Barbara Wheeler Oxford Handbook

Music Therapy Research: An Overview
Oxford Handbooks Online

Barbara L. Wheeler
The Oxford Handbook of Music Therapy
Edited by Jane Edwards
Print Publication Date: Jan 2016

Subject: Psychology, Counseling Psychology, Clinical Psychology
Online Publication Date: May 2015 DOI: 10.1093/oxfordhb/9780199639755.013.11
Abstract and Keywords
Music therapy is a diverse field and music therapy research increasingly reflects that
diversity. Many methods and approaches are used to examine the various facets of music
therapy practice and theory. This chapter provides an overview of music therapy
research, and provides basic information about how research is conducted in this field.
Research methods in music therapy research are similar to those used in other healthcare
disciplines. A range of methods are reviewed and presented including; experimental
research and Randomized Controlled Trials, Participatory Action Research, Grounded
Theory, and Phenomenological methods.
Keywords: music therapy, music therapy research, research methods in music therapy, music therapy evidence,
medical music therapy
MUSIC therapy is a diverse field and music therapy research increasingly reflects that
diversity. Many methods and approaches are used to examine the various facets of music
therapy practice and theory. This chapter provides an overview of music therapy
research, and provides basic information about how research is conducted in this field.
Music therapy research is similar to research in other disciplines, but it has some unique
aspects. It has the same definition and purposes, as described below, and most of the
research methods that are employed are similar to those in other fields of health
research. The focus on music is distinctive from most other types of health research.
When the music, the therapist, and the client are included in the research process and
outcomes a unique perspective is gained.
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Definition of research
Bruscia (1995b) has defined research as “a systematic, self-monitored inquiry which leads
to a discovery or new insight which, when documented and disseminated, contributes to
or modifies existing knowledge or practice” (p. 21). Gfeller (1995) described research as
“a disciplined or systematic inquiry” (p. 29). She has also pointed to the importance of the
definition proposed by Phelps et al. (2005) that research is “a carefully organized
procedure that can result in the discovery of new knowledge, the substantiation of
previously held concepts, the rejection of false tenets, and the formal presentation of data
collected” (p. 3).
Questions and types of research

Research comes from the questions of the researcher or research team. Once the
question is developed and refined a research method or approach is chosen because of its
suitability (p. 721) to answer the question. While some people begin their research with a
particular research method in mind, it is more usual to begin with the question and to let
the question determine the method. Some basic examples of questions that lead to
research designs are presented here.
Quantitative research
Descriptive
We might ask, “How does X influence our client during the process of therapy?” where X
could be variations in the tempo, volume, tonality, or another aspect of an improvisation;
type of instrument used; or things that are happening in the client’s life outside of music
therapy. Examples of descriptive research in music therapy could include studies that are
based on surveys and questionnaires, single subject designs that rely on numerical data
to determine the results, and studies of groups of people that use quantitative measures
of outcomes but do not include a control group for comparison.
Experimental Research
We might ask, “Does X treatment work better than Y treatment?” X and Y could be music
therapy and movement therapy or music therapy in combination with physical therapy
versus music therapy alone. In experimental research, two or more treatment conditions
are compared and participants are randomly assigned to conditions so that no variables
outside of those that are being tested vary among conditions. Although it is not possible
to achieve strict control outside of a laboratory, these designs do as much as possible to
control all factors. These are standard experimental designs that answer questions about
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the effectiveness of music therapy and are often requested by those who determine what
therapy should be supported or paid for.
Qualitative research
In qualitative research, we might ask, “What do clients experience in music therapy?”

Qualitative research examines how phenomena are experienced and constructed through
description, analysis, and interpretation. It relies upon words, music, sounds, or pictures
to report the results and can help us learn more about aspects of the therapeutic setting.
Qualitative research encompasses a wide range of methods, some of which grew out of
phenomenology, existentialism, and hermeneutics in the social sciences. It looks for
meaning and understanding and allows phenomena to unfold over time.
Examples of music therapy research

The following sections provide an overview of music therapy research with reference to a
variety of methods. Examples have been selected to represent good research using each
(p. 722) design, and encompassing a variety of topics. Although most studies are selected
to represent a single method, studies can frequently employ several methods.
Quantitative research
Experimental research, including randomized control trials; exploratory trials; meta-

analysis; survey research; quantitative single-case designs, including applied behavior
analysis; and longitudinal research are examples of quantitative research and will be
discussed here.
Experimental research/randomized control trials

A number of randomized control trials are currently available on various aspects of music
therapy. The Journal of Music Therapy and the Nordic Journal of Music Therapy require
authors to follow the CONSORT (Consolidated Standards of Reporting Trials) Statement
(Schulz et al. 2010), which provides guidelines for reporting randomized control trials
(RCTs) and insures that the reported information is transparent. In a RCT, participants
are randomly assigned to conditions, with random assignment meaning that each person
has an equal opportunity of being assigned to each condition. This controls for
confounding variables by insuring that the conditions or groups are equivalent.
Examples of RCTs include two studies by Ghetti. In one (Ghetti 2011), of active music
engagement with emotional-approach coping to improve well-being in liver and kidney
transplant recipients, she evaluated the impact of music therapy under two conditions to
which the patients were randomly assigned. One group received music therapy with an
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emphasis on emotional-approach coping, which uses emotional expression, awareness,

and understanding to facilitate coping with significant life stressors, and the other group
received music therapy without the emphasis on emotional-approach coping. In another
RCT, Ghetti (2013) evaluated the use of music therapy emphasizing emotional-approach
coping on preprocedural anxiety in adults receiving cardiac catheterization. Another RCT
by Gattino et al. (2011) examined the effects of relational music therapy plus routine
clinical activities compared with routine clinical activities alone on communication of
children with autism.
Exploratory trials or studies

Exploratory trials (Medical Research Council 2000) or exploratory studies allow the
researcher to gather information on how an intervention works but without including
random assignment to conditions. Some of these, sometimes called quasi-experimental
designs (Shadish et al. 2002), are similar to experimental designs such as the RCT but
participants are not randomly assigned to groups.
One example is a study by Bensimon and Gilboa (2010), who studied Musical Presentation
(MP), a therapeutic tool in which members of a group present themselves through
musical pieces of their choice in and receive feedback from their peers, with the aim of
increasing their sense of purpose in life and self-consciousness. Rather than randomly
assigning (p. 723) participants to experimental and control groups, the researchers
assigned them to the groups based on the times at which they were available.
Nayak et al. (2000) investigated the use of music therapy as an aid in improving mood
and social interaction among people who have had traumatic brain injuries or strokes.
Although the original intention was to randomly assign participants to the different
groups that included an experimental group who received music therapy, a control group
who received art therapy, and a control group receiving standard care, this goal was not
achieved due to problems finding enough participants who met the criteria and were
willing to participate. The completed study compared music therapy to standard
treatment, but the condition to which participants were assigned was based on their
availability rather than random assignment. Without randomization of participants the
study design is considered to be much weaker because of the risk of bias.
In another type of exploratory study, data are collected but there is no control condition.
The information gathered can help to determine whether the intervention can be carried
out as planned. Studies of this type are often shared in professional journals. It is
important that those writing them make it clear that, because they do not include any
type of control, it is impossible to say what caused the effects that are seen. These studies
are similar if not identical to what many clinicians do when they collect data on their
work about how their clients respond or change during and after therapy. It is important
for those involved with these designs to be aware of the limitations of such designs, and
also to consider the similarities with data collected in regular clinical work.
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Two studies of the Sing and Grow program for young children and their parents in
Australia used pre-experimental designs. Nicholson et al. (2008) assessed the impact of a
10-week program for marginalized parents and their children in promoting positive
parenting and child development. Williams et al. (2012) explored the impact on parental
well-being, parenting behaviors, and child development for parents of children with
disabilities and their children. Another example is of a music therapy program for women
coping with breast cancer (Wheeler et al. 2010), while a fourth is the evaluation of a
music therapy protocol to enhance swallowing training for people who have had strokes
and have dysphagia (Kim 2010). In all four studies, data were gathered on targeted
responses at several points and an evaluation of changes was made, but none of them
included a control group. The findings of such studies can be used to develop more robust
experimental procedures for future studies.
Meta-analysis
In a meta-analysis the researcher calculates a standard effect size1 for each study, giving
an indication of the size and variability of the phenomenon under investigation and
allowing the studies to then be compared among themselves across all measures and
variables. Meta-analyses have provided important information on the efficacy of music
and music therapy in medicine. Standley (2000) conducted the first of these in 1986 and
subsequently updated it several times. Standley (2002) later performed meta-analyses on
the effectiveness of music therapy with premature infants in neonatal intensive care units
and of music versus no music conditions during medical treatment of pediatric patients
(Standley and Whipple 2003).
Dileo and Bradt (2005) completed a meta-analysis of 184 studies involving music
(p. 724)
in medical treatment. They included all studies that had been conducted with a control
group that did not receive music. They included 47 dependent variables. The effects of
music and music therapy were reported for each dependent variable, grouped according
to 11 medical specialty areas: premature infants, fetal responses to music, pediatrics,
obstetrics/gynecology, cardiology/intensive care, oncology and terminal illness, general
hospital, surgery, rehabilitation, dementia, and dentistry.
Additional meta-analyses that have been conducted include an analysis of music

education and music therapy objectives (Standley 1996), dementia (Koger et al. 1999),
symptoms of psychosis (Silverman 2003), children and adolescents with autism (Whipple
2004), children and adolescents with psychopathology (Gold et al. 2004), stress reduction
(Pelletier 2004), neurologic rehabilitation of upper and lower limbs (Chandra 2005),
endoscopy procedures (Rudin et al. 2007), and several aspects of the treatment of people
with Parkinson’s disease (de Dreu et al. 2012). Meta-analyses are also part of some
Cochrane reviews, discussed elsewhere in this chapter.
Survey research
Survey research refers to:
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the selection of a relatively large sample of people from a pre-determined

population (the “population of interest”; this is the wider group of people in whom
the researcher is interested in a particular study), followed by the collection of a
relatively small amount of date from those individuals. The researcher therefore
uses information from a sample of individuals to make some inference about the
wider population.
Kelley et al. 2003
Wigram (2005) divided music therapy survey research into three categories: (a) surveys
of journals, (b) clinical surveys, and (c) surveys of training methods.
Surveys of journals, books, and other printed of web-based texts categorize the research
and other articles according to the purpose of the survey. They can alert the profession to
strengths and weaknesses, provide insight into where the research is happening, and
determine how research is divided among clinical fields. Recent examples of this type of
survey research include an analysis of music therapy journal articles by Brooks (2003)
and analyses by Aigen of journals and books (2008a) and dissertations (2008b). Roberts
and McFerran (2008) utilized both quantitative and qualitative methods for a content
analysis of how music therapy was reported in Australian print media over a 10-year
period.
Clinical surveys consider aspects of clinical practice, attitudes from both professionals
and clients, and information about where people work. Examples include such diverse
topics as: a survey of the use of aided augmentative and alternative communication
during music therapy sessions with persons with autism spectrum disorders (Gadberry
2011); a survey of repertoire and music therapy approaches employed by Australian
music therapists in working with older adults from culturally and linguistically diverse
groups (Baker and Grocke 2009); and a survey of the expectations of cancer and cardiac
hospitalized cancer and cardiac patients regarding the medical and psychotherapeutic
benefits of music therapy (Bruscia et al. 2009). In an extension of traditional survey
methods, Vega (2010) surveyed music therapists and also gave them a personality test
and a test of burnout to examine (p. 725) possible relationships between personality,
burnout level, longevity, and demographic variables among professional music therapists.
Surveys of training methods seek to learn more about music therapy practice, the
experiences and attitudes of music therapy students, to assess the effectiveness of
clinical training, and to explore competency requirements for music therapists.
Researchers have sought information on a variety of topics. Stewart (2000) surveyed
music therapists from the United Kingdom to assess personal qualities of music
therapists, working models, support networks, and job satisfaction. Young (2009)
surveyed music therapy internship directors to examine the extent to which multicultural
issues were being addressed in internships in the United States and Canada; Gardstrom
and Jackson (2011) surveyed music therapy program coordinators for information on
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personal therapy for undergraduate students; and Hahna and Schwantes (2011) surveyed
music therapy educators regarding their views and use of feminist pedagogy and feminist
music therapy.
Quantitative single-case designs and applied behavior analysis

Yin (2009) defines a case study as “an empirical inquiry that investigates a contemporary
phenomenon in depth and within its real-life context, especially when the boundaries
between phenomenon and context are not clearly evident” (p. 18). Smeijsters (2005)
developed music therapy applications of case studies as single-case designs. Examples of
quantitative single-case designs include a study of a preschooler with vision impairment
in which the authors looked at the child’s participation through several different
playground adaptations that include musical stations and staff interactions (Kern and
Wolery 2001); an examination of how girls with Rett syndrome make song choices
(Elefant 2002, 2005); and a study of the emotional development of a client as reflected in
improvisations (Smeijsters 2005; Wosch and Frommer 2002). Each of these studies used
evaluation measurements and either a single case or a series of single cases to gather
information.
Applied behavior analysis (Hanser 2005) can be considered a type of single-case design
that includes specific designs and techniques, including reversal and multiple baseline
designs. These designs are applied in behavioral research to test a hypothesis about the
behavior of a single individual or group, examine the effect of a particular strategy, or
examine intra-subject changes over time under different conditions. Wlodarczyk (2007)
used a reversal design to examine the effect of music therapy on the spirituality of people
in an in-patient hospice unit. Using a multiple baseline design, de Mers et al. (2009)
looked at the effects of music therapy on challenging behaviors of young children in a
special education setting. These designs have been used frequently in music therapy, as
evidenced by Gregory’s (2002) finding of 96 examples of this design in an analysis of four
decades of the Journal of Music Therapy.
Longitudinal research
Longitudinal research provides information over a period of time (Ledger and Baker,
2005). According to Menard (2002), longitudinal research is when: (a) data are collected
for each individual unit for two or more distinct time periods; (b) the units are the same
from one time period to the next; and (c) the analysis of collected data involves some
comparison of data between or among time periods. The most commonly used
longitudinal designs (p. 726) are: (a) repeated cross-sectional studies what are carried out
regularly, each time using a different sample (or primarily different sample); (b)
prospective (panel) studies that collect information from the same people repeatedly over
a period of time (the preferred type); and (c) retrospective studies in which people are
asked to remember and reconstruct events and aspects of their lives (Ruspini 2002).
Several methods may be combined.
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An example of a longitudinal study in music therapy is Ledger and Baker’s (2007)

investigation of the long-term effects of group music therapy on agitation levels of
nursing home residents with Alzheimer’s disease. They tested residents at five time
points over a year. Although they found short-term reductions in agitation for those who
received weekly music therapy sessions, these positive effects did not continue over the
year. Another example is Dingle et al.’s (2013) exploration of the personal experiences of
choir members with various mental, physical, and intellectual disabilities in relation to
their wellbeing using the interpretative phenomenological analysis method developed by
Smith (2004). Interviews with participants occurred at the inception of the choir, after six
months, and after 12 months. This study is an example of a longitudinal study employing
a qualitative research method.
Mixed methods research
Mixed methods research uses a range of research methods. This allows diverse
perspectives, methods, and data to generate the information that is desired (Bradt et al.
2013b; Creswell and Clark 2011). These methods are relatively new and in their very
early stages of development and expertise in music therapy research. Issues in combining
methods occur on pragmatic and philosophical/paradigmatic levels and are the subject of
numerous discussions and debates (K. Bruscia, personal communication, June 26, 2012;
Johnson and Onwuegbuzie 2004; Teddlie and Tashakkori 2003).
Examples of mixed methods research in music therapy include a study by Grocke et al.
(2009) in which they studied the effect of group music therapy on quality of life and social
anxiety for people who had a severe and enduring mental illness. Quantitative data were
gathered through several scales that measured the dependent variables, and qualitative
data were gathered through focus group interviews and an analysis of lyric themes. Barry
et al. (2010) studied the effects of creating a music CD on pediatric oncology patients’
distress and coping during their initial radiation therapy treatment. They collected
numeric and textual data for quantitative and qualitative analyses. Ridder (2005; Ridder
and Aldridge 2005) combined quantitative (including physiological measurements) and
qualitative approaches, using therapeutic singing, in case studies of individuals with
frontotemporal dementia.
Qualitative research
Qualitative research is a broad term used to describe:
the varieties of social inquiry that have their intellectual roots in hermeneutics,
phenomenological sociology, and the Verstehen tradition. Many scholars use the
phrase qualitative inquiry as a blanket designation for all forms of social inquiry
that rely primarily on qualitative data (p. 727) (i.e. data in the form of words)… To
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call a research activity qualitative inquiry may broadly mean that it aims at
understanding the meaning of human action
Schwandt 2007, pp. 247–248.
Tesch (1990) listed 46 terms used to describe different types of research that is broadly
considered as qualitative research in the social sciences. The terms include: action
research, case study, clinical research, collaborative inquiry, content analysis, dialogical
research, conversation analysis, Delphi study, descriptive research, discourse analysis,
ecological psychology, ethnography, ethnomethodology, experiential psychology, field
study, focus group research, grounded theory, hermeneutics, heuristic research, holistic
ethnography, imaginal psychology, interpretive interactionism, life history study,
naturalistic inquiry, oral history, participant observation, phenomenography,
phenomenology, qualitative evaluation, symbolic interactionism, and transcendental
realism (p. 58).
Interest in qualitative research in music therapy began in the mid-1980s, when some
music therapists started to consider the limitations of quantitative research in capturing
important aspects of the music therapy experience (Wheeler and Kenny, 2005). All around
the world music therapists started to explore the use of qualitative methods in their
research. In the US, Aigen (1991) set the stage for the consideration of qualitative inquiry
by music therapists in his doctoral dissertation, The Roots of Music Therapy: Towards an
Indigenous Research Paradigm, as he considered historical influences on music therapy
research from the philosophy and theory of science and critiqued what he called the
received view from a position of process, clinical realities, creativity, and research
methodologies (Wheeler and Kenny 2005). In Australia in the early 1990s, O’Callaghan
was researching the experience of palliative care patients using grounded theory method
and content analysis by examining the text of their songs created in music therapy
(O’Callaghan 1996). Earlier in the US, Forinash (1992) used phenomenology to consider
the experience of improvisation in Nordoff-Robbins music therapy sessions. In Germany
at the same time Langenberg (Langenberg et al. 1992) and her colleagues used
hermeneutic inquiry to understand which aspects of the therapeutic process were helpful
for the client. The First International Symposium for Qualitative Research in Music
Therapy was held in 1994, offering music therapists who were using qualitative methods
in their research an opportunity to share and collaborate (Langenberg et al. 1996). This
symposium was followed by similar gatherings, continuing until 2007.
Since the mid-1990s the number of qualitative studies has increased (see Aigen 2008a,b).
This chapter will focus on some of the qualitative research methods that have been used
by music therapists.
Many qualitative studies use naturalistic inquiry (Aigen 2005; Ely et al. 1991; Lincoln and
Guba 1985), with the research being carried out in the settings that researchers want to
understand, with the researcher’s self experience and observation as the primary vehicle
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for data-gathering and analysis. Although naturalistic inquiry is sometimes considered to

be a type of qualitative research (Aigen 2005), it is regarded in this chapter as a way of
approaching the research and gathering information/data.
Phenomenological inquiry
Phenomenology is defined as: “A philosophy or method of inquiry based on the premise
that reality consists of objects and events as they are perceived or understood in human
(p. 728) consciousness and not of anything independent of human
consciousness” (American Heritage Dictionary 2000/2009). Forinash and Grocke (2005)

stated that “phenomenologists examine what is called the lived experience. This refers to
experiences that we, as humans, have in relation to any event that we experience” (p.
321). Phenomenological inquiry is a frequently used method for music therapy
researchers, probably because many of the questions of interest to music therapists are
about people’s experiences. Reflexive phenomenology is a term used by Colaizzi (Tesch
1990) for a form of phenomenology where the researcher uses his or her own experience
as data. This is contrasted with empirical phenomenology, where data are gathered from
others.
Examples of phenomenological inquiry in music therapy include Comeau’s (2004)

examination of how music therapists experienced times of being effective and ineffective
in their work; Cooper’s (2010) study of clinical-musical responses of Nordoff-Robbins
music therapists during the process of clinical improvisation, which had a similar topic
and some similar methods to an earlier phenomenological study of the lived experience of
clinical improvisation by Nordoff-Robbins music therapists (Forinash 1992); and
Gardstrom’s (2004) study using descriptive phenomenology, as well as hermeneutic
inquiry, to explore the experience of clinical improvisation with troubled adolescents.
Hermeneutic inquiry
Hermeneutics refers to the “art, theory, and philosophy of interpreting the meaning of an
object” (Schwandt 2001, p. 115). The hermeneutic circle involves a constant analytic
movement between the phenomena of interest and the structures (theories) developed in
order to better understand the phenomenon. Theories are therefore tentative and
evaluated against the data, further refined, and then reapplied to the data. The goal of
hermeneutic research is to engage deeply in the circle of understanding in order to
develop insightful and plausible interpretations of events.
Langenberg and her colleagues (Langenberg 1988; Langenberg et al. 1992, 1993)
developed a psycho-analytically based method using what is called the resonator function
to help observers gain access to the hidden meaning of an improvisation through a series
of steps in which they listen to and respond to an improvisation by a client. Their system
involves having a number of observers listen to a recording of a music therapy session
and write down descriptions of the improvisation. They then follow a number of steps to
compare and interpret the information and, finally, analyze the results in a process of
hermeneutic circling in relation to clinical data from the client’s case history.
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Rolvsjord (2007, 2010) applied hermeneutic research to her study of a resource-oriented

approach to music therapy, which intends to amplify the client’s strengths rather than to
focus on reparation of symptoms or difficulties. Rolvsjord states:
According to the hermeneutic research tradition, understanding is arrived at

through a process of dialogue between the researchers horizon and the texts that
are studied. In my study, understanding and knowledge were generated through a
similar reflexive and dialogical process between the empirical data and theory.
This strategy for discovery has been labeled [by Alvesson and Sköldberg 2000]
abduction.
Rolvsjord 2007, p. 50
(p. 729)Others who have used hermeneutic inquiry in music therapy research include
Bonde (2005), who employed a hermeneutic framework for understanding Bonny Method
of Guided Imagery and Music (BMGIM) sessions; Gardstrom (2004), who used
phenomenological and hermeneutic inquiry to investigate meaning in clinical music
improvisation with troubled adolescents; Luce (2008), who studied music therapy
students’ epistemological development and how that influences their education and
clinical training; and Jackson (2010), who explored responses to client anger in music
therapy by examining cases, as units of data, through a process of hermeneutic
phenomenological reflection.
Grounded theory
Grounded theory is defined as:
a general approach of comparative analysis linked with data collection that uses a
systematically applied set of methods to generate an inductive theory about a
substantive area with the purpose of discovering theory from data. The researcher
focuses on one area of study, gathers data from a variety of sources, and analyzes
the data using coding and theoretical sampling procedure.
Amir 2005
O’Callaghan (2012) presents a number of considerations and applications of grounded

theory in music therapy.
Examples of grounded theory studies in music therapy include numerous studies by

O’Callaghan, including one of the perceptions of a Chinese music therapy educator and
students’ perceptions of their music project’s relevance for Sichuan earthquake survivors
(Gao et al. 2013); another on the effect of music therapy on oncologic staff bystanders
(O’Callaghan and Magill 2009); and one of the relevance of music for pediatric cancer
patients (O’Callaghan et al. 2011). Amir (1996; see also Amir 1992) studied how music
therapists and music therapy clients experienced meaningful moments in the music
therapy process; while a study by Bonde (2007) in which he used a grounded theory
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procedure to investigate how cancer survivors described the experience and perceived
outcome of therapy using BMGIM.
First-person research
First-person research is defined by Bruscia (2005b) as “any method in which researchers
or participants gather data from themselves, using processes such as introspection,
retrospection, self-perception, self-observation, self-reflection, self-inquiry, and so
forth” (p. 379). One of the most well known types of first-person research is heuristic
research (Moustakas 1990), in which a person studies his or her own responses as a way
of understanding a phenomena. Bruscia suggests that the following situations may occur
in first-person research: the researcher studies self, the researcher studies self and
participants, participants study themselves, and co-researchers study themselves.
Examples of first-person research include a study by Bruscia (1995a) of his shifts in

awareness/consciousness as he guided a Guided Imagery with Music (GIM) session and a
study by Wheeler (1999) of the various sources of pleasure experienced in working with
children (p. 730) with severe disabilities. The study of flute improvising by Schenstead
(2012), described as a heuristic arts-based self-study (under arts-based research, below),
is also an example of first-person research.
Participatory action research

Participatory action research is defined by Stige (2005b) as “… situated research
advocating the primacy of the voices and goals of the participants themselves.” Stige lists
four of the dimensions central to this tradition: (a) active lay participation in the research
process; (b) empowerment of participants and sociocultural change as part of the
research agenda; (c) linkage of theory, practice, and research; and (d) application of a
broad conception of knowledge when evaluating research processes and outcomes.
Baines (2000) reported on a pilot study for a program to “develop a cost effective group
music therapy program that prioritized the requests of the consumers as the process for
development, thereby readily incorporating consumer concerns and hopefully meeting
consumer needs” (p. 54). A survey to assess the program was jointly developed by staff
and consumers (clients), thus incorporating elements of participatory action research. A
later report (Baines and Danko 2010) provided follow-up survey data supplemented by
information from interviews with consumers.
Elefant’s (2010) research suggests the importance of considering empowerment and

social change when designing research so as not to risk ignoring critical voices among
participants and thus contributing to preserving the status quo. The participatory action
research project, with individuals who were part of a choir for people with severe
physical disabilities, was a way of helping them to make their voices heard.
There are varied examples of action or participatory action research in the music therapy
literature. One is Stige’s (2002, Chapter 4) research with Upbeat, a group of people with
mental challenges who were involved in a collaborative process to develop a more
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inclusive life in the community. Another is by Baker (2007), who used action research to
evaluate a problem-based learning activity with students who were doing their first year
of clinical training, emphasizing developing clinical reasoning skills. McFerran and Hunt
(2008) used an action research process in a program to help adolescents cope with grief
and loss in several situations. Rickson (2009) worked collaboratively with team members
to facilitate their use of music with children who have special education needs and
included action research in her consulting.
Ethnography and ethnographically informed research

Stige (2005a) stated: “Ethnography may be understood as a scholarly approach to the
study of culture as lived, experienced, and expressed by a person or a group of
people” (p. 392). There is an increasing amount of ethnographically informed research in
music therapy.
Ledger (2010a) conducted an ethnographic study of service development in a health care

organization. The ethnographic work revealed the inherent complexity of the researcher
roles as she shifted between the identities of researcher, therapist, friend, and student
while doing this research (Ledger 2010b).
Most of the case studies in the book about Community Music Therapy, Where Music
Helps (Stige et al. 2010), are ethnographically informed music therapy research exploring
how the effects of music and musicking are linked to human interaction in context.
Ansdell (2010) (p. 731) explored what happens with a group of people in West London
who get together to create and perform music. Pavlicevic (2010) documented the rich
ethnographic context in and around a children’s choir in South Africa. Stige (2010)
studied participation in a festival that was started by music therapists several decades
ago. In each of these cases, the researcher employed ethnographic research methods to
study the people, the events, and the process of collaborative music making.
Arts-based research
Austin and Forinash (2005) have defined arts-based inquiry as “a research method in
which the arts play a primary role in any or all of the steps of the research method. Art
forms such as poetry, music, visual art, drama, and dance are essential to the research
process itself and central in formulating the research question, generating data,
analyzing data, and presenting the research results” (p. 458). Only a small number of
arts-based research studies have been done in music therapy. Ledger and Edwards (2011)
reviewed the arts based research conducted in music therapy and queried why music
therapists have not engaged more enthusiastically in arts-based research. They suggested
that music therapy researchers may be reluctant to adopt arts-based research practices
due to a desire to insure that music therapy research is accepted as scientific and
scholarly among other health care research. They also wondered whether music
therapists may have used arts creation within their research approaches but have not
highlighted this for various reasons, some of which might be related to the quest for
recognition as a scientific and scholarly discipline.
Page 13 of 35

Schenstead (2012) conducted a heuristic arts-based self-study through which she took an
in-depth look at the intricacies of the personal improvisational process using her primary
instrument, the flute. She improvised on stories and poetry that she had written and
wrote about her experiences in a journal that became the main source of data. The
journal was analyzed using an arts-based method and the findings took on the form of a
performance piece in which she perform the stages of my process using a synthesis of
poetry, artwork, music, and personal reflections. A final meta-reflection of the entire
project presents a philosophy explaining the dynamics of the intrapersonal relationship.
Vaillancourt (2009, 2011) used arts-based research to create an apprenticeship music

therapy model. In the first phase of the research, a research group met for five sessions,
using “discussions, instrumental and vocal improvizations, adapted group sessions of the
Bonny Method of Guided Imagery and Music (BMGIM), mandala drawing, collective and
individual writing, and poetry” to deepen their reflections on their mentoring needs. In
the second phase, Vaillancourt used a phenomenological approach to investigate the
lifeworlds of the participants regarding their work together, using the artistic data from
the previous work together to structure the interview questions. The results of the study,
the emerging themes and essences of the participants’ experiences, were reported
through narratives and music, art, and poetry.
Evidence-based practice and music therapy

Evidence-based practice (EBP) is defined as “conscientious, explicit, and judicious use of
current best evidence in making decisions about care of individual patients. The practice
of (p. 732) evidence-based medicine means integrating individual clinical expertise with
the best available external clinical evidence from systematic research” (Sackett et al.
1996, p. 71). EBP represents the combined use of (a) systematic reviews of the scientific
literature, (b) practitioner experience and opinion, and (c) patient/client preferences and
values for making clinical decisions and treatment/intervention planning.
EBP has received increased attention in music therapy as it has become apparent that by
meeting the standards of EBP music therapy increases the opportunity to be accepted
and funded. This is not without controversy and the issues surrounding the
implementation of the evidence-based approach to music therapy have been elaborated
(Abrams 2010; Edwards 2005b) The Cochrane Library and Cochrane reviews are an
important source of information on EBP, and a number of Cochrane reviews have been
done in music therapy, with the largest number in recent years.
The Cochrane Database of Systematic Reviews (<www.cochrane.org>) includes

numerous reviews of various health care interventions. Cochrane reviews have been
undertaken on music therapy for people with acquired brain injury (Bradt et al. 2010b),
autistism spectrum disorder (Geretsegger et al. 2014), dementia (Vink et al. 2013),
depression (Maratos et al. 2008), end-of-life care (Bradt and Dileo 2010), and for
Page 14 of 35

schizophrenia and schizophrenia-like disorders (Mössler et al. 2011); music during

Caeserian section (Laopaiboon et al. 2009), for mechanically ventilated patients (Bradt et
al. 2010a), improving psychological and physical outcomes in cancer patients (Bradt et al.
2011), preoperative anxiety (Bradt et al. 2013a), and stress and anxiety reduction in
coronary heart disease (Bradt and Dileo 2009); and for singing for children and adults
with cystic fibrosis (Irons et al. 2010).
Other types of research
Research on music
Bonde (2005) suggests that researching music includes “any method within music
therapy in which researchers gather data concerning the relationship between music—
improvised or composed, recorded or performed live—and client experiences and
behavior” (p. 489) and that “the focus may be on material properties of music (stimulus
or effect); on intentional properties of music (description, analysis, and interpretation of
meaning); or on musical processes (interactions and relationships)” (p. 489). These may
include studies of nonmusical or musical responses.
Studies that focuses on nonmusical responses include one by Elefant (2002, 2005), who
used a single case multiple baseline, time series, within-subjects design to investigate
whether songs in music therapy intervention could enhance the communication skills of
seven girls with Rett syndrome. Ridder’s research (2005; Ridder and Aldridge 2005)
studied the use of therapeutic singing with individuals with frontotemporal dementia.
This is presented under mixed methods research. They also viewed nonmusical
responses, as do the examples of RCTs by Ghetti (2011; 2013) and Gattino et al. (2011);
the exploratory studies by Bensimon and Gilboa (2010); Nayak et al. (2000); Williams et
al. (2012); Wheeler et al. (2010); and Kim (2010) among others. The fact that so many
examples of research on nonmusical responses have been presented in this chapter
highlights that a great deal of music therapy research has focused on nonmusical
responses or outcomes by music therapists.
There are also numerous examples of research on musical responses. The work
(p. 733)
on the resonator function, described under hermeneutic inquiry (Langenberg 1988;

Langenberg et al. 1992, 1993), helped observers gain access to the hidden meaning of an
improvisation. Bergstrøm-Nielsen (1993, 1999, 2010) developed a graphic notation as a
tool for music therapists in notating and analyzing improvisations. Turry (2010) analyzed
the relationship between words and music in clinically improvised songs with a woman
with whom he had music therapy sessions for a number of years. Additional studies of
musical responses that have been cited earlier in this chapter are by Cooper (2010),
Forinash (1992), and Gardstrom (2004).
Historical research
Page 15 of 35

Historical research is defined as “the systematic study of the past practices, materials,
institutions, and people involved in therapeutic applications of music” (Solomon and
Heller 1982). Historical research is a way of preserving the history of music therapy that
people in the future will know of what led to that point. Historical research topics cover a
wide range.
Several studies of music therapy pioneers, including Ira Maximillian Altshuler (Davis
2003), Willem van de Wall (Clair and Heller 1989), and James Leonard Corning (Davis
2012), have been published. Historical uses of music in hospitals, and the development of
the profession of music therapy for hospital patients has been researched (e.g. Edwards
2007, 2008; Taylor 1981). Reschke-Hernández (2011) examined the history of music
therapy treatment interventions for children with autism.
Kim (2009) conducted an “Historical Investigation Regarding the Perception of Music

Therapy Among Korean Medical Professionals as Seen in Medical Journal Articles,” which
combines historical research with survey methods. In a narrative inquiry, Hadley (2001)
explored connections between historical information and other aspects of Mary
Priestley’s life and work. She conducted a similar study of the life of Clive Robbins
(Hadley 2003).
Page 16 of 35

Philosophical inquiry and theory development

Bruscia (2005a) has said that a “theory is way of thinking about what we do or what we
know” (p. 540) and that philosophy and theory “have the same aim: understanding.”
Bruscia also suggested that “they relate to practice and research in the same way” and
that “both involve thinking activities, such as reflection, reasoning, criticism, speculation,
and intuition” (p. 541).
Theory development has always been a part of the research work in music therapy. Sears
(1968) suggested three processes in music therapy: experience within structure,
experience in self-organization, and experience in relating to others, still provides a basis
for the thinking of many about what music therapy does. Kenny (1989, 2006) organized
her ideas into a formal theory and found a language to reflect her understanding of the
music therapy process in what she termed The Field of Play.
Music therapy theory has continued to develop. Working to develop theory for the music
therapy as procedural support for invasive medical procedures, Ghetti (2012) used
qualitative document analysis to examine the literature in this field. She integrated
findings from 19 primary sources to formulate a theoretically grounded working model.
Robb (2012) suggests that music therapy research is moving from being outcomes-based
to theory-based and that (p. 734) the attention that is now being paid to theory “offers
one way to advance our understanding of the complex interactions between music,
clients, and the education or health care environment” (p. 5).
In adaptations of theoretical research, Hadley (1999) compared philosophical premises

underlying two approaches to music therapy, Creative Music Therapy, developed by
Nordoff and Robbins (2007), and Analytical Music Therapy, developed by Priestley (1994).
Mössler (2011) combined the development of theory and historical research as she
examined the influence of theory construction on the formation of professional identity as
it occurs in the Viennese School of Music Therapy.
Abrams (2011) has proposed that music is a temporal-aesthetic way of being. He

proposed that music can be conceptualized as a phenomenon that transcends the
concrete, physical medium of sound. In Abrams’s theory, while music may be expressed
through sound, its essence is located in the ways that human thought, feeling, and action
unfold aesthetically in time, allowing the music in music therapy to be not merely a
means for promoting non-musical health but also a particular dimension of human health
itself, manifesting as the temporal-aesthetic component of each health domain typically
targeted within music therapy work.
Research publications
Eight music therapy journals are published regularly in English, many by music therapy
associations of their countries, and include varying amounts of research. In order of the
dates on which they commenced publication (and which are listed), they are: Journal of
Page 17 of 35

Music Therapy 1964 (US); Canadian Journal of Music Therapy 1973; Music Therapy
Perspectives 1982 (US); British Journal of Music Therapy 1987; Australian Journal of
Music Therapy 1990; Nordic Journal of Music Therapy 1992 (representing all of the
Nordic countries and now an international journal); New Zealand Journal of Music
Therapy 1994; and Voices: A Worldwide Forum for Music Therapy 2001 (on-line:
<www.voices.no>).
In addition to these journals published in English, the German journal,

Musiktherapeutische Umshcau, has been published since 1980 and plays an important
role in the development of German music therapy and thus music therapy internationally.
Music Therapy: Journal of the American Association for Music Therapy was published
from 1981–1996. The Arts in Psychotherapy, an international journal that covers all of the
arts therapies, has been in publication since 1973, and includes a substantial amount of
music therapy research. The Journal of the Association of Music and Imagery (AMI),
published since 1992, focuses on the Bonny Method of Guided Imagery and Music
(BMGIM), which is closely related to music therapy. Music and Medicine: An
Interdisciplinary Journal, published since 2009, includes current practices of music and
medicine, including music therapy. Finally, many music therapy studies are published in
journals of related disciplines.
Several people have reviewed music therapy research in the past decade, primarily
through analyses of journal articles. Brooks (2003) examined 1521 articles from nine
music therapy journals over a 37-year period, looking for trends and types of article and
comparing them across journals. She tallied the numbers of research articles classified in
the categories of quantitative, qualitative, clinical, historical, philosophical/theoretical,
and professional.2 (p. 735) The number of articles published in each of these journals is,
of course, related to the length of time that the journal has been published and the
number of issues a year. Brooks found quantitative research articles to be the
predominant category across all journals, with 542 articles. She found 55 historical
articles and 136 philosophical/theoretical articles.
Edwards (2005a) reviewed eight journals for content and trends, and also examined the
number of articles from one journal that were referenced in other journals. This was in
order to reveal the extent to which music therapists showed awareness of each others
work across the international community. To examine how many articles from one journal
were cited by authors writing in other journals, she reviewed papers from the Journal of
Music Therapy (JMT) from 1964–2003 and the British Journal of Music Therapy (BJMT)
from 1995–2003. She found no papers from either the New Zealand Journal of Music
Therapy or the Canadian Journal of Music Therapy to have been cited in JMT during the
publication period reviewed. Citations from the BJMT appeared in eight papers in JMT,
five of which were authored by music therapists from countries outside the United States.
The lack of awareness and citation of authors from other countries is a concern for the
internationalization of the discipline of music therapy.
Page 18 of 35

Aigen examined qualitative articles and chapters (2008a) and qualitative dissertations
(2008b) published from 1987–2006. He found 92 articles and book chapters, 55 doctoral
studies, and six books to have been published during that period. In the period from
1987–1990, two articles and chapters and two dissertations (or doctoral theses) were
published; from 1991–1994, five articles and chapters and seven dissertations; from
1995–1998, 20 articles and chapters and seven dissertations; from 1999–2002, 31 articles
and chapters and 13 dissertations; and from 2003–2006, 34 articles and chapters and 23
dissertations. This clearly represents a large increase in qualitative research in music
therapy, beginning in the mid-1990s.
Issues and problems
As music therapists work to meet the demands of evidence-based practice, making it

clear that RCTs need to be conducted to determine the efficacy of music therapy, there is
much discussion about several areas. One of these is whether too much emphasis is being
placed on RCTs. Many music therapists feel that the work that they do cannot be
adequately investigated using RCTs and other quantitative approaches. Edwards (2005b)
indicated some of these concerns and the ways they can be addresses in medical music
therapy, and her suggestions can apply beyond medical areas. Bradt (2012) has
emphasized that RCTs are not the only type of investigation that should be done about
music therapy processes and outcomes. She wrote, “It is of great importance to the field
of music therapy that multiple types of evidence contribute to its knowledge base and
that the dialogue of clinical effectiveness is not dominated by the biomedical hierarchical
model of evidence-based practice (EBP) in which meta-analytic reviews and randomized
controlled trials reign” (p. 121).
Another discussion is about how well the requirements for rigorous control in conducting
RCTs can match with what actually occurs in a music therapy session. As Bradt (2012)
says, “One of the major concerns expressed by music therapists about the use of RCTs is
the claim that the treatments used in RCTs suffer so severely from the required
standardization (p. 736) that they become irrelevant to clinical practice” (p. 136). One
way to address this concern is to use a treatment manual, which contains guidelines for
the treatment approach being investigated but does not provide a rigid set of procedures
to use. Rolvsjord et al. (2005), who developed a manual for an RCT investigating resource
oriented music therapy, say:
Our pragmatic solution… has been to produce a manual with open descriptions of
principles that emphasize contextual and collaborative aspects. The manual thus
focuses upon underlying assumptions and values informing a contextual approach
to resource-oriented music therapy, rather than describing specific actions,
techniques, or procedures. In this way we hope to have avoided that the
manualization should limit the possibilities for each therapeutic process to be
Page 19 of 35

tailored to match the individual client. We also think that the principles, if
practiced with competence and not only adherence, have left enough space for the
collaborative therapeutic process to develop relatively freely.
(p. 28)
Another issue is the quality of music therapy research. As research has been reviewed for
Cochrane Reviews and the quality evaluated on a number of criteria, it has become
apparent that many music therapy studies are not of high enough quality to be included.
Bradt (2012) said, “Reviews of the music therapy research literature indicate a need for
increased scientific rigor in the design and conduct of RCTs” (p. 146). “It is important
that music therapists contributing to our evidence base through RCT research are
prepared to design trials that meet current methodological standards and, equally
important, are able to respond appropriately to those design aspects (e.g. blinding of the
participants) that are not feasible in music therapy research” (p. 121).
The positive side of this is that it providing guidance for music therapy researchers in
raising the quality of the studies, leading to more studies that meet criteria for inclusion.
This applies primarily to RCTs, and it seems that the number of RCTs about music therapy
research is increasing.
Another problem in experimental research in music therapy is enrolling enough

participants for the research study, which generally requires a certain number of
participants who meet the inclusion criteria for the study. Since many music therapy
procedures require multiple sessions, the number of available participants can be further
limited. One of the solutions for this problem is for researchers from several facilities to
collaborate so that the research includes participants from several institutions. This was
done, for example, in two hospitals with a study of the effects of music therapy for mood
disturbance during hospitalization for autologous stem cell transplantation (Cassileth et
al. 2003), a multi-site study of the effects of parent-preferred melodies and entrained live
rhythm and breath sounds on babies in neonatal intensive care units (Loewy et al. 2013),
and a multi-site study of the effects of active music engagement on children with cancer
(Robb et al. 2008) as well as a more recent study further investigating a therapeutic
music video intervention (Robb et al. 2014). Increasing international cooperation is
making international multi-site studies possible, as exemplified by a study of
improvisational music therapy’s effectiveness for children with autism spectrum
disorders that aims to enroll 300 participants recruited from nine different countries
(Geretsegger et al. 2012; International Standard Randomized Controlled Trial Number
Register 2013) and one of individual music therapy for mental health care clients with
low therapy motivation that enrolled 144 adults from three countries (Gold et al. 2013).
Challenges to music therapy research that are not specific to RCTs have to do
(p. 737)
with whether music therapy clinicians and others use the research that has been done.
This has been an ongoing challenge for music therapy research (see Wheeler 2005, p. 6).
Waldon (2015) surveyed US music therapists for information on the extent to which they
engage in research-related activities or whether they perceive barriers to integrating
Page 20 of 35

research into clinical. He found differences in how research is utilized as well as

perceived barriers between music therapist whose primary job role is research and those
in clinical positions. He says that “this suggests a divide between those generating
knowledge about the profession (researchers and academicians) and those responsible
for delivering treatment (clincians). Furthermore, reported utilization varies as a function
of work setting (e.g. between rehabilitation/medical settings and others)” (p. 1). There
are also questions about how qualitative research, an important portion of current music
therapy research, is related to the demands of evidence-based practice. One way that this
is being addressed is through synthesis of qualitative research, which combines and
integrates qualitative research that addresses a similar topic, question or population
(Hannes and Lockwood 2012; Sandelowski and Barroso 2007).
Along with the challenges confronting music therapy research and researchers, there is a
great deal of development and extension work that builds the profession and increases
our knowledge within the profession as well as our visibility to others. Music therapy
research draws from various traditions of inquiry, selecting the method as relevant to the
questions being asked, and doing it with increasingly high quality. All of this brings music
therapy closer to achieving an integral connection between theory, clinical practice, and
research that Gaston (1968) suggested should form a tripod, each necessary in order for
the other to stand.
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Notes:
(1.) An effect size is the difference between means in standardized units, or the number
of standard deviations by which the means differ.
(2.) Since the focus of this chapter is music therapy research, clinical and professional
articles are not included in this summary, although they were part of Brooks’ (2003)
analysis.
Barbara L. Wheeler
Professor Barbara Wheeler, Professor Emerita, Montclair State University, USA
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Music Therapy Research: An Overview

Oxford Handbooks Online

Print Publication Date: Jan 2016

Abstract and Keywords

Subscriber: University of Warwick; date: 23 April 2018

Questions and types of research

Subscriber: University of Warwick; date: 23 April 2018

In qualitative research, we might ask, “What do clients experience in music therapy?”

Examples of music therapy research

to represent a single method, studies can frequently employ several methods.

Experimental research, including randomized control trials; exploratory trials; meta-

Experimental research/randomized control trials

Subscriber: University of Warwick; date: 23 April 2018

emphasis on emotional-approach coping, which uses emotional expression, awareness,

Exploratory trials or studies

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Additional meta-analyses that have been conducted include an analysis of music

Subscriber: University of Warwick; date: 23 April 2018

the selection of a relatively large sample of people from a pre-determined

Kelley et al. 2003

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Quantitative single-case designs and applied behavior analysis

Subscriber: University of Warwick; date: 23 April 2018

An example of a longitudinal study in music therapy is Ledger and Baker’s (2007)

Mixed methods research

Qualitative research is a broad term used to describe:

Subscriber: University of Warwick; date: 23 April 2018

Schwandt 2007, pp. 247–248.

Subscriber: University of Warwick; date: 23 April 2018

for data-gathering and analysis. Although naturalistic inquiry is sometimes considered to

consciousness” (American Heritage Dictionary 2000/2009). Forinash and Grocke (2005)

Examples of phenomenological inquiry in music therapy include Comeau’s (2004)

Subscriber: University of Warwick; date: 23 April 2018

Rolvsjord (2007, 2010) applied hermeneutic research to her study of a resource-oriented

According to the hermeneutic research tradition, understanding is arrived at

O’Callaghan (2012) presents a number of considerations and applications of grounded

Examples of grounded theory studies in music therapy include numerous studies by

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Examples of first-person research include a study by Bruscia (1995a) of his shifts in

Participatory action research

Elefant’s (2010) research suggests the importance of considering empowerment and

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Ethnography and ethnographically informed research

Ledger (2010a) conducted an ethnographic study of service development in a health care

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Vaillancourt (2009, 2011) used arts-based research to create an apprenticeship music

Evidence-based practice and music therapy

The Cochrane Database of Systematic Reviews (<www.cochrane.org>) includes

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schizophrenia and schizophrenia-like disorders (Mössler et al. 2011); music during

Other types of research

on the resonator function, described under hermeneutic inquiry (Langenberg 1988;

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Kim (2009) conducted an “Historical Investigation Regarding the Perception of Music

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Philosophical inquiry and theory development

In adaptations of theoretical research, Hadley (1999) compared philosophical premises

Abrams (2011) has proposed that music is a temporal-aesthetic way of being. He

Subscriber: University of Warwick; date: 23 April 2018

In addition to these journals published in English, the German journal,

Subscriber: University of Warwick; date: 23 April 2018

Issues and problems

As music therapists work to meet the demands of evidence-based practice, making it

Subscriber: University of Warwick; date: 23 April 2018