journal of music therapy

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JOURNAL OFMUSIC THERAPYSpring 1994

Vol. XXXl No. 1


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ASSOCIATE EDITOR BUSINESS MANAGERJANET P. GALLOWAY ANDREA FARBMANHilton Head Island NAMT National Office

EDITORIAL COMMITTEE

EDITORJAYNE M. STANDLEYThe Florida State University

ALICIA A. CLAIRUniversity of KansasALICE-ANN DARROWUniversity of KansasANTHONY DECUIRLoyola UniversityAMELIAG, FURMANMinneapolis Public SchoolsKATE GFELLERUniversity of IowaJUDITH JELLISONUniversity of TexasCLIFFORD K. MADSENThe Florida Stats UniversityCHERYL D. MARANTOTemple UniversityCAROL A. PRICKETTUniversity of Alabama

BRUCE M. SAPERSTONUtah State UniversityJOSEPH SCARTELLIRadford UniversityDAVID S. SMITHUniversity of GeorgiaALAN L. SOLOMONUniversity of EvansvilleMYRA J. STAUMWillamette UniversityLOUISE STEELECleveland Music School SettlementMICHAEL THAUTColorado State UniversityBARBARA L. WHEELERMontclair State CollegeDAVID WOLFEUniversity of the Pacific

This paper meets the requirements of ANSl/NlSO Z39.48-1992 (Permanence of Paper).


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journal ofmusic therapyCONTENTS

Vol. XXXI No. 1ARTICLES

Michael D. Cassity 2Julia E. Cassity

Cindy Lu Edgerton 31

Melissa Brotons 63,

92

Spring 1994

Psychiatric Music Therapy Assessmentand Treatment in Clinical TrainingFacilities with Adults, Adolescents, andChildrenThe Effect of Improvisational MusicTherapy on the CommunicativeBehaviors of Autistic ChildrenEffects of Performing Conditions onMusic Performance Anxiety andPerformance QualityCall For Papers


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Psychiatric Music TherapyAssessment and Treatment inClinical Training Facilities withAdults, Adolescents, and ChildrenMichael D. CassityJulia E. CassitySouthwestern Oklahoma State UniversityNew Horizons Community Mental Health CenterThis study sought to define and measure the common bodyof knowledge relating to psychiatric music therapy assess-ment and treatment as practiced in NAMT-approved clinicaltraining facilities. Specifically, the study reported areas ofnonmusic and music behavior assessed mostrequently, spe-cific component behavior and music behavior most commonlyassessed within each ares, the type of music conditions em-ployed most commonly to assess such component behavior,and the developmental level of the patients to whom theassessments were given. Developmental level was observedas a function of the degree of illness and chronological ageof the patient, and nonmusic component behaviors were re-ported es specific problem-oriented behaviors. In addition,areas clinical training directors assessed most frequently whenadministering activity assessments were determined. The re-sults indicated the existence of an extensive and significantcommon body of knowledge relating to psychiatric musictherapy assessment and treatment.

The authors wish to express appreciation to the Oklahoma State Regentsfor Higher Education, Edward Daniel Dill, Ph.D. and Charles W. Chapman,Ph.D. for funding this study. Appreciation also is expressed to the music therapyclinical training directors who made this study possible, and to Jennifer Nailand Ann Kiser for clerical assistance. This study is dedicated to Professor Emer-itus Charles Braswell for his 36 years of service to the music therapy professionat Loyola University, New Orleans.Inquires regarding this article should be addressed to Dr. Michael D. Cassity,Department of Music. Southwestern Oklahoma State University, Weatherford,OK 73096-3098.


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Vol.XXXI, No. 1, Spring, 1994 3Assessment is considered an important part of the practice

of music therapy. The National Association For Music Therapy(NAMT) Standards Of Clinical Practice (1993) specify assess-ment as the first task of music therapists following patient re-ferral and acceptance. Cohen and Gericke (1972) define as-sessment as the process of gathering information about a patientsstrengths and weaknesses for the purpose of program planning.The NAMT Standards for adult psychiatry, in addition to tar-geting areas for nonmusic assessment, require the assessment tobe appropriate for the patients level of functioning. Similarareas of nonmusic assessment are targeted with developmentallydisabled children (including psychiatric patients in infancy,childhood, and adolescence). The Standards for children alsostate that, when applicable, level of functioning or develop-mental level within these areas shall be reflected in the musictherapy assessment. The music therapy assessment, therefore,should be appropriate in terms of the level of functioning andthe chronological age (CA) of the patient.

Assessment and programming appropriate to developmentallevel also is emphasized in related professions. According to theAmerican Association on Mental Deficiency (Grossman, 1977),the appropriateness of assessment and programming for thementally retarded is dependent upon CA and degree of retar-dation. The AAMD has specified adaptive behaviors which areappropriate for specific CA levels, and states that deficits inthese adaptive behaviors should be the criteria for determiningprogramming needs. The AAMD also provides examples of thehighest level of adaptive behavior that may be expected givenCA and level of mental retardation. The American PsychiatricAssociation (APA) also provides for diagnosis according to CAlevels and degree or severity of illness. Degree of illness is ratedin the Diagnostic and Statistical Manual Of Mental DisordersIII-R (DSM-III-R) (APA, 1987) using the Global Assessment ofFunctioning Scale (GAF Scale). CA levels in the DSM-III-Rinclude infancy, childhood, adolescence, and adulthood. Othertypes of developmental indexes used by related professionalsinclude mental age (Terman & Merrill, 1960). social age (Doll,1965), and perceptual age (Frostig, 1963).The assessment mandates of the NAMT Standards also aresupported by music therapy research. With mentally retarded


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4 Journal of Music Therapyand developmentally disabled children in general, music ther-apists use music extensively to assess both nonmusic and musicbehavior (Davis, 1992; Lathom, 1980). Cassity (1985) surveyedthe practice of music therapy with trainable mentally retardedchildren according to the above AAMD CA levels. Accordingto Cassity, music therapy assessment practices with the mentallyretarded, including the types of behavior assessed and the musicconditions used to assess the behavior, differ depending on theCA level of the patient. CA, therefore, is an important measureof the validity and appropriateness of music therapy assessmentand intervention. Other types of developmental indexes utilizedin the music therapy assessment are cognitive development(Jones, 1986; Rider, 1981) and developmental norms or mile-stones (Michel & Rohrbacher, 1982).

Although the above studies have produced specific infor-mation about music therapy assessment, there has been a pau-city of similar empirical research examining assessment prac-tices in psychiatric music therapy. Two notable exceptions werestudies which defined music therapy assessment practices withdomestic violence patients according to CA level and sex (Cassi-ty & Theobold, 1990). and a music/activity therapy intakeassessment designed to collect data according to CA, diagnosis,and attitude (Braswell, Brooks, Decuir, Humphrey, Jacobs, &Sutton, 1986). Although the NAMT Standards indicate appro-priate areas for assessment, little is known concerning the fre-quency with which music therapists actually assess such areas,the specific nonmusic and music component behaviors musictherapists most commonly assess within each area, the type ofmusic conditions they employ most commonly to assess suchbehavior, or the developmental level of the patients to whomthe assessmentsare given. In addition, little is known concerningareas music therapists address most frequently when adminis-tering activity assessments. Such information was consideredessential to defining adequately the common body of knowledgerelating to psychiatric music therapy.

Identification of the above information, therefore, was theprimary purpose of the present study. Developmental level wasobserved as a function of the degree of illness and CA of thepatient. Nonmusic component behaviors were reported as spe-cific problem-oriented behaviors.


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6 Journal of Music Therapy

literature relating to psychiatric music therapy assessment(Adleman, 1985: Cassity & Theobold, 1990; NAMT, 1989, 1993;Wood, Graham, Swan, Purvis, Gigliotti, & Samet, 1974). CTDswere also requested to write in any additional areas they assessedthat were not listed. From the list of 23 assessment areas, CTDswere asked to list the five areas they assessed and treated mostfrequently. and that they felt were most important in musictherapy assessment and treatment. CTDs were next requestedto list, for each of the five assessment areas they had just listed,two specific problem (nonmusic) behaviors they assessand treatmost often. Next to each problem behavior, they also wererequested to list two specific music conditions they used to assessand/or treat the problem.

The procedure for constructing the section of the question-naires relating to music assessment was the same as above withthe exception that music areas were included. Areas of musicbehavior were derived from a review of music activities usedin psychiatric music therapy (Carroccio & Quattlebaum, 1969;Cassity, 1976; Ficken, 1976; Freed, 1987; Noland, 1983; Rubin,1976; Wood et al., 1974), and of developmental checklists, musicbehavior, and music curricula for exceptional children (Graham& Beer, 1980; Lathom, 1980; Michel & Rohrbacher, 1982).Finally, the questionnaire contained an example of a completedquestionnaire item for nonmusic behavior and one for musicbehavior to guide the CTDs in furnishing the desired infor-mation. The two questionnaires designed for children were forchildren in the CA level of childhood and adolescence, andtherefore reflected the CA levels recommended in the DSM-III-R (APA, 1987).Areas assessed most frequently during activity therapy as-sessment were determined by listing in the questionnaire 42areas of activity therapy assessment suggested in the musictherapy literature (Braswell, Brooks, Decuir, Humphrey, Ja-cobs; & Sutton, 1986; Cohen & Gericke, 1972; NAMT, 1989).CTDs were requested to choose 10 of the 42 areas, then rankorder the 10 areas by assigning a 1 to the area they assessedmost frequently and a 10 to the area they would assess leastfrequently. The areas of nonmusic, music, and activity therapyassessment were each listed in alphabetical order, with the orderof listing rotated among the questionnaires.


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Vol.XXX,. No. 1, Spring, 1994 7Following the construction of the questionnaire, a panel of

five registered music therapists employed in NAMT-approvedclinical training facilities assessed the clarity of the question-naire items, the ease with which responses could be providedfor the items, and the success of the questionnaire in surveyingthe topic (assessment techniques) it was constructed to survey.The panel did not participate in the study other than to judgethe questionnaire. Of the five music therapists, four were eclec-tic and one was of psychodynamic therapeutic philosophy. Thefour eclectic music therapists agreed the questionnaire was ap-propriate for the purposes for which it was designed. The psy-chodynamic music therapist, however, indicated the question-naire did not relate to her practice of music therapy. Cautionmust be exercised, therefore, in generalizing the following re-sults to psychodynamic settings.

ResultsOf the 100 psychiatric clinical training facilities identified,65 agreed to participate in the study. Typical reasons for non-

participation were there had been a recent change of clinicaltraining directors, and/or the CTD did not have time to par-ticipate in the study. The percentages of CTDs returning thequestionnaires for each CA level of patient were children, 61%;adolescents, 74%; adult male, 67%; and adult female, 73%.Respondent Characteristics

The first part of the questionnaire dealt with respondentcharacteristics. As may be expected, most psychiatric CTDswere females between the ages of 30 and 39. The highest degreeattained by CTDs varied depending on the CA of patient withwhom they worked. Although all had a bachelors degree, only19% of the CTDs working with adults had a masters degree.In contrast, 46% of the CTDs who worked with adolescents and53% of the CTDs who worked with children had a mastersdegree. The typical CTD had graduated from an NAMT-ap-proved music therapy program 9 years prior to the study, andwas employed as a full-time clinical training director. As forthe number of years of full-time experience in adult psychiatricmusic therapy, 41% indicated more than 9 years, 31% indicated6-8 years and 20% indicated 3-5 years. Approximately 73% of


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8 Journal of Music Therapyall CTDs were employed in free-standing psychiatric facilities,such as state or private psychiatric hospitals.

Data were obtained concerning type of music therapy em-ployed by giving CTDs the definition of activity therapy (En-glish & English, 1958), music therapy as insight therapy withreeducative goals, and insight therapy with reconstructive goals(Wheeler, 1983). and asking them to indicate the percentageof time they used each in their clinical training program. Thetype of music therapy used by CTDs varied depending on theCA of the patient with whom they worked. Music therapy asactivity therapy was used approximately 62% of the time withadolescents and children, and 37% of the time with adults. Incontrast, music therapy as insight therapy with reeducativegoals was employed 62% of the time with adults and 37% ofthe time with adolescents and children. Music therapy as insighttherapy with reconstructive goals was used approximately 14%of the time with adolescents and only 2%)of the time with adultsand children. This latter finding may seem questionable con-sidering that reconstructive therapy most commonly is usedwith adults. However, when one considers the low level offunctioning of the typical adult patient served by music ther-apists (as reported in the following paragraphs), along with theineffectiveness of reconstructive therapy with low-level, chronicpatients (Braswell, 1967), the finding is not surprising.

When asked whether they assess music behavior, nonmusicbehavior, or both, 83% of all CTDs indicated they assess bothnonmusic and music behavior. Only 17% indicated they assessednonmusic behavior only, and none assessed music behavior only.

It appears that most CTDs do not administer standardizedtests employed by other professionals. When asked if they ad-minister to their patients standarded tests commonly em-ployed by other professionals when assessing their patients, 94%indicated they do not. CTDs do, however, believe there is aneed for certain assessment materials specifically designed foruse by music therapists. Reflective of the above finding thatmore activity therapy is conducted with younger patients, theneed for a standardized activity assessment increased as the CAof the patient decreased. Seventy-five percent of the CTDs whoworked with children, 63% who worked with adolescents, and51% who worked with adult patients indicated a need for a


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Vol. XXX/, No. 1, Spring, 1994 9

standardized activity assessment. Seventy percent of all CTDsindicated a standardized test of music behavior was needed,79% believed a standardized music therapy assessment of non-music behavior was needed, and 92% of all CTDs indicated atreatment manual of techniques, procedures, and practices usedby psychiatric music therapists was needed. The need for atreatment manual was clearly the greatest need indicated byCTDs. One result of the present study was the production ofsuch a manual (Cassity & Cassity, 1993).

Patient CharacteristicsCTDs spend a significantly greater mean percentage of time

treating certain disorders, or diagnoses, than they spend treatingother disorders with adult males (x2 = 55.72, p < .001), adultfemales (x2 = 68.16, p < .001), adolescents (x2 = 38.61, p

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