Exploring the Experiences of Students in the Final Stage of Music Therapy Training

By Selina Smyth & Jane Edwards

Introduction

Music therapy courses are designed to develop students� skills in a number of areas, helping them to perform competently in the profession. While a number of reports and reviews have presented issues arising in the development of students skills from the perspective of the course academic and clinical supervision (for example Edwards & Daveson, 2004; Farnan, 2001; Oldfield, 1992), the experiences of students undertaking this journey are also an important focus. The ways in which students experience course requirements and indeed whole programmes offers a perspective as to how learning needs are met and challenges embraced.

Background to the Study

The impetus for this study came when the student researcher was asked "was the course anything like you expected it to be?" Through processing the responses to this question, the idea to pursue a small scale study of the experience of students in relation to expectations and experiences evolved in collaboration with the research supervisor.

This study is closely related to a published investigation of the experiences of eight music therapy students during their preclinical or practicum experiences (Wheeler, 2002). Six areas of interest emerged from Wheelers analysis of her open-ended interviews with the students. These included, 1) challenges encountered by students, 2) means of dealing with challenges, 3) involvement with clients, 4) areas of learning, 5) supervision issues, and, 6) structure of practicum. This research study allowed the author to learn more about her students experiences in a way that would not normally be available to her as a faculty member.

The study reported here is intended to be helpful in providing an insight into the experiences of music therapy students. It could help some future students give consideration to what may be required of them when embarking on this journey.

Review of Relevant Literature

There are a small number of studies that have examined music therapy students experiences of participating in training programmes, mostly originating in the USA. Many of these studies have used questionnaires and data compiled by a clinical team, lecturer or member of a faculty team who work in a close relationship with the students. All studies were undertaken during either the onset or middle of the academic programme (Brookins, 1984; Clark & Kranz, 1996; Grant & McCarthy, 1990; Madsen & Kaiser, 1999; Wheeler, 2002). The examination of the experiences of students nearing the end of a postgraduate music therapy training based on interviews by a music therapy student is therefore unique.

Brookins (1984) designed a project that examined the skills expected of music therapy interns in the USA. The study found that the basic abilities for a student entering a music therapy internship included, proficiency on the piano and guitar, and knowledge of psychology, sociology, health sciences and music education. In addition to these skills the study suggested the student should display independence, self-motivation and flexibility in their work.

Other studies have focused on the emotional and therapeutic aspects of music therapy internship training. Grant and McCarthy (1990) for example, explored the emotional stages in the music therapy internship. This study included fifty-nine students from eight regions in the USA. It was found that the students were able to separate their personal and private concerns, and they did not allow their professional struggle to interfere with their self-esteem. The authors suggested that a greater understanding of the growth process may provide a framework for "anticipating and programming certain experiences or passages, thus enhancing the growth process itself" (p. 103-105).

In a later study devised by Madsen and Kaiser (1999) the fears of music therapy students in a US course prior to their internship programme were examined. The authors asked the students to list three of their greatest fears on entering the program. Some fears appeared to be more prevalent than others, however, student concerns mainly focused around their placements and fear of failure. Feelings of uncertainty were also revealed in the students answers.

The experiences of new music therapy students have also been examined (Clark & Kranz, 1996). Information solicited included demographic data, academic and musical backgrounds and also their prior knowledge of music therapy. The authors provided ten open-ended questions and requested written responses focussing on students past experiences and their future expectations of music therapy. Responses were received from 297 music therapy students in 33 colleges. After reading these responses carefully the researchers placed them into representative categories. The findings included reasons as to why students chose to study music therapy at a particular university. Location of the university to their home was found as the highest priority in their decision to avoid high living costs by living away from home. Other findings showed that the most frequent occurring responses as to why the candidate chose to study music therapy included the desire to help others, having an interest in music as a career and also the desire to combine music with helping others.

Methods & Procedures

The study was intended to explore experiences of individual students, not sample a wide cohort in order to make generalisations. Therefore the student researcher focussed on three final year students, rather than interview all current students. Three students were selected from this who were willing to participate. The names of the interviewees have been changed in this paper to protect their confidentiality.

A university based ethics committee approved the study before interviews commenced. The participants were advised that if they felt uncomfortable at any stage, the interview would be stopped immediately. All participants were assured that the information they provided would remain confidential.

The students were interviewed at the eighteen-month stage of a twenty-one month full-time postgraduate music therapy course of study. Interviews took between 30 and 60 minutes. The interview questions were open ended in the hope of eliciting a broad and deep response from each students experience. The questioning style was based on techniques of the ethnographic interview (Spradley, 1979; see also Wheeler, 2002). The interviewer asked open-ended questions based on the participants answers so that the interviewees could narrate their experiences at a deep level. Prior to the interview being conducted the student researcher and the research supervisor met and through role-play practiced the techniques of open interviewing.

The objectives in interviewing in this way was similar to the study conducted by Wheeler (2002), including, a) allowing the student to express themselves, b) provide an opportunity to discuss their experiences as openly as possible, and c) to elicit an interview narrative by which to analyse each of the students experiences Each person chose the location for his or her interview. Each interview commenced with a similar open-ended question, from which the subsequent discussion evolved. All interviews were recorded on minidisk and later transcribed by the researcher (8,600 words). These interview transcripts served as the basis for the open coding of comments related to the experience of being in the final stage of a training programme. A summary of each interview is provided at the end of the paper using the exact words of the research participants.

Role of the Student Researcher

In consultation with the research supervisor, the student researcher considered whether there might be any barriers to eliciting open and free discussion in interview with the students. Students participating in the interviews were made aware that their course director could read the outcomes of the project although, their identities would not be revealed. It was therefore decided to interview the students in such a way that would allow them to tell their story without requesting identifiable details, yet asking probing open-ended questions. This would help to deepen their story in order to gain a better understanding of their experiences. After the interview was completed students were given the opportunity in confidence to debrief with the student researcher about their experience of participating in the interview.

Data Analysis

Each interview transcript was analysed using the following process.The recording of each interview was transcribed and summarized. Codes were generated through reading each transcript a number of times and notating key points in the margins beside the answers. A category was generated for each of the codes, and core categories (here called themes) were drawn from those occurring most frequently. The student researcher was involved in each of the steps and the research supervisor became involved at the process of summarizing the interviews. In this way the analysis is loosely based on Grounded Theory (Strauss & Corbin, 1990) and is somewhat like other music therapists descriptions of their use of modified grounded theory (Edwards & Kennelly, 2004; OCallaghan, 1996). Primarily it was intended that the themes were emergent from the data, rather than deductively contrived in advance and then searched for within the results.

Results

Core categories were developed from the open coding and from these the following themes emerged from analysis of students narratives looking back over a two year course of music therapy study: a) strong feelings and emotions, b) challenges, c) changes in lifestyle, d) coping, and e) enjoyment. These themes are presented and described in detail below.

Strong Feelings and Emotions

Some of the strongly worded views expressed in the interviews revealed experiences of relief, frustration, survival, fear, self-consciousness, the feeling of being daunted, a sense of being overwhelmed when first entering the course, and feelings of accomplishment. The excitement about finishing was also reported.

Some of these feelings were expressed in the responses of Mary and Jenny to the first question about reaching completion of their two-year masters program. Mary described, "I feel relieved that I survived so far and surprised that how quickly it has gone, and I suppose Im looking forward to finishing." Jenny stated: "Im really excited about finishing up and getting out into the work place...I feel I have worked hard over the last eighteen months." She said that she was "...leaving the course on a bit of a high thinking, Im really excited!."

When reflecting on first entering the course, the students recalled nervousness, feelings of being intimidated yet also willingness, as Anne said, to "put in whatever it took to get results." The nervousness seemed related to the experience of embarking on something new. Each of the students expressed fears that they were not up to standard in some way. As Anne expressed, "starting off I remember thinking that my music skills were not up to standard" and also "I remember feeling very daunted having allowed my music skills to lapse." Jenny stated "...when I first started the course I felt intimidated by other peoples knowledge."

The feeling of pressure was also expressed in relation to the course outlines and the assessment requirements distributed at the beginning of each semester. Mary said "...our first module about information and assignments, that was quite overwhelming."

It was also noted by Mary that she experienced difficulties with one placement as she described it as "disheartening" and "frustrating." Jenny described her feelings of frustration in relation to the experiential group offered in the course training. She first said "Im not getting anything from it", and then stated, "Im getting more and more frustrated as time goes on and find it a waste of time."

Interviewees reported a range of feelings and emotions that were experienced and tested throughout different aspects of the course. These experiences seemed to help each student find a niche for their skills, develop and build their confidence as well as strengthen their knowledge of academic and practical work. As Jenny expressed "Ive come to realise everybody has their strengths and weaknesses and...I dont need to feel intimidated by people who might know more than I do." She also described how she had benefited by giving presentations in front of the class saying that she "would feel more confident in presenting...work to...clinicians in the future...Id be more able to prepare something and present it to someone."

Challenges

The challenges described in the interviews were varied. They included the initial challenge of the audition, the period of settling into the course, and the music skills requirements of the programme. Other challenges described by the students included working to finish tasks within the time available, placements, modules, the psychotherapy requirements, class presentations and also considerations for the future.

Both Mary and Jenny began their interviews reflecting on the audition process they went through to get onto the course. They described working hard, being "well prepared" and also feeling challenged by the psychotherapy interview during the intake process. Jenny expressed how in the initial psychotherapy interview "you just have to answer the questions as honestly as you can because the questions...become so complicated that you just have to be honest and open."

It was also evident that experiencing these challenges made students reflect on their learning styles and ways of dealing with new information. As Jenny commented, "Im the type of person that it does take me a while to grasp something but when I grasp it Im fine...." She also stated "I think the day that I am not challenged is a day I need to worry about myself" indicating that challenges are part of growth and development in acquiring new skills. Similarly, Mary stated:

I suppose I knew that even though I was scared and didnt want to do some of these things...I felt just very self conscious and really stupid and I...needed to just go and do it and overcome that fear...just accept that this was where I was at... and realise that I was getting on ok. I suppose when I realised that I was doing alright...I became more confident.

The interviews revealed that each student had times when they found their placements challenging. Mary expressed that some placements did not suit certain aspects of her personality. Anne found herself challenged at placement by the music skills necessary to do the work.

Jenny described at length the challenges that arose for her in undertaking personal psychotherapy as well as participating in the experiential group, both requirements of the course programme. She said about starting personal psychotherapy that "...the hardest thing...was I didnt know the purpose if it. I can understand it now why you should do psychotherapy but at the time I didnt know why I was going."

In one placement Mary described her difficulties in not "getting" the nature of the environment she was working in. "I suppose I was coming to the placement with a structure...of how you do things. I couldnt see the structure in the work I was doing and felt quite unsupported...I was trying...but...I wasnt actually getting it." Jenny described how "...in my placements I seem to have a lot of issues to take on board...things I need to take on board and think about."

In responding to challenges, these students were provided with opportunities for growth. As Anne expressed about changes which occurred during her time on the course:

I think I had myself limited before coming into the course and pigeoned off...because of what I was doing before I came into the course...the past academic year has been an eye opener because it is so much broader and there are so many areas... I am interested in working.

Changes of Lifestyle

As part of her interview, Anne described how after enrolling in the course her "...lifestyle changed dramatically...time wise and commitment wise." She found that "...things that I would have taken for granted before the course or would have been priorities in my life arent priorities any longer...the changes for me [are]... adjusting to the pace and the different perspectives and the...different content" Jenny said that for her the course "...has taken over from a lot of other things that have been going on in my life."

Each of the students mentioned changes in their lives that were necessary in order to complete the course requirements. They described the need to find a balance between the course, their life style, and other extra curricular activities. Anne observed that, "...there has been a whole lot more to do on a daily basis, just with the way the course is structured...I had a structure before the course and that was completely changed. When the course started I had to change the things that I would normally do...-[my] other commitments."

Some of the factors students mentioned that required a change of lifestyle and routine were things such as the course being full time and also that there is a lot of individual research to do outside the classroom. Mary expressed that she also has a full time life outside the course. She acknowledged "I have very limited free time or leisure time at the moment but...it is a choice I am making."

It was also described that one of the changes in taking up full time study is that the pace of life is quicker; Anne felt she was "...juggling things to keep it together." She also noted, "My life before the course was very much Monday to Friday and then weekends would have been freer for me for my own personal time and space...I found that a big change. Im not free at weekends as there is always something to be done."

Coping

Throughout the interviews times when students had difficulty coping with the challenge of the course were recalled. Each described different strategies to achieve equilibrium. Some of the issues that challenged students coping included some of their experiences during fieldwork placements, feeling pressured by the demands of the course and also the work involved in balancing everything in order to keep physically and mentally healthy. The interviews revealed the ways in which they coped with these pressures.

Mary described experiencing release of tension in exercise. Anne found she was able to cope with the demands of assignments and other tasks by approaching the work bit by bit and also by talking to others in the class about different difficulties which arose in the academic and practical aspects of the course.

As each interview developed feelings expressed related to acceptance of the demands of the course, the development of greater personal interest in music therapy, and also experiencing benefits from learning. As Mary indicated, "...you need to accept that there are aspects of the course you will find difficult but if you work through them and talk to your course director you will be guided in the right direction."

Anne described coping with the demands of the course by focussing on the experience of placements as a "highlight" of the programme. As she said, "...its why youre going through what youre going through, the stress and academic side of it, you know you can tie the two together and say yes, this is why Im doing it and this is why I want to do it, Ill get through it..."

Jenny found she had to realise how important it is to be...physically well but [also] mentally...to look after yourself to do the work. In relation to a number of challenges she described the strategy of "visualising" to help her to succeed; "I visualise me doing it and doing it well." Mary also described being helped at a difficult time by talking to the course director and by deciding to be "open minded."

Marys response to the opening question of the interview was "I feel relieved that I survived". This response was developed as a sub-theme of "I was daunted yet I survived" which was explored in the interview questions which followed. Jenny also described how, as the course progressed she became aware that she was coping better with the requirements:

...when I think back to this time last year, if I was given an assignment to do, say to write an essay...I think I would have found it more daunting...whereas now...I can just do it; dont be afraid.

Enjoyment

Even though words such as intense, overwhelming, and daunting were used in the interviews, the students also described their enjoyment of studying music therapy. This theme of enjoyment was expressed in different ways. It can be seen in the descriptions of the experiences of being a student again, as Mary said "its been enjoyable being a student and interesting." There were also reports of feelings of accomplishment when work was completed, and the satisfaction when it was submitted, and also meeting new people who will be future colleagues.

A shared source of enjoyment for the interviewees was revealed in the descriptions of their fieldwork placements. Anne described that for her "...all the placements were really, really enjoyable. I took so much from them and I hope the clients have as well." She further stated that placement was "...the highlight ...because its real and its what youre aiming for." Jenny emphasised her positive experiences in the statement "I enjoyed - I really enjoyed- using the skills I had in placement."

Mary expressed satisfaction in one of her placements as it was "interesting" yet also "intense." She enjoyed being able to use techniques in working with those with dementia to help communicate with older adults nonverbally and vocally by using music. She described another of her placements as "really fascinating and really rewarding."

Anne expressed enjoyment about the skills she had learned in placement requiring her to combine the "musical side, musical interactions and musical responses" from what was learned in class and taken into the workplace. Jenny expressed her enjoyment in others acknowledgement of her work. She described her placement experiences as "rewarding and affirming." The interviews revealed ways in which overcoming challenges was satisfying, rewarding and ultimately enjoyable for the students; as Anne said "it was tough but I got there."

Discussion

These three students described experiencing strong feelings and emotions during their course as they encountered a number of different challenges. They managed lifestyle changes and reported ways of coping with what was expected of them in the course. Throughout this they told of experiencing enjoyment. This was not necessarily pleasure resulting from being immersed in a consistently enjoyable experience but rather was an enjoyment that emerged as a result of coping with challenges and feeling a sense of achievement.

Students of music therapy are a diverse group who are drawn to study music therapy for a number of reasons (Clark & Kranz, 1996). While a diversity of experiences is evident in the interviews with the three students in this study, there were also some aspects they described which emerged as congruent in the analysis; ultimately exposing an interrelationship between the themes.

The analysis of the interviews revealed that these students experienced a dichotomy between being challenged or even "daunted" by the process of studying music therapy and the contrasting experience of surviving and even enjoying this process. This daunted/surviving contrast permeated aspects of each of the themes. This idea was also evident in descriptions of fieldwork placement experiences in the interviews where challenges were talked about and yet enjoyment was expressed.

The detail provided in the recall of practicum experiences was particularly striking in the interviews and each of the themes emerging from the coding can be referenced to students descriptions of placement. These are clearly intense and memorable learning sites for students. As Anne put it, "its real." This is not too surprising since it is the context where the capacity of the student for doing the work of music therapy is experienced but also tested. This "testing" occurs through a process of self-reflection on practice as well as regular supervision and in the required feedback about the students competence provided by the placement supervisor.

It was also noted that in the students descriptions, practicum experiences were referenced to the semester in which they were completed rather than described holistically. This suggests that although each students learning process is intended to be continuous, there can be "stand out" features of learning in each placement and these are not necessarily able to be linked together yet by some students in the final stage of their studies.

It is interesting that the word intimidation appeared in a number of ways throughout the three interviews. One context was the module requirements given at the beginning of each semester. They first appeared daunting but as noted by Mary, they became more manageable as they were worked through. A further context was Jennys experience of being intimidated by other students knowledge when first beginning the course. As the course continued however Jenny seemed to be experiencing more of a level playing field among her classmates stating, "Ive come to realise everybody has their strengths and weaknesses." This highlights one of the further aspects inherent in the themes and that is the way they reveal the students growth through the experience of studying music therapy.

There were resonances between the student researchers experience of studying music therapy and the comments of these students; particularly their reports of personal growth through studying the course. Anne expressed this experience of growth for her as follows,

I just find it so fascinating that there are so many areas that it [music therapy] can be applied to...Not knowing, not having the experience, not having worked with different populations and then having worked with them and having read and studied...[I] realised that it is something I am capable of and enjoy.

Jenny also reflected this idea of growing through study in her comments about learning how to present information where she said "I feel mentally Id be more able to prepare something and present it."

Understanding the growth process for music therapy students can provide a framework for anticipating and programming certain experiences or developmental passages (Grant & McCarthy, 1990). Reflecting on the ways students grow and change in their skills, competence and confidence through their period of study provides opportunities to reflect on how course programmes should be designed to acknowledge and encourage this growth.

Each of these students made references to their study of music therapy being predominantly university based with one day of placement weekly over the 21 months. This suggests that further investigation of students experiences of linking placement work and class work might be warranted.

Summary & Recommendations

Three students near to completion of a two year MA programme of study in music therapy were interviewed for the purpose of eliciting information about their experiences in the course. Qualitative analysis of the interview data uncovered five themes in these student reports of studying music therapy a) strong feelings and emotions, b) challenges, c) changes in lifestyle, d) coping, and e) enjoyment. Students described some aspects of learning through the course as a dichotomous experience of being daunted yet surviving and enjoying the experience.

This study has provided glimpses into the experiences of these students reaching completion of a two-year full-time music therapy course programme. Understanding students experiences can be helpful to those wishing to choose music therapy as a future career, it is informative for those directing and teaching music therapy training programmes, and can be affirming for students and graduates who may find resonances in the analysis of these reflections from students near to course completion. Further examination of graduates experiences at various stages of their career could also provide insights into the study of music therapy programmes and contribute to an enriched tapestry of knowledge about learning processes as well as learning outcomes for qualified music therapists.

References

Brookins, L. (1984). The music therapy clinical intern: Performance skills, academic knowledge, personal qualities and interpersonal skills necessary for a student seeking clinical training. Journal of Music Therapy, 21, 193-201.

Clark, M. E., & Kranz, P. (1996). A survey of backgrounds, attitudes, and experiences of new music therapy students. Journal of Music Therapy, 33, 124-146.

Edwards, J. & Daveson, B. (2004). Music therapy student supervision: Considering aspects of resistance and parallel process in the supervisory relationship with students in final clinical placement. The Arts in Psychotherapy, 31, 67-73

Edwards, J. & Kennelly, J. (2004). Music therapy in paediatric rehabilitation: The application of modified Grounded Theory to identify techniques used by a music therapist. Nordic Journal of Music Therapy, 13, 112-126

Farnan, L. (2001). Competency-based approach to intern supervision. In M. Forinash (Ed.), Music therapy supervision (pp. 116133). Gilsum: Barcelona Publishers.

Grant, R. E., & McCarthy, B. (1990). Emotional stages in the music therapy internship. Journal of Music Therapy, 27, 102-118.

Madsen, C. K., & Kaiser, K. (1999). Pre-internship fears of music therapists. Journal of Music Therapy, 36, 17-25.

OCallaghan, C. (1996). Lyrical themes in songs written by palliative care patients. Journal of Music Therapy, 33, 74-92.

Oldfield, A. (1992). Teaching music therapy students on clinical placements - Some observations. British Journal of Music Therapy, 6, 13-17.

Spradley, J. P. (1979). The ethnographic interview. New York: Holt, Rinehart & Winston.

Strauss, A. & Corbin, J. (1990). Basics of qualitative research: Grounded Theory procedures and techniques. Newbury Park: Sage.

Wheeler, B. L. (2002). Experiences and concerns of students during music therapy practica. Journal of Music Therapy, 39, 274-303.

Interview summaries

Summary Interview one: Mary

I feel relieved that I survived so far and surprised that how quickly it has gone and suppose looking forward to finishing. I wanted a bit of a change from my career...I had worked hard to do the audition, then when I got in I was a bit taken aback....leaving full time employment, being financially more compromised...was daunting initially.

...its been enjoyable being a student and interesting. I have a better grasp on how to do things better than an undergrad. I can integrate the other life experiences I have had into doing the learning in the course.

...overall Im just busy doing the course and managing other aspects of my life in relation to the course. The biggest challenge would have been the music skills area. I very much didnt see myself as a musician in comparison to other members of the class.... I felt just very self conscious and really stupid...and I kind of needed to, just go and do it. I just began to accept that it didnt need to be very complex and difficult and that sometimes something very simple can work.

My current placement is very enjoyable and very interesting and quite intense, more intense than I had anticipated. It has been very interesting in terms of the way I would communicate with older adults also more at a nonverbal or vocal, non communication. My placement last term was really fascinating and really rewarding. It was challenging but it was within my realms of challenging. I really learnt a lot from it, particularly in dealing with coping with strong emotions, it was a real eye opener.

I suppose its [determination] a key aspect of my personality, I am quite a determined person, if I start something I will follow through

Summary Interview two: Anne

I was aware of this course since 1998. I was willing to put in what ever it took to get through the course. When you get your assignments its very daunting but over the past eighteen months it has become something that I am very interested in. I find it fascinating there are so many areas that it [music therapy] can be applied to...youre not limited. I think its been a real learning experience of learning how to study again and applying myself in reading and practical application.

There were different parts I found challenging. I think starting out things were a bit challenging. When it was something new and I was unfamiliar with - was challenging from the point of view I was starting at a very basic level. When we started off I remember feeling very daunted having allowed my music skills to lapse...once I got into them it was fine.

I see that (practical experience) as being the highlight of the course... because its real and its what youre aiming for. My practical skills were never an issue with my placements, by the time I came to placement I was comfortable playing. The only stumbling block on my first placement, my guitar skills would have been making eye contact, playing and singing which just took me longer to learn.

The eighteen months have gone really quickly I suppose because having an interest in what youre doing time always goes quicker.

Summary Interview three: Jenny

Im really excited about finishing up and getting out into the work place. I feel I have worked hard over the last eighteen months.

Id say my placements were a big challenge and also the area of psychotherapy within an individual and group context. I had never experienced it before so that was a totally new area to me. I can understand now why you should do psychotherapy but at the time I didnt know. The first introduction I had to psychotherapy was the interview for here. I thought if I didnt get the course it was because of the outcome of the psychotherapy...you just have to answer the questions as honestly as you can because the questions become so complicated, you have to be honest and open. The context of individual therapy I found I could talk about [things] I hadnt talked about before. Within group therapy I think at this stage if I gotten nothing else from it I know what its like to have been part of a group in psychotherapy.

With my academic work we had to do a number of presentations. I would get very nervous...intimidated... When I first started I felt intimidated by other peoples knowledge, Ive come to realise everybody has their strengths and weaknesses. One thing I have gained from this course is presenting my work. I would feel more confident in presenting my work to other clinicians in the future.

At the end of my undergrad the director of the course here had given a lecture in my university. I had never heard of music therapy and remember thinking that this was just amazing that you could use music to benefit people. I became interested in that and gathered articles and did research into it.

Over the last eighteen months I have learnt things about myself I didnt know before. I also appreciate how important it is to be, not alone physically but mentally important to look after yourself. Im really excited I have this great tool and I know how to use it. The aim in coming into the course is what I have gotten leaving the course.