. This volume completes a three part 'triptych', alongside the other volumes, Music Asylums: Wellbeing Through Music in Everyday Life, and How Music Helps: In Music Therapy and Everyday Life.

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