Brynjulf Stige

Culture-centered music therapy

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Toward an Agenda for Evaluation of Qualitative Research

Evaluation is essential for research quality and development, but the diversity of traditions that characterize qualitative research suggests that general checklists or shared criteria for evaluation are problematic. We propose an approach to research evaluation that encourages reflexive dialogue through use of an evaluation agenda. In proposing an evaluation agenda we shift attention from rule-based judgment to reflexive dialogue. Unlike criteria, an agenda may embrace pluralism, and does not request consensus on ontological, epistemological, and methodological issues, only consensus on what themes warrant discussion. We suggest an evaluation agenda—EPICURE—with two dimensions communicated through use of two acronyms.The first, EPIC, refers to the challenge of producing rich and substantive accounts based on engagement, processing, interpretation, and (self-)critique. The second—CURE—refers to the challenge of dealing with preconditions and consequences of research, with a focus on (social) critique, usefulness, relevance, and ethics. The seven items of the composite agenda EPICURE are presented and exemplified. Features and implications of the agenda approach to research evaluation are then discussed.

Invitation to Community Music Therapy

Part 1: Introduction to Community Music Therapy 1. An Overview 2. A Brief History Part 2: Basic Concepts of Community Music Therapy 3. Health and Wellbeing 4. Community and Social Resources 5. Music, Health, and Community Part 3: Community Music Therapy in Practice 6. Issues 7. Values 8. Processes Part 4: Community Music Therapy as Development of Discipline and Profession 9. Purposes and Practices of Research 10. Professionalization for Participatory Practice

Individual music therapy for agitation in dementia: an exploratory randomized controlled trial

Objectives: Agitation in nursing home residents with dementia leads to increase in psychotropic medication, decrease in quality of life, and to patient distress and caregiver burden. Music therapy has previously been found effective in treatment of agitation in dementia care but studies have been methodologically insufficient. The aim of this study was to examine the effect of individual music therapy on agitation in persons with moderate/severe dementia living in nursing homes, and to explore its effect on psychotropic medication and quality of life. Method: In a crossover trial, 42 participants with dementia were randomized to a sequence of six weeks of individual music therapy and six weeks of standard care. Outcome measures included agitation, quality of life and medication. Results: Agitation disruptiveness increased during standard care and decreased during music therapy. The difference at −6.77 (95% CI (confidence interval): −12.71, −0.83) was significant (p = 0.027), with a medium effect size (0.50). The prescription of psychotropic medication increased significantly more often during standard care than during music therapy (p = 0.02). Conclusion: This study shows that six weeks of music therapy reduces agitation disruptiveness and prevents medication increases in people with dementia. The positive trends in relation to agitation frequency and quality of life call for further research with a larger sample.

Research Rigour and Therapeutic Flexibility: Rationale for a Therapy Manual Developed for a Randomised Controlled Trial

When doing a randomised controlled trial, concrete and observable a–priori definitions and descriptions of therapy procedures are usually considered necessary for study results to be replicable, and also to enable comparisons between different therapy approaches. However, most music therapy approaches in the field of mental health cannot be defined with a fixed therapy manual without serious danger of losing their therapeutic integrity. Manuals defining therapeutic principles which can be applied flexibly, rather than a fixed set of techniques, might be more appropriate. In this article we will present the rationale for a therapy manual developed for the purpose of a randomized controlled trial on a contextual approach to resource–oriented music therapy. The article focuses upon possible ways of dealing with the tensions and contrasts that exist between the contextual and resource-oriented perspectives and the need for pre–structured definitions to meet the standards of the rigorous quantitative research methodology.

Individual Music Therapy for Mental Health Care Clients with Low Therapy Motivation: Multicentre Randomised Controlled Trial

Background: Music therapy (MT) has been shown to be efficacious for mental health care clients with various disorders such as schizophrenia, depression and substance abuse. Referral to MT in clinical practice is often based on other factors than diagnosis. We aimed to examine the effectiveness of resource-oriented MT for mental health care clients with low motivation for other therapies. Method: This was a pragmatic parallel trial. In specialised centres in Norway, Austria and Australia, 144 adults with non-organic mental disorders and low therapy motivation were randomised to 3 months of biweekly individual, resource-oriented MT plus treatment as usual (TAU) or TAU alone. TAU was typically intensive (71% were inpatients) and included the best combination of therapies available for each participant, excluding MT. Blinded assessments of the Scale for the Assessment of Negative Symptoms (SANS) and 15 secondary outcomes were collected before randomisation and after 1, 3 and 9 months. Changes were analysed on an intention-to-treat basis using generalised estimating equations in longitudinal linear models, controlling for diagnosis, site and time point. Results: MT was superior to TAU for total negative symptoms (SANS, d = 0.54, p < 0.001) as well as functioning, clinical global impressions, social avoidance through music, and vitality (all p < 0.01). Conclusion: Individual MT as conducted in routine practice is an effective addition to usual care for mental health care clients with low motivation.

On a Notion of Participation in Music Therapy

This article examines the notion of participation from a relational and culture-centred perspective, with the objective of stimulating more systematic reflection on the notions relevance in music therapy theory. Selected examples from the music therapy literature are reviewed and related to contemporary literature on learning, music, and health. In discussing the literature, a distinction is made between two basic notions of participation; participation as individual activity and participation as collaborative activity. The first usage of the term is most common in the music therapy literature, but the metatheoretical perspective underpinning this study suggests that a notion of participation as collaborative activity is more significant. In relation to participation as collaborative activity, a further distinction is made between participation as communal experience and participation as political action (citizen participation). A focus upon participation as communal experience is a clinically relevant implication of a relational understanding of humanity, but the author argues that apolitical visions of participation as communal experience may end up invoking a romanticized view of participatory community in neglect of diversity and social conflict. In an attempt at providing a platform for further discussion of and work on the notion of participation, a brief definition of participation is offered. In conclusion, the article proposes that a) a notion of participation could be integrative in relation to educational, musical, and health–related dimensions of music therapy processes and b) more work is needed on a notion of participation in music therapy, in relation to various theoretical and practical contexts.

Music Therapy for Prisoners: Pilot Randomised Controlled Trial and Implications for Evaluating Psychosocial Interventions

Mental health problems are common among prison inmates. Music therapy has been shown to reduce mental health problems. It may also be beneficial in the rehabilitation of prisoners, but rigorous outcome research is lacking. We compared group music therapy with standard care for prisoners in a pilot randomised controlled trial that started with the establishment of music therapy services in a prison near Bergen in 2008. In all, 113 prisoners agreed to participate. Anxiety (STAI-State [State–Trait Anxiety Inventory], STAI-Trait), depression (HADS-D [Hospital Anxiety and Depression Scale]), and social relationships (Quality of Life Enjoyment and Satisfaction Questionnaire [Q-LES-Q]) were assessed at baseline; every 2 weeks in the experimental group; after 1, 3, and 6 months in the control group; and at release. No restrictions were placed on the frequency, duration, or contents of music therapy. Duration of stay in the institution was short (62% stayed less than 1 month). Only a minority reached clinical cutoffs for anxiety and depression at baseline. Between-group analyses of effects were not possible. Music therapy was well accepted and attractive among the prisoners. Post hoc analysis of within-group changes suggested a reduction of state anxiety after 2 weeks of music therapy (d = 0.33, p = .025). Short sentences and low baseline levels of psychological disturbance impeded the examination of effects in this study. Recommendations for planning future studies are given, concerning the careful choice of participants, interventions and settings, comparison condition and design aspects, choice of outcomes, and integration of research approaches. Thus, the present study has important implications for future studies evaluating interventions for improving prisoners’ mental health. Trial registration: ISRCTN22518605

Concepts of context in music therapy

In contemporary music therapy as well as in related interdisciplinary fields, the importance of context in relation to theory, research, and practice has been emphasized. However, the word context seems to be used in several different ways and conceptualizations of contextual approaches vary too. The objective of this theoretical article is to clarify traditions of language use in relation to context in music therapy. In reviewing and discussing the literature, we focus on the field of mental health care. When discussing issues related to context, this literature partly focuses on the surroundings of music therapy practice, partly on the ecology of reciprocal influences within and between situations or systems. On this basis, three types of context awareness in music therapy are identified: music therapy in context; music therapy as context; and music therapy as interacting contexts. The identified types of context awareness are exemplified through references to music therapy literature and then discussed in relation to two very different metaphors, namely context as frame and context as link. Implications for practice, research, and theory development in music therapy are suggested.

Perspectives on Meaning in Music Therapy

In this article I discuss some questions on meaning in music therapy by taking as my point of departure the different perspectives of two British music therapists, Mary Priestley and Gary Ansdell. Since all discussions of meaning – even when considering ‘non-verbal phenomena’ – are based on an understanding of language, I have found the philosophy of Ludwig Wittgenstein an interesting port of entry to this topic. Following an introduction to Wittgensteins concepts of ‘language game’ and ‘family resemblances’, I give a brief discussion of Wittgensteins relevance for aesthetic understanding, highlighting the concept of ‘intransitive understanding’. These three concepts will then be used as a basis for examining the differences between Priestleys and Ansdells perspectives, which may serve to expand our thinking about meaning in music therapy.