Hannah Rhinehart's First Journicle Review!

 

Autism Spectrum Disorder (ASD) is large client population for many music therapists. Typically in ASD, target goals are set around communication and social interaction. Being that environments (particularly new ones) can often be overstimulating and seen as chaotic by children with ASD, it is important to keep routine and predictability in their schedules. This begs the question, ‘Why would you promote improvisational music therapy (IMT) if children with ASD prefer routine?” The answer may sound ironic, but IMT can be made predictable. It can contain “repetitions at different levels while at the same time providing ‘controlled’ flexibility in forms of variations in melody, harmony, rhythm, dynamics” (Geretsegger et al., 2015). Specific target areas for ASD using IMT intervention are imitation, joint attention, reciprocity, affective sharing, and initiation of interaction. Music therapists created general intervention goals that included self-expression, rehabilitation, communication, and interaction. In this study, therapists from 10 countries were represented to provide their experiences and successes in IMT to develop a standardized test that could do three things; "1) identify common characteristics of improvisational approaches in music therapy when working with children with ASD, based on targeted areas of development and core guiding principles. 2) If possible, describe an international consensus model that balances standardization with flexibility to accommodate individual client needs and varying therapy contexts and settings. And 3) create treatment guidelines based on this principles, evaluate their feasibility as a tool to assess adherence and competence in IMT” (Geretsegger et al., 2015).

After taking surveys, having focus groups around the world, and revising the initial conclusions, the authors founded three categories in which to divide the principles of improvisational approaches. The categories were unique and essential, essential (but not unique to IMT), and compatible. In the unique and essential category was placed facilitate musical and emotional attunement, scaffold flow of interaction musically, and tap into shared history of musical interaction. In essential was build and maintain a positive therapeutic relationship, provide a secure environment, follow the child’s lead, set treatment goals and evaluate progress, and facilitate enjoyment. In the compatible category was to adjust setting children’s or families needs, clinical judgement, and practical possibilities. Because of the research collected, it was concluded that creating a standardized treatment tool for IMT in the field of ASD is “feasible in research, clinical practice, and training” (Geretsegger et al., 2015).

I am impressed with the breadth of the study; to have committed professionals from ten countries participate, have three countries actively holding trials, and an intervention that spans a spectrum disorder is an incredible feat. I can not imagine what it took Geretsegger et al to accomplish this and am personally grateful that there are people in my profession who are so invested in research and developing material that enhances my learning and clinical practice. While I am incredibly encouraged with the breadth, I am also made a little nervous. If you read the presented objectives, we have (abridged): to find common characteristics of IMT, to describe and international consensus model, and to create treatment guidelines. All three objectives have evidenced findings in the conclusion that supports and validates their purposes. But I wonder if IMT is the best standardization tool to use internationally or if something that resembled a truer clinical approach could be more internationally accessible. The researchers of this study never claim to have found the most appropriate tool for international standardization, it simply raises the question for me of whether there is an intervention that could serve that role best or are we simply too diverse musically to handle such specific parameters.

This being said, I find myself a big fan of IMT. I am obviously a huge advocate of music therapy as a general intervention to assess and strengthen an individual's abilities, and I see benefit to using improvisation as a means to evoke social and communicative responses from children with ASD. Everyday conversation in and of itself is improvisatory and if we can promote the same communicative nuance through music, I’d call it therapy.

 

Geretsegger, M., Holck, U., Carpente, J. A., Elefant, C., Kim, J., & Gold, C. (2015). Common      Characteristics of Improvisational Approaches in Music Therapy for Children with Autism Spectrum Disorder: Developing Treatment Guidelines. Journal of Music Therapy, 52(2), 258-281.

Hannah Rhinehart, LPMT, MT-BC

The George Center, 12060 Etris Road, Roswell, GA, 30075