Although many music therapists work with adolescents, this work is not always distinguished as being different from work with other age groups. This report describes information gathered about the current practice and training of music therapists who work with adolescents across the world. It was undertaken by three music therapists who have been working with adolescents in a range of contexts for some years and who were interested to compare what they were aware of with a broader subsection of therapists from around the globe. To explore music therapy practices, we decided to informally question music therapists through our professional networks using an online survey platform called Survey Monkey (www.surveymonkey.com). We also approached a number of music therapy organisations to see if they would be willing to distribute a link to the survey, which the German organisations responded to, along with the British Music Therapy Association. We translated our questions into our three primary languages to facilitate distribution and participation rates therefore reflect our countries of origin and languages, namely Italian (Fedrigo), German (Wölfl) and English (McFerran). This took place between late December 2016 and April 2017.

A range of developmental theories have been used historically to articulate the unique features of the time of life labelled as adolescence. The most quoted is Erik Erikson (1968) who emphasised the task of identity formation during this period, and the risk of role confusion if this was not achieved. However, binary understandings such as Erikson’s are increasingly critiqued in the literature, and some commentators have highlighted that adolescence is not a universal stage, but rather, a Western construct based on adult expectations of how young people should behave (Epstein, 2007). Young people living in cultures that do not require an extended period of dependence do not seem to report the same characteristics of ‘sturm und drang’ as it was named by Anna Freud (1966). The responses in this report are mostly from Western countries where this construct does still seem to be relevant and where concepts such as ego-development are still of interest to developmental theorists (i.e., Loevinger, as cited in Kroger, 2004).

Even within these limits, the concept of adolescence is rapidly changing from the society that Erikson (1968) was referring to. Intersectional identities (Crenshaw, 1991) is now the most common way to refer to the multiple positions from which individuals are constructed both by society and by themselves. This refers to the unique interactions of race, gender, sexuality, ability, social status, etc., which all combine to inform the ways that young people (and others) see themselves and are also given access to opportunities and resources within their own culture. Feminist scholars with an interest in gender and sexuality have introduced this notion into the adolescent music therapy literature (Scrine & McFerran, 2017) as well as those sensitive to race (Santos, 2018; Viega, 2018) and (dis)ability (Rickson, 2014). A more critical perspective on the stage of adolescence is particularly relevant as society undergoes necessary changes to respond to developments in technology and increased awareness of the disparities in the lived experiences of youth around the globe. Music therapists would be well served to take this perspective into account in describing and attempting to understand adolescents in our practices.

We asked music therapists to answer 18 questions about different facets of practice and training (see Appendix 1). There were 11 general questions about music therapists’ perceptions of music therapy practices with adolescents in their country. This included questions about university education for music therapists on the topic of adolescents, services for adolescents in general, and the position of music therapy within those services. Following this were seven questions only for those currently working with adolescents that were about participants’ understandings of their current practice. This included questions about where they worked, what theoretical perspectives they found relevant, the type of adolescents they worked with, and the methods they used.

We approached people across several continents and acknowledge that surveys are differently understood in each. For example, in Italy and Germany, surveys of professionals do not require ethics review. However, other countries might expect ethical review of a professional survey as it could be considered research. Since we did not aim to answer a research question, no ethical review was applied for and participants were not required to complete ethics documentation when they chose to do the survey.

A total of 247 people from 25 different countries answered our questions, and the country with the most music therapists was Germany (20%), followed by Italy (15%), Switzerland (14%), and the United Kingdom (12%; see Table 1). However, the largest proportion of music therapists (n = 114, 46%) chose to answer in English (German, n = 97, 39%; Italian, n = 36, 15%). In total, the music therapists (MTs) were located in 61 different cities/areas where London was the most represented (n = 11), followed by Zurich (n = 8), Melbourne, Belfast and Edinburgh (all with 6 MTs each).

Further information about the demographics collected in questions 2–5 is not included because it may be too easy to identify music therapists who are experienced practitioners working with adolescents. When reporting on the answers provided, we have chosen to use linguistic groupings as the main comparisons in order to maintain privacy for the music therapists who replied.

One of our primary interests was in music therapy training in the field of adolescence. Music therapists could choose from 11 entries describing topics related to adolescence that may have been covered in their university training. There was also the option to add their own response in a free text area when they marked the “other” label. Table 2 shows the topics relevant to adolescents that music therapists described being covered in their university training. The percentages show the relationship between the topics reported by the music therapists and the number of completed questionnaires in total, and for each different language. The first and most relevant were emotional and social development, reported by 83% of music therapists, followed by adolescent mental illness ¹ (65%), cognitive development (64%), identity formation (57%), and at-risk youth (40%). The less represented topics were family therapy (21%) and sexuality (18%). It is noteworthy that the theme of sexuality was the least reported topic among those listed in the survey. This is conspicuous given that sexuality and identity are intimately linked and affirms a more general and long-standing critique of society.

Some differences could be seen among the types of topics reported as more prominent in different languages. 59% of the German speaking music therapists reported being trained in Developmental Profiles, while only 23% of the English-speaking group noted this topic, and it was not reported from Italian speaking music therapists (0%). Family therapy was selected by a little over 20% of those music therapists who responded in English and in German (23% and 24%, respectively), but only 6% of the Italian speakers. Similarly, physical development was represented half as much in the Italian speaking group compared with the German speaking one (19% vs. 41%). Italian speaking participants were also the group that most indicated a lack of specific training on issues related to adolescence (in the None category we found 8% in the Italian speaking music therapists compared to 1% of German speakers and 3% of English speakers).

In gathering information about the settings in which adolescents are usually found, we suggested five categories and included the option to add a different setting by selecting “other.” We first asked generally in which settings other equivalent professionals worked with this population as well as specifically about the presence of music therapists in the same settings. Music therapists reported employment opportunities in mental health facilities (23%), special education (22%), schools and medical hospitals (20% and 18%) as the most common workplaces in which adolescents were seen by other professionals, with some differences in the three linguistic areas. For example, medical hospitals were reported in 84% of the German speaking group, whilst they were reported in half that amount in the Italian speaking group (42%) and 63% in the English speaking one. In contrast, community programs appeared to be chosen more often by the English and Italian speaking music therapists (70% and 53%) than by the German speaking music therapists (39%). In the mental health facilities, we found a similar frequency in the German and English-speaking music therapists (93-94%) but only 53% among the Italian-speaking music therapists.

We then asked the music therapists if music therapists were also employed in these settings and we gave music therapists the opportunity to choose between four frequencies of practice. What emerged was that MTs were sometimes employed in the same settings (77% of the total answers), but more frequently the settings in which music therapy took place with adolescents were different (Figure 1). Music therapists who identified as Italian speaking were most likely to work in settings such as schools and special education (both 64%), whilst medical hospitals and mental health facilities were the most common settings reported by German-speaking music therapists (62% and 52%, respectively). Amongst the responses from English-speaking music therapists there was a fairly even split between schools, mental health facilities and community programs, with less in medical hospitals. It is noteworthy that a reasonably large number of music therapists reported working in ‘other’ contexts across all languages, which was noticeably different to the areas where other professionals were reported as working with adolescents (only 11%). In “other” settings the music therapists were invited to add the specific setting in which they worked. In the majority of cases, the setting reported was a private practice (n = 28 out of 70; 40%), followed by a constellation of other settings such as patients’ homes, hospice, private schools or associations, foster care centres and daily centres.

164 of the music therapists who responded (66% of the total) were working with adolescents at the time they participated in the survey. Most of them worked with adolescents in an ongoing way (65%), some with temporary placements (28%) and a small number (7%) working on short term projects or freelance work (Table 3). There were some similarities between the English and German-speaking music therapists being mostly in ongoing work (78 and 69%), whilst Italian-speaking music therapists were mostly employed in temporary jobs rather than in continuing positions (57% vs. 29% of the music therapists). In the “other” category music therapists reported both freelance work and volunteering. When they answered the survey, most music therapists were working less than 3 hours a week with adolescents (37%), with 26% working between 3 and 6 hours a week, 18% between 6 and 12 hours a week, and 19% employed for more than 12 hours a week working with adolescents. Again, we found some similarities between English and German-speaking responses and a different pattern in Italian speakers who mostly worked for less than 3 hours a week with this age group (n = 12 out of 21; 57% of the cases).

When we asked about the settings in which the music therapists were working, the results were similar to what was reported generally in the question that gathered the most common music therapy settings for adolescents. Special education, medical hospitals and schools were the most popular settings as well as a large number of music therapists (n = 49 out of 164 questionnaires; 30%) described working in “other” settings (Table 4). There were some differences between the three linguistic areas: schools were one of the most frequent settings reported by the Italian speaking music therapists (43%) whilst it was an uncommon response from the German speakers (5%); medical hospitals were reported by 37% of the German-speaking music therapists whilst it was less frequently checked by English and Italian-speaking music therapists (20% and 14%, respectively). Community programs were common between the English-speaking music therapists (26%) whilst just a small percentage of German (3%) and Italian-speaking music therapists (5%) worked in this setting. These differences could be explained by the varying backgrounds in the three groups considered. In Italy, for example, the MT profession has not received a recognition yet, and this could have influenced the presence of music therapists in certain settings or the employment situation of Italian-speaking music therapists.

We highlighted five categories for music therapists to choose from describing the types of adolescents they worked with, plus an open-ended text box when the music therapist selected “other.” The conditions and lived experiences of adolescents described by music therapists were varied (Table 5): emotional and behavioural problems were the most reported (78%), followed by mental illness and disability (both at 57%), being “at-risk” (49%), and having a physical illness (30%). The answers to this question were similar across the three linguistic areas. The area that differed most between the three linguistic areas was Italian-speaking music therapists who reported working with adolescents who had disabilities far more frequently (71% of the Italian-speaking music therapists).

Improvisation was the most common method selected by music therapists across all language groups (90% of music therapists). However, receptive methods were also frequently selected particularly music listening (75%) and lyric discussion (58%). Song based methods were also popular, including singing (77% in total, but conspicuously lower in Italian speakers at 57%), songwriting (74% in English speaking and 67% in Italian-speaking music therapists, but only 46% in German-speaking music therapists) and band-workshops (21% in total with little variation). Other common methods were less frequently reported, such as musical reconstruction, music and imagination and Guided Imagery and Music (GIM). Even less so were Neurological Music Therapy (NMT), therapeutic instrumental teaching, musical games, composition, performance, music-assisted relaxation, music and body work, and rhythm therapy. These were all individual suggestions from the “other” option where an open-ended text space was available.

The questions about theoretical frameworks included a list of nine theoretical orientations from which music therapists could choose the one that best suited their work in the field. As can be seen in Figure 2, English and German-speaking music therapists had a similar distribution in the listed categories; Italian speakers, in contrast, showed a different pattern of preference. A psychodynamic approach was the most common selection by Italian speaking music therapists (43%) whilst neuropsychology, cultural and ecological/system theories were not reported by the Italian-speaking music therapists.

Music therapists were also asked to indicate their therapeutic goals by selecting from nine different topics or selecting “other” and responding in the free text space. The most commonly reported were in the domains of emotional (89%), relationships (76%), social (73%), creative (70%) and identity formation (66%; see Table 6). The results were similar across the three linguistic areas although there were some differences in two of the domains. German speakers were much more likely to identify goals related to identity formation as compared with the English speakers (57%) and the Italian speakers (29%), whilst the work on relational goals appeared to be the most prevalent among the Italian-speaking music therapists.

There appeared to be some congruence between the types of knowledge that were emphasised by music therapists as being taught in university training and the ways music therapists described working with adolescents. For example, emotional and social development was the most commonly taught topic in coursework programs around the globe, and emotional and relational goals were chosen as the most frequently addressed in practice. Similarly, psychological models were reported as a major topic area in training, and music therapists reported working in contexts where developmental models are prominent, such as education and medical settings. There is enough consistency across the three linguistic groups to suggest that this is the most common approach of music therapists who work with adolescents—they are educated about adolescents’ needs in areas of emotions and relationships, and they focus on these areas in practice, whether in mental health or educational domains.

However, another way to interpret these answers would be to question if we have a limited view about the ways music therapists feel competent to work, due to our focus on the traditional medical and educational models. Minimal reporting of any emphasis on issues of real-world importance to adolescents such as sexuality, marginalisation, homelessness, grief and loss is noteworthy. The current foci are all internal and subjective and emerge from psychological understandings that people’s problems exist within themselves. Sociological models suggest that contextual understandings are particularly pertinent for youth, who have little control over their lives and a reduced range of choices, compared to adults facing the same challenges. More emphasis on models that are common in social work and youth work approaches may benefit music therapy students. For example, music can be used to advocate for social change, share the often-unheard voices of youth, or express their hopes and aspirations for a new and different world through videos and performances.

In addition, new social models are sweeping through youth culture, and teaching theories that explain thinking from more contemporary social perspectives that might be extremely relevant. For example, intersectional identity theories (Crenshaw, 1991; Vaillancourt, 2009) may usefully expand beyond the white culture binaries assumed within normative psychological models of identity development such as Erikson (1968) and Piaget (Piaget & Inhelder, 1958). Another possibility could be to accompany the teaching of diagnostic thinking with critical debate about the validity of such constructions and ensure that music therapy training includes both dominant views, perspectives from those with lived experiences, and a consideration of who constructs societal hierarchies (Fansler et al., 2019). By teaching emerging theories and social movements, we might find that music therapists also feel competent to move into new work domains beyond traditional institutions and be able to secure ongoing positions because they have knowledge that suits more diverse contexts and approaches.

In contrast to learning about contemporary theories, the survey revealed a consistent focus on humanistic and psychodynamic frameworks—a trend which reaches back several decades. Psychodynamic thinking has now been expanded to include integrative and developmental approaches, which were also more prominently selected by music therapists than other theories. However, these ideas remain rooted in the long-standing traditions that emphasise unconscious influences and recovery through increased insight—albeit expanded to include new ideas from infant research, attachment theory, trauma-informed approaches and neuroscience. Humanism, or person-centred approaches, also continue to be described as central to the creative profession of music therapy, with minimal reference to newer models of aesthetic, ecological, culture-centred, resource-oriented approaches. The stark lack of emphasis on other approaches is, once again, comforting in terms of global agreement, but concerning with regard to youth in particular, for whom contemporary thinking is perhaps most relevant. This is reflected also in improvisation being the most popular method named by music therapists in this survey. This de-emphasises the everyday music preferences of young people at a time when music is of great importance. The integration of preferred music may have enormous potential that is being avoided in order to focus on more familiar (to music therapists) ways of working, as has been suggested by Randi Rolvsjord in adult mental health discourse (2010). Improvisation also affords many potentials for therapeutic processes; however, it would be heartening to see more balance in emphasis between the methods that are most viable for the professional and those that utilise musical approaches which are more familiar for the young person. For youth in particular, it is important to reflexively consider what musical opportunities matter most to them.

This was the first attempt to gather information about music therapy with adolescents globally and it was an achievement to move beyond a single language. This represents an extension on previous surveys in music therapy that have been only in one language. We are aware of five published surveys that are relevant to adolescent music therapy, three of which are in German, including two on music therapy in child and adolescent psychiatry (Evers, 1991; Stegemann et al., 2008) and one on music therapy in schools (Bundesweiter Arbeitskreis, 2004). Another two were in English and based on participants in the United States, including one on ADHD (Jackson, 2003) and another on music therapy and music medicine for children and adolescents (Yinger & Gooding, 2014).

This report makes it possible to better understand the current state of practice and training of music therapists working with adolescents globally. It provides a broad picture on how 247 music therapists speaking English, German and Italian describe their practice with adolescents from 25 different countries across the globe. The report provides a foundation to further explore this increasingly prominent area of practice, which is perhaps on the verge of going through its own adolescence, having conquered the most traditional and normative behaviours during its childhood. Adolescent music therapy may be ready to lead the way forward into more recent approaches to understanding both music and identity.

Professor Katrina McFerran is a music therapy researcher, practitioner and educator at The University of Melbourne in Australia. She has focused her career on working with young people using music across a wide range of settings. This has included developing research and theory to explain how and why music therapy may be relevant in the lives of young people, particularly during difficult times.

Giulia Fedrigo is a music therapist and speech pathologist who lives and works in Verona, Italy. She completed her Master’s Research at Aalborg University, and has published a book with Erickson Publishers, 'La Casa Dei Suoni e Delle Parole' in 2020.

Andreas Wölfl, Dr. phil. (Music Therapist, Psychotherapist for Children and Adolescents, Supervisor) works in the Institute of Music Therapy at Freies Musikzentrum München e.V. Germany and in a hospital for child and adolescent psychiatry and in his practice for supervision, coaching and music therapy. Wölfl is head of the music therapy training BWM and the workgroup “prevention“ at the Institute of Music Therapy.