Attunement in Music Therapy for Young Children with Autism: Revisiting Qualities of Relationship as Mechanisms of Change

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Musical Progress Towards Therapeutic Change: A Qualitative Study on How to Develop a Focus in Music Therapy

By sharing and shaping a common focus through music, music therapy clients in mental health care involve themselves in a therapeutic process which is not necessarily bound to verbal language. Supplementing previous research showing that even clients with a low therapy motivation can benefit from music therapy, this study concentrates on how a therapy focus can develop in a client population that is often hard to reach by verbal approaches. Based on the assumption that our clients’ implicit ideas of favourable changes inform their way to use music, we examined how music-related activities addressed in music therapy might depict underlying processes of therapeutic changes. A qualitative content analysis was conducted utilising session logs from 23 music therapy clients. Three session logs (one each from the beginning, middle and end) were analysed for each participant using both structured and latent coding strategies. Findings suggest that music-related activities reflect the client’s responsiveness towards her/his own inner world and those of others. To the therapist, this shows a certain quality of the therapeutic encounter which can be divided into seven levels: the encounter in music therapy offers space for acceptance, provides orientation, allows contact, creates confidence, promotes expression, supports abstraction and enables transformation. (PsycINFO Database Record (c) 2017 APA, all rights reserved

The room is a mess: Exploring the co-creation of space for attunement dynamics between an autistic child and a non-autistic music therapist

Introduction Music therapy practice and research in the field of autism has often followed medical narratives that reinforce neurotypical normalcy by locating the difficulties of social interaction in the autistic person. By exploring the relational phenomenon of attunement, this paper focuses on the social and material ecology of interactions. The authors try to unpack circumstances that can support or hinder attunement dynamics between autistic and non-autistic people. Method A video-vignette from music therapy with an autistic boy, who explores the sound of building blocks formed the point of departure for this research. The vignette was self-identified by the music therapist as an apparently failed attunement experience. Based on this vignette, we conducted an interview with the therapist and focus groups with parents of autistic children and colleagues from different professions, one of whom is autistic. We used an interpretative hermeneutical methodology for crystallisation of perspectives. Results We uncovered four spaces that impacted on the mutuality and co-creation of attunement dynamics. The room (physical space), the school context (professional space), and the material (sensory space) afford the interaction (relational space) between the child and the therapist in enabling and disabling ways. Listening to the child's sound making with the building blocks was identified as the autistic child’s way of knowing and sounding that needs to be listened to carefully, rather than being questioned or disregarded. Discussion Findings of this research might encourage therapists to foster an understanding of social interaction that is mutually co-constituted and enactive, and that contradicts the mainstream pathologisation of autism.publishedVersio

Converging Reflections on Music Therapy With Children and Adolescents: A Collaborative Seminar on Diverse Areas of Music Therapy Practice and Research

Four music therapists working at the Grieg Academy Music Therapy Research Centre (GAMUT) in Bergen, Norway, collaborated in providing a seminar at a national conference called “Barn og deres andre” [Children and their others] in November 2012. The four therapists were educated in different music therapy training courses in four different countries, and have worked and carried out research in distinctly different areas of music therapy practice: pediatric traumatic brain injury, children with autism, and children and adolescents in child welfare. Significantly, their experience of creating a collaborative seminar led to an awareness of each other’s work and also a process of identifying shared perspectives about music therapy with children and adolescents. This report on the symposium presents the three seminar papers and documents the journey of a team-building process within the music therapy discipline

Music Therapy Techniques as Predictors of Change in Mental Health Care

The application of music in therapy is realised through different working modalities which can be categorised into three types of techniques: production, reception, and reproduction. These techniques are commonly used in mental health settings in music therapy practice and previous research suggests that specific working modalities might be important predictors of change in music therapy. However, little is known about which ingredients specifically contribute to the outcomes of music therapy. This study aimed to investigate the application of music therapy techniques and whether they predict changes in clinical outcomes in mental health settings with individuals displaying a low therapy motivation. Participants (N =31) were assessed before, during, and after participating in individual music therapy. Music therapy techniques were assessed for three selected therapy sessions per participant. Associations between music therapy techniques and outcomes were calculated using linear models with repeated measures. Results showed that reproduction techniques were used most intensely. In addition, relational competencies (interpersonal and social skills) amongst the participants improved when focusing on reproducing music (e.g. singing or playing familiar songs, learning musical skills). Results indicated that reproduction music therapy techniques may foster the development of relational competencies in individuals with low motivation. (PsycINFO Database Record (c) 2016 APA, all rights reserved

Effects of Improvisational Music Therapy vs Enhanced Standard Care on Symptom Severity Among Children With Autism Spectrum Disorder

Importance: Music therapy may facilitate skills in areas affected by autism spectrum disorder (ASD), such as social interaction and communication. Objective: To evaluate effects of improvisational music therapy on generalized social communication skills of children with ASD. Design, Setting, and Participants: Assessor-blinded, randomized clinical trial, conducted in 9 countries and enrolling children aged 4 to 7 years with ASD. Children were recruited from November 2011 to November 2015, with follow-up between January 2012 and November 2016. Interventions: Enhanced standard care (n = 182) vs enhanced standard care plus improvisational music therapy (n = 182), allocated in a 1:1 ratio. Enhanced standard care consisted of usual care as locally available plus parent counseling to discuss parents’ concerns and provide information about ASD. In improvisational music therapy, trained music therapists sang or played music with each child, attuned and adapted to the child’s focus of attention, to help children develop affect sharing and joint attention. Main Outcomes and Measures: The primary outcome was symptom severity over 5 months, based on the Autism Diagnostic Observation Schedule (ADOS), social affect domain (range, 0-27; higher scores indicate greater severity; minimal clinically important difference, 1). Prespecified secondary outcomes included parent-rated social responsiveness. All outcomes were also assessed at 2 and 12 months. Results: Among 364 participants randomized (mean age, 5.4 years; 83% boys), 314 (86%) completed the primary end point and 290 (80%) completed the last end point. Over 5 months, participants assigned to music therapy received a median of 19 music therapy, 3 parent counseling, and 36 other therapy sessions, compared with 3 parent counseling and 45 other therapy sessions for those assigned to enhanced standard care. From baseline to 5 months, mean ADOS social affect scores estimated by linear mixed-effects models decreased from 14.08 to 13.23 in the music therapy group and from 13.49 to 12.58 in the standard care group (mean difference, 0.06 [95% CI, −0.70 to 0.81]; P = .88), with no significant difference in improvement. Of 20 exploratory secondary outcomes, 17 showed no significant difference. Conclusions and Relevance: Among children with autism spectrum disorder, improvisational music therapy, compared with enhanced standard care, resulted in no significant difference in symptom severity based on the ADOS social affect domain over 5 months. These findings do not support the use of improvisational music therapy for symptom reduction in children with autism spectrum disorder. Trial Registration isrctn.org Identifier: ISRCTN7892396