Dissertation Index

Author: Van Colle, S. J.

Title: Music therapy process with young people who have severe and multiple disabilities

Institution: University of Reading

Begun: April 1988

Completed: January 2003


This research was inspired by the responses of children with cerebral palsy and severe and multiple disabilities during music therapy at the Cheyne Hospital for Spastic Children, London, 1985-1986. These responses were surprisingly full of life, optimism and awareness. They prompted the writer to investigate her work in the hope of finding some explanation.

A detailed description was made of the processes of interactive music therapy with two groups each of four children who were described as having cerebral palsy and severe and multiple disabilities. The writer's interest was that of a developmental music therapist. The sessions took place over one academic year and were video-taped. Two early and two late sessions were transcribed, first as a written musical score with coded observables, then distilled into a computer file as a list of timed events.

The study was qualitative and quantitative. Descriptions and interpretations were made of selected portions, and corroborative evidence of the findings sought by performing analyses of the event list. In relation to the enormity and complexity of the data gathered, this study has only explored a fraction of the possibilities.

There were two major aims: (1) to investigate the hypothesis that the role of the music therapist is like that of the 'good-enough mother' as described by D. W. Winnicott (2) to generate some broad guidelines of music therapy.

Three main questions were addressed:
(1) Did the children take more part in music therapy sessions over a period of time?
(2) When did the major child-therapist interactions occur?
(3) When the music therapist focused on an individual child how could it be known that the child was aware of this attention?

The study showed that the children responded to music therapy and had some expectation of how the music 'worked'. For example, some beat on the downbeat, pitched in the therapist's tonality and followed V7-I shifts. One child sang four notes of a scale.

There was every indication that children with severe and multiple disabilities possessed and used a musical understanding which enabled them to connect and relate to the therapist.


Chapter 1 Music Therapy: Introduction and Broad Historical Overview
1.1 A Background to Music Theray
1.2 The Legacy of the Greeks
1.3 The Transitional Period
1.4 Music Therapy in the Middle Ages: Religion and Magic
1.5 The Renaissance and Musical Harmony
1.6 Views of Other Cultures
1.7 Music Therapy in Victorian Britain
1.8 The Development of the Music Therapy Profession
1.9 Difficulty in Defining Music Therapy
1.10 Current Trends in Music Therapy Practice
1.11 The Research of Fenwick and Robertson
1.12 Conclusions
Chapter 2 Music Therapy Research in Great Britain
2.1 Foundations of British Research
2.2 The Shape of British Research
2.3 The Writer's Research Position
2.4 Conclusion
Chapter 3 Intervals and the Piano
3.1 Introduction
3.2 The Piano as One of Many Instruments in Music Therapy
3.3 Fundamental Properties of the Piano and their Value to the Music
3.4 The Psychological Relationship Between Therapist and Piano
Chapter 4 Donald W. Winnicott
4.1 Introduction
4.2 Towards Sharing the External World
4.3 Environmental Provision
4.4 Early Psychic Functioning
4.5 Conclusion
Chapter 5 Mother-Infant Relationship: A Model for the
Therapist-Client Relationship?
5.1 Introduction
5.2 Ethology
5.3 Development of the Mother-Infant Relationship
5.4 The Basic Structure
5.5 The Basic Structure and the Good-Enough Mother
5.6 The Writer's Philosophical Position
5.7 Conclusion
Chapter 6 Research Methods
6.1 Introduction
6.2 Orientation
6.3 Description of Cerebral Palsy
6.4 Augmentative and Alternative Communication
6.5 The Writer's Clinical Technique
6.6 Design of Study: Development
Chapter 7 Measures of Behaviours
7.1 Introduction
7.2 Choice of Sessions
7.3 Choice of Observables
7.4 The Number of Observables
7.5 Reliability Test
7.6 Rating Scales
7.7 Definitions of Observables
7.8 Overview of Catalogue of Observables
Chapter 8 Descriptive Analysis of Observables
8.1 Introduction
8.2 Frequency of Observables
8.3 Duration of Observables
8.4 Children's Observables of the Head
8.5 Children's Observables of the Arms and Torso
8.6 Children's Observables of the Legs and Feet
8.7 Children's Observables and BAR
8.8 Children's Vocalisations
8.9 Therapist's Visibles
8.10 Therapist's Audibles
8.11 Helper Observables
Chapter 9 Rare Events and Change Events
9.1 Introduction
9.2 Rare Events
9.3 Discussion of Rare Events
9.4 Change Events
9.5 Summary of Change Events
9.6 Conclusions
Chapter 10 Therapist's Time-Signature Change
10.1 Introduction
10.2 Background to Episode
10.3 Comments on Background
10.4 Conclusion
10.5 Description of Episode
10.6 Comments on Episode
10.7 Conclusion
Chapter 11 Mahmoud's Vocalisation
11.1 Introduction
11.2 Background to Episode
11.3 Comments on Background
11.4 Conclusion
11.5 Description of Episode
11.6 Comments on Episode
11.7 Conclusion
Chapter 12 Making Music with an Instrument
12.1 Introduction
12.2 Background to Episode
12.3 Comments on Background
12.4 Conclusion
12.5 Description of Episode
12.6 Comments on Episode
12.7 Conclusion
Chapter 13 Barnaby's Imitative Behaviour
13.1 Introduction
13.2 Background to Episode
13.3 Comments on Background
13.4 Conclusion
13.5 Description of Episode
13.6 Comments on Episode
13.7 Conclusion
Chapter 14 Christopher's Smile
14.1 Introduction
14.2 Background to Episode
14.3 Comments on Background
14.4 Conclusion
14.5 Description of Episode
14.6 Comments on Episode
14.7 Conclusion
Chapter 15 Teachers' Ratings
15.1 Introduction
15.2 Changes in Ratings across each Session
15.3 Mean and Standard Deviation of Change Scores
15.4 Student's t-Test
15.5 Discussion
Chapter 16 Examining the Process of Music Therapy
16.1 Introduction
16.2 Short-Term Sequential Analysis
16.3 Long-term Sequential Analysis
16.4 Analysis of Observables on the Downbeat
16.5 The Basic Structure and Child-Therapist Relationship
16.6 The Three Research Questions
16.7 Music Therapy Guidelines
16.8 Ways in which the Research could have been Improved
16.9 Conclusions
Appendix A Themes of the Basic Structure
Appendix B Consent Form
Appendix C Register of Attendance
Appendix D Detailed Definitions of Observable Codes
Appendix E The Event List: Format and Sample
E.1 Event List Format
E.2 Sample Excerpt
Appendix F Reliability Test Results (Kappa)
Appendix G Observable Occurrence Totals
Appendix H Descriptions of Rare Events
Appendix I Descriptions of Change Events
Appendix J Transcriptions
Appendix K Teachers' Ratings
Appendix L Short Term Sequential Analysis Results
Appendix M Long Term Sequential Analysis Results
Appendix N Methods of Data Analysis
N.1 Reliability Test (Kappa)
N.2 Co-Occurrence Analysis and Long-Term Sequential Analysis
N.3 Short Term Sequential Analysis
N.4 'Downbeat' Analysis


Email: suevancolle@sjvc.co.uk

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