Australian Journal of Music Therapy - austmta.org.au Delaney AJMT Vol 26, 201… · Australian Journal of Music Therapy, 26, 74-87. Volume 26, 2015 Special Edition: Music therapy

Delaney, A. (2015). The Intimate Simplicity of Group Singing: A Reflection of Practice. Australian Journal of Music Therapy, 26, 74-87.

Volume 26, 2015 Special Edition: Music therapy and Ageing Well

Australian Journal of Music Therapy

74 Australian Journal of Music Therapy, Vol 26, 2015

The Intimate Simplicity of Group Singing: A Reflection of Practice

Angela Delaney MMusThy BSpecEd, RMT

St Vincent’s Care Services, Brisbane, Queensland

Email: [email protected]

Abstract

Reflexivity is an integral component of professional healthcare practice that

stimulates questions, fosters professional growth, and promotes change. This article discusses

a music therapist’s reflexive processes in relation to a spontaneous group singing session for

residents with dementia. The author used Shoemark’s (2009) illustration of reflexive practice

and research to guide the reflexivity. By defining the process and impacts of reflexivity, it is

the author’s objective to assist others to develop reflexive skills. This includes applying four

lenses: self, theory, practice and evidence to further understand the clinical experience.

Considerations and observations including the simplicity of singing together, the experience

as a moment of shared humanity, the value of group singing and music therapy within the

context of successful aging are discussed.

Keywords: reflexivity, group singing, dementia, music and health

Reflexivity is integral to core healthcare professional practice. To better understand a

spontaneous group singing experience and deepen reflexivity, this article describes a music

therapist’s reflexive processes as a means of capturing a multi-layered understanding of

practice (Etherington, 2004; Shoemark, 2009). The objective for documenting this process is

to illuminate how reflexivity supports growth and change for clinicians.

The author will narrate a spontaneous group singing experience drawn from a

residential facility for people with Dementia. In order to understand and illustrate the

reflexive processes of this lived experience the author applies the four lenses as offered by

Shoemark (2009). The lenses: self, theory, practice and evidence, assist the author to build

on existing knowledge and increase insight. Shoemark (2009, p.34) recognised that “by

consciously using a combination of unique lenses we actively create a depth of insight that

will help us progress our practice, research and writing.” Considerations and observations of

the clinical approach and context were shared to develop music therapy practice, and increase

the capacity and quality of service. These include the experience as a moment of shared

humanity, and the simplicity and value of group singing within the context of quality of life

and aging.

Literature Review

Shoemark’s (2009) description of the journey through reflexive practice and research

refers to and elaborates on Gold’s pyramid (2008). Gold (2008) and Shoemark’s (2009)

writings prompted the author to deepen personal reflexivity as a mid-level practicing

clinician and novice researcher. Clinical practice within dementia care provides the context

for this process.

Reflexivity

Reflexivity is an important practice skill that is critical for fostering self-awareness in

the practitioner (D’Cruz, Gillingham & Melendez, 2007). This awareness encompasses the

practitioner’s understanding of theory, engagement and questioning of how knowledge is

applied, while also considering the self in the context. The ability to question personal

practice, knowledge and assumptions develops with experience. Thus enhancing an ability to

appreciate significant moments, possibilities and drawbacks in clinical practice (D’Cruz et

al., 2007; Etherington, 2004; Shoemark, 2009).

The self-confidence associated with practice experience and levels of expertise is

required to engage in reflexivity, and while reflexivity may assist increasing expertise, it

requires a certain level of expertise to begin with (D’Cruz et al., 2007). Shoemark (2009)

explained that reflexivity requires the clinician to begin with the self, and an understanding of

the interpersonal processes we as clinicians influence. Reflexivity is therefore, a pertinent

concept for a mid level clinician on the professional trajectory. Figure 1 illustrates the

author’s interpretation of reflexivity. This illustration represents the lenses presented by Gold

(2008) and Shoemark (2009). Theory provides a foundation in the process, with practice, self

and evidence represented within a circular relationship. In this way reflexivity can be

illustrated as each lens impacting and expanding understanding of practice. Using these

lenses in combination promotes clear links and deeper insight between theoretical constructs,

practice, and our unique individual influence.


CLINICAL REFLEXIVE WRITING /

PRACTICE PROCESS RESEARCH

Figure 1. Process of reflexivity along the professional trajectory.

Dementia

The number of people living with dementia is rapidly increasing as the global

percentage of older people increases (Batsch & Mittelman, 2012; World Health Organisation,

2012). Batsch & Mittelman (2012) recently estimated 36 million people currently live with

dementia. Dementia impacts the ability to regulate emotion, access memories, and engage in

inter-personal communication and relationships, factors which contribute to increased levels

of agitation and neuropsychiatric behaviours (Khachiyants, Trinkle, Son & Kim, 2011;

Ridder, Stige, Gunnhild & Gold, 2013). These symptoms and behaviours related to dementia

lead to severe disturbances in quality of life (Ledger & Baker, 2007, Ridder et al., 2013).

Public policies promote ‘active lives’ in aging to promote quality of life (World Health

Organisation, 2012; Roe, 2013). Innovative care is crucial as the number of people with

dementia increases (Baker, Grocke & Pachana, 2013).

Music Therapy in Dementia Care

Music has been described as an innate human ability and a universal human

characteristic that is retained in people with severe cognitive deficits (Sacks, 2008). Singing,

music therapy and the importance of care for the elderly are increasing as popular themes in

current literature (Clark & Harding 2012; Gold, 2013; Ridder et al., 2013). Music is

Reflexivity

Evidence

Practice

Theory

Self

recognised as an innovative resource that increases quality of life (Davidson & Faulkner,

2010; Ridder et al., 2013) through its capacity to optimize physical health and cognition, treat

behavioural and psychological symptoms, and enhance verbal and non-verbal

communication for people with dementia (Clift, Hancox, Staricoff, & Whitmore, 2008; Hara,

2011; Belgrave, Darrow, Walworth & Wlodarczyk, 2011; Ledger & Baker, 2007; Sloboda,

2009; Ridder, 2006). Active music therapy interventions, in particular singing, are frequently

used in aged care to improve quality of life (Clark & Harding, 2012; Davidson & Faulkner,

2010; Ridder, 2006; Ridder & Aldridge, 2009; Ridder et al., 2013).

Group Singing

The specialist role and curative value of singing is documented within various health

domains including dementia (Davidson & Faulker, 2010; Ridder & Aldridge, 2009). Ridder

and Aldridge (2009), describes a long tradition of therapeutic singing as a central role in

Australian music therapy. Ridder (2003) also highlights the wide application of singing by

music therapists as an intervention that readily adapts to various levels of functioning in

persons with dementia.

Music therapists provide innovative and meaningful activities such as group singing

to facilitate social contact, reminiscence, cognitive stimulation, increased mood ratings,

periods of lucidity and communication (Clift et al., 2000; Ridder, 2003). Bailey and

Davidson (2005) described these positive impacts from group singing as being holistically

beneficial and related to quality of life. Group singing, a common pastime amongst older

adults, provides familiarity in an otherwise confused existence. Singing promotes deep

breathing and aerobic activity leading to improved blood oxygen levels and circulation.

These benefits are implicated in research describing reductions in anxiety related behaviours

and improved psychological and physiological health amongst older adults (Engström,

Hammar, Williams & Götell, 2011; Clift, Hancox, Morrison, Hess, Kreutz & Stewart, 2010).

This intrinsic value placed on group singing and the author’s experience narrated in this

article encouraged further examination of the relationship between the self, theory and the

phenomenon.

The Narrative

The following narrative of the author’s clinical work forms the basis for the reflexive

process description. The narrative aims to preserve integrity of the clients and convey a sense


of the humanity of care. Informed consent was obtained from the facility manager prior to the

publication of this narrative.

The facility is a large six-floor building with over 150 residents at varying stages of

aging, most of whom have dementia. Music therapy is provided for referred residents over

two days during the week. The music therapist facilitates a closed group for high care

residents and individual sessions for referred residents. The facility also has an established

performing choir for higher functioning residents.

The following narrative describes a spontaneous group singing session that occurred

late one afternoon:

In a large residential aged care facility for people with dementia, residents often sit

quietly on lounges in the entrance foyer of the building. It is a daily experience to enter or

leave the facility passing through the area where the residents are seated. Some residents are

escorted to the foyer and others bring themselves. The residents sit in a parallel existence

with expressions of anticipation at the comings and goings or with flat affect. Despite varying

levels of function most no longer have capacity to independently interact with each other due

to significant cognitive deficit, a symptom of their dementia.

Late one afternoon, a resident referred to as ‘Ruby’ (alias), could not be located for

her individual session. Ruby had been receiving music therapy in her room for over 12

months. She was found sitting in the entrance lounge, confused, anxious and becoming

agitated. Staff members were unsure how she came to be there.

I greeted and invited Ruby to join me for some singing. The anxiety and confusion

Ruby was experiencing was escalating, further impairing her ability to understand what was

happening and independently walk with me. While assessing the least intrusive way to

proceed, a co-resident, invited me to ‘play Ruby’s concert here (in the entrance), they

wouldn’t mind’. It was decided that moving Ruby would increase distress, as she was still

confused and unsure. Abandoning verbal communication, sitting on a wheelie walker I began

to sing a familiar song, The Tennessee Waltz. Accompanied with simple guitar using bass

notes for grounding. Ruby started singing almost immediately:

‘I was dancing, with my darling,

To the Tennessee Waltz.

When an old friend I happened to see,’

At this lyric, Ruby smiled to the lady sitting beside her. The beginnings of social

connection noted. The other six residents sitting in the entrance joined in. Smiling more than

usual, Ruby’s anxiety related behaviours continued to decrease. She began making eye

contact with myself and the other residents. The gentle process of singing with Ruby in this

public space allowed the music to catch each other’s spirit. The spontaneous group singing

connected the residents as a small musical community. We continued to sing various familiar

songs such as Maggie, An Irish Lullaby, You are my Sunshine, as more residents quietly

arrived to join us.

There is a significant amount of foot traffic through the entrance foyer space late in

the afternoons. Staff finishing farewell the residents and visitors coming and going pass

through. There are a variety of reactions to the group sitting in the entrance, and it is perhaps

a confronting space for some. Some visitors are notably uncomfortable and avoid eye

contact, while others greet the residents. Generally interactions appear brief, lacking

meaning.

With group singing in the entrance this afternoon the interactions of people passing

through were notably different. A different connection to the residents was observed as the

residents continued to sing together. Staff danced in the space before they left sharing a

longer moment, some stayed for a whole song. Visitors arriving or leaving abandoned the

rush, smiled, and joined in for a song, commenting positively about the experience. The

residents smiling at the joy and frivolity created by their singing, appeared to experience

increased social connection with each other and those passing through. The music was

radiating, connecting people, and the ‘ripple-effect’ was obvious.

The meaningful connections witnessed inspired internal dialogue, questioning, and

clarification of the therapy. My clinical experience and awareness highlighted the

significance of this moment, giving permission to experience the simplicity and energy

created. Through reflexivity I was able to understand this as a demonstration of humanity,

connection and the intimacy of singing.

Reflexive Process

Applying the four lenses provided a unique process to observe growth, learning and

change. The application of these lenses, self, theory, practice and evidence, is now discussed

with reference to the narrative.

Self

Shoemark (2009) suggested that, “the task of reflexivity is to begin with the self” (p.

34). Through the accumulation of clinical experience, self-reflection and supervision we


develop the ability to understand our uniqueness as individuals and what interpersonal

processes influence our experiences of engagement (Shoemark, 2009; Karkabi, Wald &

Castel, 2014). As individuals we interpret concepts practically and contextually, creating

practical meanings appropriate to the clinical work place (D’Cruz et al., 2007; Shoemark,

2009).

Our uniqueness includes a foundation of culture and personal heritage. Through this

lens I reflect and acknowledge what I bring to the practice. As a clinician I value

understanding, learning how to observe and explain the intimate connections and

interpersonal processes. The knowledge and skill base founded in my personal heritage have

been enhanced by several experiences. These include an extensive teaching career, working

in third world communities, an Australian middle class upbringing in a large family and more

than one professional career. Our foundation and heritage influences an ability to share with

others and find understanding.

With this accumulated experience I have developed a philosophy central to my

practice, that is, the simple need to experience connection. This practice philosophy values

meaningfulness and connection as being intrinsic to health and wellbeing, and fundamental to

quality of life. A lack of social connection, meaningfulness and isolation can have a profound

effect on our quality of life (Stillman, Baumeister, Lambert, Crescioni, Dewall & Fincham,

2009). As a professional in allied health settings I allow myself to consider an individual

holistically, distinct from medical diagnosis and symptoms. These facets of personal

foundation, and ongoing clinical experiences contribute to the personal lens though which I

evaluate, reflect and observe my clinical practice.

Theory

Theoretically the author takes cues founded on humanistic principles. This

perspective provides a framework for observing human behavior as it considers the whole

person in relation to the context of the environment (Corey, 2005; Wigram, Pedersen &

Bonde, 2002). A humanistic orientation assists clinical processes and understanding

regarding aspects of appreciating potential for human meaning and growth at various stages

and conditions in life (Corey, 2005; Wigram et al., 2002). Music is a social phenomenon with

high impact when shared between people (Baker et al., 2012). Singing with persons who

have dementia encourages social connection and meaning, directly impacting the

participant’s quality of life (Bailey & Davidson, 2005). In this way music acts as a bridge

connecting people with dementia to themselves, others, and personal history, and therefore

facilitates reality-orientated behavior in the present moment, even for those with significant

cognitive impairment (Ridder et al., 2013; Sacks, 2008). These benefits of music and singing

are strongly aligned with humanistic theory (Wigram, Pedersen & Bonde, 2002).

The narrative describes a spontaneous group singing experience as a unique

opportunity to address negative symptomology and provide opportunities for social

engagement. Knowledge of relevant literature allowed the author to observe several benefits

within the spontaneous singing session. Smiling, eye contact and verbal interactions

suggested increased social connection. Agitation related behaviours, including confusion,

aggression, and repetitiveness dissipated to be replaced by moments of clarity and lucidity

within the group singing (Davidson & Faulkner, 2010; Khachiyants et al., 2010, Ridder,

2003; Ridder et al., 2013). Documented positive effects including emotion regulation and

cognitive stimulation were noted (Bailey & Davidson, 2005; Ledger & Baker, 2007).

With a humanistic orientation, the author was able to apply theoretical knowledge to

group singing practices. The author views music therapy as an interpersonal process. Group

singing is an example of simple musical interplay of human interaction and music. Shoemark

describes simple musical interplay as a ‘moment of shared humanity’ (2009, p.33). In this

narrative, theoretical knowledge coupled with experience allowed the author to appreciate the

significance of the spontaneous group singing experience for Ruby, other residents and staff.

Shoemark (p.37, 2009) stated that theory must serve as the basis, with practice and

research guiding our way forward. The author’s theoretical underpinning understands that

connection and meaningfulness are central to quality of life. This philosophy navigates the

author’s interest with group singing, in particular how this phenomenon alters interactions

between participants and their environment, increasing connectedness, and adding to quality

of life.

Practice

The reflexive practice of this narrative allowed a deeper exploration of the processes

occurring. Accumulated experience with group work to create social connection and meaning

contributes to the author’s capacity to give voice and meaning to this practice example.

Though not a formal group with specific identified therapeutic goals, a responsible and

intentional use of music was applied. The author’s interpersonal processes, knowledge,

intuition and practice philosophy applied during practice facilitated a flexible approach. The

spontaneous nature of the group singing provided connection between the broader outside

community and the group singing participants inside. The author was able to appreciate the


significance of the spontaneous group singing participation from the perspectives of those

who were ‘inside’ and ‘outside’ the experience. Combining existing knowledge and personal

experiences allowed to author to acknowledge the session as unique, providing experiences

that deserved more exploration. The spontaneity and environment of the session allowed an

increased number of people to share and experience the positive benefits of singing, which in

turn impacted positively for those singing as a group.

The power of the group singing formed the corner stone for the discussed music

interaction, demonstrating a valuable practice in clinical dementia care. Though people with

extremely limited cognitive ability may not offer music making spontaneously, the

responsible and intentional use of music provided an experience highlighting the capacity for

a relatively simple intervention to provide meaning and connection. The reflexive process

allowed the author to recognise meaningful opportunities for engagement, stimulation and

connection contributing to well being. Shoemark (2009) discusses the humanity of care and

development of science in medicine. With this perspective, the group singing experience

illustrates a moment of shared humanity. An experience of human interaction, where basic

concern, respect and dignity were fundamental despite cognitive capacity.

Evidence

Following the spontaneous group singing experience, the residential care facility

internally evaluated the benefits of music therapy, and a regular group singing session has

been added to the weekly program. This group aims to emulate the spontaneous group

experience with participation from people ‘inside’ and ‘outside’ the facility. The foyer group

singing sessions also contributed to successful external accreditation of the facility.

Where to from here? As a mid-level clinician the process of collecting data to

evaluate practice, and identify and recognise significant benefits is important for funding,

evaluation and to serve other clinicians. With an established philosophy, theoretical

framework and practice method clinicians are better equipped to move towards research, and

understand what data is required for research (Shoemark, 2009). Reflexivity provided the

author a depth of insight and language in which to communicate the benefits of the

spontaneous session as an innovative intervention, contributing to the humanity of care

through the simplicity of singing, and possibly paving the way for further exploration and

refinement in research. Shoemark (2009) stated that “clever partnerships will champion the

need for research which will acknowledge the humanity of healthcare” (p. 39). There is now

potential working from a theoretical and practical basis to develop a study, potentially with

like-minded partnerships within the context of dementia and group singing. The author’s

next steps would consider which partnerships would enable further developments.

Conclusion

This article discussed the process of reflexivity and how the author engaged in

reflexive process to expand current practice in the area of dementia. Reflexivity played a

formative function that enabled the author to develop her vision of practice and

professionalism, modify interventions, and understand the impacts on participants. Research

has shown how individual clinicians interpret theoretical concepts and create meaning

appropriate to their practice contexts in a range of innovative ways (Shoemark, 2009). With

Shoemark’s (2009) illustration of reflexivity guiding the process, the author considered the

self, underlying theory, and a rationale built on theory, and employed these to justify

practice. Practicing reflexivity supports decision-making processes, regarding what evidence

is needed, potentially leading to the generation of evidence through formal research projects

(Gold, 2008; Shoemark, 2009). Reflexivity and a humanistic perspective assisted the author

in capturing what was being enacted and created through group singing. The resulting

narrative explored group singing for people with dementia and identified experiences of

connection and meaningfulness. Applying the various lenses allowed for observations and

considerations of the experience. Through these, the author was able to witness the simplicity

of singing together as a moment of shared humanity. This triggered further questions and

information seeking using various lenses. Increasing depth of insight to this experience has

highlighted the value of group singing and music therapy within the context of quality of life

and ageing. Reflexive practice assists articulation of this experience as contributing to the

humanity of care and meaningfulness, and serves as the basis for further clinical practice

development, writing and research.

References

Bailey, B.A., & Davidson, J.W. (2005). Effects of group singing and performance on

marginalised and middle-class singers. Psychology of Music, 33, 269-303. doi:

10.1177/0305735605053734

Baker, F.A., Grocke, D., & Pachana, N.A. (2012). Connecting through music: A study of a

spousal caregiver-directed music intervention designed to prolong fulfilling

relationships in couples where one person has dementia. Australian Journal of Music

Therapy, 23, 4-21.


Batsch, N. L., & Mittelman, M. S. (2012). World Alzheimer Report 2012: Overcoming the

stigma of dementia. London: Alzheimer’s Disease International, 75.

Belgrave, M., Darrow, A.A., Walworth, D., & Wlodarczyk, N. (2011). Music therapy and

geriatric populations: A handbook for practicing music therapists and healthcare

professionals. Silver Spring, MD: The American Music Therapy Association.

Clark, I., & Harding, K. (2012). Psychosocial outcomes of active singing interventions for

therapeutic purposes: A systematic review of the literature. Nordic Journal of Music

Therapy. 21(1), 80-98. doi: 10.1080/08098131.2010.545136

Clift, S., Hancox, G., Morrison I., Hess, B., Kreutz, G, & Stewart, D. (2010). Choral singing

and psychological wellbeing: Quantitative and qualitative findings from English choirs

in a cross-national survey. Journal of Applied Arts and Health, 1, 19-34.

Clift, S., Hancox, G., Staricoff, R., & Whitmore, C. (2008). Singing and health: A

systematic mapping and review of non-clinical research. Canterbury: Canterbury

Christ Church University. Retrieved from

http://www.canterbury.ac.uk/centres/sidney-de-haan-research/

Corey, G. (2005). Theory and practice of counselling and psychotherapy (7th ed.). Belmont,

Calif: Brooks/Cole.

Davidson, J.W., & Faulkner, R. (2010). Meeting in music: The role of singing to harmonise

carer and cared for. Arts and Health, 2(2), 164-170. doi:

10.1080/17533010903488608

D’Cruz, H., Gillingham, P., & Melendez, S. (2007). Reflexivity: A concept and its meaning

for practitioners working with children and families. Critical Social Work, 8(1), 1-18.

Retrieved from http://www1.uwindsor.ca/criticalsocialwork/reflexivity-a-concept-and-

its-meanings-for-practitioners-working-with-children-and-families

Engström, G., Hammar, L.M., Williams, C., & Götell, E. (2011). The impact of singing in

caring for a person with dementia. Music and Medicine, 3(2), 95-101. doi:

10.1177/1943862110386048

Etherington, K. (2004). Becoming a reflexive researcher: Using our selves in research.

London: Jessica Kingsley Publishers.

Etherington, K. (2007). Ethical research in reflexive relationships. Qualitative Inquiry, 13(5).

599-616. doi: 10.1177/1077800407301175

Gold, C. (2008). The theory and the evidence. Nordic Journal of Music Therapy, 17(1), 2.

doi: 10.1080/08098130809478190

Gold, C. (2013). The meaning of life. Nordic Journal of Music Therapy, 22(1), 1-2. doi:

10.1080/08098131.2013.766451

Hara, M. (2011). Expanding a care network for people with dementia and their carer

through musicking: Participant observation with “singing for the brain”. Voices: A

World Forum for Music Therapy, 11(2). Retrieved from

https://voices.no/index.php/voices/article/viewArticle/570/459

Karkabi, K., Wald, H.S., & Castel, O.C. (2014). The use of abstract paintings and narratives

to foster reflective capacity in medical educators: A multinational faculty development.

Medical Humanities, 40, 44-48. doi: 10.1136/medhum-2013-010378

Khachiyants, N., Trinkle, D., Son, S.S, Kim, K.Y. (2011). Sundown syndrome in persons

with dementia: An update. Psychiatry Investigation, 8, 257- 287. doi:

10.4306/pi.2011.8.4.275

Ledger, A., & Baker, F. (2007). An investigation of long-term effects of group music

therapy on agitation levels of people with Alzheimer's Disease. Aging and Mental

Health,11, 330-338. doi: 10.1080/13607860600963406

Sacks, O. (2008). Musicophilia: Tales of music and the brain. London: Macmillan.

Sloboda, J.A. (2009). Music in everyday life: The role of emotions. Handbook of music and

the emotions. Oxford: Oxford University Press.

Stillman, T.F., Baumeister, R.F., Lambert, N.M., Crescioni, A.W., DeWall, C.N., &

Fincham, F.D. (2009). Alone and without purpose: life loses meaning following

social exclusion. Journal of Experimental Social Psychology, 45, 686–694. doi:

10.1016/j.jesp.2009.03.007

Shoemark, H. (2009). Music therapy as an exercise in humanity. Australian Journal of

Music Therapy, 20, 31-44.

Ridder, H.M. (2006). Music therapy as a way to enhance lucidity in persons with dementia

in advanced stages. Music Therapy Annual: Research and Development, 1, (25-40).

Ridder, H.M., & Aldridge, D. (2009). Individual music therapy with persons with

frontotemporal dementia. Nordic Journal of Music Therapy, 14 (3), 91-106. doi:

10.1080/08098130509478132

Ridder, H.M., Stige, B., Qvale, L.G., & Gold, C. (2013). Individual music therapy for

agitation in dementia: An exploratory randomized control trial. Aging and Mental

Health, 17, 667-678. doi: 10.1080/13607863.2013.790926


Roe, B. (2013). Arts for Health Initiatives: An emerging international agenda and evidence

base for older populations. Journal of Advanced Nursing, 70(1), 1-3. doi:

10.1111/jan.12216

World Health Organisation (2012). ‘Aging’ health topics. Geneva: World Health

Organisation. Retrieved from http://who.int/chp/chronic_disease_report/index.html

Wigram, T., Perdersen, I.N., Bonde, L.O., & Aldridge, D. (2002). A comprehensive guide to

music therapy: Theory, clinical practice, research and training (pp. 45-111). London:

Jessica Kingsley Publishers.

Documents

Australian Journal of Music Therapy - austmta.org.au Delaney AJMT Vol 26, 201… · Australian Journal of Music Therapy, 26, 74-87. Volume 26, 2015 Special Edition: Music therapy