Research Article
Personal identity narratives of therapeutic
songwriting participants following Spinal Cord
Injury: A case series analysis
Chantal Roddy
1
, Nikki Rickard
1,2
, Jeanette Tamplin
3,4
3
, Felicity Anne Baker
1
School of Psychological Sciences, Monash University, Clayton, VIC, Australia, 2Centre for Positive Psychology,
Graduate School of Education, University of Melbourne, Parkville, VIC, Australia, 3Faculty of VCA & MCM,
University of Melbourne, Southbank, VIC, Australia, 4Royal Talbot Rehabilitation Centre, Austin Health, Kew, VIC,
Australia
Context/Objective: Spinal Cord Injury (SCI) patients face unique identity challenges associated with physical
limitations, higher comorbid depression, increased suicidality and reduced subjective well-being. Post-injury
identity is often unaddressed in subacute rehabilitation environments where critical physical and functional
rehabilitation goals are prioritized. Therapeutic songwriting has demonstrated prior efficacy in promoting
healthy adjustment and as a means of expression for post-injury narratives. The current study sought to
examine the identity narratives of therapeutic songwriting participants.
Design: Case-series analysis of the individual identity trajectories of eight individuals.
Setting: Subacute rehabilitation facility, Victoria, Australia.
Participants: Eight individuals with an SCI; 7 males and 1 female.
Intervention: Six-week therapeutic songwriting intervention facilitated by a music therapist to promote identity
rehabilitation.
Outcome Measures: Identity, subjective well-being and distress, emotional state.
Results: Three participants demonstrated positive trajectories and a further three showed negative trajectories;
remaining participants were ambiguous in their response. Injury severity differentiated those with positive
trajectories from those with negative trajectories, with greater injury severity apparent for those showing
negative trends. Self-concept also improved more in those with positive trajectories. Core demographic
variables did not however meaningfully predict the direction of change in core identity or wellbeing indices.
Conclusion: Identity-focused songwriting holds promise as a means of promoting healthy identity reintegration.
Further research on benefits for those with less severe spinal injuries is warranted.
Keywords: Spinal cord injuries, Self concept, Rehabilitation, Music therapy, Identity
Introduction
Approximately 10,000–20,000 Australians currently
have a traumatic Spinal Cord Injury (SCI). The incidence of SCI is heavily skewed toward men, with estimates suggesting 70–80% of those with a SCI are
men.1,2 Spinal injuries are predominantly experienced
within the 16–30 year age group, but recent reporting
has noted an increase in older age groups. The causes
of SCI are varied, but the majority result from motor
vehicle accidents or falls.
Correspondence to: Chantal Roddy, School of Psychological Sciences,
Monash University, Clayton, VIC, 3800, Australia. Email: chantal.roddy@
monash.edu
© The Academy of Spinal Cord Injury Professionals, Inc. 2018
DOI 10.1080/10790268.2017.1364559
The effects of SCI depend to a large extent on the
level and grade of injury. The level dictates whether
the SCI results in tetraplegia (loss of sensation and/or
movement of all four limbs) or paraplegia (loss of sensation and/or movement in lower limbs and trunk).
The grade is categorized as complete, involving a loss
of all movement and sensation in affected areas, or
incomplete, involving some retention of movement
and/or sensation below the level of SCI. In addition
to paralysis and sensation loss, frequent sequelae of
SCI include bowel and bladder incontinence, pain, spasticity, and sexual dysfunction.
Research suggests that people with SCI face a number
of significant challenges with respect to the psychosocial
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and emotional impact of their injury, which may go undetected during subacute rehabilitation.3,4 People with SCI
face increased risk for psychopathology, including
depression and anxiety 5–10; with some authors citing
a fivefold increase in suicide rates following SCI.11
Changed family responsibilities and associated carer
burden can also lead to relationship breakdowns and
loss of friendships, which increases the risk of social isolation and can perpetuate depressive symptomatology.12
Reduced subjective quality of life is frequently reported
among SCI populations,3,13,14 and this can perpetuate
mood disturbances. Maladaptive coping styles and
emotion dysregulation have also been noted to be
major influences on wellbeing after SCI.15,16
Identity is a construct which underpins many aspects
of post-SCI adjustment.7,17 Identity is both personally
and socially constructed and captures a person’s
unique, individual perceptions as to their nature, life
roles, goals, ambitions and achievements. While identity
has been long emphasized as a critical component of psychosocial adjustment, the role of identity for those with
SCI remains understudied.18 The traumatic nature of
SCI means that the injury is internalized as a significant
and immediate threat to self.19,20 In this sense, traumatic
SCI shares a commonality with the Acquired Brain
Injury (ABI) and Traumatic Brain Injury (TBI) literature. Exploration of identity across both SCI and ABI/
TBI studies has identified themes of a shattered or
broken self21–23 whereby adjustment difficulties are predicated on the disconnect between perceived current
and prior ( pre-injury) selves. Maladaptive views of identity post-injury, which can include the desire to return to
their former identity and level of functioning, have been
associated with maladaptive coping styles and subsequent risk for the development of psychopathology.24
By contrast, healthy perceptions of self appear more
aligned with the literature on post-traumatic growth in
which people find new meaning and a re-alignment of
values and core priorities post-injury.25,26 Reintegration
or renegotiation of identity remains a key goal of effective psychosocial adjustment following SCI.27
Therapeutic songwriting is one approach that has
been used to promote adjustment to some of the
typical losses following TBI, including loss of independence and functioning, loss of life roles and loss of
future hopes and dreams.28 Songwriting within a therapeutic context involves assisting individuals to tell their
stories through the creation of lyrics and music.29
Therapeutic songwriting enables the person with an
acquired injury to use the creative process in a way
that allows for reviewing, processing, reframing, and
re-authoring his or her life. Songwriting is a culturally
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acceptable and accessible medium for expression.
When used in a therapeutic context, songwriting can
reflect a person’s unique experience and personality,
and in so doing also capture a representation of their
emotions and feelings at that particular point in
time.29 Further, the song itself can be a means of communicating with loved ones, reliving positive memories,
and affirming progress and recovery. Songwriting provides an alternative vehicle for communication and
exploration of pertinent personal concerns and emotional distress and has been found to be an effective way of
enhancing growth and self-awareness.30 Further description of the potential underlying mechanisms of therapeutic songwriting are accessible in Baker et al.31
A specific identity-focused therapeutic songwriting
intervention has not been previously reported in an
inpatient SCI rehabilitation setting. Further, the postSCI experience and identity perceptions of SCI patients
in sub-acute rehabilitation remain underrepresented in
the literature. This project aims to characterize the identity narratives of people with SCI in a sub-acute rehabilitation facility that underwent a tailored identityfocused therapeutic songwriting program.
Method
Setting and participants
Participants were individuals with SCI undergoing inpatient rehabilitation at a large rehabilitation hospital in
metropolitan Melbourne, Victoria, Australia.
Materials
Identity measures
Identity was evaluated via the Head Injury Semantic
Differential Scale (HISDS)32 and the Tennessee SelfConcept Scale – 2 (TSCS-2).33 The HISDS comprises
20 contrasting adjective-pairs (e.g. dependent, independent) rated on a 7-point Likert scale from one descriptor to the opposite descriptor. The HISDS has been
shown to have internal reliability (Cronbach’s alpha
0.88), as well as concurrent validity with the Leeds
Scale for emotional distress (Tyerman,32 as cited in
Ellis-Hill & Horn34). The TSCS-2 comprises 82 items
across six self-concept subscales: physical, moral, personal, family, social, and academic, which are rated
on a 5-point Likert scale ranging from ‘always false’
to ‘always true.’ Fitts and Warren33 cite adequate psychometric properties with a median internal consistency score of 0.80 for adults and strong test-retest
reliability (0.82).35 Both scales were utilized to determine which measure was most sensitive to identity
changes within this population, to inform a future
larger scale study.
Chantal Roddy et al.
Personal identity narratives of therapeutic songwriting participants following Spinal Cord Injury
Subjective wellbeing/ distress
Subjective wellbeing and associated constructs were
measured through the Satisfaction with Life Scale,36 a
5-item measure rated on a 7-point Likert scale
(Cronbach’s alpha of 0.78; Vassar,37 as cited in
Corrigan et al. 38), and the Flourishing Scale (FS),39 an
8-item measure assessing thriving or self-perceived
success in life on a 7-point Likert scale. The FS was
recently supported as a reliable and valid tool for use in
a New Zealand population,40 with results comparable
to Diener’s original validation.39 Subjective distress was
measured through the Generalized Anxiety Disorder 7item (GAD-7) questionnaire41 and the 9-item Patient
Health Questionnaire (PHQ-9).42 The GAD-7 has been
validated as a brief screen of anxious symptomatology
(α = 0.8943) and uses a 4-point scale to assess the severity
of generalized anxiety symptoms. The PHQ-9, a measure
of depressive symptomatology, has been found to have
adequate sensitivity and specificity in detecting symptoms
of depression in TBI populations.44 The Positive and
Negative Affect Schedule45 was also incorporated as a
20-item measure of affective state using 5-point Likert
scales. The PANAS has been found by Crawford and
Henry46 to have adequate convergent validity with the
Depression Anxiety and Stress Scales (t (986) = 7.523,
P < 0.001) and the Hospital Anxiety and Depression
Scale (t (737) = 7.667, P < 0.001).
Procedure
Participants underwent a 6-week tailored music therapy
intervention (therapeutic songwriting) during which
they worked together with a registered music therapist
over 12 sessions to create three songs exploring past,
present, and future selves. An individual song was
created about each of these perceived selves. Each
song was created via a collaborative process between
participant and music therapist, following the protocol
outlined in Figure 1 below. Sessions one to four
focused on the participant’s past, and were dedicated
to using the participant’s perception of their life
history to shape a song that captured the participant’s
view of their pre-injury identity. Sessions five to eight
focused on the present, with participants creating a
song that reflected on changes resultant from their
injury. Sessions nine to twelve focused on the future,
and participants created a song that captured their
views about their future self. Throughout the songwriting process, participants were encouraged to reflect on
their identity perceptions to shape the song lyric
content collaboratively with the music therapist, and
make choices in terms of the musical elements that
shaped each song (genre, melody, key, harmonies,
Figure 1 Songwriting for self-concept protocol (Reproduced
with permission from Tamplin et al.48).
instrumentation, etc.). Participants reported varied histories with regard to prior engagement with music.
Two participants indicated a prior history of learning
a musical instrument. Music listening behaviors also
varied across the sample. Two participants reported listening to music for several hours each day. Remaining
participants reported listening to music for varied
amounts of time ranging from ‘about an hour a day’
to ‘less than once a year’.
In order to assess any corresponding changes in identity self-ratings, subjective mood and wellbeing indices,
participants utilized an iPad application to complete a
questionnaire battery outlined above at three timepoints
— prior to the intervention, at the mid-point of the
intervention (3 weeks) and at the conclusion of the intervention (6 weeks). Two participants (Participants 3 and
4) were unable to complete mid-intervention measures
due to impending discharge timing. Further details
about the intervention protocol and songwriting
measures are accessible elsewhere (refer31,47,48).
Results
Demographic and clinical characteristics
There were eight participants in this study. The mean
age was 30.4 years, (SD = 12.2 years, range = 17–50
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years) and only one was female. They were an average
of 2.8 months (SD 1.4 months, range = 45–157 days)
post-injury. The level and grade of injury were as
follows: incomplete paraplegia (Participants 3, 5, 6,
and 8), complete paraplegia (Participants 2 and 4)
and complete tetraplegia (Participants 1 and 7). Of
the eight participants, two (Participants 2 and 5) were
prescribed mood-altering medication at the time of
the intervention.
Initial classifications
Raw scores and change scores from pre- to post-intervention in all outcome measures were compared for all participants. From this examination, participants were
categorized as either those with positive trajectories;
those who exhibited the greatest degree of the positive
shift relative to other participants on at least three
indices, or those with negative trajectories; those who
exhibited the greatest degree of negative shift relative to
other participants on at least three indices. The change
in outcome measures from baseline to post-intervention
was highly varied, both across participants and within
participants across outcome measures. Nonetheless,
Participants 3, 6 and 8 showed the greatest degree of positive change in at least half the outcome measures, and for
the purposes of this paper, were classified as those with
positive trajectories. Participants 1, 4 and 7 showed the
greatest degree of negative changes on at least three of
the eight outcome measures, and for the purposes of this
paper, were classified as those with negative trajectories.
Participants 2 and 5 demonstrated more mixed profiles
but with limited change in most indices from pre- to
post-intervention and thus were not examined further in
this paper.
Identify profiles associated with positive and
negative trajectories
Table 3 presents an overview of the core identity scores
for all participants on the TSCS-2 and the HISDS
respectively. Table 2 shows that those with positive trajectories generally demonstrated an improvement in
self-concept over time, with both self-concept indices
showing an increase pre to post-intervention for
Participants 6 and 8. Participants 3 also showed
improvement in the HISDS measure, but conversely
showed a decline in TSCS-2 scores. In contrast, all participants with negative trajectories showed a decrease in
self-concept scores over time as measured by the TSCS2. Participants 1 and 7 showed an initial decline in selfconcept scores as measured by the HISDS, but demonstrated an improvement by post-intervention. These
data indicate that the two measures used to assess selfconcept in this study are measuring different constructs
and that neither conceptualization clearly predicted
whether participants responded to the songwriting intervention over time. Nevertheless, there was a general
trend for self-concept scores to improve over time in
those with positive trajectories. Tables 4 and 5 present
an overview of the accompanying subjective wellbeing
and subjective distress measures for both participant
groups.
Demographic predictors of classification
Core demographic variables were examined to determine patterns of change in those showing both positive
and negative trajectories (see Table 2). Gender could not
be assessed in light of the lack of female representation
in the sample (n=1). Age did not appear to differ systematically between the two trajectory types. Both
Table 1 Participant demographic characteristics.
Participant
Gender
Age
Participant 1
Participant 2
M
17
No higher than Year 10
Single
C4 ASIA A complete paraplegia
M
F
M
19
20
27
Completed high school/ VCE
Completed high school/ VCE
Completed Apprenticeship / T.A.F.E. / College
Diploma
Single
Single
Single
T5 ASIA A complete paraplegia
T11/12 incomplete paraplegia
T3 ASIA A complete paraplegia
M
29
Single
Participant 6
M
37
Completed Apprenticeship/ T.A.F.E./ College
Diploma
Post-graduate university degree
Participant 7
M
44
Completed high school/ VCE
T12 ASIA D incomplete
paraplegia
T4 incomplete paraplegia
(tumour)
C4 ASIA A complete paraplegia
Participant 8
M
50
Post-graduate university degree
Participant 3
Participant 4
Education
Marital Status
Injury categorisation
Participant 5
Note. All participants reported having been born in Australia.
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Married/ de
facto
Married/ de
facto
Married/ de
facto
T8 ASIA B incomplete
paraplegia
Chantal Roddy et al.
Table 2
Personal identity narratives of therapeutic songwriting participants following Spinal Cord Injury
Summary of key changes in direction and strength of change in outcome measures.
Participant
3
8
6
2
5
1
7
4
SLWS
CHANGE
Improved
+10
Improved
+4
Improved
+5
Declined
−4
Declined
−5
Steady
−1
Declined
−9
Declined
−6
FS
CHANGE
Improved
+3
Improved
+3
Improved
+4
Steady
0
Steady
+1
Improved
+5
Declined
−5
Declined
−20
PA
CHANGE
Improved
+5
Steady
+1
Declined
−6
Steady
−1
Steady
+1
Improved
+5
Declined
−11
Declined
−10
GAD
CHANGE
Steady
−1
Steady
0
Steady
−2
Steady
−2
Steady
−1
Declined
+7
Declined
+3
Declined
+10
PHQ
CHANGE
NA
CHANGE
Steady
−2
Declined
+5
Improved
−6
Improved
−3
Steady
−2
Declined
+5
Steady
+2
Declined
+5
Steady
+2
Improved
−4
Declined
+8
+2
HISDS
CHANGE
Improved
+15
Improved
+8
Improved
+25
Improved
+4
Improved
+6
Improved
+34
Improved
+5
Declined
−52
Improved
−5
Steady
+2
Steady
−1
Declined
+7
TSCS
CHANGE
Improved
+19
Steady
+2
Improved
+19
Steady
−2
Steady
−1
Declined
−6
Declined
−5
Improved
+4
SLWS, Satisfaction with Life Scale; FS, Flourishing Scale; PA, Positive Affect Subscale of the PANAS; GAD, Generalized Anxiety Disorder
7-item scale; PHQ, Patient Health Questionnaire; NA, Negative Affect Subscale of the PANAS; HISDS, Head Injury Semantic Differential
Scale; TSCS2, Tennessee Self-Concept Scale 2nd edition. Light shading reflects improved scores, while darker shading reflects
declined scores.
groups were of mixed ages ranging from 17–50. Twothirds of those with positive trajectories had undertaken
a postgraduate university degree and were either
married or in a defacto relationship, although it is
unclear based on these participant numbers whether
education or relationship status is reliably able to differentiate positive from negative trajectories.
All three participants showing positive trajectories
had a comparatively less severe injury (incomplete paraplegia) than those with negative trajectories (complete
paraplegia or tetraplegia). Those with negative trajectories were also on average longer post-injury as compared to those with positive trajectories.
Table 3 Identity (Tennessee Self-Concept Scale and Head
Injury Semantic Differential Scale) Scores at Pre-, Mid- and
Post-intervention for Participants with Positive and Negative
Trajectories.
TSCS-2
Participant
Positive Trajectories
Participant 3
Participant 8
Participant 6
Negative Trajectories
Participant 1
Participant 7
Participant 4
HISDS
Pre
Mid
Post
Pre
Mid
Post
33
61
40
60
49
52
63
59
106
118
91
113
94
121
126
116
48
25
20
35
26
-
42
20
24
80
112
113
69
111
-
114
117
61
Note. The TSCS-2 Total score is reflective of an individual’s
overall self-concept and associated level of self-esteem. High
scores (≥ 60T) are suggestive of a largely positive self-view,
whereas low scores (≤30T) suggest more long-standing personal
difficulties and conflicted self-view. HISDS Total possible scores
range from 20 to 140, with higher scores indicative of a more
positive self-concept.
Table 4 Subjective Wellbeing Scores on the Flourishing Scale,
Satisfaction with Life Scale and Positive Affect Subscale of the
PANAS at Pre-, Mid- and Post-intervention for Participants with
Positive and Negative Trajectories.
Flourishing
Scale
Participant
Positive
Trajectories
Participant 3
Participant 8
Participant 6
Negative
Trajectories
Participant 1
Participant 7
Participant 4
Satisfaction
Positive Affect
with Life Scale
(PANAS)
Pre Mid Post Pre Mid Post Pre Mid Post
46
48
46
-
49
51
50
10
20
21
23
20
24
26
40
36
36
28
45
37
30
43
53
51
31
46
-
48
48
31
10
31
22
5
26
-
9
22
16
25
42
42
21
34
34
30
31
31
Table 5 Subjective Distress Scores on the Patient Health
Questionnaire (PHQ-9), Generalized Anxiety Disorder Scale
(GAD-7) and Negative Affect subscale of the PANAS at Pre-,
Mid- and Post-intervention for Participants with Positive and
Negative Trajectories.
PHQ-9
Participant
Positive
Trajectories
Participant 3
Participant 8
Participant 6
Negative
Trajectories
Participant 1
Participant 7
Participant 4
Negative
Affect
(PANAS)
GAD-7
Pre Mid Post Pre Mid Post Pre Mid Post
6
2
9
9
9
4
7
3
1
1
6
7
10
0
1
4
20
16
22
19
31
22
12
30
6
1
9
16
4
-
11
3
14
1
0
2
8
4
-
8
3
12
17
18
21
29
23
-
19
17
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While a content or qualitative analysis of song lyrics
was beyond the scope of the current study, a brief
inter-rater reliability exercise was undertaken to review
the affective content of song lyrics within the past-,
current-, and future-focused songs of those with positive
and negative trajectories. This process, based on gross
coding of positive, neutral or negative themes within
the song lyrics, did not identify any reliable differentiation of those with positive and negative trajectories
based on affective song content alone. However, visual
inspection revealed that those with negative trajectories
tended to express themes of grief, loss or regret. This is
illustrated through some of the following lyrics:
“I wish I wasn’t here/ So you couldn’t see me in
this mess/ I’m sorry for putting you through/
All the worry and stress” (Participant 1)
“I don’t let people see it, but my heart’s breaking/
Grieving for the dreams I’ve lost” (Participant 4)
“I look completely different, lost so much weight/
I feel disconnected from my body in this state”
(Participant 7)
Interestingly, all three participants with negative trajectories also appeared to express some optimism about
the future in the third, future-focused song:
“No one ever knows how things will be/ Stuff
might happen, wait and see/ Take it how it
comes, just my fate/ Happiness comes to those
who wait” (Participant 1)
“I’ve got a new path to move on/ I have chosen
what I want, and I won’t look back again/
Morning sunshine brings me charm” (Participant
4)
“It’s time to fight for a future that I like/
Everything is changing, but it’s gonna be alright”
(Participant 7)
Those with positive trajectories also touched on themes
of loss or grief in their songs, but additionally included
lyrics that touched on gratitude for family and friends,
perseverance, re-evaluation of future priorities, and
optimism:
“Now I see, the me that I was meant to be”
(Participant 3)
“ … I’m grateful for each day that I might never
have had” (Participant 3)
“After being somewhere so dark/ I’m moving
forward to a future that is full of light”
(Participant 3)
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“Time is the healer and I know I will survive/ I
have lost some things, but gained good things
too” (Participant 6)
“I don’t know who I am now, and how I’ll
provide/ I’ve lost my motivation, but not my will
to survive” (Participant 8)
“I know in time we’ll survive this ordeal”
(Participant 8)
The above example lyrics note some of the themes emerging for those with positive and negative trajectories. A
more rigorous examination of content across the three
songs produced for all participants, alongside the
additional measures collected which gauged the experience of ‘flow’ and meaning during the songwriting
process, would be of value in future research to
provide a stronger empirical basis for any genuine differences between participants with positive and negative
trajectories.
Discussion
The current paper presents an analysis of the identity,
subjective well-being, and distress measures completed
by eight people with SCI undertaking a targeted 6week therapeutic songwriting program during their
inpatient rehabilitation program. Some participants,
classified here as those with positive trajectories, demonstrated positive shifts in many of the relevant indices,
whereas other participants tended toward negative
shifts. No clear patterns in core demographic variables
such as age, gender, education or relationship status
served to differentiate these classifications as these attributes were mostly evenly distributed between groups
(with the exception of the aforementioned gender bias
in the sample overall, which hindered closer examination of gender roles).
With regard to the classification of those with positive
and negative trajectories, it is of interest that the two
participants who were under treatment with mood-altering medications displayed neutral trajectories. It is not
within the scope of the current study to determine
whether the presence of mood-altering medications
may have ‘blunted’ any response to treatment, but the
role of such medication in shaping treatment response
is an area of note for future control comparison studies.
One key factor that did appear to differentiate the two
evident trajectories was injury severity. All participants
with positive trajectories were those with less severe injuries. The underlying contributors to this apparently
reduced benefit for participants with more severe injuries are unclear. The severity of an injury and associated
Chantal Roddy et al.
Personal identity narratives of therapeutic songwriting participants following Spinal Cord Injury
life role participation restrictions, the significant threat
to identity resulting from this injury, and the expectation
of longer duration of rehabilitation and reduced mobility may all have played a role in the experience of
these participants in the sub-acute rehabilitation
environment. These factors would align with prior
research which has identified perceived health and
mobility4, and the extent to which rehabilitation trajectories/progress matched expectations9 as predictors of
post-injury adjustment. Severity of injury has also
been found to be positively associated with suicidal ideation and attempts post-SCI.49
It should be noted that one participant with a negative
trajectory had a significant pre-morbid history of psychopathology, primarily depression. This participant
had extreme difficulty adjusting to the rehabilitation
environment, and threatened to self-discharge on multiple occasions. Although prior literature has established
that depression is a common comorbidity after a SCI
(e.g.50), the role of pre-injury psychopathology as a
potential predictor of post-injury adjustment remains
less clear. However, it is reasonable to assume that
those with pre-existing tendencies toward rumination
or anxiety may face a greater challenge in adjusting to
their changed circumstances after injury, particularly
where this implies a significant threat to physical
functioning.
The relationship between injury severity and treatment response warrants further investigation, and
holds promise for the applicability of an identityfocused songwriting intervention for those with less
severe injuries. Further research into factors such as
age, gender, and education in larger samples is also recommended. Although coping style and stress response
were outside of the scope of the current study, these
have been proposed as predictors of SCI adjustment in
prior research51,52 and would also be worthy of future
exploration. Significant life events and changes in
relationships post-injury were not directly evaluated in
the current paper, although the impact of relationship
breakdowns on injury adjustment is another area that
warrants further investigation.
The current study has a number of limitations. Firstly,
the research design precludes any causal inferences being
drawn about the effects of the intervention. In the
absence of a control condition, it is not possible to attribute any changes in core identity or well-being indices to
the music therapy intervention. The small sample size
also limits the generalisability of current findings.
While recent studies have suggested emerging evidence
for identity-focused therapeutic songwriting programs
in facilitating post-injury adjustment (e.g.32,49), it is
important that future such studies investigate the key
causal factors that influence treatment response and in
turn, shape post-injury adjustment.
Conclusion
The current paper presents an initial analysis of some of
the possible contributors to post-injury adjustment for
patients with SCI, and the potential efficacy of an identity-focused therapeutic songwriting program in addressing these. It should be noted that a more extensive
comparison with control data is warranted to enable
comparisons between those undergoing treatment as
usual and those undergoing the songwriting program
in the rehabilitation setting. The current study acted as
a feasibility study to inform treatment response trends
and the sensitivity of the identity and subjective wellbeing measures for ABI and SCI populations. It is
hoped that the preliminary findings from this study
can inform the development of future projects.
Identity remains an important driver of the postinjury identity rehabilitation focus, and one which
merits attention in a subacute rehabilitation setting.
More specifically, therapeutic songwriting holds
promise as a means of promoting healthy adjustment
and associated positive shifts in mood, well-being and
quality of life. Injury severity should be further explored
in future studies as a predictor of identity-specific treatment response. The individual narratives and identity
trajectories of patients with SCI continue to be an
important contributor to the development of effective
post-injury therapies to promote healthy, reintegrated
self-concept.
Acknowledgement
We would like to thank Young-Eun Claire Lee for
assistance in data collection, and Peter New for advice
on the draft manuscript.
Disclaimer statements
Contributors None.
Funding details: This work was supported by the
Australian
Research
Council
[grant
number
DP150100201].
Declaration of interest: None.
Conflicts of interest None.
Ethics approval The current project was approved by the
Austin Health Human Research Ethics Committee
(REF H2013/05038).
The Journal of Spinal Cord Medicine
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Chantal Roddy et al.
Personal identity narratives of therapeutic songwriting participants following Spinal Cord Injury
ORCID
Chantal Roddy http://orcid.org/0000-0001-5220-9226
Nikki Rickard http://orcid.org/0000-0002-4236-8538
Jeanette Tamplin
http://orcid.org/0000-0002-3623033X
http://orcid.org/0000-0003Felicity Anne Baker
2213-4467
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