Researching Ones Own Clinical Practice

Managing Multiple Roles in an Action Research Project

By Daphne Rickson

Abstract

Action Research is a useful approach for practitioners who want to develop or improve on their everyday activity, while simultaneously contributing to a scientific body of knowledge. Action Researchers need to be able to reflect critically on their actions and interpretations, and be aware of their biases. This becomes increasingly complex and important when the researcher is engaged in multiple roles during the research process. This paper describes some of the dilemmas encountered by a music therapist using Action Research to develop a music therapy consultation protocol while simultaneously gathering data for a thesis towards a PhD in Music. The use of a research journal as an aid to self-understanding is discussed.

Background to the Action Research Project

Almost all of the literature relating to music therapy with children who have special needs in New Zealand describes work in clinic settings in special schools or units. However the Ministry of Education�s commitment to inclusive education, and the geographical isolation of many students, suggests they are not likely to have access to a music therapist in an ongoing way. Further, there are still very few music therapists available to work in special education settings in this country because the tertiary training of music therapists began relatively recently, in 2003. It seems important to find new ways of working with students who would benefit from music therapy input. I therefore began an Action Research project to 1) develop a music therapy consultation protocol for music therapists who work in special education settings, and 2) to investigate how it would be used, perceived, and valued by participants.

Introduction to a Music Therapy Action Research Project

Before beginning the action research cycles, I interviewed music therapists who had worked with children who had special education needs or done consultation in other fields, and analysed video material of single session music therapy assessments. This information was used to develop an initial protocol.

I aimed to gradually develop and/or improve the protocol as I trialled it with four special education teams. The four non-consecutive case studies in consultation were undertaken primarily to provide support to special education teams in their therapeutic use of music, but from the perspective of developing the protocol they enabled four cycles of learning to occur. Following each case, data from field observations, journal entries, and interviews, were analysed to uncover important themes which were used to inform the developing protocol.

Contained by the research which focused on developing the protocol each special education team engaged in their own smaller projects, collaborating with the researcher to plan and implement strategies to introduce or improve their use of music with children who had special needs. The Action Research process therefore involved spin off cycles (McNiff, Lomax, & Whitehead, 2003). It is the multiple roles I engaged with when working directly with teams that is the focus of this paper. The researcher encouraged teams to share ownership of the research to promote maximum participation. Higher involvement means the participants not only become more self-determining, but are able to make sense of the data in relation to their own observations, insights and values (Bray, Lee, Smith, & Yorks, 2000).

The smaller projects therefore had much in common with Participatory Action Research because of the emphasis on shared problem solving through the direct and active involvement of all parties (Park, 2001; Stige, 2005), and on enabling participants to continue to learn after the researcher leaves the system (Bray et al., 2000). The Participatory Action Research process has been described as "steps toward social change through a series of collaborative action-reflection cycles" (Stige, 2005, p. 409) which, like other forms of action research, involve assessment, planning, action, evaluation and reflection.

Space limitations prevent no more than a brief introduction to the protocol and the research findings, which will be offer for publication elsewhere. The initial protocol was broad, outlining information-gathering and sharing activities that were deemed to be essential for effective consultation while allowing teams the flexibility to engage with specific tasks in ways that they felt were most appropriate for their situation. Most of the consultation activities are described below in the brief description of the case studies.

My cycles of learning following each case study resulted in relatively minor changes being made to the overall structure of the initial protocol. However the balance of emphasis given to particular activities shifted, especially as the significance of the ecological assessment became progressively more evident. The clinical music therapy assessment session, undertaken mid-consultation, remained important as a way of identifying students strengths, particularly since it notably contributed to team members developing a positive view of their students. However, I became increasingly aware that work with students in the playground and classroom seemed more meaningful and the music therapy session was becoming less significant. The findings enabled the addition of important qualitative data that served to caution, clarify, affirm, inform and support aspects of music therapy consultancy work, and add validity to the practice.

Following the completion of the four case studies the themes were subjected to further analysis to determine how the process of collaborative consultation was perceived, used, and valued by teams overall.

When working with teams I was both researcher and music therapy clinician, and was therefore intimately involved with participants. Although the research was pragmatic in nature, the uncovering of a valid and authentic research perspective involved stepping back and looking at the work through another lens, or indeed multiple lenses, as well as moving forward to closely examine and reflect on the data with the aim of increasing personal authenticity. Three specific examples arising from my engagement with multiple roles are described in following paragraphs. Just as significantly though, I needed to examine in an ongoing way the beliefs and values I brought to the process and the impact they might be having on the research.

Action Research

Action Research (AR) has been increasingly adopted by educators who wish to improve their teaching and/or to examine other classroom or managerial issues in school settings, and in teacher education (e.g. Kitchen & Stevens, 2008). It can also enable music therapy researchers to generate detailed description of the music therapy process which can in turn be rigorously and systematically analysed (Bunt, 1994). Hunt (2005) argues that Action Research is a form of research that moves away from traditional research methods and therefore researchers, conducting Action Research may come up against resistance and criticism of this method. Nevertheless Action Research can be effectively applied to music therapy and is an "interesting context-sensitive alternative for music therapists who want to document the value of their work"(Stige, 2002) and is beginning to be used in music therapy research (Baker, 2007; Hunt, 2005; Stige, 2002a, 2005; Tait, 2005; Warner, 2005). It is an approach used by individuals or groups of people who aim to improve their own practice, and are therefore willing to submit that practice to critique.

AR emerged primarily from the work of Lewin (1946) who described possibilities for research into the conditions and effects of social action using cycles of planning, action, and fact-finding about the result of the action. The repetitive phases of investigation and analysis, planning and action, and evaluation and reflection remain central to the approach. Nevertheless action research has now been used in so many contexts with different approaches, methods and traditions that its meaning and function need to be consistently and regularly reinterpreted as ideas are applied to a particular context (Cardno, 2003; Reason & Bradbury, 2001).

AR draws from critical theory which emphasises the importance of critiquing and changing society rather than simply trying to understand and explain it. Over the years, practitioners have variously emphasised the role of critical theory in Action Research. Kemmis (2001) now differentiates three kinds action research in education settings.

A technical form which aims to change particular outcomes of practices, and is considered successful when the defined goal of the project has been attained. This research does not question the goals, or how the situation in which the research is undertaken has been constructed.
A practical form in which "practitioners aim not only to improve their practices in functional terms, but also to see how their goals, and the categories in which they evaluate their work, are shaped by their ways of seeing and understanding themselves in context" (p. 92). The researchers aim to understand and change themselves as practitioners.
A critical form which aims to improve outcomes and self understanding as well as assisting practitioners to critique their social or educational work and work settings. This research recognises that there may be collective misunderstandings about what people do, and aims to help practitioners to understand the way people and settings are shaped by history, culture, and discourse.

Johansson and Lindhult (2008) make a distinction between pragmatic approaches (1 and 2 above) and a critical orientation, and argue that the pragmatic orientation is appropriate where targeted and immediate action is required whereas the critical approach is necessary when transformative action needs to be preceded by critical thinking and reflection. Nevertheless they accept that pragmatic action also builds on critical reflection, and action leads to knowledge through reflection. Johansson and Lindhult argue that all Action Researchers need to maintain a critical stance; i.e. to "step back and distance yourself from the action context, with freedom from pressures to act. Through such reflective efforts people can broaden their perspective, reflect back on themselves and their role in relation to the situation and context, problematise what is taken for granted in the action and open up new perspectives on the situation" (p. 107).

Self-inquiry is essential to qualitative research. Stige (2002b) argues that when researchers use self-inquiry effectively, and remain aware of the way in which their personal perspectives and biases are implicated in the research, they demonstrate reflexivity. Metaphorically stepping back, as described by Johansson and Linhult (2008), allows a researcher to see the bigger picture. In contrast, reflexivity can also involve moving variously in and out of the data to explore ones own way of knowing and to examine a "myriad of personal and professional experiences, concerns, needs, reactions, thoughts, feelings, values, beliefs, and so forth that may influence the study" (Bruscia, 2005).

Coglan (2008), draws on the work of Rogers (1961) and theologian philosopher Lonergan, to argue for attention to experience (intellectual activity as well as feeling states) "which does not stop at introspection but drives towards meaning and value and ultimately action" (p. 354). Lonergan (in Coghlan, 2008) describes a three-step dynamic process of knowing through conscious attending to an experience, asking questions of that experience to receive insight or understanding, and following up with careful reflection to determine whether the insights, or judgement, fits the evidence. Coghlan argues that a researchers personal authenticity is characterised by attentiveness to data, intelligent inquiry, and the making of reasonable judgements and decisions, which in turn lead to responsible actions.

Participatory Action Research aims to liberate participants by valuing individual knowledge and experience and empowering people to take action to make change in their own lives. It has been adopted by practitioners who hold the goal of fostering learning how to learn among participants as well as solving problems and generating valid knowledge (Bray et al., 2000). For example, while music therapists understand humans to be musical beings, many individuals deny or suppress their inherent ability because they have not had the opportunity or motivation to develop musical confidence (Austin, Renwick, & McPherson, 2006), or have had it destroyed as a result of unhelpful interactions with others. The success of the music therapy consultation relied as much on team members being able to regain or develop musical confidence and refine musical skills to use music freely with children who have special needs than learning new skills from an expert. A highly collaborative consultation approach can be considered to be effective when team members are able to sustain their therapeutic use of music by engaging with their own cycles of reflection, evaluation, planning and action after the music therapist leaves the field.

Brief Description of Case Studies in Consultation

The aim of Participatory Action Research is to focus on an area of interest to the group (in this case music making with children who have special needs) and for the research process to be a learning experience for all team members. In each of the case studies, team members were able to decide with the music therapist how they could use music to meet Individual Education Programme goals, and how they might monitor the effectiveness of their interventions. In this respect they were involved in the design, data collection, and analysis of their own projects. Each team was responsible for deciding how they used the information obtained from their individual music projects.

Many team members (parents, teachers, teachers aides and allied health professionals) were already using music with students and were requesting help to develop therapeutic strategies, while others were interested to begin introducing music into their students programmes. The consultation involved the thorough assessment of children in their school contexts, as well as an individual clinical music therapy session. However, in addition to coming to know the student, it was essential to find out what strengths and potential strengths team members had, and the barriers they faced with regard to using music at school. I had to encourage them to take risks, learn new skills, have confidence and feel good about their work, to be empowered to use music in an ongoing sustainable way, yet know their limits. It was essential therefore to build positive relationships with all the adults as well as the students they were supporting.

I was with each team for a week, and over that time was involved with data gathering, observing the students with their team members, facilitating a music therapy assessment session, watching video of the session and discussing the work with team members, collaborative programme planning, reporting and providing resources, and facilitating the implementation of team members musical interactions with students.

In the main teams had requested music therapy support because they were struggling to manage day to day life with their student in an inclusive setting, so the work was often highly emotionally charged. The unique personalities, strengths, and needs, of the team members involved in the work (a total of thirty-five team members participated in the four case studies) demanded consistency of careful advice and considered responses. Throughout the process I needed to examine the influence I was having on them and to acknowledge the way in which my values and beliefs might be coloring and shaping the research.

Multiple Roles

As a music therapist my primary concern was to engage effectively and sensitively with teams so they might introduce music strategies to enhance students development and learning. In my role as a leader within the New Zealand music therapy community, my interest focused on developing the consultation protocol with the intention that it would not only support me but other music therapists in their quest to provide a good quality consultation service to children who have special education needs. As a PhD research student I was interested in gathering extensive and rich data for a thesis which would earn me a qualification and, by natural implication, career advancement. I was a participant researcher, a music therapy consultant and clinician, a multidisciplinary team member, and a parent who has been a consumer of special education services.

My first dilemma with regard to the complexity of multiple roles occurred during the recruitment stage. Music therapists in New Zealand, even in a consulting role, would hope to be considered to be a member of each students multidisciplinary team, and I wanted to keep that role typical. It would be usual for colleagues in allied health fields and other educators involved with the student both on and offsite, to be invited to participate in a music therapy assessment process as they were able, in an effort to maximise the two-way sharing of information. For example, in previous consultations team members have been invited to observe video of a music therapy session together. The meetings give team members an opportunity to observe the students responses to music; to determine what particular music activities appear most engaging for that student; and to celebrate their strengths and to begin to identify needs which might be addressed in an ongoing music programme. Involving team members in clinical work which was also associated with a research project was more complex however.

For example, even though the referral for the student at the centre of the first case study came from a Ministry of Education Group Special Education Advisor, no Group Special Education staff members were listed on the Expression of Interest form as potential research participants. Government funded Group Special Education is the main employer of allied health professionals. Most of these professionals (occupational and physio therapists, speech language therapists, psychologists and so on) are located in main centres and travel to schools to support children educated in mainstream settings. Their omission felt problematic. Multidisciplinary collaboration was seen as integral to music therapy assessment work in clinical practice and in that context professional colleagues would be invited and actively encouraged to participate in the process. And yet to directly approach individuals in the same way when the work was classed as research activity might have been considered to be coercive. On the other hand it seemed logical to draw from and share information and experiences with colleagues to gain maximum understanding of the potential for music to assist students, and I wanted any team members who were willing to view video of the music therapy assessment session and/or discuss findings, to be able to do so. It was important to ensure that the assessment and consultation process was not compromised because of the research. People needed to be involved in whatever way they might under usual practice conditions.

After discussing, reflecting, and writing about my problem, the Team Leader Research at Group Special Education was approached for assistance in determining the role staff might play in the research process. She agreed to forward letters to Service Managers explaining the research process and 1) requesting that Group Special Education staff be given permission to collaborate in the music therapy consultation process and 2) suggesting that from a research perspective it would be helpful to have a range of cross-discipline views about the work. Permission was sought for Group Special Education staff to be allowed to give informed consent to be involved as participants in the study should they choose to do so.

My second example is of managing multiple roles in the field. Team members were invited to join focus groups, to view video of their students music therapy session, and to discuss their observations and make plans for future music work. I wanted to be a music therapist, asking and responding to questions, and giving advice as I might in other circumstances. However, my research interest to find out how others perceived the music therapy consultation process, especially their view of their students responses in the individual music session, encouraged me to hold back a little until they had shared observations and/or expressed opinions and had given what feedback they were able to. The teams discourse during and following the viewing of the video provided useful information about the way they perceived the process and what they needed from the consulting music therapist. The research process, and in particular the journaling, therefore helped me to examine my role as an expert and to become a more effective collaborator, as well as a reflexive researcher.

A final example highlights some of the complexities associated with developing and maintaining positive relationships with team members, critical to the success of the work. Therapeutic relationships developed particularly with onsite team members as they recognised my genuine interest in their circumstances, and began to appreciate having the support of an active listener. They began to trust me yet recognised that the short-term nature of my work meant I would remain relatively distant in their lives. They therefore felt safe enough to share, and at times to express strong feelings, about sensitive issues in particular about the lack of support they perceived they received from other off-site professionals.

The extreme frustration they experienced because visits were rare and unpredictable, and because workers lacked continuity, resonated with me. It was easy to understand why at least one team member was lacking in energy and appeared impotent, disempowered through lack of knowledge and a paucity of interaction with enthusiastic and energetic colleagues who could support her work. Some team members had given up requesting help from Group Special Education staff because they didnt expect a response and others because they didnt think the level of support that would be forthcoming would make any difference to their situation. In contrast still others became increasingly vocal until they received help when they were at the "desperation" stage. It was essential for me to remain aware of the ways in which my personal experience and the emotional journey I had been on over the last 22 years while parenting a deaf daughter was affecting my relationships with participants and my interpretation of findings (see Rickson, 2004, for context). I needed to examine my reactions carefully to keep a balanced view of the situation, to remain open to discovering new ideas, and to ensure I made a reasonable judgement of the situation before making a response.

Managing the Complexities of Multiple Roles

In AR, the researchers beliefs, values, and assumptions become fundamental to the work and the ways in which these influence thinking and behaviour clearly must be openly examined. My ability to reflect critically was central to the process, and it was essential for me to continually ask how and why I understood things the way I did and to make the process explicit in research reports.

In the first example I wondered how I might ask to share work with team members (usual practice) or recruit team members who would be research participants (a research activity). The issues of informed consent in action research are intricate. As Smith (2008) argues, "Participatory Action Research by its very nature, makes it challenging to meet the criterion for informed consent. The cyclic process of planning, action, observation, and reflection means that much is unknown at the project's commencement beyond its overarching research questions" (p. 18). As Smith posits, consent is not necessarily a single activity undertaken at the beginning of a project but can be an ongoing negotiated process, maintained throughout the project by reflection, open communications, negotiations and agreed actions.

Positioning myself variously in relation to the research process enabled me to gain new perspectives and to remain aware of my assumptions and potential biases. However, engaging with multiple roles also led to complex relationships and complications in process, and findings needed to be closely examined and questioned before judgements were made. For example I observed my reactions and feelings in the light of my parenting experience as well as my professional understandings and questioned what I was "finding" one example in "a myriad of personal and professional experiences" that contribute to my way of knowing" Bruscia (Bruscia, 2005). I asked myself constantly what I was thinking and feeling, questioned where those thoughts came from, and wondered what they meant. I tried to examine my thought processes and to determine whether I was able to make a reasonable judgement or conclusion. I looked at the congruence between my thoughts and feelings and I wondered about the relationship between them. And I wrote these things down.

According to Abrams (2005), everything that is produced in a research study is based at some level on the researchers interpretations of a phenomena. Recording my thoughts, feelings, reactions and concerns in a reflexive journal helped me to conscientiously inquire into my own relationship to the research, taking ownership and responsibility for my perspective, assumptions, motives, values, and interests. When I was trying to simultaneously manage my role/s as music therapy clinician and team member, and facilitator of a research focus group, I was balancing the need to offer support and clinical expertise with the need to step back and distance myself from the action, and in reflecting I gained a new perspective on the situation (Johansson & Lindhult, 2008). I particularly value my relationships with participants and my role as a participant. Writing helped me to clarify my thoughts in relation to the thoughts of others and in the process to be challenged to develop those thoughts further.

Summary

In addition to the beliefs and values I brought to this project, I created a complex web of relationships. I needed to remain alert as to how I was playing out each of my roles, and how that might affect the research process. Nevertheless, while tensions between clinical practice and research are inevitable, they have been minimised by a highly collaborative approach which encouraged negotiation and pragmatic problem solving. Maintaining a research journal facilitated authentic self-inquiry, and in that respect has a similar function to clinical supervision. Barry and OCallaghan (2008) found that journal writing is beneficial for "understanding contextual influences of practice, connecting theory and practice, self-evaluation and supervision, practice development, and understanding the usefulness of music therapy" (p. 55).

The action research approach enabled me to simultaneously engage with several highly motivating tasks and my aims, to work collaboratively with team members to facilitate their use of music with children who have special education needs were not compromised by the PhD research process. The research was with and for the participants, of whom I was one. Using a highly collaborative Action Research approach and checking interpretations with participants have also enabled me to develop a music therapy consultation protocol which will be useful for music therapists and meaningful for special education teams. Further I am confident that being closely involved with teams as a participant in the work, and engaging in high levels of critical reflection, has allowed me to accurately report the way in which the consultation process was perceived, used and valued by team members. Systematically questioning my thoughts and feelings and recording these in a journal increased my personal authenticity and the value of the project as a whole.

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