Philosophical Reflections on Music Therapy Musicianship.

This philosophical inquiry critically examines music therapy musicianship in order to reconceptualize the ways in which musicianship is conceived of and taught in education and training programs in the United States. Through a constructive and critical interaction with historical and extant literature, we seek to create space for the uniqueness of musicianship in our field. We challenge the relevance of the conservatory model, the primacy of the work concept, and the focus on fine art often found in educational settings. In doing so, we align music therapy musicianship with relevant musics, instrumentation, and the unique contextual and relational components of music experiences in our work. We construct multidirectional connections between musicality, musical identity, musicianship, music therapy context, musicking, and the clients'/participants' lifeworld, introducing subconcepts within and between each concept. This co-construction with the literature asserts our identity in education, training, practice, and research. We conclude by offering preliminary guidance that may further develop music therapy musicianship in education and clinical training programs, in alignment with current reports on education.

Leadership and Teamwork During the COVID-19 Pandemic: Experiences of Music Therapy Business Leaders.

This study investigated the experiences of music therapy private practice business leaders providing services in school, healthcare, and community settings, including clients' homes, during the first 12 months of the COVID-19 pandemic. Qualitative content analysis was utilized to analyze semi-structured interview data collected from 10 business leaders (5 CEOs and 5 clinical directors) recruited from 5 businesses. 8 themes were revealed: (1) significant impact shaped by uncertainty and values, (2) temporal dimensions of change, (3) changing dynamics of relationships, (4) issues leading to burnout, (5) unexpected opportunities for all stakeholders, (6) the weight of being responsive, (7) the ambiguity of role changes, and (8) the collective functioning of the clinical team. In the context of leadership and teamwork, these themes illuminated the challenges these business leaders encountered while also providing insights into the importance of collaborative structures, transparent communication, and flexibility integral to leading organizational change. Further, resilience, robustness, and antifragility provide theoretical constructs through which to consider change processes, providing music therapy professionals with the opportunity to consider core leadership, teamwork, and organizational characteristics essential to music therapy teams.

Receptive Music Therapy for Patients Receiving Mechanical Ventilation in the Intensive Care Unit.

BACKGROUND: Live music therapy provided by a board-certified music therapist reduces anxiety, decreases pain, and improves the physiological response of patients in the intensive care unit (ICU). OBJECTIVES: To examine the effect of live music therapy on the physiological parameters and pain and agitation levels of adult ICU patients receiving mechanical ventilation. METHODS: A total of 118 patients were randomly assigned to live music therapy or standard care. The music therapy group received 30 minutes of live music therapy tailored to each patient's needs. The Richmond Agitation-Sedation Scale and the Critical Care Pain Observation Tool were completed by critical care nurses immediately before and after each session, and the patients' heart rates, respiratory rates, and oxygenation levels were measured. RESULTS: Patients who received live music therapy had significantly different scores on the Richmond Agitation-Sedation Scale (P < .001) and the Critical Care Pain Observation Tool (odds ratio, 6.02; P = .002) compared with the standard care group. Significant differences between groups were also reported in heart rate (P < .001). No significant differences were found in oxygen values. CONCLUSIONS: Live music therapy significantly reduced agitation and heart rate in adult patients receiving mechanical ventilation in the ICU. These findings provide further evidence for the benefits of music therapy in the ICU, including in intubated patients.

Impact of an Active Music Therapy Intervention on Intensive Care Patients.

BACKGROUND: Nonpharmacological interventions appear to benefit many patients and do not have the side effects commonly associated with medications. Music-based experiences may benefit critical care patients. OBJECTIVE: To examine the effect of an active music therapy intervention on physiological parameters and self-reported pain and anxiety levels of patients in the intensive care unit. METHODS: A study was conducted using a pretest-posttest, within-subject, single-group design. The study population consisted of a convenience sample of 52 patients. Study participants received a 30-minute music therapy session consisting of either a relaxation intervention or a "song choice" intervention. The music therapist recorded the patients' vital signs before and after the intervention, and patients completed self-assessments of their pain and anxiety levels before and after the intervention. RESULTS: After the intervention, significant decreases (all P < .001) were found in respiratory rate (mean difference, 3.7 [95% CI, 2.6-4.7] breaths per minute), heart rate (5.9 [4.0-7.8] beats per minute), and self-reported pain (1.2 [0.8-1.6] points) and anxiety levels (2.7 [2.2-3.3] points). No significant change in oxygen saturation level was observed. Outcomes differed between the 2 intervention groups: patients receiving the relaxation intervention often fell asleep. CONCLUSIONS: The results of this study support active music therapy as a nonpharmacological intervention in intensive care units. This study may lay the groundwork for future research on music therapy in critical care units using larger, more diverse samples.

Differences between Supportive Music and Imagery and Music Listening during Outpatient Chemotherapy and Potential Moderators of Treatment Effects.

BACKGROUND: Supportive music and imagery and music listening interventions have been effective in decreasing distress and improving mood in cancer patients receiving chemotherapy, but it is unclear whether the two interventions differ in their treatment benefits. Furthermore, previous studies have not examined moderators to determine which subgroup(s) of patients may benefit most from each intervention. OBJECTIVE: To examine the effects of supportive music and imagery compared with preferred music listening on responsiveness to music therapy, distress, anxiety and depression, and benefit finding. A secondary purpose was to explore sense of coherence and locus of control as potential moderators of intervention effectiveness. METHODS: A single-session, two-group comparative effectiveness randomized trial in two cancer centers. Patients were randomized to supportive music and imagery or preferred music listening during outpatient chemotherapy treatment. Data were collected at baseline and immediately after the 45-minute session. ANCOVA models were used to determine main effects of intervention as well as pairing potential moderators with group assignment to explore differences in intervention effects by moderator. RESULTS: There were differential effects between the two interventions with the supportive music and imagery group scoring higher in responsiveness to music therapy and benefit finding. The music listening group scores indicated lower distress. The exploratory moderating analyses suggested Health Locus of Control-Internal and Sense of Coherence influenced intervention effectiveness. CONCLUSIONS: Music and imagery and preferred music listening experiences may serve different therapeutic purposes, access and activate different patient resources, and may be helpful at different stages of treatment.

Core Themes in Music Therapy Clinical Improvisation: An Arts-Informed Qualitative Research Synthesis.

BACKGROUND: Although clinical improvisation continues to be an important focus of music therapy research and practice, less attention has been given to integrating qualitative research in this area. As a result, this knowledge base tends to be contained within specific areas of practice rather than integrated across practices and approaches. OBJECTIVE: This qualitative research synthesis profiles, integrates, and re-presents qualitative research focused on the ways music therapists and clients engage in, and make meaning from, clinical improvisation. Further, as a conduit for broadening dialogues, opening up this landscape fully, and sharing our response to the analysis and interpretation process, we present an arts-informed re-presentation of this synthesis. METHODS: Following an eight-step methodological sequence, 13 qualitative studies were synthesized. This included reciprocal and refutational processes associated with synthesizing the primary studies, and additional steps associated with an arts-informed representation. FINDINGS: Three themes, professional artistry, performing self, and meaning-making, are presented. Each theme is explored and exemplified through the selected articles, and discussed within a larger theoretical framework. An artistic re-presentation of the data is also presented. CONCLUSIONS: Music therapists use complex frameworks through which to engage clients in, and make meaning from, improvisational experiences. Artistic representation of the findings offers an added dimension to the synthesis process, challenging our understanding of representation, and thereby advancing synthesis methodology.

Measuring Supportive Music and Imagery Interventions: The Development of the Music Therapy Self-Rating Scale.

BACKGROUND: Previous research has demonstrated modest benefits from music-based interventions, specifically music and imagery interventions, during cancer care. However, little attention has been paid to measuring the benefits of music-based interventions using measurement instruments specifically designed to account for the multidimensional nature of music-imagery experiences. OBJECTIVE: The purpose of this study was to describe the development of, and psychometrically evaluate, the Music Therapy Self-Rating Scale (MTSRS) as a measure for cancer patients engaged in supportive music and imagery interventions. METHODS: An exploratory factor analysis using baseline data from 76 patients who consented to participate in a music-based intervention study during chemotherapy. RESULTS: Factor analysis of 14 items revealed four domains: Awareness of Body, Emotionally Focused, Personal Resources, and Treatment Specific. Internal reliability was excellent (Cronbach alphas ranging from 0.75 to 0.88) and construct and divergent-discriminant validity supported. CONCLUSIONS: The MTSRS is a psychometrically sound, brief instrument that captures essential elements of patient experience during music and imagery interventions.