Tony Wigram's Contributions to Research

By Christian Gold

To provide a complete overview of Tony Wigram's research would be impossible in a brief article like this. Here I will merely outline – very subjectively – a few themes of his research that I feel were important.

To Publish or Perish (the "Aalborg Effect")

As a music therapist, Tony could be considered to have been a part of the "second generation," as he trained with one of the pioneers. As a music therapy researcher, he was a part of the "first generation" and will undoubtedly be remembered as one of the great pioneers. A complete – and impressively long – list of his publications is provided elsewhere in this issue (Bonde, 2011). It is fitting that this list was compiled by one of his long-time colleagues at Aalborg University (AAU) because the largest share of his research activities was linked to his position there. Tony referred to the rise in the number of publications at AAU proudly as "the Aalborg Effect" (Wigram, 2007a, p. 49). In his typical self-ironic way, he described it as "the narcissistic and grandiose idea that all the people out there want to know what you do, think, theorise, practice," so that "writing becomes almost a compulsive exercise, a 'pathology'" (ibid.). If it is true that an academic has to "publish or perish," Tony definitely chose the former.

Among the many books, book chapters, and journal articles he published, the five most cited as of the time this article was written[1] include two clinically-oriented books (Wigram, 2004; Wigram, Pedersen, & Bonde, 2002) and three meta-analyses providing evidence of music therapy's effects (Gold, Heldal, Dahle, & Wigram, 2005; Gold, Voracek, & Wigram, 2004; Gold, Wigram, & Elefant, 2006). He was a clinician with heart and soul as well as a relentless fighter for producing scientific evidence to support the value of music therapy, and I would say that his passion for the latter was founded in his passion for the former.

Evidence (and the Religion of It)

I had the honour of joining Tony as a co-author in one of his last publications (Wigram & Gold, in press), which was revised at a time when he was already seriously ill. For that book chapter, Tony chose the wise and provocative title: "The religion of evidence-based practice: Helpful or harmful to health and well-being?" As one who had been on the forefront of producing and disseminating evidence for many years, he was definitely in a position to be asking such questions. He was very aware that regardless of how much, or how good, scientific evidence music therapists were going to produce, there will always be some who will question its value. Furthermore, scientific evidence can never replace, but on the contrary has to build on, good clinical practice. Further, scientific evidence also needs enthusiastic people who carry the message into the political arena if it is to have an impact there. And lastly, the value of good clinical anecdotes in convincing policy-makers is unlikely to ever be replaced completely by numbers. In the book chapter, Tony both discussed the evidence that already exists, the influence it has had on relevant policy documents, and the frustration that can arise when policy-makers do not seem to listen. He concluded that evidence-based practice "can be a force for good" but should be "supported not only by rigorous research, but by clinical knowledge, wisdom and personal experience."

Systematic reviews and meta-analysis are usually considered to be at the top of the "hierarchy of evidence," and Tony's top five cited publications include three of these. All three found positive and encouraging results for music therapy. The first, Gold, Wigram, & Voracek, 2004, provided a broad overview of the effects of music therapy for children and adolescents with mental health problems, and concluded that music therapy had a "medium to large positive effect … on clinically relevant outcomes" (p. 1054). The second review, including only the most rigorous randomised controlled trials (RCTs), concluded that music therapy "helps people with schizophrenia to improve their global state and may also improve mental state and functioning if a sufficient number of music therapy sessions are provided" (Gold, Heldal, Dahle, & Wigram, p. 1). The third review focused on children with autism spectrum disorders (ASD), one of Tony's main areas of both practice and research (Gold, 2011a). Also here, the encouraging results were that "music therapy may help children with autistic spectrum disorder to improve their communicative skills" (Gold, Wigram, & Elefant, p. 1), again including only rigorous controlled trials.

However, a tension that also reflected Tony's quest for both clinical wisdom and scientific rigour was found in all these reviews to some extent, and particularly in the autism review: Many of the included studies were "of limited applicability to clinical practice" (Gold, Wigram, & Elefant, p. 1). Clinical improvisation, widely used by music therapists worldwide and promoted and developed enthusiastically by Tony in seminars and books (Wigram, 2004), was hardly ever used in the RCTs that met the methodological criteria for inclusion. One drawback of systematic reviews is that they have to rely on studies that were conducted in the past. Conversely, one of their strengths is that they highlight gaps. Although the studies included in the autism review were likely over-structured in the type of music therapy that was applied, Tony was also able to make something positive out of this: He noted that those studies did "illustrate the value of structure, which is generally an essential element for children with ASD," and that music contains "rhythmic, melodic, harmonic and dynamic structure" which can be effective if "applied systematically and skilfully" (Gold, Wigram, & Elefant, p. 8). Tony then went on to co-author the first RCT on improvisational music therapy for ASD (Kim, Wigram, & Gold, 2008, 2009).

Collaboration in Research

One thing that these examples illustrate is the need for collaboration, and Tony was excellent in doing this. To produce the best research on the best clinical work, it is important that the best researchers and the best clinicians work together (or even better, good researchers who also understand clinical practice and vice versa). In the past, music therapy research was often a "one-man show;" but as the discipline develops, this is unlikely to remain the most successful strategy. Tony's publication list (Bonde, 2011) demonstrates collaboration with local and international colleagues, as well as PhD students and former PhD students, with a clear increase in such collaborative work over the years.

Another area where he collaborated with enthusiasm, versatility, and perseverance, was the Nordic Journal of Music Therapy (NJMT). A fuller account of his contributions to NJMT is provided elsewhere (Gold, 2011b), but he helped the journal continuously since its beginning in 1992. Over the years he was active for the journal as Reviewer, Language Consultant, Section Editor, and Associate Editor. He was also Guest Editor for a special issue linked to the 6th Nordic Conference of Music Therapy in Aalborg (Wigram, 2010a, b). Both the conference and the special issue were examples of how he used social networks (real ones, not the virtual ones that people associate with the term today!) to develop academic and scientific research in collaboration with many others.

On Having Fun with It

Hard working as Tony was, he was very aware of the need to have fun with the work and to celebrate the successes – big ones as well as small ones. His friends will remember a phrase that he used to shout out: "What a triumph!" The occasion could be as small as a successful conference presentation or even a good and enjoyable dinner. "A cosy atmosphere" (Wigram, 2007b, p. 77) was important to him, and he was mindful that this was important for the success of his PhD students as well: "Above all, I believe that doctoral researchers need nurturing and support, and part of the success of the programme has relied on a milieu that is friendly, allowing, respectful, fun, interesting, supportive and caring." (ibid.) His "morning jokes" and home-cooked meals (three kinds of chicken curry, "garlic bomb", and other delicacies) at PhD courses, and the "robing ceremony" after PhD defences were legendary. He also brought the same sense of enjoyment into other arenas of research collaboration (such as NJMT). But he could also be ironic about that. In one of my first PhD supervision meetings with him (12 years ago), I remember him saying: "I am not satisfied until a PhD student breaks down in tears." I added: "tears of laughter," to which he agreed.

As I wrote in my NJMT editorial (Gold, 2011b), Tony was always clear that the basis of good research is good clinical work, and the basis of that is being a good musician. Thus, his achievements as a researcher cannot be separated from those as a music therapist and as a musician. He will be sadly missed, but his legacy will continue to inspire musicians, clinicians and researchers alike.

Note

[1]calculated using Harzing's Publish or Perish software, which is based on the Google Scholar database. Search date: 6 September, 2011.

References

Bonde, L.O. (2011). Tony Wigram Bibliography: 1992-2011. Voices, 11 (3).

Gold, C. (2011a). Special section: Music therapy for people with autistic spectrum disorder (Editorial). Nordic Journal of Music Therapy, 20(2), 105-107. doi:10.1080/08098131.2011.569164

Gold, C. (2011b). Goodbye, Tony Wigram (1953–2011) (Editorial). Nordic Journal of Music Therapy, 20(3), 2054-2076.

Gold, C., Heldal, T. O., Dahle, T., & Wigram, T. (2005). Music therapy for schizophrenia or schizophrenia-like illnesses. Cochrane Database of Systematic Reviews(2), CD004025.

Gold, C., Voracek, M., & Wigram, T. (2004). Effects of music therapy for children and adolescents with psychopathology: A meta-analysis. Journal of Child Psychology and Psychiatry and Allied Disciplines, 45(6), 1054-1063.

Gold, C., Wigram, T., & Elefant, C. (2006). Music therapy for autistic spectrum disorder. Cochrane Database of Systematic Reviews(2), CD004381.

Kim, J., Wigram, T., & Gold, C. (2008). The effects of improvisational music therapy on joint attention behaviors in autistic children: A randomized controlled study. Journal of Autism and Developmental Disorders, 38(9), 1758-1766.

Kim, J., Wigram, T., & Gold, C. (2009). Emotional, motivational and interpersonal responsiveness of children with autism in improvisational music therapy. Autism, 13(4), 389-409.

Wigram, A. L. (2004). Improvisation: Methods and Techniques for Music Therapy Clinicians, Educators and Students. London: Jessica Kingsley Publishers.

Wigram, A. L., Pedersen, I. N., & Bonde, L. O. (2002). A Comprehensive Guide to Music Therapy: Theory, Clinical Practice, Research and Training. London: Jessica Kingsley Publishers.

Wigram, T. (2007a). "An Englishman in Denmark": What have I learned from Dansk Musikterapi. In Ridder, H.M. (ed.) Musikterapiuddannelsen 25 år. Festskrift. Aalborg: Aalborg Universitet, s. 47-50.

Wigram, T. (2007b). Doctoral Research School in Music Therapy, Aalborg University. In Ridder, H.M. (Ed.) Musikterapiuddannelsen 25 år. Festskrift. Aalborg: Aalborg Universitet, s. 73-78.

Wigram, T. (2010a). Guest Editorial. Nordic Journal of Music Therapy, 19(2), 85-86.

Wigram, T. (2010b). Keynote presentation by Daniel Stern: Preface. Nordic Journal of Music Therapy, 19(2), 87.

Wigram, T., & Gold, C. (in press). The religion of evidence-based practice: Helpful or harmful to health and well-being? In R. MacDonald, G. Kreutz & L. Mitchell (Eds.), Music, Health and Wellbeing. Oxford, UK: Oxford University Press.