Introduction
In 2015, approximately 43% children experienced poverty in the United States (Jiang, Granja, & Koball, 2017). Families
experiencing poverty are often exposed to unique stressors such as housing instability,
poor nutrition, and community violence. Poverty is an inequity that impacts physical and
mental health for both children and adults (Buckner, Bassuk, Weinreb, & Brooks, 1999; Raver, 2004). Psychosocial treatment interventions, including
music therapy, may be used on an individual level to decrease the effects of stresses
related to poverty (APA Taskforce on
Socioeconomic Status, 2007; Guarino,
2014).
While music therapists have worked with families experiencing poverty in various
settings including homeless shelters (Fairchild,
Thompson, & McFerran, 2017; Iliya,
2011; Straum & Brotons, 1995;
Yates & Silverman, 2016),
community-based organizations (Austin, 2007;
Kowski, 2007), schools (Camilleri, 2007; Montello & Coons, 1998; Snow & D’Amico 2010), and state-operated facilities (Lotter, 2010), little empirical literature exists
concerning music therapy with this group. There is a small but growing body of
literature regarding the use of music therapy with at-risk families. For the purposes of
this study, “families experiencing poverty” refers to broad scope of issues related to
families in a large Midwestern city in the United States who live below the poverty line
and are either housed or homeless (APA Taskforce
on Socioeconomic Status, 2007; Bassuk,
Weinreb, Dawson, Perloff & Buckner, 1997). The inequities of poverty are a
violation of human rights (United Nations
Development Programme, 2003) that must be tended to on a broad systemic scale.
However, for the purposes of this study, the researchers focus on the possible use of
music therapy to create change among individual families experiencing poverty. The
purpose of this study was to gain an understanding of the experiences and perspectives
of music therapists who work directly with families experiencing poverty.
Families Experiencing Poverty
Forty-three percent of children in the United States experieinced
poverty with their families in 2015 (Jiang,
Granja, & Koball, 2017). Children from low-income families frequently
encounter traumatic events such as persistent hunger, anxiety, and witnessing or
experiencing violence among others. The effects of trauma often accumulate over time,
intensifying reactions to stress with each compounding event. The culmination of
adverse events puts low-income children and teens at higher risk than their peers for
mental health and developmental challenges. (Buckner, 2008; Cowan, 2014; Donlon, Lake, Pope, Shaw, & Haskett
2014; Guarino, 2014; Samuels, Shinn, & Buckner, 2010).
Parents experiencing poverty often face a number of economic and
emotional stressors that can detract from their ability to provide consistent and
supportive parenting. These stressors may include singleparenthood, social ioslation,
substance abuse, and mental illness (Bolen,
McWey, & Schlee, 2008). These factors can leave their children at-risk
for developmental difficulties (Foley,
2010). Additionally, poor parent-child interaction, including child abuse and
neglect, during infant and toddler years can adversly impact social and emotional
development (Bolger, Patterson, Thompson, &
Kupersmidt, 1995; Samuels, Shinn, &
Buckner, 2010; Sroufe, 2005).
Chronic negative parenting and frequent exposure to traumatic events can lead to
behavior issues (i.e., difficulties with impulse control, self-regulation, and
sustatined attention) that can negatively impact children’s success in school (Herbers, Cutuli, Monn, Narayan, & Masten,
2014; Herbers, Cutuli, Supkoff et
al., 2014; Masten, 2012; Narayan, Herbers, Plowman, Gewirtz, & Masten,
2012; Obradovic et al.,
2009; Smith, Stagman, Blank, Ong, &
McDow, 2011).
Families experiencing poverty in the United States are
disproportionally people of color. In 2015, 63% of black children, 61% of Hispanic
children, and 61% of American Indian children lived in low-income families. Immigrant
families also represent a disproportionately high population of low-income families,
as 52% of children of immigrant parents experienced poverty in 2015 (Jiang, Granja, & Koball, 2017).
Linguistic and cultural differences can become barriers that keep families
experiencing poverty from the available community resources, thus limiting their
opportunities to receive mental health services and developmental supports (McCabe, Gilchrist, Harris, Afridi, &
Kyprianou, 2013). Particularly in the United States, systems of
discrimination towards families of color over many decades have left urban areas
segregated, often isolating families of color from educational resources and physical
and mental health services (APA Taskforce on
Socioeconomic Status, 2007; Cooper &
Masi 2007).
Current Best Practices to Meet the Needs of Families Experiencing Poverty
Guarino (2014) suggested
that service providers working with families experiencing poverty be aware of how
trauma impacts behavior, emotions, and attitudes. Trauma-informed practice comprises
understanding the specific trauma, promoting safety, supporting the client’s sense of
control/choice/autonomy, sharing power, integrating care, and ensuring cultural
competence. Masten (2015) identified that
interventions specifically geared towards improving executive functioning and
self-regulation skills among children experiencing poverty can reduce problem
behaviors and increase school success. It is important to support parents
experiencing poverty by teaching positive parenting practices and by offering direct
engagement opportunities that promote parent-child bonding (Smith et al., 2011). Parent education groups that teach
parents positive control and active listening improve outcomes among their children
(Herbers, Cutuli, Supkoff et al.,
2014; Yang, 2016). Additionally,
there is a growing body of research that has identified mindfulness interventions to
improve self-awareness among children and adults with greater self-awareness
correlating with improved ability to adapt in adverse situations (Masten, 2015).
Music Therapy and Families Experiencing Poverty
Music therapists have reported working with low-income families in
various settings including homeless shelters (Fairchild, Thompson, & McFerran, 2017; Iliya, 2011; Straum &
Brotons, 1995; Yates & Silverman,
2016), other community-based organizations (Austin, 2007; Kowski,
2007), schools (Camilleri, 2007;
Montello & Coons, 1998; Snow & D’Amico 2010), and state-operated
facilities (Lotter, 2010). Music therapists
have also reported working with at-risk families to support parent-child interaction
among parents and their infants and toddlers (Abad
& Williams, 2007; de l’Etoile,
2006; Jacobsen, McKinny, & Holck,
2014; Nicholoson, Berthelsen, Adad,
Williams, & Bradley, 2008).
Among the limited music therapy literature for families experiencing
poverty, the most common interventions were songwriting (Austin, 2007; Camilleri,
2007; Fairchild, Thompson, &
McFerran, 2017; Kim, 2015; Straum & Brotons, 1995), music listening
(Kim, 2015; Montello & Coons, 1998), singing (Iliya, 2011), and improvisational instrument playing (Austin, 2007; Kim, 2015; Kowski, 2007; Lotter, 2010; Montello & Coons, 1998; Snow & D’Amico 2010). The goals and objectives addressed
by music therapists often mirrored the recommended objectives made in related
literature; expressing and regulating emotions (Fairchild, Thompson, & McFerran, 2017; Kim, 2015; Kowski,
2007; Montello & Coons,
1998), reducing impulsive behaviors (Austin,
2007; Montello & Coons,
1998), improving social skills (Austin,
2007; Camilleri, 2007; Straum & Brotons, 1995; Yates & Silverman, 2016), improving
communication (Austin, 2007; Camilleri, 2007; Kim, 2015; Snow &
D’Amico 2010; Yates & Silverman,
2016), and building academic skills (Yates & Silverman, 2016).
Due to a lack of empirical research in relation to music therapy and
families experiencing poverty, Yates and Silverman (2016) set out to establish a base for future research by
conducting a qualitative investigation to understand the needs of children
experiencing homelessness as perceived by staff at a homeless shelter. Yates and
Silverman (2016) identified four themes:
(a) staff need to be positive role models and provide trusting and affectionate
relationships, (b) older children require programming and opportunities for
communication and emotional support, (c) well-being must be screened and monitored,
and (d) routine and expectations are needed to promote a calm living environment.
These themes provide insights that music therapists working with families
experiencing poverty may use to develop goals, objectives, and interventions.
The existing accounts of music therapists working with families
experiencing poverty are found in case studies (Austin, 2007; Camilleri, 2007;
Kowski, 2007; Lotter, 2010; Snow &
D’Amico 2010), a book chapter (Jacobson,
2016), and empirical research studies (Fairchild, Thompson, & McFerran, 2017; Montello & Coons, 1998; Straum & Brotons, 1995). Although Yates and Silverman (2016) studied the perspectives of homeless
shelter staff, there remains a gap in the literature concerning the perspectives and
experiences of music therapists who work with this population. Investigation
concerning how music therapists work with this specific population is needed to
determine appropriate directions for future music therapy research with families
experiencing poverty. Therefore, the purpose of this study was to gain an
understanding of the experiences and perspectives of board-certified music therapists
who work with families experiencing poverty. The primary research question guiding
the study was as follows: What are the experiences and perspectives of music
therapists working with families experiencing poverty?
Method
Participants
Participants were five board-certified music therapists who have previously or are
currently working with families experiencing poverty in urban areas in the United
States. Three participants had previously worked for a community based non-profit
organization that provided services at a multicultural therapeutic preschool and with
low-income parent education/support groups. One participant had previously worked at
an emergency homeless shelter, providing services to children ages 3-12. One
participant currently works in the special education department of a large urban
school district and treats many children experiencing poverty. Despite some variance
in the specific settings, all participants worked as music therapists with service
users who were experiencing poverty in the same city. All participants were female,
three were Caucasian, one was black, and one was Japanese-American. In this initial
investigation, all participants were previously known to the researchers and had
provided music therapy services to families experiencing poverty in the same
geographic location in the US. These five music therapists were approached for
participation due to their experiences and their familiarity with the researchers.
Each participant was individually approached by the principal investigator (PI) and
introduced to the study before providing consent to participate in a semi-structured
interview which would be audio-recorded, transcribed, and used as qualitative data
after removing names to maintain confidentiality. The Institutional Board of Review
of the researchers’ affiliated university approved the project.
Procedure
The investigators developed a semi-structured interview (Appendix A) to engage the
participating music therapists in conversation about their perspectives and
experiences. The interview questions were discussed and conceptualized among a class
of music therapy graduate students who provided feedback to help develop the
questions, to ensure the interview focused on and addressed the research question,
and to minimize biases by identifying and modifying questions that may have been
leading or assumptive. The PI conducted four interviews in-person in a quiet, public
space, and in order to make the interview more convenient for one particular
participant, one interview over the phone. Each interview lasted approximately
60-min. During the interviews, the PI asked the participants to elaborate on and
clarify statements to fully understand the participants’ experiences and
perspectives. All interviews were audio recorded and transcribed by the PI and
undergraduate student transcribers. After transcription, the PI initially reviewed
the transcripts and identified clarifying questions and statements. The PI then
shared the transcripts with the participants and asked them to review the data for
member checking purposes. At this stage, participants were encouraged to add
additional information to the transcripts to ensure the data accurately reflected
their experiences and perspectives.
As the goal of the research was to understand and interpret participants’
experiences, the researchers used a phenomenological approach. The researchers
believed the participants’ perceptions were consequential and the goal of the study
was to reveal the meanings based on their perceptions of those lived experiences
(Laverty, 2003) in working as music
therapists with people experiencing poverty.
Qualitative Analysis
The investigators analyzed the interview transcripts for emerging themes using Braun
and Clarke’s (2006) six phases of
thematic analysis including 1. familiarization with the data, 2. generating initial
codes, 3. searching for themes, 4. reviewing themes, 5. defining and naming themes,
and 6. producing the report. The investigators implemented the six phases as follows:
1. the investigators repeatedly read the data, 2. the PI created initial codes, 3.
the related codes were organized into themes in a separate document, 4. the themes
were repeatedly reviewed and refined to best represent the data and answer the
research question, and 5. themes were named and defined after trustworthiness was
obtained via the second author who separately reviewed transcripts and created codes
and themes. After the themes emerged, the participants were also contacted to provide
feedback on the emerging themes and the quotes used to depict them. Results were then
presented at a research poster session at a professional music therapy conference and
the authors integrated suggestions made by attendees into the paper. As this was a
poster session, some suggestions that attendees made were already in the paper but
not on the poster. Other suggestions were included when applicable.
Authors’ Lenses and Biases
At the time of data-analysis, the PI was a board-certified music therapist with six
years of experience working with families experiencing poverty, who primarily uses a
variety of interventions, including experience-oriented improvisation and songwriting
(Baker, 2015) paired with a cognitive
behavioral music therapy approach. The second author is a published music therapy
educator, researcher, and clinician who specializes in cognitive behavioral music
therapy with adult mental health populations. Issues related to poverty are
frequently a concern with these clients. Both authors are Caucasian, both live and
work in the United States. The current study is specific to families experiencing
poverty in the United States and the authors recognize that other countries may have
different circumstances and contextual parameters that influence programming,
treatments, and poverty. It would be impossible to separate those experiences from
the researchers’ way of knowing, interpreting, and understanding the data (Edwards, 2012; Stige, Malterud, & Midtgarden, 2009).
Results
Four themes emerged during data analysis. These four emerging themes are presented below
in boldface font and then explained in the subsequent paragraph. Codes used to
categorize data are depicted. Participants’ statements are also portrayed to provide
contextual support for the themes and honor their unique perceptions, lived experiences,
and voices.
Music therapy facilitates the development of parenting skills via education and
interaction
Codes: structure; interaction; reunification; modeling; engagement;
provide parent support; positive feedback; enjoyment; comfort
Participants noted that music therapy interventions facilitated positive parenting
skills and appropriate parent/child interaction during the reunification process,
during which parents had supervised visits with their children who had been removed
from the home due to child protection cases. The participants indicated that
low-income parents who engage in group music therapy sessions with their children may
successfully practice positive parenting skills and build healthy attachment, while
receiving the benefits of peer modeling and positive feedback. Additionally,
participants articulated that music therapy groups engaged parents at their
developmentally appropriate level, allowing them to comfortably participate and gain
parenting and self-care skills.
MT #1: They were able to actually enjoy their time with their child
you know, in a structured environment…I think those [reunifications] environments
can also be stressful because they are being observed and watched, but music had a
way of making them feel comfortable…[Music therapy group] was a way of
strengthening those bonds and showing them healthy and appropriate interactions …
the whole point was to be a model for the moms and to teach them appropriate ways
to interact with their child and to increase, improve their bond with their
child…For the family groups engaging in appropriate behavior, using appropriate
language with each other, gentle touches, that would be a couple [of goals] for
the families…if I’m doing a reunification, I would just ask the parents what kind
of songs they sing with their child to get their preference. I do remember a lot
of the times when I went in-home, it was because the parents need extra support
and I would try to teach them appropriate ways to interact with their kid.
MT #2: I thought that music could be a non-invasive, least
threatening way to communicate best parenting practices regardless of culture… [The moms] could also
see the modeling going on, receive some positive feedback, and just kind of be
comfortable…I do feel that’s why most of them didn’t want to run away from music.
For most of them, even to just get on the floor and just play with their children
is one of the hardest things for them, because they’ve never seen it
modeled…Without a television going on, without any kind of distraction, but just
kind of sitting and playing, and talking, and singing with their children, having
that kind of contact. So that kind of communication and relationship building was
really good…Even if it’s something like hand over hand, “help your baby do this”.
Eye contact with the mother, so that the mother can initiate eye contact with her
child. So the primary focus is on the mother so that they can mother their child,
you praise, you give feedback for all of the successive approximations that they
are accomplishing.
MT #3: I did individual mommy/baby time within the groups and I did
the same sort of things like ‘This is what we did today and these are things that
you can do,’ or I could talk to the parents about developing goals for their
kiddos too, I was just wanting to engage the parents. My goal was to have a good
conversation about ways to be playful with their kids. You know, we’re going to be
there for a blip in their life, especially when they’re so transient, who knows
how long they’re going to be in this program? So, if we can give parents skills, I
feel like that’s really important…When the kids were in foster care and they would
visit their parents…if the family requested it or if the social workers thought
that they needed another person to structure the time and make it successful, they
would have me come in and I would do a family music therapy time. And that would
be just these same goals of like interaction, nurturing touches and words, and
parent education
MT #4: It really let the parents get to see and have fun with their
child, which was so important…When you’ve had parents who had been separated from
their children, I just think that opportunity to structure positive interactions
where the focus is on the child becomes a really key thing….And I think by having
a music therapist in the shelters and in the community programs and in the
parenting programs, you get a chance, rather than being talked at, you get a
chance to really set up the group…You model, “Let the child have a turn! My turn,
your turn!”
Children and adults generalize skills from music therapy sessions to daily
life
Codes: Transfer, generalize, interactive music activities; practical;
take home; adapt
In addition to supporting parenting skills, the participants noted that music therapy
interventions also provided an opportunity for siblings to practice healthy
interactions that generalized to what may be a chaotic home life. The participants
expressed that music therapists can provide practical music-based interventions that
can directly transfer to use at home to improve relationships/attachments for
parents/children and siblings. By creating song books or CDs, families can receive a
tangible resource to transfer skills from music therapy sessions to home or other
settings. The participants expressed that music therapists can engage parents by
brainstorming ways to adapt music games and activities for use at home or other
settings. Also, the participants noted that a music therapist can suggest “homework”
for children and adults to practice non-music skills outside of the music therapy
session.
MT #1: With the mom and babies it was more like lap play, bouncy
games, lots of parachute, and lullabies, bubbles. With that group you want to be
more practical, because you want them to practice with their babies at home. Of
course you’re going to have things that they’re not going to have, but you have to
teach them how to adapt….The sibling groups didn’t involve a lot of manipulatives
because we did want them to practice at home, so I think we did a lot of, dance
and songs that they could sing together … With music therapy, for a lot of
families it’s so simple to incorporate in real life – you know, you learn some
finger play or a lap game or any of that, so all that stuff that you can do and
you don’t need stuff to do it.
MT #2: Really encouraging the parents and talking about how they
could use music with their kids, how can you put that on the table and how can you
make that connection.
MT #3: A lot of these siblings would benefit from extra support and
working together. These are the goals I was trying to do, working together or
using words, problem solving, so when they go home, if it is not a safe
environment, they can maybe work with each other and figure out things and have a
solid bond together…And then I would give them those visuals and we would make a
book, then they could take the book home. So for the siblings, I liked to give
them something to take home, as like a really cognitive, concrete thing of like
“We’re taking these skills home!” …I would do songwriting with the families, and I
could record it right then, burn a copy of the CD and they could have it, and that
was something really meaningful. With the little babies I would have a little
sheet of like ‘these are the things we did today, these are some other things that
you could do along the same lines.’ So they had some materials because “I can’t be
here every time you have visitation, but here are some ideas and then you can do
it yourself next time.” So I’d try to give the parents tools and I think they
appreciated that.
MT #4: Instead of having the child go to school and then go home and
no generalization, having that opportunity for that parent/child together in a
real world, which is to me what music therapy can do.
Awareness of the factors and unique stressors associated with poverty positively
impacts the therapeutic process
Codes: Immediate success, context, awareness; diversity; abuse/neglect;
choice; linguistic diversity; minorities/immigrants; generational; factors associated
with race; cultural sensitivity
The participants noted music therapy group sessions may be particularly engaging for
diverse populations because culturally and linguistically specific music can be
incorporated while working towards goals. The participants indicated that awareness
of common issues related to cultural and linguistic diversity (including English
language learners, non-English speakers, or non-English readers) may impact the
therapeutic outcomes. As navigating the available community resources can be a
frustrating and daunting task for low-income families, the participants noted that
because music therapy can be a non-intimidating intervention, both children and
adults may benefit from the opportunity to experience immediate success in music
therapy. The prevalence of abuse and neglect cases, chemical dependency, and mental
health issues is high among the population of families experiencing poverty and the
participants indicated that awareness of the social, emotional, and developmental
factors related to these issues can also impact the therapeutic process. The
participants also expressed that awareness of the barriers was crucial when working
across racial, cultural, and socio-economic lines. Participants noted these factors
may impact the development of the therapeutic relationship as many families
experiencing poverty are people of color and/or recent immigrants, while music
therapists in the US are predominantly white.
MT #1: There were definite differences between the cultures…. I
think, a lot of times, what scares people about working with this population is
that they don’t know about it…So I’m not saying that you can’t be Caucasian to
work with people in poverty, I’m just saying have awareness and cultural
sensitivity and just knowing about the population and what they are going through
and why they don’t know their ABCs, they are too worried about feeding them.
MT#2: As music therapists, we’re trained to do that; we want everyone
participating to actually be fairly successful almost immediately and then you can
work with them. Music therapy was just nonthreatening, it was a really comfortable
way and an easy way for people to get some success. If you can go in and be open
and flexible, and listen, then it will bridge practically everything. Just laying
aside my own expectations and really going into the family care. In providing
culturally sensitive therapy and programs, I think music was a perfect
addition.
MT #3: A lot of the kids had mild to moderate delays, we had some
kids that had diagnoses, there were some that were on the spectrum, there were
some that had exposure in utero to drugs or alcohol, so there were some delays in
that way. There was some abuse that had occurred and then resulted in traumatic
brain injuries or shaken baby syndrome, you know, those kind of things, or falling
down steps, neglect…There were a lot of child protection cases open with their
families, and a lot of the moms that went to our parenting programs were court
mandated to go to them.…These parents were products of this cycle also, and so
just another way that music really can make it successful because they can
anticipate what I’m doing and it’s repetitive.
MT #3: Like for everybody, this is something that everybody can do
and experience and find enjoyment in. I can have these large community-type groups
and serve so many people that may not have a common language and yet they’re all
doing something together, and that’s a pretty cool thing …I think it makes perfect
sense for there to be music therapy, because we have such a diverse group of
families, language wise, experience wise, socio-economic wise, but music is
something we can all do, and it really evens the playing field… I could easily add
a cultural aspect. We would do something every time there was some kind of
cultural celebration I was there, you know, because it was a way that I could
serve and help.
MT #4: Lack of experience and awareness of things that you might take
for granted--that’s one of the biggest differences I think when you’re working
with students of poverty. You don’t necessarily know what the student is coping
with…We know students of poverty come into school with three million less
words…Children really parallel their parents’ language, and so when you have
meetings and you’re talking to parents, you really have to be sure you’re
communicating, or you will just wash over them and they won’t understand what
you’re doing or trying to do for their child … So it’s probably just that
awareness factor as much for when we’re working with parents if we want to impact
what they’re doing with their children.
MT #5: So music was something that most of them could be instantly
successful at. It was great to see them be successful and interact with each
other, and also use skills that they didn’t know they have…it’s just a chance to
be expressive in a way that was really safe.
Music therapy compliments the broader continuum of support services to meet
individual needs
Codes: Fills gap, collaboration, unique, holistic, flexible
The participants indicated that music therapy interventions can provide a unique,
alternative modality to meet individual and collective needs. The participants noted
that music therapy can provide support through direct collaboration between
practitioners or through reinforcing goals worked on in different therapeutic
modalities. During the interviews, participants articulated that collaboration
between service providers may be particularly easy for music therapists due to the
inherent flexibility of music. The participants expressed that children and adults
benefit from music therapy intervention that supports overall outcomes (i.e.,
chemical dependency recovery and developmental and educational goals) by bridging the
gap between other service providers.
MT #1: I think families liked having music therapy because it was
different. It’s so nonthreatening… Everyone learns differently, you know. It was
kind of a well-rounded approach to helping them reach the level they needed to
reach…I think music therapists are just another piece of that puzzle that can help
the families… It was just a different modality to occupational, physical or
speech. And it was really nice, as music therapists we can work together, we can
collaborate with all the other therapies … Sometimes collaboration didn’t
necessarily have to be a planned thing.
MT #2: So music is such a malleable tool. They were not looking for
music as rigidly as they would have looked at OT [occupational therapy] or speech
[therapy] or PT [physical therapy], they saw it as a much less invasive, much more
conducive way to just reach some overall goals. Very appropriate for everyone to
participate in… With just adult groups, it was a feeling of a kind of actual
physical relief that comes from the drumming, from the entrainment. From the
little bit of aerobics that they would do, a little bit of brain stimulation. And
the other part was just building community.
MT #3: I definitely collaborated with the OTs, the speech language,
the PTs, and teachers…Always communicating with them and the social workers and
play therapists. I’d communicate with them a lot. I would go out with
the social or family workers when they would do a home visit…Whenever I’d be
making goals I’d go to the teachers, I’d meet with them …I think they appreciated
that I wasn’t just like making these goals without talking to them and, you know,
that there was a mutual respect happening.
MT #5: Music therapy seemed to really fit with what the shelter’s
goals are. They definitely want more than just [recreational] music time.
Especially given how fragile that community is and how high-risk they are, I think
it makes a lot more sense than having someone else come in, because it’s a huge
adjustment for going from like living with another family prior to becoming
homeless or however they became homeless
Discussion
The purpose of this study was to gain an understanding of the experiences and
perspectives of board-certified music therapists who work with families experiencing
poverty.
Five US-based board-certified music therapists participated in semi-structured
interviews. The investigators analyzed the interview transcripts and identified four
emerging themes: (a) music therapy facilitates the development of parenting skills via
education and interaction, (b) children and adults generalize skills from music therapy
sessions to daily life, (c) awareness of the factors and unique stressors associated
with poverty positively impacts the therapeutic process, and (d) music therapy
compliments the broader continuum of support services to meet individual needs.
All participants perceived music therapy to uniquely benefit families experiencing
poverty, particularly within the context of parent education. Music therapy group
sessions can improve parent-child attachment while providing an opportunity to practice
positive parenting skills with support from peers and the music therapist (Abad & Williams, 2007; Herbers, Cutuli, Supkoff et al., 2014; Jacobsen, McKinny, & Holck, 2014; Smith et al., 2011; Yang,
2016). According to the study participants, music therapy group sessions may
also be used to help facilitate the reunification process among families who have been
separated due to child protection cases. Both children and adults benefit from the
structure provided within music therapy interventions as the nature of music often
allows for rhythmic repetition of ideas and actions (Yates & Silverman, 2016). The participants expressed that music therapy
may also provide an opportunity for parents to see appropriate behaviors modeled by
peers and by the music therapist within the context of familiar songs and activities,
making it easy for individuals to be successful.
The results of the present study compliment and expand upon the emergent themes
identified by Yates and Silverman (2016).
Although Yates and Silverman’s (2016)
investigation focused specifically on the needs of children experiencing homelessness
from the perspective of non-music therapists (and the present study approached families
experiencing poverty on broader scale using music therapists as participants), the
conceptual links between the two sets of results may be considered together in the
development of music therapy practices. The present study identified the importance of
structured routine and opportunities to observe appropriate behaviors modeled by peers
and music therapists that is consistent with Yates and Silverman (2016). Additionally, Yates and Silverman (2016) recognized the importance of relationship building to
develop a strong working alliance. The present study supplemented that idea noting the
clinicians’ awareness of factors associated with poverty may help establish a
relationship and strong rapport.
Implications for Music Therapy Practice
Clinicians may use the themes identified in this study to expediently develop working
alliance, trust, and rapport with families experiencing poverty. Particularly, the
awareness of factors related to poverty and the implementation of trauma-informed
practice may help facilitate positive outcomes for this population (Guarino, 2014; Yates & Silverman, 2016). Music therapists may benefit
from opportunities to develop cultural competence in relation to issues associated
with poverty. This could take place within university curriculum, practicum
experiences with this population, or conference presentations on music therapy best
practices with families experiencing poverty.
Music therapists may consider how issues of race and culture impact their working
alliance and rapport particularly when Caucasian music therapists are engaging with
predominately communities of color. Developing an awareness of culturally specific
music traditions and connecting with community musicians may positively impact the
therapeutic process (Oosthuizen, Fouche,
Torrance, 2007).
Based on the emerging themes, there may be potential for the creation of music
therapy positions serving this population. The participants outlined specific ways
that music therapy can address the goals of parent-support and education groups and
early childhood education groups often provided by community-based non-profits and
government-run institutions.
Limitations
The five participants in this study all shared experiences working within the same
large, Midwestern city. Thus, the current study provided a limited perspective on
poverty only within a specific urban context in the United States. Additionally,
although all five participants had music therapy experience with families
experiencing poverty, their work settings differed and represents a limitation. While
the current study provided insights from music therapists who have experience working
with families experiencing poverty in a variety of settings in the same city,
additional research might provide a broader perspective on the experiences of music
therapists working with low-income families.
The study is also limited, as it did not investigate potential disadvantages or
contraindications of using music therapy when working with families experiencing
poverty. The semi-structured interviews were specifically designed to answer the
narrow research question. Moreover, the results are limited by the authors’ biases
resulting from their previous practice, research, educational experiences, and
geographic location.
Additionally, as race and culture play a significant role in the experience of
poverty in the United States, it should be noted that the authors recognize their
perspectives as Caucasian individuals results in inherent biases during
interpretation and reporting of the data presented in this study.
Suggestions for Future Research
Future researchers may consider investigating how music therapy functions in the
context of parent education and parent support with families experiencing poverty.
For example, investigators, could observe positive parenting behaviors exhibited
within a music therapy session or interview parents to identify how they perceived
music therapy to support their parenting skill development. Additionally, researchers
could investigate how music therapy impacts working alliance among clinicians and
families experiencing poverty. Understanding how to develop a stronger working
alliance may lead better outcomes for this population. Researchers may also consider
investigating how to best prepare music therapists and music therapy students to meet
the multifaceted needs of this unique and marginalized population. For example,
researchers may investigate how a music therapy practicum experience with this
population impacts a student’s awareness of the factors associated with poverty.
Additionally, researchers may compare cultural competency training among related
professions such as art therapists, occupational therapists, as well as
parent-educators and early-childhood teachers. Future researchers may consider
interviewing music therapists from diverse regions to compare their perspectives
working with families experiencing poverty. Further research identifying the links
between music therapy and positive outcomes among families experiencing poverty could
be used as rationale for developing new music therapy positions. Finally, results of
this qualitative study could be used in future quantitative studies by designing
interventions to target identified factors including parenting skills, interactions
between parents and children, and stressors.