Abstract
With apologies to Forrest Gump ‘Music therapy research is like a box of chocolates . . . ’
Introduction
Imagine the largest, most extravagant box of luxury chocolates. Where are you going to start? Are you a milk chocolate or dark chocolate person? Do you go for truffles or caramels? Do you take your time to study the descriptions on the box or dive straight in and take your pick? Well, Wheeler and Murphy’s third edition of Music Therapy Research is a little like an enormous box of chocolates. When dividing up the chapters and units for the purposes of this review, it was a bit like selecting our favourite or most familiar chocolates. There have already been several reviews of Music Therapy Research published and so we were keen not to duplicate the information already available. Odell-Miller (2018), for example, provides a detailed review of the content, while Rickson (2017) and Arns (2017) provide overviews of the book, highlighting aspects of the content and structure. So, to stay with the chocolate box metaphor, we aim to provide a brief overview of each layer, picking out a few individual flavours to describe in more detail, followed by a brief description of the companion volume, An Introduction to Music Therapy Research. We hope our review will provide ‘food for thought’ and encourage readers to maybe try some new flavours and delve into this rich, multi-layered and essential book.
Units One to Three: overview, preparations and foundations (Jodie Bloska)
When the reader first opens this textbook, the content can be overwhelming. Similar to a posh box of chocolates, there are new terms for old flavours and brand-new combinations of flavours that you’d never even considered – where do you even start? These introductory chapters provide brief descriptions of approaches in research and definitions of terminology, allowing the reader to have a base knowledge before diving into the following chapters.
Unit One begins with an overview of music therapy research (chapter one, Wheeler and Bruscia) and its history (chapter two, Merrill), and then discusses the relationships between research, theory and clinical practice (chapter three, Baker and Young; chapter four, Amir, LaGasse and Crowe). As a music therapist in the early stages of my research career, this was particularly relevant in determining what my motivations are for undertaking research and how this is reflected in the various research approaches described by Wheeler and Bruscia. Music therapists without much interest in conducting research themselves would benefit from Baker and Young’s discussion of the relationship between research and clinical practice, which provides an honest account of the practicalities of evidence-based practice while highlighting the benefits of this for clients.
Unit Two provides practical advice in preparing to undertake research, from the early stages of defining a research topic (chapter five, Darrow) to applying for funding (chapter 10, McFerran and Hunt). These chapters incorporate advice and real-world examples from successful music therapy researchers, which is of course helpful but also encouraging to read how others have overcome the inevitable challenges in research.
Unit Three dives into the specific details of ‘interpretivist’ and ‘objectivist’ research. Chapter 11 (Hiller) introduces and defines the differences between these approaches and relates this to qualitative versus quantitative research, respectively. This is a bit like opening a box of chocolates and discovering that your go-to chocolate truffle has been rebranded as a ‘decadent smooth milk chocolate cream’. However, once you determine it is quite similar, and still delicious, you realise that this new name provides a new understanding of the flavours and textures. This unit provides brief definitions of terminology and descriptions of methods that would be used within objectivist and interpretivist research. As a practical starting point, these chapters outline what research questions should be asked using each approach.
These introductory units provide helpful background knowledge before approaching the more specific and detailed chapters presented later.
Unit Six: objectivist designs: from case studies to big science (Alisa Apreleva)
The overview of objectivist research has undergone significant revision since the previous edition in 2005. As stated in the opening chapter, the resulting presentation closely follows the research typology traditionally accepted by the natural and social sciences (Wheeler and Bruscia, p. 5). Multiple variations contained within each type of objectivist music therapy research have been identified and included in this overview, and new terminology has been introduced and suggested for use by prospective researchers. Across all the chapters, clarifications have been offered regarding inconsistent or confusing concepts and terms to further contribute to a systematic description. For example, the distinction is made between applied behaviour analysis research design and applied behaviour analysis as a specific type of therapy (chapter 25, Jones and Brown, p. 303). Furthermore, there is a critique of the interchangeable use of withdrawal and reversal design, clear-cut separation of statistical analysis tools from research designs, and comprehensive lists of terms previously used to describe the research designs discussed in each chapter. Such systematisation is essential as it potentially leads to further integration of music therapy research into mainstream scientific discovery and, consequently, wider acceptance of evidence-based music therapy services by multidisciplinary treatment teams across various clinical and community settings. In our chocolate box, objectivist research would be the dark chocolates with exact percentages (65%, 90%, and so rarely 100%) with unusual additions – like jalapeños and salt – thrown in occasionally.
The sequence of the chapters corresponds to the levels of evidence, proceeding from manipulation of individual participants or small groups, to the comparison of an existing group with a matched group, to the comparison of experimental and control groups, to the manipulation of several groups, and finally to the systematic reviews.
Chapters 24 to 26 are dedicated to single subject and small n research. Objectivist case study research design is introduced by Ridder and Fachner (chapter 24), who define the rigorous and systematic case study approach within objectivist research. The authors argue for the application of this research type in response to the rapid advancement of new technology allowing the production of measurable outcomes in real-world clinical situations. Chapter 26 (Napoles) introduces concepts of multiple baseline design, changing criterion design and multiple treatment design as the tools a music therapy researcher may find useful in situations when return to baseline behaviours is impossible or undesirable due to ethical considerations.
An overview of descriptive research, that is, the studies when the researcher does not manipulate any of the variables, follows in chapters 27 – 31. The designs described include survey research (chapter 27, Curtis), correlation and regression in experimental and non-experimental research (chapter 28, Ghetti) and health economics in music therapy (chapter 29, Else). The Delphi technique, a method for obtaining consolidated data from a group of experts concerning a certain topic, though currently rarely used in music therapy research, is discussed in chapter 30 (Cassity). In chapter 31, Baker and Ledger share their experience of conducting longitudinal studies, where data are collected for more than 12 months, and argue for the benefits of this research design in music therapy despite the difficulties it often presents.
The unit continues to move up the levels of scientific evidence with pre-experimental one-sample designs (chapter 32, Jones) as a means of systematic investigation of treatment effects that can be implemented in day-to-day music therapy practice. de l’Etoile (chapter 33) explains how quasi-experimental static group comparison designs may be utilised in situations when practical or ethical issues prevent random assignment of participants.
Finally, chapters 34–36 describe experimental designs in music therapy. Silverman (chapter 34) presents information about popular parallel group designs, including the gold standard of quantitative research designs – randomised controlled trials (RCTs) – and Solomon Four Groups design. DeLoach, Wheeler and Murphy’s chapter on crossover designs includes a substantial discussion, illustrated with multiple examples from the literature, regarding the importance of following the guidelines for analysing and reporting crossover trials. Chapter 36 (McKinney) introduces the full factorial and the split-plot factorial (mixed) designs – the methods used in larger scale studies to explore the effect of several independent variables (factors) on one dependent variable.
Each chapter outline includes definition and characteristics of the research design in question, clear guidelines for designing and conducting the study, and criteria for evaluation of its quality. Multiple examples from the literature are provided, implications for the research conducted in real-life clinical situations are discussed and further reading suggestions are offered. Importantly, authors examine the weaknesses of the existing body of objectivist music therapy research and offer practical ways for researchers to improve validity and reliability (for example, the critical need for replication of existing music therapy studies). The unit highlights emerging opportunities for objectivist research in music therapy, including those related to the recent advancement of portable, inexpensive technology that provides measurable outcomes, for example, biomarkers derived from physiological measures, electronic musical and acoustic features, computerised observation of gait and speech performance, and so on.
Although this section places overall emphasis on systematic description of objectivist research methods in music therapy, some minor inconsistencies still occur. At times, authors prioritise specific types of outcome measures, for example, exclusively behavioural, when describing a particular research design, which may be misleading for some. Similarly, although great effort is made to introduce research methods in a logical sequence from the lower-level (‘nonexperimental’) to the higher-level (‘experimental’) designs, the complex nature of music therapy research does not always allow such a clear-cut systematisation (e.g. nonexperimental higher-level research designs are, in fact, possible), and this, again, may create some confusion. However, the value of the information presented is not to be underestimated: it is essential for new music therapy researchers and useful reference for experienced ones.
Interpretivist designs: from ethnography to grounded theory (Claire Molyneux)
Unit Five consists of four chapters that provide valuable information concerning data collection and analysis methods in interpretivist research. The reader is encouraged to consult this section to gain further understanding of some of the methodological issues in designing interpretivist research. I particularly enjoyed chapter 21 (Bonde) which is essential for any researcher looking for robust ways to include analysis and interpretation of musical data. It would have been helpful if the chapters in this unit had cross-referenced chapters in Unit Seven where further detail and examples of specific approaches is given.
Unit Seven contains 17 chapters and expands on the previous edition which dedicated 12 chapters to ‘types of qualitative research’. The chapters are grouped into sub-sections covering natural setting approaches, phenomenology, meaning-focused approaches, language-focused approaches, theoretical approaches and case approaches. New chapters covering critical inquiries (chapter 43, Rolvsjord and Hadley), discourse analysis (chapter 46, Talbot), consensual qualitative research (chapter 51, Kim) and thematic analysis (chapter 52, Hoskyns) reflect the expansion of music therapy research and the refining of methodological approaches in recent years. The chapters are organised with a similar structure providing scope for the authors to comment on the definition, purpose, history and epistemological foundations of the approach. This leads to a discussion of variations to the approach and music therapy examples, followed by methodological guidelines. Considerations for the process of writing about the different approaches are given in each chapter along with an evaluation of quality or critique of the method.
Interpretivist approaches are bound by philosophical inquiry and can lead the researcher into complex terrain. In relation to the chocolate box metaphor, some of the chapters in this section pertain to methodologies (e.g. phenomenological or naturalistic inquiry) – the ingredients that go into creating a chocolate that is consistent and predictable. We could relate some to specific methods for creating the chocolate (e.g. the sub-section on ‘Theoretical approaches’) and others to the origin of the cocoa beans, the conditions under which the raw ingredients have been sourced and produced (e.g. critical inquiries and discourse analysis). While the individual chapters provide useful maps and examples of music therapy research for further reading and reference, I found myself wanting a ‘big-picture’ map to help position the different approaches in relation to one another, especially where epistemological foundations converge or diverge.
Unit Seven begins with research in natural settings. Chapter 37 (Stige and Ledger) effectively illustrates practical considerations for undertaking ethnography through detailed presentation of the authors’ own studies. Arnason covers ‘Naturalistic inquiry’ in chapter 38 while chapter 39 (Stige and McFerran) provides a robust analysis of 17 studies that used action research. The sub-section ‘Phenomenology’ updates two chapters from the second edition covering ‘Phenomenological inquiry’ (Jackson) and ‘First-person research’ (Hunt). Further critical analysis of the relationship between the origins of these two approaches would be helpful for the reader to gain a more comprehensive understanding of the overlaps and distinctions between the two.
The section on meaning-focused approaches includes four chapters (‘Hermeneutic inquiry’ by Loewy and Paulander, ‘Critical inquiries: feminist perspectives and transformative research’ by Rolvsjord and Hadley, ‘Arts-based research’ by Viega and Forinash, ‘Morphological research’ by Weymann and Tüpker). Rolvsjord and Hadley’s chapter provides space to consider the impact and importance of critical theory for music therapy research. The authors outline three different epistemological positions found in feminist research. While they acknowledge the contrasting frameworks that exist, they helpfully summarise core themes and methodological strategies. Furthermore, the chapter models reflexivity and calls for the researcher to engage actively with epistemology. Chapter 44 (Viega and Forinash) has been expanded to update the definition of arts-based research and provides additional examples of music therapy studies using this approach since the second edition.
The section on language-focused approaches includes two new chapters: ‘Discourse analysis’ by Talbot and ‘Qualitative content analysis’ by Ghetti and Keith. Talbot outlines a ‘methodological toolkit’ for discourse analysis, emphasises the challenges of engaging in this approach, and provides examples within music therapy research. Talbot acknowledges that while the examples are useful, ‘very few do the work of fully and multimodally examining power and ideology in order to uncover inequalities’ (p. 516), and so it seems there is some way to go for music therapists to fully realise the potential of this approach. Ghetti and Keith provide an overview of content analysis which many music therapy researchers will find useful. However, I felt this might have been better placed more closely to or integrated with chapter 52 on ‘Thematic analysis’ (Hoskyns) as the two are closely linked.
The unit concludes with four chapters on theoretical approaches (‘Grounded theory’ by O’Callaghan, ‘Personal construct psychology and the repertory grid technique’ by Abrams, ‘Consensual qualitative research’ by Kim and ‘Thematic analysis’ by Hoskyns) and one chapter on ‘Interpretivist case study research’ by Murphy. ‘Consensual qualitative research’ presents an innovative research method that the author advocates as ‘an advantageous, trustworthy interpretative research method that deserves to receive more attention from music therapy researchers’ (p. 561). This approach was developed by a group of counselling psychologists and combines both constructivist and postpositivist viewpoints. This may cause consternation for some researchers and it will be interesting to see how this develops in the future. The chapter on thematic analysis by Hoskyns is a welcome addition to the book. Hoskyns helpfully refers to other chapters in the book where there is overlap, for example, chapter 47, ‘Qualitative content analysis’ and chapter 46, ‘Discourse analysis’. This cross-referencing is helpful for the reader and I think could have been attended to more closely in the unit as a whole. This may have assisted the reader to develop a greater understanding of the links between epistemology, research paradigms, methodological issues and methods.
Unit Eight: other types of research: from microanalysis and mixed methods to systematic reviews (Laura Blauth)
Unit Eight includes eleven chapters, of which eight chapters have been conceptualised for this third edition and were not included in previous editions. This demonstrates that novel and mixed research approaches have gained popularity and importance in music therapy. The unit opens with two new chapters on microanalysis which are a timely and welcome addition. Wosch and Erkkilä describe ‘Microanalysis in objectivist research’, and Trondalen and Wosch introduce the reader to ‘Microanalysis in interpretivist research’. This distinction between objectivist and interpretivist research follows the general outline of the book but feels slightly unnatural in the context of microanalysis. To me, the division between video microanalysis, music microanalysis and text microanalysis that Wosch and Wigram (2007) chose in their book Microanalysis in Music Therapy seems more practical and relevant.
The following three chapters focus on mixed methods research designs (‘Combining interpretivist methods with objectivist methods in explanatory sequential designs’ by Burns and Masko, ‘Combining objectivist with interpretivist methods in exploratory sequential designs’ by Magee, ‘Mixing interpretivist methods’ by Zanders). In our chocolate box metaphor, these research designs remind us of the praline creations mixing scrumptious, well-established ingredients to get new chocolates that fuse all the good tastes. To some, these combinations are immediately appealing, others may prefer the pure chocolates. Utilising and integrating different methods allows the researcher to address complex real-life questions and phenomena, to consider multi-level perspectives, to draw on the complementary strengths of each method and to gain enhanced understanding and interpretability of results (Creswell et al., 2011; Robson, 2011). It is therefore an important improvement that this third edition includes a whole section on mixed methods designs. Even though the explicit term ‘mixed methods research’ is relatively new, research combining and integrating quantitative (objectivist) and qualitative (interpretivist) approaches has been conducted in both the natural as well as the social sciences for centuries (Maxwell, 2016). Similarly, in the history of music therapy, the common practice of describing studies as mixed methods research has emerged only in more recent years. However, numerous music therapy research studies have integrated quantitative and qualitative methods from an earlier time (see Aigen, 2008; Bonde, 2015). The chapters describing the history of mixed methods research in music therapy focus mainly on the studies that use the distinct label ‘mixed methods’. It would be worthwhile in the future to also explore the impact and importance of some of the earlier research.
The section on systematic reviews, meta-analysis and synthesis includes three chapters (‘Systematic review and meta-analysis in objectivist research’ by Bradt, ‘Synthesis of interpretivist research’ and ‘Synthesis of mixed methods research’ both by Meadows and Wimpenny) and adds another relevant and important area of research. All three chapters provide detailed descriptions of the methods, give helpful examples, and engage the reader in a critical discussion and appraisal of the methods. Meadows and Wimpenny highlight research gaps and outline what they believe is required from a new generation of researchers. Two very informative chapters introduce the readers to historical research (‘Historical research in music therapy’ by Solomon and Davis, ‘Interpretivist historical research’ by Hadley). The new chapter on interpretivist historical research brings important perspectives and developments from other social sciences disciplines to music therapy research. Hadley reminds us that we must not forget to listen to ‘those voices that are vulnerable in our music therapy communities’ (p. 670).
The final chapter in this unit is concerned with ‘Philosophical inquiry’ (Stige and Strand). In an engaging way, the authors introduce the reader to some of the big questions in philosophy and link these to music therapy research. While I enjoyed reading this chapter very much, I wondered whether it would have been better situated in one of the earlier units outlining foundations and principles of research. As the authors state, philosophical critical thinking is fundamental to any research no matter which method one applies and should thus be part of every music therapist’s training.
Unit Nine: evaluating, reading, writing, and submitting (Jodie Bloska)
Unit Nine, which mostly relates to the final stages of a research project, covers a lot of ground. The chapters provide a balance between theory, examples and practical advice in undertaking evaluation, reading, writing and submission of the research. These topics logically come at the end of the textbook, mirroring the end stages of research, especially evaluating results (chapter 65, McKinney; chapter 66, Abrams) and submitting for degree or publication (chapter 67, Meadows; chapter 68, Gardstrom). However, I found that Meadows and Gardstrom’s discussions of ‘reading’ music therapy research pertain more to the early stages of research and should perhaps fall under the literature review stage in the preparation chapters. In addition, the ‘writing’ process may traditionally be considered the final step of a research project, but in actuality it is likely to be an ongoing process throughout the project. Despite coming at the end of the textbook, these chapters should not necessarily be saved until last. These topics are relevant throughout the research process and can shape how one approaches and manages the intricacies of completing a major research project.
Summary
Generally, the book is easy to navigate, although there appear to be some issues with the indexing (some page numbers take the reader to references rather than text for example) and the author index is not comprehensive given the large number of references in the book. However, these are minor issues in what is certainly a major achievement for editors Wheeler and Murphy and it is worth noting the robust process the editors followed in putting this compendium together. Feedback from educators about how the book was used and what might be useful in a new edition was collected. Independent evaluations were commissioned of each chapter from the second edition with suggestions for additions, revisions and potential contributors. This thorough review process has resulted in a rich and varied edition, assembling a wealth of knowledge which makes it indispensable for researchers, clinicians and trainees. We would like to argue that good chocolate, like good writing about research, is not a luxury, but is something that every fine music therapist really cannot live without. A small caveat however: we would recommend not gulping down all 68 chapters at once. This is a very large box of chocolates – take your time to savour and enjoy the different flavours and be prepared to learn something new.
