M.A. (Social Work) / The primary aim of this study is to explore the use of music as an aid in the Social Work profession in South Africa with reference to other disciplines. In order to achieve this aim the following objectives were used: (i) To compare a literature study on the historic development of the use of music as an aid in rendering help; (ii) To investigate the nature and extent of training in the use of music therapy; (iii) To investigate the extent to which music as a tool is utilized by music therapists; and (iv) To suggest ways in which music as a therapeutic tool can be utilized in Social Work.

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A dissertation submitted to the Faculty of Humanities, University of the Witwatersrand, Johannesburg, in fulfilment of the requirements for a Masters degree with the Faculty of Humanities (Health Communication and Music). Johannesburg, May 2017 / This dissertation synthesises the fields of narrative medicine and music composition to address the experience of delirium, and to learn whether music has a role to play in understanding and communicating its nature. My submission takes the form of a written dissertation accompanied by a new musical composition, Delirium Part II. Both written and composed texts are based on interviews and small discussion groups with people who have experienced delirium, their families, and healthcare professionals who are familiar with delirium in people under their care – as well as observation and recording from a hospital intensive care unit (ICU). The composition incorporates both interviews and ambient hospital sounds as audio components, and was performed first on 2 March 2017 at the Music Room, University Corner, University of the Witwatersrand. The study addresses significant gaps in our understanding of delirium, from its definition to the qualities of the experience for all those affected by it. Violence is shown to be inherent to the experience, driven by a cycle that imposes it by turns on HCPs and patients. Delirium is, moreover, characterised by losses of numerous kinds: orientation, dignity, control, and ultimately personhood. This study suggests, however, that it is within our grasp to limit significantly the impacts of these losses through re-evaluating our interactions with patients and families and challenging the dehumanising aspects of care. The music of Delirium Part II, moreover, is shown to have the capacity to contribute to this re-evaluation. There are clear indications here of the potential for music and the arts more broadly to convey complex health experiences, and to be of use in training and education. Music contributes centrally to the development of this research, as a tool both for data analysis and for provoking discussion of a complex, emotive topic. The possibilities for creative practice in narrative medicine are illuminated by this cross-disciplinary study, which demonstrates both that narrative-based musical composition can teach us much about delirium; and that delirium can teach us much about care. / MT2018

Objetivo: El objetivo de este estudio fue determinar la influencia de la música en la reducción del miedo en pacientes de 6 a 10 años durante su primera cita odontológica en el Centro universitario de salud de la Universidad Peruana de Ciencias Aplicadas (UPC). Materiales y métodos: El presente estudio es de tipo ensayo clínico aleatorizado y ciego simple. La muestra se constituyó por 24 pacientes pediátricos, entre 6 y 10 años que sea su primera atención dental y visita al Centro universitario de salud UPC. El número de participantes se determinó mediante el programa estadístico OpenEpi versión 3, utilizando la fórmula de comparación de medias, para lo cual se tomaron los datos de medias y desviación estándar de una investigación previa. Se utilizó la Escala de evaluación del miedo dental en niños (CFSS-DF) antes y después de la atención de cada paciente. Se dividió la muestra en 2 grupos, un grupo con intervención música y el otro fue un grupo control. Ambos fueron evaluados en una sola cita. Resultados: Se encontró diferencia significativa en la reducción del miedo, según la escala utilizada, entre el grupo experimental y el grupo control. Conclusión: La música utilizada tiene influencia en la reducción del miedo y contribuye a mejorar el manejo de conducta del paciente durante la cita odontológica. / Tesis

Background: Acute inpatient stays are decreasing. Evidence for music therapy in mental healthcare exists but practice varies. Short admissions and therapy frequency (usually weekly), limit access, yet acceptability of increased frequency to patients is unknown. Research to model processes and outcomes of intensive provision may identify how best to provide for acute contexts informing clinical practice and future research. Methods: 114 patients admitted to hospital with acute mental health problems were recruited. Patients attended group music therapy 1-3 times per week during admission. Repeated measures assessing patient experiences, session appraisal, motivation and commitment were completed. Questionnaire thematic analysis identified important processes which were coded from session recordings. Multilevel modelling was used to examine associations between music therapy components, session appraisal, motivation, commitment and subsequent attendance. End of therapy interviews with 16 patients explored changes experienced and views on therapy frequency. Results: Attendance was 3 times greater for patients with 3 sessions per week. The majority found increased frequency acceptable and beneficial. Processes of engagement, emotional expression and social connection suggested active music-making, synchrony and singing to be important for group cohesion. Singing was significantly associated with appraisal and motivation. Musical initiation by group members was associated with motivation and commitment. All three outcomes were associated with each other, with session appraisal and increased frequency independently associated with subsequent attendance. Patient attributions for change included creativity, experiential learning and therapist directed reflective discussions. Conclusion: Intensive group music therapy is acceptable to the majority of patients, perceived as beneficial and increases access. Intensive provision is associated with greater engagement and positive experiences, which in turn, are associated with group commitment. Patient experiences can inform practice. Further research should examine effectiveness of intensive provision. Therapists should continue to prioritise engagement through active music-making and singing, and services consider implementation of intensive provision.

The overarching purpose of the study was to explore how music interventions, including spoken communication can be effectively facilitated with older adults with hearing loss. Specifically, aspects of the listener, auditory input, environmental factors, and non-auditory information that could be modified within the context of music therapy sessions to enhance music and speech perception were explored. A modified sequential exploratory mixed methods design (Qual->Quan+Quan) was used to address the research questions. The first phase of the study consisted of a one-time large group interview with audiologists to elicit an open discussion related to three questions: (a) What do music therapists need to know about hearing loss and assistive listening devices to effectively design and implement music therapy interventions for older adults with hearing loss? (b) What environmental considerations and modifications can be used to enhance successful communication and music listening in individual and group settings? and, (c) Are there strategies for supporting effective hearing and listening by older adults that could be applied to the context of music therapy? Data were gathered through written responses from the interview participants as well as notes taken by the moderator and a non-participant observer. Thematic analysis revealed the general categories of “areas of therapist knowledge,” “maximizing individual interactions,” and “improving access to communication.” From the initial phase of the study, a conceptual framework was identified to guide the parallel second and third phases to specifically investigate two forms of music stimuli. Phase II of the study included the creation of standardized recordings of 24 musical instruments to answer the question, How do musical instruments commonly used by music therapists with older adults interface with common configurations of hearing loss? The spectral analysis from each instrument was then applied to a series of audiograms to facilitate the comparison of each instrument’s spectral properties with common hearing loss profiles to determine potential audibility. Phase III consisted of a single-group, repeated measures design to investigate sung sentence recognition and the potential benefit derived from the inclusion of non-auditory information to facilitate top-down processing. For the purposes of this study, the Sung Sentence Recognition Test was developed to measure sentence recognition under three presentation conditions: sung with guitar accompaniment (SU-G), sung with guitar accompaniment and contextual cues (SU-G+C), and sung with guitar accompaniment and visual cues (SU-G+V). A total of 24 bilateral hearing aid users between the ages of 60 and 79 participated in Phase III. Results indicated that the presence of non-auditory information, in the form of contextual or visual cues, was beneficial for all listeners with a greater degree of benefit derived from visual cues. In addition, Phase III affirmed that listener characteristics such as music training also play a role in determining success. Clinical implications in the form of general strategies as well as recommendations matched with the auditory perceptual requirements of specific music interventions are proposed integrating the results from each of the three phases in this study.

Music therapists are expected to provide live music for clients with diverse preferences, yet these therapists face many barriers preventing them from recreating client-preferred music in a way that adheres to the expectations of the genre, or with “musical authenticity.” The purpose of this study was to investigate music therapists’ perceptions and practices regarding musical authenticity. Survey responses (n = 904) indicated that music therapists highly value musical authenticity, but a major theme in the qualitative data revealed they often balance its importance with other factors. Descriptive survey data and qualitative themes revealed lack of training in functional musicianship and electronic technology as major barriers to musical authenticity. A major qualitative theme regarding therapists’ practices was the use of collaboration with clients and creative solutions. Most participants indicated use of non-electronic strategies and reported they had not used electronic technology to increase musical authenticity. Descriptive survey data and qualitative themes revealed frequent and effective use of recorded music. Finally, chi-square analyses revealed significant relationships between age and use of technology and iPad and between gender and use of technology. Music therapists would benefit from additional training, more research on authenticity, and music therapy specific guidelines for using music authentically.

The purpose of this study was to gain a better understanding of music therapy among the elderly. This qualitative study utilized interviews as a means to extract themes from the experiences of music therapists who have provided music therapy to the elderly. Results were transcribed to written form. Qualitative analysis procedures were followed to identify themes and subthemes. Areas of particular interest to the social work profession were the emotional, social, physical, and mental benefits and challenges of music therapy among the elderly. Through the guidance of systems theory and the concept of holism, spiritual benefits and challenges were also introduced.

This study examined the use of music as an intervention tool with primary school aged children with Specific Language Impairment, specifically in the linguistic areas of semantics, pragmatics and oral narrative. As teachers and speech pathologists have the most professional contact with children with language impairment, they would benefit from access to suitable music activities. As it cannot be assumed that they have musical training, activities must be designed to be easy to use and adapt. The main aims of the study were (1) to determine whether a range of music activities designed to teach specific language skills were suitable for language intervention programmes, and (2) to ascertain the extent to which teachers and speech pathologists could use these activities (and similar activities) in language intervention. A preliminary survey of Grade Two teachers in Language Development Centres (LDCs) in Perth, Western Australia provided the basis for specific skills to be targeted. Music activities were designed and implemented with a Grade Two class in a Language Development Centre. Four of the students were selected as case studies in order to evaluate the impact of the activities. The classroom teacher was also studied as a case example to determine the usefulness of the activities for professionals with no musical training. Additionally, surveys of teachers in LDCs and speech pathologists (both public facilities and private practice) working with children in the Perth metropolitan region were conducted. Evaluations by the researcher, classroom teacher, a speech pathologist and the four student case studies indicated that the activities designed in this study addressed the specific language goals appropriately, were suitable for use with groups, and that the students were learning and developing the targeted language skills. In addition, the activities were suitable for use by professionals with little musical background, and were perceived by the teacher to be adaptable for different skill levels and age groups. This suggests that music can be effectively used in semantic, pragmatic and oral narrative intervention for primary school aged children with specific language impairment.

This study compared the impact of instructional and improvisational music therapy approaches on the level of motor impulsivity displayed by adolescent boys who have Attention Deficit Hyperactivity Disorder (ADHD). Measures included numbers of errors made on a Synchronised Tapping Task (STT); and Conners' Rating Scales (Conners, 1997). Participants (n=13), aged 11 - 16 years, were enrolled in a special residential school. A combination of a multiple contrasting treatment and an experimental control group design was used. Students were randomised to three groups; control (Group A) and two treatment groups. Students in Group B received eight sessions of improvisational music therapy followed by eight sessions of instructional music therapy, while the order was reversed for Group C.There was no statistical difference between the impacts of the contrasting music therapy approaches on the level of motor impulsivity displayed by the students as measured by the STT and the Restless-Impulsive and Hyperactive-Impulsive Conners' subscales. However all students significantly improved on the STT across each phase of treatment and improvement was slightly greater during the instructional treatment periods for both groups. During these same periods teachers reported a small decrease in restless and impulsive behaviours. The results therefore cautiously imply that the instructional approach might contribute to a reduction in motor impulsivity in the classroom.Significant improvement on STT without the corresponding improvement in motor impulsivity suggested that increased accuracy on the STT might be attributable to progress in other developmental domains. Teacher report of significant improvement for treatment groups on the DSM-IV Total Subscale adds weight to this suggestion, and implies that combined music therapy approaches might have contributed to a reduction in DSM-IV symptomology in the classroom.Rickson's (2001) tentative suggestion that creative music-making might over-arouse students with ADHD was not confirmed. Students did make more errors when tested on the STT a second time on the same day but this was regardless of whether they had been involved in instructional, improvisational or no music therapy programme. It is possible that students who have ADHD are easily aroused by the general school milieu and classroom or music room interactions with peers.