Tony Wigram

Therapeutic songwriting in music therapy Part I: : Who are the therapists, who are the clients, and why is songwriting used?

Songwriting as a therapeutic intervention has received increasing attention in the field of music therapy over the past decade however much of the publications focus on clinical outcomes rather than methods of practice. This paper, part of a two-part research report into trends in the clinical practice of songwriting, aims to describe the most frequently employed goal areas across a range of clinical populations and compare these findings with the published literature. Responses to a 21-question online survey were obtained from 477 professional music therapists practicing in 29 countries which focused on approaches to songwriting within their practice with a single clinical population. Chi–square or comparable Exact tests (Fisher-Freeman-Halton) were applied to the data and significant associations were found according to different clinical populations particularly with respect to the aims of songwriting in clinical practice and the frequency with which songwriting is employed in practice. The data highlights that songwriting is frequently employed in developmental disability and ASD practice, with reports on songwriting with these diagnostic groups being underrepresented in the music therapy literature. The survey identified that the most frequently endorsed goal areas align with the literature base and included a) experiencing mastery, develop self-confidence, enhance self esteem; b) choice and decision making; c) develop a sense of self; d) externalising thoughts, fantasies, and emotions; e) telling the clients story; and f) gaining insight or clarifying thoughts and feelings.

The Effects of Improvisational Music Therapy on Joint Attention Behaviors in Autistic Children: A Randomized Controlled Study

The purpose of this study was to investigate the effects of improvisational music therapy on joint attention behaviors in pre-school children with autism. It was a randomized controlled study employing a single subject comparison design in two different conditions, improvisational music therapy and play sessions with toys, and using standardized tools and DVD analysis of sessions to evaluate behavioral changes in children with autism. The overall results indicated that improvisational music therapy was more effective at facilitating joint attention behaviors and non-verbal social communication skills in children than play. Session analysis showed significantly more and lengthier events of eye contact and turn-taking in improvisational music therapy than play sessions. The implications of these findings are discussed further.

Indications in Music Therapy: Evidence from Assessment That Can Identify the Expectations of Music Therapy as a Treatment for Autistic Spectrum Disorder (ASD); Meeting the Challenge of Evidence Based Practice

When children with Autistic Spectrum Disorder (ASD) are assessed in music therapy, significant strengths, potentials and resources emerge that may remain hidden in other, more formalised assessments. Therefore, it is becoming more necessary to develop a systematic method of describing this responsiveness, in order to define the expectations of therapy. Music therapy is a particularly important intervention for children with ASD to engage and nurture their capacity for flexibility, creativity, variability and tolerance of change, in order to balance the more structured and behaviourally driven education that is currently popular. The potential of treatment can be defined within the context of meeting healthcare needs. A case study will illustrate a model for defining ‘expectations of therapy’, by drawing on one childs awakened capacity for interaction through shared, improvised music-making. This article includes a long appendix providing an evidence-based review and recommendations regarding assessment and referral criteria based on current research and clinical evidence.

Regression in individuals with Rett Syndrome

Data on features of regression and pre-regression developmental history in a case series of 53 girls and women with Rett syndrome are presented. Consistent with the diagnostic criteria, hand skills and verbal or non-verbal communication skills were the most common skills lost during regression. Play and motor skills were also lost in half the cases. Regression most commonly occurred between 12 and 18 months of age but was noted in a few cases before 6 months or after 36 months. Pre-regression developmental delays or abnormalities were noted in over two-thirds of cases, increasing to 85% of the youngest cases where parental reporting was likely to be more accurate. Age at regression was not associated with severity of physical and growth symptoms, and thus did not appear to be an index of neurological severity. There is a continuing need to further elucidate the pre- and post-regression features of Rett syndrome in order to aid early identification, diagnosis and referral for genotype mutation analysis.

Learning ability in children with Rett syndrome

The purpose of this article is to present results of a research study examining learning ability in individuals with Rett syndrome. The material for this article was drawn from a more extensive doctoral study, designed to investigate intentional communication in this population, through the use of songs in music therapy. Rett syndrome is a neurological disorder resulting from an X-linked mutation, affecting mainly females, and found across racial and ethnic groups worldwide. One of the main areas affecting functioning in individuals with Rett syndrome is a severe impairment of receptive and expressive communication. This creates difficulties when attempting to reveal their potential learning abilities. This population has been observed as very responsive to music hence music therapy intervention has been advocated in promoting and motivating them to communicate and to learn. Seven girls with Rett syndrome, between ages 4 and 10 participated in the study. A single subject, multiple probe design was applied during 30-min trials, three times per week and lasted 8 months. During the trials the participants were asked to choose from a selection of 18 familiar and unfamiliar songs, while their ability to learn was observed and measured. Findings revealed that all seven girls demonstrated an ability to learn and to sustain learning over time. This intervention demonstrated that individuals with Rett syndrome could be promoted and motivated to communicate and learn when therapeutically employed by a trained music therapists.

Therapeutic songwriting in music therapy, Part II: Comparing the literature with practice across diverse clinical populations

A growing body of literature on therapeutic songwriting with diverse clinical populations indicates that clinicians employ a wide range of approaches. The purpose of this research was to establish trends in the clinical practice of songwriting as implemented across a range of clinical populations. Responses to a 21-question online survey were obtained from 419 professional music therapists practicing in 29 countries which focused on approaches to songwriting within their practice with a single clinical population. Results suggest that, in general, the literature provides good representation for what is occurring in clinical practice. Generally, songs were composed with individual clients in single sessions, with lyrics created prior to the music. Clinicians had a significant role in creating the music with improvised and pre-determined musical structures being equally employed. Chi-square or comparable Exact tests (Fisher–Freeman–Halton) were applied to the data and significant associations were found according to clinical populations, particularly with respect the number of sessions required to complete a song, approaches to composing lyrics and music, the context with which songwriting was employed, and the types of allied health professionals involved in the songwriting interventions. There is a distinct absence of songwriting literature as applied in developmental disability, autism spectrum disorder, and aged care contexts so the resulting practice trends offered here contribute to the increasing body of knowledge about songwriting practices.

A pilot study on the effects of music therapy on frontotemporal dementia – developing a research protocol1

Some forms of dementia particularly affect the frontal parts of the brain which, in some cases, causes the onset of severe behavioural and psychological symptoms. No specific treatment for the primary diseases that cause these frontotemporal dementia conditions has yet been developed, and pharmacological treatment of the psychiatric symptoms is difficult, requiring specialist proficiency in the field. As there is not yet sufficient research that examines the effects of non-pharmacologic treatment with this group, there is a need to develop valid and reliable research protocols. Music therapy was investigated as an example of a non-pharmacologic treatment procedure. A pilot study was carried out with the focus to develop a research protocol for a future larger population study. In two case studies a combination of data collection methods were examined with the overall goal to document changes in intersubjectivity. In this pilot study there was a specific interest in selecting a relevant and manageable dementia specific instrument for measuring quality of life and relating it with other instruments. The following three instruments were tested: the Alzheimers Disease-Related Quality of Life (ADRQL), the Cohen–Mansfield Agitation Inventory (CMAI), and the Neuro-psychiatric Inventory (NPI), and were related to case descriptions and video analyses. Recommendations for a mixed method research protocol focused on measuring the effect of music therapy with persons with frontotemporal dementia are presented.

The effects of a song-singing programme on the affective speaking intonation of people with traumatic brain injury

Primary objective: To examine changes in the relationship between intonation, voice range and mood following music therapy programmes in people with traumatic brain injury. Research design: Data from four case studies were pooled and effect size, ANOVA and correlation calculations were performed to evaluate the effectiveness of treatment. Methods and procedures: Subjects sang three self-selected songs for 15 sessions. Speaking fundamental frequency, fundamental frequency variability, slope, voice range and mood were analysed pre- and post-session. Results: Immediate treatment effects were not found. Long-term improvements in affective intonation were found in three subjects, especially in fundamental frequency. Voice range improved over time and was positively correlated with the three intonation components. Mood scale data showed that immediate effects were in the negative direction whereas there weres increases in positive mood state in the longer-term. Conclusions: Findings suggest that, in the long-term, song singing can improve vocal range and mood and enhance the affective intonation styles of people with TBI.

Effectiveness of music therapy for children and adolescents with psychopathology: A quasi-experimental study

Abstract Music therapy has been found to be effective for children and adolescents with psychopathology, but its effectiveness in routine practice is unknown. The aim of this study was to examine whether individual music therapy as provided in outpatient services is an effective treatment for this group of clients and to examine potential predictors of its effectiveness. The authors assessed symptoms, competencies, and quality of life in children and adolescents with psychopathology (N=136) before and after up to 25 weekly sessions of individual music therapy or corresponding waiting time. No significant interaction effects were identified, although quality of life showed a tendency in favor of music therapy. Effect sizes were smaller than in previous experimental research. Effects on symptoms depended on the presence and severity of comorbid medical conditions. The results suggest that music therapy as provided in routine practice is effective for some but not all groups of clients.

Evidence and Effectiveness in Music Therapy: Problems, Power, Possibilities and Performances in Health Contexts (A Discussion Paper)

Adopting a knowledge-based controversy perspective, this article considers critically the ‘fit’ or appropriateness of the so-called ‘gold standard’ of assessment – the Randomised Controlled Trial. It sets the growing dominance of this method within music therapy in the contexts of medical work and the changing social relations of medical expertise, the importance of local practice in music therapy (and healthcare more widely), and the politics of representation as they apply to medical modes of accounting and measurement. I then consider what is overlooked when experimental models are used as the prime mode of perceiving the music therapeutic process and suggest that they may not provide a good or appropriate way of observing, accounting for and assessing music therapy. I suggest that they are not amenable to the observation and documentation of temporal and local craft practices and that these practices provide the active ingredients of music therapys effectiveness. I conclude that music therapy is poised to highlight the radical performative and social features of health status and that these features have far-reaching implications for our concepts of illness and the aetiology of illness and, most importantly, for the ways in which we conceptualise and implement therapeutic procedures of all kinds.