[Section Voices: Qualitative Study]

Music Therapy Students’ Experiences of Interactions with Young Clients During Fieldwork Placements

By Elvie Miller

Abstract

In this phenomenological research study, I investigated the experiences of music therapy students’ musical interactions with young clients during fieldwork placements. Six Masters level students provided written narratives describing their interactions and then engaged in semi-structured follow-up interviews. Four main themes emerged during qualitative data analysis: 1) Breakthrough Interactions, 2) Balancing students’ needs with clients’ needs, 3) Role, identity and reflections of self, and 4) Supervisor issues. These themes are discussed in detail and include excerpts from the interviews. Reflections based on my reflexive journal are presented. Implications and recommendations for future research are discussed.

Keywords: Interactions with young clients, music therapy students, fieldwork placement experience

Music Therapy Students’ Experiences of Interactions with Young Clients During Fieldwork Placements

The fieldwork placement in music therapy training is a complex and unique learning experience. Each music therapy student has a different placement experience, working in different settings with different client populations, and these experiences help shape the growth and development of the students as music therapists. Music therapy training programs vary throughout the world in the parameters, goals and expectations of students during fieldwork experiences.

Entering music therapy training from a performance background, I saw that some aspects of my experience in musical interactions, such as timing, responsiveness, and relating to others, transferred to therapy sessions with clients during my fieldwork placements. I felt in sessions with clients that I was continually looking for a “shared” musical experience, particularly in improvisational interactions with children and adolescents. As I reached the end of training and reflected on my experiences in the training course, fieldwork placement held, for me, many of the defining moments of “becoming” a music therapist. As a result, I was interested in exploring other music therapy students’ experiences of musical interactions with children and adolescents during their fieldwork placements.

Review of Relevant Literature

The literature was reviewed in two areas: (1) Music therapy students’ experiences of fieldwork placements and (2) Music therapists’ musical interactions with young clients. These areas were identified in the context of the research question.

Music therapy training often includes a component of practical experience. These experiences have been termed “preclinical” or “practicum” experiences, “internships” or “fieldwork placements,” depending on the location and type of training course. One study to date has examined the structure and content of these experiences (McClain, 2001). Research in this field originating in the United States has primarily focused on the professional competencies published by the American Music Therapy Association (2003), which supervisors have used to assess music therapy students during clinical training.

Studies of student music therapists’ experiences include data collected from several questionnaires and surveys and several qualitative studies of music therapy students’ experiences. Questionnaires and surveys investigated various aspects of students’ experiences, including perceived deficits in professional competencies prior to starting internships (Knight, 2008), fears about internships (Madsen & Kaiser, 1999), students’ backgrounds, attitudes and expectations at the beginning of training (Clark & Kranz, 1996), and emotional stages of music therapy students during internships (Grant & McCarthy, 1990).

Knight (2008) compared questionnaire responses of 85 music therapy students to determine the students’ perceived deficits in professional competencies. In another survey, Madsen and Kaiser (1999) found that students’ greatest fears were in being prepared and having the necessary skills and knowledge.

A survey reporting the free-form responses of 297 music therapy students highlighted many areas of student experience and background, including reasons the students had chosen music therapy as a career and the role of music in their lives (Clark & Kranz, 1996).

In a study measuring feeling states of 59 student music therapists throughout a six-month internship, Grant and McCarthy (1990) identified a series of emotional stages. This research revealed that music therapy students experienced a personal emotional struggle in the first four months of internships, before significant feelings of a positive professional identity emerged.

Qualitative studies of music therapy students’ experiences have been conducted by academic and clinical supervisors or by a peer in close contact with the students. These articles have used methods of observation (Luce, 2008; Oldfield, 1992) and qualitative interviewing and analysis (Wheeler, 2002; Smyth & Edwards, 2009) to research topics including music therapy students’ development as well as students’ experiences of supervision, client interactions, musical improvisation and general reflections of the training course.

Luce (2008) qualitatively investigated the epistemological development of music therapy students, or the ways students learn and know. He found that a dualistic perspective could limit music therapy students’ abilities to modify therapeutic interventions and adapt to different professional settings, whereas a relativistic perspective was more helpful to students in transitioning from an academic environment to an internship and profession. Another article written from a music therapy supervisor’s perspective presented reflections on students’ experiences over many years of supervising experience (Oldfield, 1992). In this article, the author described the difficulties some music therapy students have when beginning placements, including adjusting to work with people with disabilities and creating boundaries with clients.

Wheeler (2002) phenomenologically investigated undergraduate music therapy students’ experiences of and concerns about music therapy practica. She conducted open-ended interviews with eight music therapy students three times each over a year. She identified the following themes in the data:

Challenges
Involvement with clients
Areas of learning
Supervision
Structure of experience

As a music therapy educator, Wheeler pointed out the importance of understanding students’ perspectives. Her study indicated that students’ views sometimes differ from academic or clinical supervisors’ perspectives.

In a similar study, Smyth and Edwards (2009) presented a qualitative study of three music therapy students’ experiences in the final stage of their training program. The students were peer-interviewed at the 18 month stage of a 21 month postgraduate course. The participants were asked open-ended questions in order to elicit narrative responses. Based on an open coding process, the authors identified themes that emerged from the data. Within the data, students’ specific references to fieldwork placement experiences included adjectives such as “disheartening” and “frustrating,” “enjoyable” and as one of the “challenges.”

The relationship between the therapist and the client that develops through musical interactions is central to the music therapy process. Bruscia’s (1998b) definition of music therapy stresses that both the “music experiences and the relationships that develop through them” act as “dynamic forces of change” (p. 20). Hanser (1999) suggested that the therapeutic relationship may be the most influential factor in “determining success in therapy” (p. 211). In music therapy, the therapeutic relationship is formed either from musical or verbal interactions, or both, between the therapist and client/clients (Darrow, Johnson, Ghetti, & Achey, 2001; Pavlicevic, 1997). Therefore, it is important to consider the implications of musical interactions to the therapeutic relationship.

Limited research was located examining music therapy students’ experiences of musical interactions with clients, and none specifically addressing students’ experiences with young clients. One study examined the musical and verbal interactions of twelve music therapy practicum students during music therapy sessions (Darrow et al., 2001). Through video behavior analysis, the researchers found that the music therapy students spent more time in verbal engagements than in musical interactions with clients.

The musical interactions between qualified music therapists and young clients have been described in terms of “interaction themes,” or the “result of a joint interaction history that develops gradually between child and therapist and at the same time a frame for the continued interaction between them” (Holck, 2004, p. 7). In a case example, Holck (2004) described how an interaction theme emerged in music therapy with a nine-year-old boy with a diagnosis on the autism spectrum as he initiated turn-taking and mutuality in improvisation. Garred (2001) also described musical interactions through improvisation with a 14-year-old girl with Rett Syndrome. The relationship between the therapist and child was mediated by musical interactions. Much of this literature suggests that, through musical interactions, the client gathers experiences that can be transferred to non-musical interactions and relationships outside of music therapy.

In summary, the literature reporting music therapy students’ feelings and experiences of fieldwork placements and music therapists’ musical interactions with young clients includes a small number of surveys, most of which have been conducted prior to or in the beginning stages of the practical experience, several qualitative studies exploring student development, a limited amount of research examining students’ experiences with young clients and several case examples describing interactions between therapists and young clients. None of this research centrally focuses on student therapist-client musical interactions, and very little of it has been conducted from a peer researcher perspective. The current study aims to address these gaps.

Purpose

The purpose of this research project is to gain an understanding of second year music therapy students’ experiences of musical interactions with clients during fieldwork placements. This research may provide valuable feedback to the participants about commonalities among their experiences, and it may also help future prospective student music therapists understand some aspects of what to expect during the music therapy fieldwork placement.

Method

I contacted eight second-year music therapy students and requested their participation in this research by email. All eight students provided informed consent to participate. Because all were Masters level music therapy students undertaking the same two-year training course and were my peers, this was considered a selection process of convenience (Bruscia, 2005). Of the eight students who consented to participate, seven students returned written narratives within the time-frame of the research project. One student who returned a narrative was excluded from the study because of a malfunction with the audio-recording equipment during the interview. Therefore, the number of students included in the study is six, one male and five females, all in their 20’s. The students came from diverse backgrounds and included teachers and performers as well as music majors matriculating directly from undergraduate education.

Each student received detailed information about the study and was given the option not to answer any question and to withdraw at any time. I asked each student to write a narrative response to the following open-ended question:

Could you tell me a story about musically interacting with a client or clients under 18 years old during your fieldwork placement?

The purpose of requesting the narratives was to give students time and space to reflect on their fieldwork experiences before picking an interaction, to see what kinds of experiences students would tell about in order to prepare for interviews, and to open up a dialogue with the participants about their experiences. After each narrative was returned (seven out of eight consenting participants returned narratives ranging from 320-850 words), I requested a follow-up interview with each participant and all assented.

In the interviews, I asked the same open-ended question of each participant at the beginning:

In as much detail as you would like, would you describe the interaction you chose to write to me about?

Then, I based follow-up questions on ideas or issues that the interviewee brought up in his/her answer, or that had emerged in the written narratives. This interviewing method was based on Wengraf’s (2001) description of semi-structured interviews. Some questions were prepared in advance, based on each student’s written narrative, but each interview was loosely structured, and allowed for follow-up questions in order to gain the fullest possible understanding from each participant. This interview method was also informed by methods used by Amir (1999), Wheeler (2002) and Smyth and Edwards (2009). The interviews were audio-recorded (six in total) in order to allow me to give full attention to the interviewee rather than needing to pause to take notes (Elliot, 2005). Interviews were 25-35 minutes in length. In order to give participants a sense of how much detail to provide, I told them beforehand that the interview would be approximately half an hour (Elliot, 2005).

Then, I transcribed the interviews (22,000 words), summarized them and returned them to each interviewee for approval, review and revision. I made corrections based on their feedback. Because of a malfunction with the audio-recording equipment during the interview, one interview was not available for transcription. As a result, specific data from this interview has not been included in the results of this study. However, it is likely that my own memory of the interview influenced my perspective on the research. This student told me about a “breakthrough” interaction with a client and this may have contributed to the emergence of a theme surrounding this issue during analysis.

The approach to this research project is phenomenological, meaning that a complex human experience is being studied, and the aim is not to impose preconceived ideas or categories on the data, but rather to let themes emerge and to be open to discover something new from the data (Forinash & Grocke, 2005). In a broad sense, this approach took the form of “in-dwelling” in the data (Meekums, 2008), while the specific steps I used in data analysis were outlined by Smeijsters (1997) as follows:

Reading all transcripts of interviews
Extracting significant statements
Formulating what participants mean
Clustering overlapping formulated meanings and organizing these into themes
Validating these themes by returning to the original protocol
Writing an exhaustive description of the topic under study
Making a statement of its fundamental structure
Validating the description by research participants

This process was aided by regular meetings with a research supervisor to discuss the process and emerging results.

Confidentiality Issues

Narrative research is a process of identifying the broad interpretive framework that people use to tell about meaningful experiences. Because narrative research is situated in individual experiences and interpretations, it is necessary to place the participants in context when presenting data (Ezzy, 2002). It can be challenging for the researcher to find a balance between portraying the broader context of the research and protecting the confidentiality of the participants.

In order to address issues of confidentiality and to avoid objectifying the participants, I aimed to view the participants as an “editorial board” (Lather and Smithies, 1997, p. 215) in my research process. This approach both involved them in the process and helped to validate the research. At each stage of research, I checked back with the participants about the responses they provided. Additionally, I contacted the students who participated after graduation from the course to ask them if their responses were in any way influenced by additional factors or confidentiality issues. I did not receive any responses that this was the case.

One issue that arose in this process of review by participants was the gender ratio of respondents, which was one male to five females. In order to maintain confidentiality, I considered various ways of disguising the male student’s identity within the responses. These included: changing gendered pronouns within his data to feminine pronouns; randomizing all gender pronouns within the data; and attempting to eliminate all gender pronouns from the data. In order to resolve the problem, I contacted him and asked what he would like me to do. He responded that he would prefer for me to change pronouns to feminine when referring to him. Although this does create some limitations to the data, there is no perfect solution to this dilemma, and I believe that any solution would limit the data in some way.

Another limitation arose when one student told me about an interaction in which she used her first instrument, which identified her. This was difficult because her instrument is unique in the data and is an instrument that requires extensive training, making it relatively inaccessible to the other participants. (In contrast, for example, the gathering drum used by one student is an instrument any of the students could have used because it requires a relatively low level of proficiency). Because of this, I have not included data about the interaction that identifies the instrument.

It should be noted that no student names have been used and names of clients have been changed for anonymity in this study. This study was reviewed by the University of Limerick Research Ethics Governance committee and received ethics approval. Written, informed consent was provided by all participants.

Reflexive Process

In using narrative data to generalize about realities outside of the interview data, it is important to recognize the researcher’s assumptions and contextual knowledge that play a part in interpretation (Wengraf, 2001). The respondent’s voice is filtered by the author’s account (Hertz, 1996), and the author’s decision about what data is meaningful can shape the results of the research.

Throughout the research process, a reflexive journal provided me with an opportunity for self-inquiry about the research (Bruscia, 2005; Barry & O’Callaghan, 2008). The reflexive journal is an “attempt of the researcher to bring into awareness or to understand his or her own personal and professional perspective” (Brusica, 2005, p. 130). Over the eight-month research process (September, 2009-April, 2010), I reflected on my own interactions with clients during fieldwork placements, the process of ethical review, and the ongoing data collection and analysis. The reflexive journal was invaluable as a place to express ideas emerging throughout the research process, and as a record of reflections and ethical issues at certain points in the research process. Some of the specific questions I addressed in the reflexive journal included:

How does the research question reflect my own personal and professional perspectives?
How have my relationships with participants affected the research process, and how has the research process affected my relationships with participants?
Am I open to discover something I did not expect?
How might participants’ knowledge that others will read the report affect their responses?
What types of experiences have respondents shared with me?
How do the emerging themes in the interviews reflect my own biases and opinions?

Following discussion of the results of this research, I have included a section devoted to material based on entries in my reflexive journal about the research process.

Results and Emerging Themes

The six participants in this study worked with clients ages three to 13. Students’ placements took place in a variety of settings, including special needs schools, a hospital, a youth development project and an early intervention facility. The participants identified their use of music therapy to meet clients’ needs in areas of: sensory development, sense and awareness of self, communication, emotional expression, self-concept and self-esteem, and assessment of Autism Spectrum Disorder. Three students chose interactions from the first semester of their supervised placements (second semester of training); two students chose interactions from the second semester of their supervised placements (third semester of training), and one student chose an interaction from her independent placement in the final semester. Five students chose interactions using improvisation as the main method and one student chose a songwriting interaction. Instruments used included voice (four students), piano (two students), guitar (two students), glockenspiel (one student), hand bells (one student), drum beaters (one student), gathering drum (one student), and another instrument (one student), not identified here to preserve the student’s identity.

Based on numerous readings of the written narratives and interview transcripts, Smeijsters’ (1997) eight-step process, “in-dwelling” in the data (Meekums, 2008), and with the help of a research supervisor, themes were identified in the narrative and interview data. Four main themes emerged: 1) Breakthrough interactions, 2) Balancing students’ needs with clients’ needs, 3) Role, identity and reflections of self, and 4) Supervisor issues. These themes are described in detail below.

Breakthrough Interactions

Table 1 Sample of Music Therapy Students’ Quotations and Coding to Inform Categories Depicting Breakthrough Interactions
Quotations	Codes	Categories
“It was a breakthrough in that I was able to come into his personal space without him becoming upset, and he actually interacted with me, and he began to smile and glance out of the side of his eye at me which was massive.”	Client interacts in a way student has never seen	Breakthrough consists of positive responses that the student hasn’t yet seen during work with client, and comes as a surprise to the student
“This was the first time that it really felt like we had connected in the music that was happening.”	Music facilitates interaction for the first time
“I suppose I never expected anything from him in the six weeks, so it was a surprise when it happened; It was totally out of the blue. It’s not like…I maybe thought he’d stop crying for a session but I didn’t actually expect a massive turnaround like this in one session.”	Student is surprised by a big change for the client
“I had at that stage been unsure whether she was verbal or not, and to hear her say anything was a big thing.”	Breakthrough is preceded by doubt	Prior to the breakthrough, the student experienced doubt or anxiety about the client or about herself
“I think I was getting a bit anxious that it was never going to happen.”	Breakthrough is preceded by anxiety	Student therapist expressed positive feelings about a client and/or a sense of achievement when the breakthrough happens
“I remember the feeling of seeing “Tom’s” response, because he immediately lifted his head, gave a big smile, and started giggling. Now, I hadn’t heard him giggle before. Something about that was just, really, like, it was really special.”	Client’s response elicits feelings in student therapist
“I just remember smiling and feeling that I had done something to help.”	Student takes responsibility for positive change
“I felt I had achieved something in the individual sessions from her interactions in the group.”	Student takes responsibility for positive change
“It must have been [a breakthrough], because sometimes he’d be aware what others were doing and sometimes he wasn’t, but again, it’s hard to pinpoint a look, or that exact moment in time when you know, okay, he gets this, at this moment, but it’s just that feeling you get.”	Client’s response elicits feelings in student therapist

Most of the participants described the interactions they had chosen as breakthroughs. Table 1 shows how I coded the direct quotations of the participants and then generated categories. Student music therapists described interactions that were characterized by clients’ responding in new and positive ways. These interactions were often preceded by doubt or anxiety about the client or the student’s capabilities, and the students felt positive feelings and surprise when the interactions took place.

The fact that almost every participant chose an interaction he/she described as a breakthrough for the client is significant. What emerges is that the breakthrough is important not only for the client, but also for the student. By selecting the interaction, the student has shown that the interaction is memorable over time. From the data provided by students, it seems that interactions students describe as breakthroughs for the client also represent moments when students developed either a sense of confidence, a professional identity, an understanding of music therapy methods, or an understanding of the potential for music therapy with a specific client population.

While the fieldwork placement is a chance for students to practice newly acquired skills and gain experience working with various client populations, understanding a client’s needs and using new skills to address them can be very challenging. Many of the students in this study placed an emphasis on the importance of seeing an improvement for the client, and this may be a reason why most students chose to tell about breakthrough interactions during their placements. The breakthroughs also seemed to give students a sense of success and became defining moments in the students’ professional identity development, moments that are memorable over time.

Balancing Students’ Needs with Clients’ Needs

In the narratives and interviews, students described their own needs as well as the clients’. Many of the students brought up their personal feelings about the client. These feelings were characterized by anxiety or frustration in the period leading up to the interaction, and joy or happiness when the interaction happened. Often, the student’s feelings about the client were tied to his/her own feelings about self-efficacy as a music therapist. One student said she was “relieved” because the client’s self-harming behavior was less dangerous while he was interacting. This student was worried about the client’s safety during the session, and interacting with him was her way of coping with his behavior. Another student reported feeling “drained” and “physically tired” after the interaction, although the interaction was not physically strenuous. This student said she repeated what she was doing musically several times in order not to overwhelm the client, then varied it slightly over the whole session. This required slow, gradual musical variations in the improvisation that seemed to require an unusual amount of patience for the student. However, she was able to find this patience in order to meet the client’s needs, and dealt with the effects of feeling drained after the session.

One student described feeling happy during the client’s interaction. When I asked her to describe what she meant when she said she felt happy, she said:

That feeling was probably quite a dangerous feeling, because I was looking for something for me out of that interaction, and that is probably really dangerous. And I recognize that now…That because of the nature of the anxiety that I had experienced, I was looking for…reassurance from Tom and from his mum that I had something to offer as a music therapist, and that was enhanced by the anxiety that I had experienced.

This student’s comment is particularly insightful because she was able to reflect on her own needs during the interaction in a self-critical way. She recognized her own need for reassurance from the client and his mother, and she connected this to the happiness she felt when the client responded to her. In fact, she remembered the feeling of joy when the interaction took place:

I was sort of overwhelmed by my own feelings of joy and being able to offer something unique, and I think I probably forgot to think where Tom was at that point.

By recognizing her own needs, the student was able to reconcile the complex feelings she had during the interaction, reflect on the distraction of those feelings, and she was able to refocus her attention on the client in future sessions. She described her method of coping with feeling overwhelmed and distracted in future sessions this way:

The way I dealt with it was that I would plan what I would do with Tom and his mum very carefully, so I would have each activity lined up, ready to go, and if it didn’t work, I’d have a few back-ups.

While Edwards and Daveson (2004) described a student’s resistance from a supervisor’s perspective, none of the students chose to tell about an interaction in which they felt resistance. One student did describe a client’s resistance, and her own way of coping with it, which was using her musical improvisation skills creatively and initiating interaction with him slowly and repeatedly. This student recognized her own feelings during the session when she described feeling “dejected” before the interaction. She said,

I was very dejected, in a way, or just…Okay, I’m here, and I’m doing all of this, and there’s very little response, so you feel like you’re throwing a tennis ball off a brick wall or something. So, yeah, you feel, I suppose I felt silenced, in a way, as well, because he kept throwing the instruments on the floor, and pushing the guitar away. And I felt very exposed.

The way the student dealt with feeling silenced and exposed was to use her voice, which she described as the only instrument the client couldn’t take away from her. She persisted in interacting musically with the client until she found a creative way to incorporate his resistance into a musical interaction.

Another student described how she was feeling and her own techniques of dealing with the stress of her client’s self-harming behavior in this way:

I was getting very frustrated. I don’t know if it was frustration or worry on his behalf because his behaviors were so extreme and dangerous that before he’d come into the session I had to really take time to breathe and relax myself. Because I found when he escalated his crying, I had to take a minute to de-escalate myself, to just calm right down. Because it would be very easy, when you see a child in such distress, to go on their level to stress as well.

This student described her process of “de-escalating” from the client’s distress as using skills of grounding and breathing to cope with her own stress. By relaxing herself, she was then able to meet the client’s needs more effectively, and soon after this, described the client’s breakthrough.

During and after many of the students’ interactions, they reported feelings of happiness or joy. One student described the session when the interaction took place as “really, really slow,” but then said, “it felt amazing when he did interact.” When I asked one student if it was important for her to see an improvement in the client, she responded, “it maybe boosts your self-esteem a little bit, that you are doing the right thing.” One student described feeling that the interaction was the first time the client liked her. She said, “I felt she trusted me, or just, not even trusted, but just liked me, you know, if nothing else.” This seemed to be important to the student’s sense of efficacy with the client, and the same student said that if she hadn’t seen this change in the client, she would have determined that music therapy was not appropriate.

From the data, it is clear that the students described their own needs as well as the clients’ as central to the interactions. These needs included achieving a sense of success, attaining reassurance or affirmation from an observing supervisor or parent, gaining acceptance or interaction from the client, and coping with elevated stress levels during the session. Students drew on a variety of resources to meet their own needs, including actively seeking reassurance from clients and supervisors, having patience with clients, using music skills in alternative, creative ways, and using methods of grounding and self-relaxation. In this way, the students worked to recognize and meet their own needs in order to be present therapeutically for the clients.

Role, Identity and Reflections of Self

Many of the students described having realizations of professional identity during or as a result of the interactions. For some students, there was a single moment when they realized they were “being a music therapist,” rather than being a music therapy student. For others, the entire interaction showed them how their skills and previous experiences helped them be more effective music therapists.

Several students cited their previous experience in teaching as influencing their actions with the client. These students reported feeling a need to “leave behind” the skills they had used in teaching and become “comfortable with the waiting.” In order to process this change in professional role, one student talked about her feelings with her supervisor. Considering her role in the interaction, another student said,

I think in more ways I had to leave my musician self behind in a way, and leave my teacher self behind as well, because I wasn’t there to, you know, teach him anything. We weren’t playing melodies or…It wasn’t complicated, just very, very basic musical connection.

One student found her new role challenging. She said, “As a therapist, I had to really stop myself from doing that and sit back, and that’s what I find distressing…That I couldn’t jump in and stop…So that really challenged me.”

While some students experienced a departure from past roles and identities during the interaction they described, one student cited her experience playing a supportive role in a band as similar to her role in the therapy session. She wrote,

I would match that in the songs, you know, if I had some very sort of unobtrusive accompaniment, you know, nothing that overshadows what the client’s doing, a supportive thing, mostly supportive. That’s the most important bit, I’ve found. So I really carried that with me.

One student who chose an interaction of songwriting with the client said that her experience of learning songwriting techniques during her music therapy training helped her understand what the experience might be like for the client. She said,

It was fresh in my mind what it’s like to kind of, you know, start doing something, that you’re not comfortable, maybe, or haven’t done before, you know, so I kind of…I could empathize, I suppose, with her anxieties about putting forth ideas for songs that, you know, you hadn’t done before.

Many of the students described a realization of professional identity or feelings of competence during the interaction. Perhaps that was a contributing reason to the choice of interaction to describe. For many of the students, there was an element of feeling useful and effective as a music therapist in the interactions they chose. Statements alluding to these feelings of professional identity development included:

“It changed more how I saw myself, I think. I don’t think it changed my feeling toward him, but, yeah, it was more about, right, ok, now I’m being a music therapist.”
“The fact that I used my first instrument was very important to me… because that was something unique, that I felt that I had and I could offer that and maybe other people couldn’t.”
“I’m always going to look back on this as, like, my first case…my first client, where I feel that, in the short time that I’ve seen him, I’ve seen a…bit of a benefit of maybe work that I have done, and that’s why it’s so special.”
“That interaction was one of the first interactions that I really felt the joy of being a music therapist.”
“I think it’s the first time I felt like a therapist, like I’d actually achieved something.”
“I suppose I felt it was the one interaction that would really stay with me from the placement.”

Clearly, the students had a chance to develop and gain experience doing music therapy, and many of them experienced moments that defined to them the purpose of what they were doing. In a training program in which students may work with clients with a wide variety of needs, the placement may be the first time a student has worked with a certain client population. Additionally, instruments used in the therapy session may not be the student’s principal instrument, and certain skills, such as clinical improvisation and songwriting, may be fairly newly acquired skills for the student. All of these factors create hurdles for students in achieving a professional sense of self during training. Students coming from a variety of backgrounds bring diverse skills and experiences into their placements, some which may be directly transferable to the therapy setting and others which may need modification in order to address clients’ needs effectively.

Supervisor Issues

The open-ended research question did not specifically ask about the student’s placement supervisor. However, many students chose to tell me about the ways the supervisor had influenced the interaction, indicating that, for many of the students, the supervisor played an important role in their interactions with clients. Two students noted the presence of a supervisor and a parent in the room during the interaction, while four students either didn’t acknowledge the presence of a supervisor or parent, or stated that they weren’t present. The two students who reported the presence of a supervisor and parent in the room talked at length about how this affected the interaction. For one of these students, the supervisor played a supportive role in the interaction. The student said,

It was good to have her there because of her experience. I don’t think it hindered my interactions with him. It maybe gave me confidence to try, because I knew that she would be there if something did happen.

The second student whose supervisor was present during the interaction said,

I wanted to prove myself as a student. My supervisor was also in the room—that also created a lot of anxiety, so I wanted to prove to my supervisor that I was able to be in this situation with Tom’s mum and Tom and to negotiate that.

The same student said, “I felt like I had to perform for the supervisor,” and “I felt a lot of pressure.” This student reported that she sought reassurance from the supervisor, but also felt that the supervisor’s presence in the room created anxiety for her.

Some students whose supervisors were not present during the interaction described their supervisors’ influence on the session. One student reported that,

Just watching [my supervisor] with someone who had a more severe disability than my client, you know, any little thing that that client did, he would react to musically, and that was kind of an approach then I took with John, to just see, if I kind of wait and see what he does, does he understand that he’s affecting me?

Another student said that the supervisor had worked with the client previously, and that the client “opened up” more with the student than he had with the student’s supervisor. I asked the student if this changed her relationship with her supervisor in any way. She responded, “No, it didn’t change one bit. With my supervisor, it was just a total, sort of, mutual respect there, you know, and support.”

Interview responses indicated that students valued supervisors who were supportive and mutually respectful, and felt safe knowing that the supervisor was on hand to help. In one instance shared with me, the supervisor created stress and anxiety for the student, and the student felt the need to “perform” for the supervisor. It seems that this student’s anxiety was connected to multiple factors, including: working with a client whose needs were very complex; working with a non-verbal client; being at the start of her fieldwork placement and therefore relatively inexperienced with music therapy techniques; using unfamiliar instruments prior to this interaction, in which she used her primary instrument; and having a parent and supervisor present. Based on the existing literature about supervision, it appears to be unusual for a student to report feelings of anxiety from supervision. However, this student had strong feelings about the role of her supervisor, indicating that issues in supervision may play an important role in students’ sense of success and professional identity during fieldwork placements.

It also appears that it is important for the supervisor to consider carefully whether or not he/she should be present during any or all sessions a student undertakes with each client, and make clear to the student his/her intentions if he/she is present. When the supervisor makes it clear to the student that he/she is present to ensure the student’s safety and to step in if he/she feels necessary, this may create a sense of safety and security for the student and allow the student to interact effectively with the client. If the student feels the supervisor is judging or criticizing him/her, this may create anxiety for the student that impedes the therapeutic potential for the client.

Some students whose supervisors were not present during the interaction still felt the supportive presence of the supervisor, either through an influence to the approach and methods used, or by not being present in the session, which one student perceived as appropriate given her level of experience in working with a particular client.

It also appears to be important how a supervisor introduces the student to clients and care-givers and also how the supervisor prepares the student for the client. Based on students’ reflections of supervision, it appears to be important to students that supervisors recognize the students’ individual needs, abilities and previous experience when referring clients to students at the beginning of fieldwork placements. This may be especially the case when parents will be present in the sessions. It may also be important to students that supervisors clearly state their intentions when they are present during a student’s sessions.

Discussion

It is clear that at certain points in a music therapy student’s fieldwork experience, certain interactions with clients help shape a student’s sense of identity and confidence as a music therapist. These interactions are memorable to students as breakthroughs for several reasons. First, the client often responds in a way the student hasn’t seen before, which allows the student to see the value of the work he/she is doing; Second, in these interactions, the student experiences a realization of professional identity, personal development, and self-efficacy and -awareness. Breakthroughs are often preceded by anxiety, doubt, or frustration on the student’s part, and followed by feelings of accomplishment, happiness or joy for the client or for herself. Smyth and Edwards (2009) also described this feeling of students’ enjoyment of experiences during fieldwork placement.

In this study, students often focused on the importance of meeting the clients’ needs, which is similar to findings by Wheeler (2002), which found that music therapy students were very concerned with understanding and meeting clients’ needs. Students’ own needs also arose as a theme in the data, often presented as secondary to clients’ needs, but clearly important to students during fieldwork placements. These needs were diverse and showed the individuality of each student. They ranged from dealing with stress effectively when a client’s behavior seemed dangerous, to focusing on the client’s needs even with a parent or supervisor in the room, to creatively using music to address a client’s resistance, to finding patience during demanding interactions, to effectively integrating the use of a principal instrument with more traditional “therapy” instruments. Using “music skills necessary to do the work” is a challenge also described in Smyth and Edwards (2009) by a student during fieldwork placement. Similar to the findings in this study, Smyth and Edwards (2009) also reported that students found coping with some of their experiences during fieldwork placement challenging.

A fieldwork supervisor can play various roles in a student’s experience. The data showed that students felt grateful when supervisors played a supportive role, which is similar to Wheeler’s (2002) findings that students felt good when supervisors respected them. However, it is clear from this research that, in some instances, the supervisor can intensify feelings of anxiety or doubt about the student’s professional efficacy. This can impinge on the student’s confidence and ability to interact with a client. It is important for the supervisor not only to be present in situations where the student may be in physical danger, but also to be aware that the student may need space to develop confidence in interacting with clients with complex difficulties. The presence of a parent, the way a student music therapist is introduced to clients and care-givers, and the way a supervisor prepares a student may also create frustration or reassurance for the student, depending on the situation and the student’s previous experiences.

Music therapy students’ previous experiences in other fields, in personal interactions and in musical experience may influence how a student interacts with young clients during fieldwork placement. Experiences of teaching, playing in a band, or even playing with young people in a social context may help develop the skills needed. Musical improvisation is often used by music therapy students when working with children and adolescents with complex needs, and with non-verbal clients, possibly because of its potential for spontaneity and connection within musical interactions. Many students are relatively inexperienced with clinical improvisation skills prior to undertaking music therapy training, and therefore are learning practical skills along with the clients. Songwriting was also described as an effective method in working with a young client, and the student described feeling that she could relate to the client’s nervousness about songwriting because she could recall her own recent experience learning songwriting techniques during her music therapy training. All of this suggests that improvisation and songwriting may be important methods in achieving breakthroughs for both clients and music therapy students. Diverse previous experiences may help music therapy students relate to young clients and contribute to a valuable self-awareness and reflexivity during fieldwork placements.

Reflection

According to Hertz (1996, p. 6), “voice is a struggle to figure out how to present the author’s self while simultaneously writing the respondents’ accounts and representing their selves.” In analyzing the data presented here, I found it difficult to find this “voice,” which was a process of paraphrasing or putting respondents’ ideas into my own words without losing some essential meaning of what each student had told me. Also, I felt that extracting phrases from the interview transcriptions was, to a degree, a false representation of the students’ experience as a whole, since not only were their words situated in the experience, but also in the narratives as they presented them.

One issue that I grappled with in data analysis was that my research question (Could you tell me a story about musically interacting with a client or clients under 18 years old during your fieldwork placement?) focused specifically on musical interactions, and yet participants’ answers addressed a wide range of issues arising during their fieldwork placements. They focused much less on the actual musical interactions (i.e. notes played, musical parameters, musical dynamics, etc.) and much more on their feelings and thoughts about the interactions (i.e. their needs, their reactions to others present, the clients’ needs).

As I reflected on my own expectations, I realized that the research data involved much different information than I had expected. Some reasons for this may be: a) some of the interactions chosen by students took place long before the interviews, and memories of specific musical parameters may have been vague, and b) as a peer researcher, I felt that many of the students assumed that I knew “what they were talking about.” For example, they didn’t feel they needed to go into detail about a musical improvisation with a child with a diagnosis on the autism spectrum because they knew I had experienced similar interactions as a music therapy student. A final important reason I may have ended up with unexpected research data stems from the nature of phenomenological investigation. Perhaps if I had planned a more structured interview method, in which I asked participants specific questions about the musical parameters of their interaction, I would have obtained results closer to those for which I was looking. However, the gift of this method of open-ended research seems to be that I found not what I was looking for, but what the respondents wanted to provide.

While my original topic and guiding question were focused on musical interactions with clients, the students’ responses overwhelmingly reflected issues of role and identity formation during the interactions. Although I was not expecting the data to focus on these issues, I think that discovering something I had not expected to find adds validity to the research, and also added spontaneity to the interviews. These unexpected findings also point out that students felt they were able to respond to my research question in a way that was meaningful to their experiences.

Prior to interviewing participants, I read and thought about my approach to the interviews. Although I had brainstormed a list of topics that I thought might come up for participants, I started each interview with the same open-ended question. I then let the respondent lead the interview in a direction he/she wanted. I found, on reviewing the transcripts that at times I asked assumption-laden questions, which may have contributed to a “jointly constructed discourse” by the interviewer and interview that Elliot (2005) describes. For example, when one respondent told me that a client’s father had said he was going to buy a drum to use at home, I asked, “Did it kind of demean the work that you had done, in that an instrument would be able to do the same thing?” This question embodied several of my own assumptions about the student’s experience: a) that a parent’s efforts to reproduce results at home might undermine the therapist’s work; and b) that, as a student, she might have insecurities about her own efficacy. In another interview, a student told me that her client attended sessions with her supervisor before going to her, and that the client opened up much more with the student than the supervisor. I assumed that this may have created discomfort between the student and supervisor, and asked the question: “How did it make you feel that he didn’t share this with the supervisor even though he was going to her before he came to you, and then when he came to you he shared this material with you?” When the student didn’t provide the answer I expected, I asked “What about your relationship with your supervisor? Do you think it was changed at all by this interaction, that [he/she] was so open with you?” In this example, I feel I based my questions more on my own assumptions about the student’s relationship with her supervisor than on what the student had shared with me.

So, in several instances during the interviewing process, I think I led the interview or conversation in a direction influenced by my assumptions and understandings. Overall, however, I perceived that the students responded openly and honestly and didn’t “fall into the trap” of answering an occasional leading question. Additionally, for the most part, my own questions were open-ended “how” questions, rather than narrow, leading questions.

I also found that my style of questioning varied from participant to participant, keeping in mind that “the need to ask open-ended questions in everyday language that address the interests of the interviewee rather than the sociologic interests of the researcher [should be] emphasized” (Elliot, 2005, p. 34). Because I was interviewing my peers, we had a shared understanding of music therapy goals and processes. Even so, I felt that with some students I used more technical terms (such as “objectives” and “countertransference”) to ask the students about their experiences, whereas with other students I used more everyday language. This may have been due to the differences in my own relationship with each participant, my experiences with them in the training course, and the ways they had presented their written narratives to me. In general, I found I was very aware of the approach I took with each person, and how it might have affected the ways they responded to me.

Recommendations for Future Research

Based on the findings of this study, there are numerous directions future research could follow. Some possible directions are outlined below.

1. Future research might investigate whether realizations of professional identity are experienced primarily during breakthrough interactions with clients during fieldwork placements, or whether realizations of self-efficacy contribute to the music therapy student’s confidence and allow for breakthroughs to happen.

2. This study revealed results in areas of songwriting and improvisation with clients. Future research might address to what degree other music therapy methods, such as re-creating and listening (Bruscia, 1998a) are used by students with young clients, and in what way these methods could shape the musical interactions with the client and the student’s development.

3. Research addressing students’ needs during fieldwork placement might examine music therapy students’ experiences of musical interactions with clients as they progress through a training course, similar to Wheeler’s (2002) use of three interviews with the same students over time. A larger sample size would allow for comparisons to be made among students at various stages of training.

4. Students’ previous experiences play an important role in the ways they interact with clients during fieldwork placements. The students in this study came from a variety of backgrounds, but students’ backgrounds were largely not correlated with the results, due to issues of confidentiality. Another, larger scale study, might investigate students’ previous qualifications, education and work experience in relation to how they describe interacting with clients during fieldwork placements. It would be equally valuable to explore whether therapy outcomes differ depending on whether students use their primary instruments or traditional music therapy instruments (voice, piano, guitar).

5. While there has been much written about music therapy supervision from the supervisor’s perspective, it is relatively rare to read published literature from the student’s perspective, perhaps because of the unlikelihood of journals publishing students’ work, but also perhaps because of the potential power dynamic between supervisors and students. Future study of students’ experiences in supervision across multiple, multi-cultural training courses followed by qualitative interviews investigating this topic in depth would contribute to an understanding of supervision from the students’ perspective.

6. Finally, it was decided in this study to ask students about their musical interactions with young (under 18 years old) clients in the interest of limiting the scope of the study and addressing the researcher’s interests. Future research might address musical interactions with other client populations during fieldwork placements, such as adults with mental health needs and older adults with needs related to aging. It might also be helpful to undertake a similar study with a more limited scope, for example, investigating students’ experiences of musical interactions with children with diagnoses on the autism spectrum, or students’ experiences with adolescents with social and emotional needs.

Conclusion

In this research study, I investigated the experiences of six music therapy students through written narratives and semi-structured interviews. In particular, I was interested in their musical interactions with young clients during fieldwork placements. I discovered through the narrative research process and qualitative data analysis that the students chose to tell much more about their experiences of fieldwork placements, their feelings and the dynamics of the interactions with clients and supervisors, than they chose to tell about the specific parameters of musical interactions. While musical interactions were important to the students as breakthroughs, this research suggests that these breakthroughs were important to the students’ growth as music therapists as well as to the clients they worked with. Finally, in this research, I have considered how my role as a peer researcher has influenced and been influenced by the research process, and I have considered ethical issues and confidentiality in a reflexive process.

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