Flower, C. (2014) Music Therapy Trios with Child, Parent and Therapist: A Preliminary Qualitative Single Case Study. Psychology of Music, 42(6), 839-845

Abstract

Abstract
There is an increasing body of literature within music therapy that describes the possible benefits
of parental involvement in music therapy sessions with a child. This article describes a preliminary
study into existing music therapy practice in this area within an NHS Child Development Service. The
qualitative study, using video elicitation interviews, investigates a single music therapy trio of child,
parent and therapist, exploring the ways in which the parent and therapist describe their experiences
of music therapy. A thematic analysis of the interview data demonstrates that the music therapy trio
of child, parent, and therapist, is experienced by the parent and therapist as a fluid, dynamic web of
musical and interpersonal relationships, rather than a fixed entity. Within this emergent network,
individuals, pairs and the triad itself assume greater or lesser significance at different points.

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DOI: 10.1177/0305735614547065
2014 42: 839Psychology of Music
Claire Flower
case study
Music therapy trios with child, parent and therapist: A preliminary qualitative single
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Psychology of Music
2014, Vol. 42(6) 839 –845
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DOI: 10.1177/0305735614547065
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Music therapy trios with
child, parent and therapist:
A preliminary qualitative
single case study
Claire Flower
Abstract
There is an increasing body of literature within music therapy that describes the possible benefits
of parental involvement in music therapy sessions with a child. This article describes a preliminary
study into existing music therapy practice in this area within an NHS Child Development Service. The
qualitative study, using video elicitation interviews, investigates a single music therapy trio of child,
parent and therapist, exploring the ways in which the parent and therapist describe their experiences
of music therapy. A thematic analysis of the interview data demonstrates that the music therapy trio
of child, parent, and therapist, is experienced by the parent and therapist as a fluid, dynamic web of
musical and interpersonal relationships, rather than a fixed entity. Within this emergent network,
individuals, pairs and the triad itself assume greater or lesser significance at different points.
Keywords
children, music therapy, parental involvement, video elicitation interviews
Recently, there has been an increasing interest in music therapy practice involving children and
their parents (Edwards, 2011; Oldfield & Flower, 2008). Research studies have suggested ben-
efits of parental involvement on developmental outcomes for the child (Walworth, 2009;
Williams, Berthelsen, Nicholson, Walker, & Abad, 2012) and in supporting the parent–child
relationship (Pasiali, 2012; Thompson & McFerran, 2013; for specific contexts see also
Haslbeck, 2013; Lindenfelser, Hense, & McFerran, 2011; Malloch et al., 2012).
This study emerges from the context of a music therapy department within a National
Health Service (NHS) Child Development Centre. Children of pre-school age, or those with
Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
Corresponding author:
Claire Flower, Music Therapy Service, Cheyne Child Development Service, Chelsea and Westminster Hospital NHS
Foundation Trust, 369, Fulham Road, London SW10 9NH, UK.
Email: claire.flower@chelwest.nhs.uk
This paper was written on the basis of a poster that was presented at the inaugural Nordoff Robbins Plus Research
Conference “Music and Communication: Music Therapy and Music Psychology.”
547065POM0010.1177/0305735614547065Psychology of MusicFlower
research-article2014
Perspectives on Music and Communication, Short Paper
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840 Psychology of Music 42(6)
particularly complex physical or communication needs, often attend music therapy with a
parent or carer in order to enable the child’s optimal involvement in movement and com-
munication. Accounts of music therapy practice also suggest that parental involvement
allows parents to experience their child, and their relationship with them, in positive or
unexpected ways (Flower, 2008; Jones & Oldfield, 1999). As a practitioner, I became inter-
ested in the music therapy “trio” formed by the child, parent and therapist, aware of the
complexity of musical and relational processes within such trios, and curious about how
such trios worked.
My identity as a practitioner shaped my approach as researcher. I was interested in exploring
practice in this setting, considering what participants of such a trio “do”, and how they describe
their experiences (Aigen, 1993). My experience suggested that each member of the trio, three
different individuals with their own backgrounds and perspectives, would experience music
therapy differently, and so within the study I acknowledge the multiple perspectives which
might emerge and thus contribute to an understanding of the trio (Aigen, 2005). To avoid play-
ing multiple roles within the study, I recruited a colleague whose work could be the focus of the
investigation. This had the additional benefit of including the wider team in the whole project.
Given this background, I formulated two primary research questions and, in this article, I
focus on the first:
1. How do a parent and therapist describe the experience of music therapy for a child when
a parent is also present?
2. How can an analysis of musical processes and structures within the trio contribute to a
greater understanding of the phenomenon of the child, parent, therapist trio?
Methods
An idiographic approach, based on a single trio, offered the best “fit” for this qualitative pilot
study. The in-depth exploratory analysis of the experiences of the participants, in which the
particularity of the trio might be reflected, would, it was hoped, allow initial themes to emerge
that would be of value in themselves, but also point towards areas of interest for further study
(Ansdell & Pavlicevic, 2010).
The trio recruited to the study included a 3-year-old child, with a diagnosis of global devel-
opmental delay. He had attended two courses of music therapy, lasting 10 and 6 weeks, respec-
tively, with the same therapist at the music therapy clinic. His mother attended each session
with him. (All names have been changed in order to protect confidentiality.)
The focus on everyday practice informed the choice of research tools used (Wheeler, 2005).
Video recordings are routinely made of music therapy sessions within the service and used as a
basis for discussion between therapists and parents. I, therefore, used an existing video of a
music therapy session involving the recruited trio which provided the framework for the
research interview, using a video elicitation model (Henry & Fetters, 2012).
Henry and Fetters describe video elicitation interviews as a useful qualitative method for
understanding interactions between, primarily, health professionals and patients. Interviews
entail participants viewing video footage of a recent interaction as a prompt for more detailed
discussion than might be possible in a standard interview.
The therapist and parent, separately, watched with me a video of a recent 30-minute ses-
sion that was the only existing video of the recent course of sessions. Participants were
invited to pause the video at any point when they wished to make any comment. This invita-
tion was deliberately open-ended, reflecting the exploratory nature of the study and my wish
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Flower 841
to allow the participants’ descriptions of the experiences or events of particular interest to
them to guide the course of the interview. Interviews were audio-recorded, and notes made
of the timing of the pause points made by participants for later use. I did not view the video
until the first interview as doing so might have suggested lines of inquiry to me prior to the
interview.
Because of his complex disabilities, it was not possible to inter view the child directly, although
his actions, and possible experiences, were discussed in detail by both the therapist and parent.
The inclusion of microanalysis in the study was, in part, in order to include the activity of the
child within the trio in the research. This situation highlights the difficulties inherent in explor-
ing the experiences of children with complex disabilities in music therapy.
Following transcription, thematic analysis was undertaken drawing on the framework of
Interpretative Phenomenological Analysis (IPA) (Smith, Flowers, & Larkin, 2009). IPA is a
qualitative research methodology, concerned with understanding the ways in which individu-
als make sense of their experiences, and the significance to them of those experiences. The
process of analysis involved close, repeated readings of the transcripts, an initial stage of com-
mentary in which broad areas of interest emerged, followed by a further, more detailed process,
through which emergent themes were identified, categorized and refined (Smith & Osborn,
2003; Smith et al., 2009).
In this article, I focus on a grouping of themes that emerged through the process of analysis.
Results and discussion
The thematic analysis highlighted the ways in which both participants experienced the com-
plex nature of relationships between child, parent and therapist in the trio. Both participants
appeared to shift their focus fluidly across a spectrum which included one, two or three of the
trio members as follows:
 The individual within the trio.
 The possible pairings within the trio.
 The three participants as a single grouping.
This structure, concentrating on the individual, the pair and the whole group within the trio,
provides a means by which to explore the ways in which both therapist and parent describe
their experiences of music therapy. Brief narrative examples from each grouping highlight key
areas of interest.
The individual within the trio
The analysis revealed that, when discussing one person only, the parent talks most frequently
about her child. This is not surprising given the context within which the trio takes place. Her
degree of focus on the child may also be understood in terms of her parental role, and the con-
cern and pleasure which that appears to bring. She describes the range and quality of his devel-
oping skills. For example, “Barney has started actually vocalizing in sessions” or, “Barney’s just
started holding a, I don’t know what you call it, a beater, and hitting objects with it.” She also
reflects on his possible experience of such skill acquisition. Of his holding a beater, she says,
“He’s actually quite proud of himself as well that he can do it … he’s in a session when, which
he really loves doing and then he can say ‘Look, I can do this!’” A similar example occurs when
she describes his response to a song in which the therapist raised an instrument up in the air:
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842 Psychology of Music 42(6)
“He’ll reach up and he’ll shout… he’s got quite confident and will demand ‘I want it down
here.’” The parent appears to ascribe feelings of pride and confidence to him.
The potential significance for a parent of a child with complex disabilities of witnessing
them engaged in music therapy has been reported previously (Flower, 2008; Oldfield, 2008).
One parent comments: “I had spent so much time talking about what Alice couldn’t do, it was
so refreshing to come and have her able to do something and enjoy it” (Flower, 2008, p. 179).
Similarly, findings in this study suggest that it is not only the child’s acquisition of skills but
also the enjoyment expressed by the child which is seen by the parent as significant.
While the parent’s primary focus in talking about an individual appears to be the child, the
therapist’s attention appears to be roughly equally divided between the child and herself.
Such a degree of focus on herself may be understood in terms of a professional culture of
reflective practice.
The therapist’s familiarity with watching herself on video and a sense of a process of reflec-
tion appear to be evidenced in the text. Having paused the video to comment on a musical ges-
ture she made, and the reasoning behind it, she says, “As I watched myself do that just now I
think I had the same impulse again which was ‘Oh look, something’s happening that they’re
[parent and child] doing together that I can support’, play a more of a supportive role.” Along
with recalling and considering her own actions, she also demonstrates the interconnectedness
between herself and the child–parent pair. She has noticed them engaged in something
“together,” and notes her “impulse” to sustain the musical connection between them. This
impulse is echoed in music therapy literature in which therapists seek to support the musical
connection between parent and child (Levinge, 2011; O’Neill & Pavlicevic, 2003; Shoemark,
2011). Shoemark (2011, p. 169) suggests that the music therapist adopts “a supportive exter-
nal role” at such points, privileging, in her accompaniment, the music of the parent–child pair.
The possible pairings within the trio
Both participants refer to each possible pairing within the trio, namely, the dyads of child–
parent, child–therapist, and parent–therapist. The parent–child pair is discussed at greatest
length, and from clearly differing perspectives; the parent talks from within, as one of the pair,
while the therapist observes and comments on the pair from an external position.
The therapist notes the sensitivity with which the parent relates to her child: “she’s always
very attentive to what his expression is, or how he’s playing.” She also notes the ways in which
the parent is able to respond to moments of distress in her child: “When he has become a bit
upset I think Mum manages it very well in that she can comfort him … ‘Well, he’ll be ok, he does
kind of get distressed at times.’”
The parent comments on the enjoyable experiences of playing with her child in music ther-
apy, saying, “He sees me getting involved as well… he clearly watches me doing it, and finds it
quite funny I think, and so it’s really lovely.” Thompson and McFerran (2013) suggest that a
key therapeutic outcome of parental involvement in therapy is a deepening of the parent–
child relationship. Here, at one level, the parent is commenting on the child’s developing
capacity to watch, and attend to, her activity. She also remarks, however, on her perception of
his enjoyment of her involvement, and her own feeling of the interwoven process as being
“really lovely.”
A vivid theme for the parent, however, is her experience of finding a role in the sessions: “I
was kind of very conscious to step back and let Barney do it and see what happened and not
‘Come on Barney, you do it.’” Again, later in the interview, “I’d just wait to be told when I
needed to be involved rather than, you know, try and make him do things, ‘cos it would change
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Flower 843
his experience of it as well.” An uncertainty about role is suggested, together with a positioning
of herself as one who should “step back,” and wait. This seems to stem, in part, from sensitivity
to her child’s own experience, wanting him to experience events and relationships for himself.
It also raises the implicit questions of power and role within the therapist-parent relationship,
to which Thompson and McFerran (2013) suggest attention must be paid.
The three participants as a single grouping
Neither participant refers to the trio itself specifically. The ambiguous use of personal
pronouns, such as “we” or “us,” does, however, suggest collective activity and experience,
which may shift between being dyadic or triadic. For example, the parent notes that in the
session, “we’ve started having a couple of little games that we play, so he sees me getting
involved as well.” The therapist, commenting on the increased physical capabilities of the
child, says, “things have opened up a bit in terms of the way that we can play together.”
The parent repeatedly links the shared play within the session to experiences at home, when
the trio comprises the child, herself and her partner. Having described a musical exchange
between therapist and child, she says, “We try and copy some of it at home as well… we’ll sit at
the dinner table, if he’s banging the table my husband would bang the table too…we’ll do
responses you know, respond and communicate.”
While her husband only attended one session, he is a vital participant in music therapy. The
mother appropriates musical activity from the session, locating it within the physical and rela-
tional context of the family dinner table, at which her husband is a responsive, musical presence.
Conclusions
The analysis suggests that the music therapy trio of child, parent, and therapist is experienced
by the parent and therapist as a fluid, dynamic web of musical and interpersonal relationships,
rather than a fixed entity. Within this emergent network, individuals, pairs and the triad assume
greater or lesser significance at different points.
The video elicitation interviews offered participants the opportunity to view and comment
on the video of a music therapy session in which they had been involved. Henry and Fetters
(2012) identify three types of experiences within video elicitation interviews: recall of feelings
or thoughts from the time of the event, a reliving of the event, including emotional or physio-
logical changes, and reflection on their activity and thinking at the time. Examples of each of
these can be extrapolated from the data. For the purposes of this preliminary study, not only
does the breadth of comment add richness to the descriptions of experiences, but it also serves
as a useful test of the method in considering further study.
A further ongoing phase of the study is concerned with a microanalysis of a short section of
the video used within the interviews (Wosch & Wigram, 2007). This process aims to investigate
the ways in which an analysis of musical events and structures might expand an understand-
ing of this particular trio of child, parent, and therapist and the trio more generally.
In conclusion, this article has outlined a number of key aspects of a preliminary study aris-
ing directly from questions emerging from practice. It has described the use of a particular
video-based research tool – the video elicitation interview – and has sought to explicate a num-
ber of themes arising from thematic analysis. It is hoped that by integrating the findings thus
far with those from the ongoing microanalysis process, the study will be of value in shaping and
informing clinical practice within the host, and other, music therapy services, as well as sug-
gesting directions for future study.
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844 Psychology of Music 42(6)
Ethical approval
Ethical approval was given by NHS National Research Ethics Service (Ref. 12/NW,0496), Research and
Development Department, Chelsea and Westminster Hospital NHS Foundation Trust, London (Ref.
C&W12/061), and the Nordoff-Robbins Research Ethics Committee.
Funding
This work was supported by the Music Therapy Charity.
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