Inside the black box

How relevant is music therapy research for practitioners? This is a question that Eric Waldon and Barbara Wheeler ask in this issue (p. 395). A “gap” between research and practice has been lamented and discussed for decades in many areas, in psychotherapy at least as much as in music therapy. In their survey of more than 1000 practitioners worldwide, Waldon and Wheeler found this same gap again, dependent on the respondents’ proximity to academia. However, respondents also felt that research in general was relevant to them.

The question can be viewed from two sides: practitioners may not always see the relevance of research without appropriate guidance; alternatively, the research itself may not be sufficiently relevant for practitioners. Research on effects is far away from the daily and moment-to-moment decisions of practitioners, but is connected to the ultimate goals of therapy. In contrast, research aiming to provide insights about processes can be close to the daily work, but may fail to explain what helps in the longer term.

The National Institutes of Health director Francis Collins, together with opera singer Renée Fleming, recently outlined the achievements and challenges of music therapy research as follows:

Music therapy is now used to improve health outcomes in pediatric cancer, autism, Alzheimer disease, chronic pain, and Parkinson disease, to name a few applications. In just the last 10 years, there have been more than 100 systematic reviews on the topic, including 10 Cochrane analyses. Individual cases have reported compelling results, but relatively few large-scale clinical trials have been conducted. The largest of these trials have yielded mostly inconclusive results, possibly because of the heterogeneity of affected individuals, interventions, and responses. Research requires standardized interventions while music therapy likely requires interventions tailored to the individual. More defined biological targets and biomarkers could facilitate assessment of the degree of target engagement by music therapy and could be useful in interpreting outcomes. (Collins & Fleming, 2017, p. E1; emphasis added)

In this issue, we have three articles exploring different aspects of tailoring music therapy to the individual (as well as one involving a potential biomarker). Avi Gilboa and Yael Almog (p. 411) summarise 53 case studies discussing why clients chose a particular instrument, and what meaning either the client or the therapist ascribed to that choice. Such meaning could be related to the instrument’s sound, the way it is used, or the symbolic representations it affords. The idea that music instruments have a “character” or a “personality” was already voiced by music therapy pioneers nearly 50 years ago, but this bibliographic study adds an overview of current practices.

While Gilboa and Almog start with a client “who enters a typical music therapy room” (p. 411), Manuel Goditsch and colleagues (p. 432) ask, what is a typical music therapy room? The perception of a room’s atmospheric qualities is often not mentioned or described explicitly, but can be a powerful way expectations are shaped. Properties range from practical aspects such as sound insulation, through atmospheric qualities such as offering a “safe place”, to expectations regarding communications or musical styles that are shaped by the arrangement of seating and the availability and placing of musical instruments in the room.

When the room and the instruments have been chosen, how do you best facilitate a therapeutic process? Olivier Brabant and colleagues (p. 453) compared the effects of different breathing and relaxation techniques on the intensity of subsequent emotional processing in the therapy session with a healthy volunteer. It may seem paradoxical that more relaxation in the preparatory breathing exercise was associated with higher emotional stress in the subsequent improvisation and the verbal processing that followed. However, the authors note that this may mean that deeper emotional processing was facilitated.

Together, these articles show that it is possible to examine granular questions about small details in the therapy process, which are relevant to practitioners, in scientific research. I look forward to seeing more research in the future that looks inside the black box while also answering questions about what works.

I wish to conclude by offering some insight into the black box that an editorial team may sometimes be perceived to be. Lars Ole Bonde, who has been connected to the Nordic Journal of Music Therapy in various roles since its inception, has decided to retire from his role as Associate Editor, which he has had since 2009. As an early advocate for mixed-methods research and a pragmatic philosophical stance, he has helped many of our authors to develop research that is relevant for practitioners as well as methodologically sound. I would like to express my heartfelt thanks for his many years of service for the journal.