Journal of Music Therapy, 53(2), 2016, 121–148

doi:10.1093/jmt/thw002; Advance Access publication February 24, 2016

© the American Music Therapy Association 2016. All rights reserved.
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“Music Therapy Helped Me Get Back

Doing”: Perspectives of Music Therapy
Participants in Mental Health Services
Tríona McCaffrey, PhD
Irish World Academy of Music & Dance, University of Limerick, Ireland

Jane Edwards, PhD, RMT

Deakin University, Victoria, Australia

Background:  Mental health service development internationally is

increasingly informed by the collaborative ethos of recovery. Service
user evaluation of experiences within music therapy programs allows
new phenomena about participation in services to be revealed that might
otherwise remain unnoticed.
Objective:  The aim of this study was to demonstrate how asking service
users about their experience of music therapy can generate useful infor-
mation, and to reflect upon the feedback elicited from such processes in
order to gain a deeper understanding of how music therapy is received
among service users in mental health.
Methods:  Six mental health service users described their experiences of
music therapy in one or two individual interviews. Transcripts of interviews
were analyzed using the procedures and techniques of Interpretative
Phenomenological Analysis.
Results:  Interviews with mental health service users provided rich, in-depth
accounts reflecting the complex nature of music therapy participation. Super-
ordinate themes refer to the context in which music therapy was offered, the
rich sound world of music in music therapy, the humanity of music therapy,
and the strengths enhancing opportunities experienced by service users.
Conclusions:  Participants indicated that they each experienced music
therapy in unique ways. Opinions about the value of music therapy were
revealed through an interview process in which the researcher holds an
open attitude, welcoming all narrative contributions respectfully. These
findings can remind practitioners of the importance of closely tuning into
the perspectives and understandings of those who have valuable expertise
to share about their experience of music therapy services in mental health.

Thanks to each of the service users who participated in this research and also to
Rory Adams, Music Therapist, and Catherina Brady, Art Therapist of the National
Centre for Arts and Health, Tallaght Hospital, Ireland.
Address correspondence concerning this article to Tríona McCaffrey, PhD, Irish
World Academy of Music & Dance, University of Limerick, Limerick, Ireland.
E-mail: triona.mccaffrey@ul.ie. Phone: 35361-234358.
122 Journal of Music Therapy

Introduction
Recovery is a leading approach in modern mental healthcare that
endorses the inclusion of the service user as an expert-by-experience
in the planning, delivery, and evaluation of services. Recovery under-
pins mental health policy in many countries, such as the United States,
United Kingdom, Canada, Australia, New Zealand, Ireland, Norway,
Sweden, Taiwan, South Korea, and Iceland (Slade et al., 2012), and
The Mental Health Action Plan 2013–2020 (World Health Organisation,
2013) emphasizes the recovery ethos in mental health services.
Anthony (1993) has described recovery as a “deeply personal, unique
process of changing one’s attitudes, values, feelings, goals, skills and/
or roles” in order to live a “satisfying, hopeful, and contributing life”
(p. 18). The narratives of people who have experienced mental health
services provide a means by which human diversity can be illuminated.
They also personalize the experiences of people with mental health
difficulties so that they can be involved as active agents of change
within mental healthcare systems (Smith, 2005).

Individual Voices in Music Therapy

In the past decade, discussion about the potential role of music
therapy as a recovery-oriented practice has occurred (e.g., Chhina,
2004; Eyre, 2013; Kaser, 2011; Kooij, 2009; McCaffrey, Edwards, &
Fannon, 2011; McCaffrey, 2014). Music therapy “can realise some of
the central themes of recovery by responding to the individual wishes
and requests of people with enduring mental illness in a way that
realises their personal choices, strengths and potentials so that they
can reclaim control over their lives” (McCaffrey et al., 2011, p. 187).
Solli, Rolvsjord, and Borg (2013) considered the resonances between
music therapy and recovery-oriented practice, concluding that
“music therapy can contribute to the quality of mental health care
by providing an arena for stimulation and development of strengths
and resources that may contribute to growth of positive identity and
hope for people with mental illness” (p. 244). There is a small body of
literature that records and reflects service user experience of music
therapy (Hammel-Gormley, 1995; Rolvsjord, 2010; Solli, 2014; Solli &
Rolvsjord, 2014; Stige, 2012), and there is some evidence that service
user evaluation of services has been undertaken (Baines, 2003; Baines
& Danko, 2010; Carr et  al., 2011; Dye, 1994; Heaney, 1992; Reker,
1991). This body of work provides opportunities for deeper learning
about music therapy’s impact on individuals, and offers insight into
personal processes engaged in the journey toward wellness.
Vol. 53, No. 2 123

Personal accounts based on lived experience can disrupt or

challenge dominant narratives that have emerged within practice.
For example, Ansdell and Meehan (2010) interviewed 19 service
users with chronic mental health problems and found that service
users “do not necessarily experience (and value)…therapy in the
way referring clinicians, and researchers defining ‘outcomes’ and
‘effectiveness’ in this clinical area may perhaps anticipate” (p. 35).
A recovery approach in mental health service provision empha-
sizes the expertise of the service user in being able to indicate their
needs in relation to wellness and recovery. Music therapists have
heeded the call to include the voices of service users in multiple
ways. A small number of reports have indicated service users’ con-
ceptualization and engagement with music therapy. Nine inpatients
were interviewed about their music therapy experiences, with the
researchers concluding that in many situations in which they expe-
rienced music therapy, service users described it as the “opposite of
treatment” (Solli & Rolvsjord, 2014, p. 18). Their findings cautioned
about the risk of “pathologizing” or “medicalizing” the processes
that occur within sessions (Solli & Rolvsjord, 2014, p. 18). Hammel-
Gormley (1995) stated that “we need to illuminate how our patients
use music and view music therapy. After all, our patients are the
‘experts’ themselves; they know themselves better than we do” (p. 5).
Such illuminating may uncover existing unknown implications while
also prompting new directions for practice.
This paper presents the first author’s PhD research, super-
vised by the second author, that focused on service user evalua-
tion of music therapy in mental health. This evaluation specifically
focused on personal lived experience of music therapy in order
to gain a deeper understanding of how such a service is received
among those who have attended sessions in mental health. Both
authors have experience in music therapy service provision in men-
tal health services and expertise in service development.

Method
Participants
A statutory mental health provider of music therapy agreed to host
this study in an inpatient hospital setting in Ireland. Ethical approval
from the relevant hospital ethics committee was attained to carry out
individual interviews with service users who attended music therapy
124 Journal of Music Therapy

at this hospital. Inpatients and outpatients were included so as to

allow follow-up if a change in patient status occurred between initial
information and informed consent stages of the research. The main
inclusion criteria were that participants were over 18 years of age and
were willing and able to speak about their experiences of voluntarily
attending weekly music therapy in a verbal interview in the English
language for approximately 20–50 minutes’ duration. Each partici-
pant was an inpatient or discharged patient of the psychiatric unit
at the hospital who had attended a minimum of two music therapy
sessions within the past six months. The exclusion criteria applied
where informed consent could not be given due to diminished cog-
nitive capacity to the extent where a potential participant did not
sufficiently understand the nature or purpose of the interview and
any consequences.

The Researchers’ Lens
Both authors of this study have experience in music therapy service
provision in mental health services and expertise in service develop-
ment. The first author previously worked in a recovery-oriented men-
tal health service where the importance of meaningful collaboration
between service users and providers was emphasized. Both authors
have experienced the valuable and influential role that promoting
individualized treatment offers service development in mental health.
As recovery-oriented practice underpins adult mental health services
in the country that this study was undertaken, research that involved
listening to stakeholder perspectives was deemed timely. At the time
the research was conducted, there were few music therapy mental
health services in existence in this small country. The music therapy
service evaluated in this study was provided by two music therapists
professionally known to both authors. Their practices in the inpatient
setting described varied in therapeutic approach and encompassed
a range of principles from psychodynamic, humanistic, and person-
centered traditions. The nature of the music in group or individual
sessions is primarily focused on clinical improvisation.

Procedure
Methodology
Interpretative Phenomenological Analysis or “IPA” (Smith,
2004; Smith, Flowers, & Larkin, 2009) offers an approach to
Vol. 53, No. 2 125

qualitative, experiential, and psychological research by which to

investigate human experience (Eatough & Smith, 2006; Owens,
Crone, Kilgour, & El Ansari, 2010; Pothoulaki, MacDonald, &
Flowers, 2012). IPA has been used in service user evaluation in
mental health research (Fortune et  al., 2010; Furness, Armitage,
& Pitt, 2011). According to Shinebourne (2011), IPA has a distinc-
tive epistemological framework that features theoretical underpin-
nings in phenomenology and hermeneutics while it also takes an
idiographic perspective. Together, these elements conceptualize
lived experience in a way that acknowledges the subjective nature
of human existence and the interpretative function of research in
responding to and representing participants’ experiences.
IPA endorses the one-to-one interview as the most appropriate
way to foster rapport between the interviewer and participants.
The interview aims to elicit the participant’s thoughts, stories,
and feelings with the aim of providing a deep understanding of
the phenomenon under investigation (Smith et al., 2009). It is a
“dialogue whereby initial questions are modified in the light of
participants’ responses, and the investigator is able to enquire
after any other interesting areas which arise” (Smith et al., 2009,
p.  57). The interview involves a process of active participation
where the participant is regarded as “the experiential expert
on the topic in hand” (Smith et  al., 2009, p.  58). Participants
were invited to participate in two face-to-face interviews with the
researcher. Two interviews provided participants with an opportu-
nity to clarify, contest, confirm, or elaborate upon earlier discus-
sions for the purposes of clarity and transparency, credibility and
trustworthiness (Telford & Faulkner, 2004; Finlay, 2006; Kowlessar
& Corbett, 2009).

Data Collection
Poster advertisements were placed on notice boards in the unit.
A research gatekeeper, as the main point of contact for research-
related issues at the hospital, handed information to people who
had attended music therapy. There was a three-month window
during which interviews could be conducted, due to the avail-
ability of the research gatekeeper at the service. Recruitment con-
tinued until expressions of interest around involvement ceased.
A total of two men and four women agreed to participate in the
126 Journal of Music Therapy

interview stage of this study. These included Luke, Ollie, Pauline,

Barbaraella, Carma, and Laura (participant-chosen pseudonyms),
each of whom were attending music therapy at the time of recruit-
ment. This sample size fitted the small participant pool available at
the hospital and provided a group sufficient to undertake a quality
IPA study.
The location of the interviews depended upon participants’ sta-
tus within the service. Five of the six participants were interviewed
in a private room at the psychiatric unit of the hospital. One partic-
ipant who had been discharged from the hospital was interviewed
in a community mental health day center. After being provided
with an opportunity to ask questions and clarify that they agreed
to participate, each participant was given an informed consent and
audio-recording consent forms to sign.
The direction of the IPA interview is co-determined in situ,
prefaced with the leading statement of “I am interested to learn
about your experience in music therapy.” Overall, the researcher’s
main focus during the interviews was upon being open and avail-
able to participants in a way that would encourage them to dis-
cuss and reflect upon their personal experiences (Ezzy, 2010). This
included being open to the possibility that participants may wish
to share their dislikes or annoyances regarding music therapy. The
duration of each of the six initial interviews varied approximately
between 18 and 55 minutes.
At the end of the first interview, participants were asked if they
wished to receive 2–3 newsletters over the lifetime of the research
that would keep stakeholders updated on related progress and
developments. These have been used successfully in previous
research with which the authors have been associated (Ledger,
2010). Provisional arrangements were then made for follow-up
interviews to which four participants agreed (Luke, Ollie, Pauline,
and Barbaraella). Carma chose not to participate in a follow-up
interview. It was not possible to carry out a follow-up interview with
Laura, as her initial interview took place on the final day of data
collection.
Audio recordings of the first interviews were listened to and
transcribed before carrying out the follow-up interviews. Brief sum-
mary points and surprising or poignant moments of the first inter-
view were noted. These highlighted the points of clarification or
elaboration to be pursued in the follow-up interview.
Vol. 53, No. 2 127

Trustworthiness
Follow-up interviews provided participants with an opportu-
nity to clarify, contest, confirm, or elaborate upon earlier discus-
sions. After contributing to the study, all participants were given
an opportunity for a debriefing about their experience of being
involved in this research. Participants were either phoned or vis-
ited on the ward by the first author or gatekeeper. Having previ-
ously carried out a music therapy study that employed IPA, the first
author was familiar with utilizing this methodology (McCaffrey,
2013). However, as a means of creating greater trustworthiness,
the Tríona continually checked all emergent themes with Jane
throughout the analysis stage of the McCaffrey interviews.

Analysis
Audio recordings of all interviews were transcribed verbatim.
Any personally identifying information, including names of peo-
ple, places, and geographical locations, was omitted from the inter-
view transcripts so as to ensure that the participants would not be
identifiable to external parties. As advocated by Smith et al. (2009),
IPA was carried out on a case-by-case basis, whereby four cases con-
sidered two interviews while the remaining two cases involved a
single interview. The following steps of analysis were undertaken:
1. The interview transcript was carefully read a number of times,
and the audio recording of this was listened to on at least
two occasions, during which initial impressions of these were
noted. These notes were considered in relation to the corre-
sponding entries that were recorded in my reflexive journal
at the time of recording the original interview.
2. The text from the electronic transcript was copied into
a table consisting of three columns allowing space for IPA
analysis. Each line of text was double-spaced, and pages were
numbered.
3. The transcript was read again for the purposes of familiarity.
4. Exploratory comments were noted in the far-right-hand col-
umn of the table. These included descriptive comments that
highlighted the objects that structured the participants’
thought process; linguistic (language) comments that were
concerned with language use; and conceptual comments that
moved toward a more interrogative analysis that focused on
128 Journal of Music Therapy

overarching understandings of what participants said (Smith

et  al., 2009). Each comment category required a separate
reading of the transcript.
5. The researcher’s thoughts and impressions were noted while
reading and analyzing the transcripts. These were written in
a reflexive journal and also inserted in comment boxes in the
interview transcript.
6. Emergent themes were developed from the various forms
of exploratory comments. These were inserted into the left-
hand column of the table.
7. All of the emergent theme names were copied and pasted
into a separate Microsoft Word document in a large font
size. The corresponding transcript page was noted after each
theme in brackets. This was for the purposes of ensuring ease
of reference at later stages of analysis.
8. The list of emergent themes, varying from 62 to 178 per inter-
view, was printed, and each theme was cut out of a separate
piece of paper, as suggested by Smith et al. (2009). These were
then placed on the floor so that they could easily be moved
around when developing superordinate themes. Once cross-
checked with the interview transcripts, the superordinate
themes consisting of multiple emergent themes represented
on paper slips were stuck on a wall. Photographs of the super-
ordinate themes were taken and transferred onto a computer.
These were used to inform the completion of written summa-
ries of each superordinate theme. A summary table in relation
to each interview was compiled. This featured a description of
the superordinate themes which were ranked in descending
order in accordance to its comprising number of emergent
themes, which varied in number from 52 to 2.
9. The process described above was repeated across interviews on
a case-by-case basis until all six cases were analyzed. Supporting
quotes were then extracted from the transcripts to support
each of the superordinate themes arising within the interviews.

Findings
Ten interviews with six participants who described their experi-
ences of individual or group music therapy in mental health were
transcribed and then analyzed. These interviews provided insights
Vol. 53, No. 2 129

into lived experience of music therapy in mental health. A selec-

tion of the main superordinate themes in relation to each partici-
pant’s interview are presented below. Some of the interview dia-
logue reflections are reported in present tense. This can have the
effect of making the information more immediate and compelling
to the reader. After presentation of the main themes, a brief sum-
mary is provided that reflects the distinctive contributions made by
each of the service users in the context of this research.

Luke
Luke described his experiences of attending individual music
therapy as an outpatient. Some of the main themes found across
his two interviews included “Being introduced to music therapy,”
“Person-centered nature of individual music therapy,” and “Music
in music therapy.”
Person-Centered Nature of Individual Music Therapy . Music
therapy offers Luke a space in which he feels acknowledged as a
unique and individual person. He commenced music therapy fol-
lowing his trauma, at a time when “I wasn’t fully within myself.” He
was seeking a personalized approach to aid his recovery. Given his
interest in music, music therapy seemed like an obvious path to
pursue. His sessions were initially offered to him on a trial basis,
whereby “he’d just do the first few” in order to see if these “would
help me out.”
Feeling comfortable in music therapy is something that is impor-
tant to Luke. His sense of ease in music therapy is due to being
within an environment where he has no fear of being judged by
others:
When you get to do it you find that you are expressing
yourself the way that you feel comfortable that you want
and you are not judging yourself or if you’d just like to
decide “I’ll create this, this is what I like to do, I love to do
in my own way.”
Luke alludes to music therapy’s flexibility. Such flexibility fosters
Luke’s sense of self-direction given the multiple choices that can
arise in sessions; these require him to make decisions about what
he wishes to pursue. The music therapy process involves negotia-
tion between Luke and his therapist, a person who offers him “a
130 Journal of Music Therapy

helping hand” in order to support Luke as he assumes a leading

role in sessions.
For Luke, music therapy is a place of possibility rather than cer-
tainty. One possibility presented to him in sessions related to the
development of his musical skills. For Luke, this is a way of “better-
ing yourself on an instrument” and enabling personal growth. This
notion of connecting with or enhancing oneself is something that
is very important in Luke’s life:
Researcher: And you’ve mentioned already that music
therapy helps you … helps you to be you.
Luke: Yeah, I  mean if there’s anything in anybody’s life
that they do or it would be that helps them to be really
themselves, that’s a very good thing for anybody or if they
can be more themselves I think that’s a very positive thing
that they should keep that in their lives as best as possible.
Reflection upon this description highlights that some of the pro-
cesses that occur in music therapy can be part of a much grander
narrative in one’s life that extends beyond participation in sessions
for the purposes of addressing an illness or need.
Music in Music Therapy . Luke views music as a natural means of
expression in sessions. Music is something that is not set apart from
discussion but instead an extension of it and vice versa, whereby easy
transitions are made between these two mediums of expression. For
Luke, improvisation involves making choices and opening up mul-
tiple possibilities during play where both structure and duration of
the music are variable. Luke is “drawn to an instrument” in accord-
ance to his emotional state or in relation to how he wishes to deal
with an issue or situation at a particular time. This “draw” sometimes
involves his music therapist checking with him to see if he is satisfied
with his choice of instrument. This has encouraged him to be more
decisive and take ownership of his decisions in sessions.
According to Luke, music is an “unverbal way of kind of express-
ing yourself,” where there is a strong focus upon his emotions. This
means of expression gives him an opportunity to address difficult
feelings and “deal with an issue” while at the same time recogniz-
ing that his therapist has a role within this process. He recalls how
sometimes he and his therapist “would jam around” in a casual
manner, whereas on other occasions a highly interpersonal process
can be at play:
Vol. 53, No. 2 131

whatever instrument you decide to play and then the music

therapist plays another instrument with you by you playing
that and then you can feed off it and they would be giving
you a certain way of doing it or playing their instrument to
try and benefit you in some way.
“Feeding off” the therapist’s play contributes to Luke’s feeling
of being nurtured in improvisation, a space in which he shows an
awareness of how such interactions are aimed to his benefit. These
shared exchanges in music are experienced by Luke as a form of
communication:
Whenever I’m playing I  don’t have to like contradict or
stop the way I’m playing through it and often what she will
be playing with me, I can tell music wise, like she wouldn’t
physically say it you know or wouldn’t act physically a certain
way it’s the way that she’s been musically playing with me.
In Luke’s opinion, improvisation can accommodate his variable
emotional and cognitive states even when he is “absentminded.”
When engaged in play, he sometimes feels “quite soulful in a happy
way” in addition to being “comfortable” and “ecstatic.” These emo-
tional experiences of playing music are moments for Luke when
the music takes over and his sense of time is lost: “it just happens,
you can’t stop it.”
Summary . According to Luke, the rigid and depersonalized cul-
ture of previous healthcare services viewed him through a disabled
lens that caused him to doubt his own abilities. By contrast, in the
music therapy environment, choice, direction, and leadership were
encouraged by his therapist, similar to that recounted by other ser-
vice users (Stige, 2012). Luke appreciated health professionals who
were “being themselves.” He valued genuineness in others. This
resonates with approaches in psychotherapy where the authenticity
of the therapist is esteemed (Rogers, 2004[1967]), and with refer-
ences in the music therapy literature to the authenticity and pres-
ence of the music therapist (Rolvsjord, 2010), where the therapist
is “a warm and empathic partner, trying to understand and meet
the client as an equal” (Stige, 1999, p.  61). This genuineness of
the practitioner is also a central tenet of cultural-relational theory
(Baker Miller et al., 2004). The authenticity of the music therapist
positively influenced Luke’s ability to be at ease and feel comfort-
able in sessions.
132 Journal of Music Therapy

Luke was someone who noticed “being drawn” to an instrument

before playing it. His instrument choice was variable from session
to session, with decisions based upon his emotional state or the way
in which he decided to deal with a particular issue. The complexity
involved in service user choices of instruments in music therapy
has received scant attention in training and practice literature to
date. Luke’s experiences highlight the importance of catering to
such complexity by offering a broad rather than narrow selection
of musical instruments within sessions for some service users.
Luke could “feed off” the music therapist’s playing during improv-
isation. The dynamic and reciprocal nature of playing music with
his music therapist and the nurturing role of the music therapist
were important to him. He was sometimes “absentminded” while
playing music, which resonates with Edwin’s descriptions of partici-
pating in music therapy in the mental health services in the UK.
He said, “when I’m playing music, the brain just goes completely
blank” (Ansdell & Meehan, 2010, p. 36). Music participation in these
descriptions is revealed as having the potential to promote interper-
sonal communication and to switch off one’s negative or preoccu-
pying thoughts and be completely immersed in an interpersonal
sound world. Luke’s descriptions validate improvisation as a type of
“human communication in sound” (Pavlicevic, 2000, p. 275).

Ollie
Themes found across two interviews with Ollie described his
experiences of attending group music therapy sessions in an inpa-
tient setting. These included “Finding a voice in play” and “Music
therapy reignites a spark for music.”
Finding a Voice in Play. Ollie’s early memories of music therapy
are of a place where an array of different instruments are available
to choose while beginning to embark upon shared play with other
people. He recalls being encouraged to try out a number of instru-
ments, stating that this type of encounter of playing music with
others was:
surprisingly great, you know. Ahm, surprisingly great,
I  was…I don’t know if it’s about the acoustics in the
room… the sound is great, you know it’s sort of ah. You
sort of experience good sounds and it was just, it was just
really refreshing or something surprising.
Vol. 53, No. 2 133

Within improvisation, Ollie tries to “pick up on whatever I’m

feeling myself or [pause] try to express myself.” This type of playing
is “a sort of voice” that aids him to express himself and makes him
“feel better.” Over time, Ollie has come to the opinion that:
You can be yourself through an instrument or you can
express yourself and it’s really a very simple way of express-
ing, it’s a very simple way of…I don’t mean that in a wrong
way or I tend to say something simple but it is really simple
and it’s a great way, it’s a great way of saying how you’re
feeling or…music is a great way of expressing yourself and,
ah, probably more than actual words actually you know.
When playing music in past sessions, Ollie is of the view that
“there was a communication there.” This type of musical interac-
tion is one where he can find a voice but also share his voice with
other people. Playing music with others offers Ollie a way of break-
ing down social barriers related to culture, language, and ability:
you could put people in the room like that room when we
were doing the music therapy, it could be different coun-
tries, different continents, speak different…not speak the
same language…you would be able to communicate with
that, I thought that was really powerful like so…
Thus, Ollie can find a means of communicating with others
using music.
Music Therapy Reignites a Spark for Music. Ollie recalls how
“there was a lot to take in” when he attended his first session.
Due to the array of instruments that were on offer to him at that
time, this environment was unlike anything that he had previ-
ously experienced. “Having sort of stepped back” from playing
guitar in previous years, he recalled immediately seeing this
instrument as he entered the music therapy room, stating that
“the last thing I wanted to do was pick up a guitar and play it.”
There was “a good sound” in his first experience of improvisa-
tion, which sort of “hooked” him into playing. By the end of the
session, he found himself improvising music on guitar despite
his earlier wish not to play guitar at all. For Ollie, “something
sparked” in that session, adding that “it takes something really
special to get me moved or towards, ‘cause I get really down.” He
134 Journal of Music Therapy

recalled how he “couldn’t wait for the next music therapy session
the next week.”
With this spark to play music once again reignited, Ollie has
plans to get back playing outside music therapy: “the spark, the
thing has got me back, I checked about maybe going doing a bit of
music, going back playing ahm…love to play with other people, I’d
love to get back playing myself.” Such rekindling of music in his life
is “strange” and a “totally unexpected thing,” particularly consider-
ing that this spark has occurred at a time when he is quite unwell.
For Ollie, music therapy:
helped me get back doing…it’s a great help to me to go
from not wanting to do anything, play guitar, play music
or…and then by the end of maybe two sessions, two, three
sessions I  was back playing guitar and wanted to make
music or whatever.
Reigniting his interest in music “was the best thing really, I have
to say, it’s probably the best compliment I can give.”
Summary. Ollie was surprised upon hearing “good sounds” as he
played music with others in his first session. This highlighted the
newness and wonder that can be involved in playing music with
others. Group improvisation offered Ollie a new way of experienc-
ing himself among others, where musical expression offered him
“sort of a voice” that could be heard and witnessed by others in
a social setting. Aigen (1991) has previously described music as a
natural voice of the human spirit.
Music therapy helped Ollie reconnect with his previous relation-
ship with music. Having “stepped back” from music during his ill-
ness, he was amused at how the “spark” to play guitar once again
was reignited in his first session. This rekindling of a relationship
with music in such a short space of time was to Ollie “the best com-
pliment” he could give music therapy. Ansdell and Meehan (2010)
defined the “music-health-illness narrative” (p. 32) as one in which
music is mobilized as a health-promoting resource for people in
times of illness or difficulty. It relays how Ollie’s past relationship to
music as a health resource was lost due to illness but then recovered
through music therapy so that music could once again play a help-
ful role in his life. For Ollie, this meant making plans to resume
guitar lessons in the future. This exemplifies a central process of
Vol. 53, No. 2 135

recovery in mental health that relates to having hope and optimism

about the future (Leamy, Bird, Le Boutillier, Williams, & Slade,
2011). Ollie’s wish to pursue guitar lessons indicates not only that
he is thinking about his future, but also that he is looking forward
to continuing his relationship with music in a way that will extend
beyond the parameters of the music therapy room.

Pauline
The themes found across two interviews with Pauline were devel-
oped from her descriptions of her experiences of attending group
music therapy sessions in an inpatient setting. Such distinctive
themes included “Music therapy is about one’s life in music” and
“Shared improvisation is interpersonal.”
Music Therapy Is about One’s Life in Music . Music plays an
important role in Pauline’s life. It is laden with memories, mean-
ing, and connections with others. She attributes her interest in
music to her mother, who encouraged both Pauline and her sib-
lings “to do everything” when growing up. Pauline has taken a simi-
lar encouraging role, whereby she purchased a keyboard for her
relative’s son one Christmas. This was undertaken in the hope that
the instrument would nurture this young boy’s love of music.
Pauline’s relationship with music and music therapy is something
that is bound in her musical relationships with many immediate
and extended family members and friends. She grew up in a house
where many family members played music or sang. She has strong
musical memories of her late father and also of her late brother,
“whom music meant a lot to.” Although Pauline wishes to keep
the past and present separate, her memories of music therapy are
blended into the other musical memories in her life. This makes
it difficult to distinguish which of these memories were related to
music experiences in her life, and which related to music therapy.
It leads to the conclusion that these are inextricably bound for
Pauline, as she says:
I can think of lots of them, they blend in with everything,
[name] and [name] here especially and everywhere I go
I can blend in with music and therapy. And back to choirs,
singing in choirs in the chapel, hymns and anything and
everything.
136 Journal of Music Therapy

Pauline connects music therapy participation with other music

experiences in her life. Her reason for attending music therapy is
simply because she “took an interest in music.” This interest was
the starting point for participating in sessions, unlike frequent
accounts in the literature that describe how people begin music
therapy because of having a specific need that they wish to address.
Shared Improvisation Is Interpersonal . Improvisation can
involve the playing of multiple instruments, such as xylophones,
“the gondolas, the shakers, rattly things,” and “many instruments
that you shake and rattle…cowbell and all.” A recent improvisation
in music therapy began by the process of one group member play-
ing a leading note on an instrument that others followed in play.
This sequence was facilitated by the music therapist, who “is very
good and gives us all time to get organized.” Pauline explains how
the ensuing music is then developed by the group:
Well you have to just ahm, hit a note on a drum or what-
ever you want…[therapist’s name] had the guitar, I  had
the drums. [Name] had the xylophone, somebody else
had something else so it all worked out nice what the
instruments were playing into many instruments.
This “working-out” process involved in improvisation comes with
Pauline’s awareness that it is “everyone’s music” rather than one’s
“own music.” Such shared play with fellow group members is to
Pauline a culmination of multiple musical contributions. These
blend together within a dynamic process that involves “playing and
listening”:
I blend in with them and then when I know they’re…even
though I’m playing and I  know they’re playing and I’m
playing along with them and when they play along with me
then I play with them and then they ease off, I ease off too
then…ease off with them.
Pauline explains how one person usually assumes the role of
leader within this shared process of blending music. She some-
times takes on this role within the group: “well today we did of, sort
of a little, our own little…I was the one who started the music off
and they followed, you know, their own little syndromes and follow
the leader. I was the boss.” Pauline easily assumes this role; “there’s
no problem with it.”
Vol. 53, No. 2 137

Summary . Music and music therapy were inseparable for Pauline.

Her experiences of sessions blended into other music-related events
and interactions of her life. When Pauline talked about music
therapy, this could trigger personal and sometimes painful musical
memories relating to family and friends. Pauline related genres of
music and instruments in music therapy to various people, and this
prompted considerable reminiscence about her life. All of these
experiences of music, both within and outside sessions, blended
together. This is suggestive of the idea that music therapy may rep-
resent an extension of past relationships and events involving music
experience rather than being set aside as a therapy that is distinc-
tively different to other experiences with music. Pauline’s perspec-
tive also highlights the polysemic nature of music, as an entity that
contains many possible layers of meaning (Stige, 1999).
The beginning stages of improvisation in group music therapy were
distinctive for Pauline. This may commence with one person playing a
note from which others followed. Yet, in her view, there is something of
a working-out process during this time where group members explore a
way to play with one another until they arrive at perhaps an unknown
destination in music where some sense of consensus is achieved.

Barbaraella
Themes found across two interviews with Barbaraella described
her experiences of attending group music therapy sessions in an
inpatient setting. Some of these included “Ability replaces disability
in music therapy” and “Music is a reminder of youthful wellness.”
Ability Replaces Disability in Music Therapy. Barbaraella portrays
herself as someone who is “disabled,” particularly when recounting
how her efforts to learn ballroom dancing were unsuccessful. This
disabling self-image is set against contrasting descriptions of past
abilities and achievements in her life, such as writing for a maga-
zine, public speaking, and accomplishments in music. In relation
to her present circumstances, she is of the view that “there’s a com-
fort to be able to do anything really.”
In contrast to her portrayal of herself as someone who is “dis-
abled,” Barbaraella’s involvement in music therapy is something
that is based upon her ability. As a person who would “like to throw
my hand in on everything,” Barbaraella can “pick up a new instru-
ment” in music therapy to learn a new skill. These experiences in
138 Journal of Music Therapy

sessions have fostered “a sense of fulfilment and achievement,” par-

ticularly when she succeeds in playing an instrument, stating that:
“I think it’s a pleasure, as I’ve told you, for people who’ve never
played an instrument to go in there and achieve something.” For
Barbaraella, hearing the sound of her instrument during shared
play is a way of instilling “confidence to get up and do it.” In speak-
ing about the various instruments, Barbaraella says she likes “to
try them all” and only recently tried “a completely different instru-
ment.” These encounters with unfamiliar instruments not only
enable new experiences for Barbaraella but also overcome barriers
by offering those with no formal music skills the opportunity to
engage with music:
Well music is a drug. It can make you feel great, it can make
you high, it can make you feel good, that’s why the world
is full of musicians. People like music. Often we do with-
out it. You know, it’d be a boring world if we didn’t have
it. It’s a chance for people to, who never studied music to
get out there and try and do their thing every week and it
gives him a sense of fulfilment and achievement if they suc-
ceed…that’s what I think anyway. So it gave me a chance to
get out there and do my thing.
At first, it was unclear if Barbaraella was referring to music or
music therapy in the lines above. However, upon reflection, it was
concluded that she was describing both, and appeared to place
these on one continuum. Barbaraella’s use of the word “drug” was
interesting and seemed to portray music as something that is ben-
eficial medicine to the individual.
Music Is a Reminder of Youthful Wellness. Barbaraella is aware
that she is getting older, saying, “I joined an old persons’ group,
I’m sixty-four now.” However, it is important for her to connect
with younger people in order to stay young at heart. She recalled
previous experiences of watching young people dancing:
Barbaraella: I  used to go to dances where young people
danced and sit on the steps and watch them do all their
dancing and movements.
Researcher: So it keeps you young?
Barbaraella: That’s the way I look at it.
Researcher: And how important is that for you as a person?
Vol. 53, No. 2 139

Barbaraella: Well, that’s the kind of person I am. I’m young

at heart when I’m well.
Barbaraella’s interaction with and observations of young people
serve as a reminder of what it is like to be well. Group music ther-
apy sessions give Barbaraella an opportunity to mix and associate
with young people. This association with youth is reflected in her
choice of music, as she prefers to listen to popular music for the
purpose of keeping young:

It has an effect on you like, when I grew up I always loved

pop music, I  was trained in classical music. I  loved pop
music and I said why should I stop loving it if I get older
and I still love it. It keeps me young.

For Barbaraella, music plays a significant role in reminding her

of the wellness part of her identity. In sharing her determination
to return to wellness, she explains how she associates wellness with
past experiences of dancing and engagement with various genres
of music:
Researcher: Is that fair to say, Barbaraella, about music
being important about identity?
Barbaraella: Maybe not for everybody, maybe not to
everybody.
Researcher: OK.
Barbaraella: To me certainly yeah.
Researcher: Yeah.
Barbaraella: That’s the way I would say now.
Researcher: Mmm. So what’s the important parts of your
identity in music at themoment?
Barbaraella: I have to remember I’m young at heart. I want
to go back to the scene I have before I got sick. I want to go
back to my dancing and my lovely Irish traditional music,
country and western music and everything else. That’s my
goal. Is to get out of here and go back.

Music provides Barbaraella with a means of helping her connect

with her youth, a period in her life in which she was well. Reflection
upon this description led to the conclusion that this is an impor-
tant connection for Barbaraella, as it reminds her not only of what
it is like to feel well but also that wellness is possible.
140 Journal of Music Therapy

Summary. Barbaraella’s ability in music therapy was distinctive

and positive. It contrasted to a disabling self-image outside the
sessions. She experienced achievement and success when playing
instruments because musical skill was not required. The freedom
and accomplishment gained within this process seemed to “rede-
fine and reframe” the limiting lens from which she viewed herself
in circumstances beyond music therapy (DeNora, 2013, p.  45).
A  more nuanced interpretation of this process of play has been
termed as musicking, defined as a place where common artistic
and human values are shared (Small, 1998). This process of play
or, musicking, was a type of drug for Barbaraella that gave her a
chance to “get out there and do my thing” every week, similar to
other service users, who have described music as a medicine or
“legal dope” (Stige, 1999, p. 77).
Barbaraella experienced herself getting older and has become
a member of an older persons’ group. When she is feeling well,
she is someone who is “young at heart.” Various musical processes,
genres, and experiences connect Barbaraella with her youthful-
ness and perhaps remind her of younger days in her life when
well-being prevailed. Barbaraella used music to experience herself
differently in a way that reoriented her to wellness. Ansdell (2014)
suggested that the altering of identity in music is made possible
because within music-making, the boundaries of the physical and
psychological self are less defined. Therefore, music allows for a
type of transcendence that is without risk, where “the extraordi-
nary is prepared and controlled through the ordinary” (Ansdell,
2014, p. 271).
Carma
Carma described her experiences of attending group music
therapy sessions in an inpatient setting. One poignant theme
emerging from her interview included “Experiencing sound in
music therapy.”
Experiencing Sound in Music Therapy . Carma’s first memory
of music therapy related to the sound of the drums. This made
the first “class” “a bit daunting.” This “noise” prompted feelings of
apprehension about returning to the second class which she was
able to overcome. Over time, she has learned how to disregard cer-
tain sounds during musical play:
Carma: You can just disregard it from the sound.
Vol. 53, No. 2 141

Researcher: And is that a good thing to be able to

disregard it?
Carma: I think it’s good because you’re in tune with what
you are listening to.
Researcher: Right.
Carma: You know. You’re bringing it together, what suits
and what doesn’t.
This disregarding of sound enables Carma to experience music
in a way that “suits” her. In improvisation, she listens to the sound
of her instrument and that of others. Sometimes certain instru-
ments “wouldn’t necessarily fit” with musical play, “but it doesn’t
matter that it doesn’t work.” Sometimes tolerance is required of
sound in music therapy, particularly when she is feeling unwell:
“Well, I  suppose if you are distressed you’re sensitive to noise.”
Pleasant experiences of hearing sound can also be experienced,
as the bongo drums are “nice and sweet and enticing so to speak.”
Carma’s perspective is a reminder that music comprises many
sound components and that elements of sound can be quite selec-
tively experienced in music.
Summary. Carma’s experiences in music therapy particularly
emphasize the idea of sound. Her initial experiences within her
first session were “daunting,” due to the sound of drumming and
so much noise. Such a choice of word indicates that all instrument
sounds are not experienced as music within sessions. Other ser-
vice users have also used the word noise to describe what they have
heard in music therapy (Carr et  al., 2011; Stige, 2012). Carma’s
daunting experience of drumming illustrates how its sound pres-
ence was palpable and even perhaps imposing during her earliest
experiences of improvisation in sessions. Similarities can be found
with descriptions of drumming within the literature that suggest
that this form of musical play has the capacity to create a sense
of unease among some service users (Carr et al., 2011; Hammel-
Gormley, 1995). Hammel-Gormley (1995) recounted how one ser-
vice user thought that she was playing “evil words” on the drums
in music therapy (p. 185). Although the musical characteristics of
drumming in this literature were not detailed, it is possible that the
strength and audibility of the sound from these instruments might
influence how such a stimulus is received by its listeners. Carma
explained that when unwell, she experienced sensitivity to noise.
142 Journal of Music Therapy

As she became more acquainted with improvisation in music, she

learned to cope with this sensitivity by being able to disregard cer-
tain sounds. This was a way of overcoming her earlier experiences
when hearing the drums and indicates that over time she was able
to manage her perception of sound in sessions.

Laura
Themes found in Laura’s interview describe her experiences
of attending group music therapy sessions in an inpatient setting.
Some of these included “Context of the music therapy setting” and
“Instruments visually stimulate.”
Context of the Music Therapy Setting. This theme outlines the
context in which music therapy is offered. Laura views the hospital
where music therapy is provided as “home” and, like herself, the
other service users in this facility are “all wound up.” She recalled
other settings in which she has been placed in the past, exclaiming
that these were “the good old days,” thus suggesting that she has
had satisfactory experiences of institutionalized care.
When first attending music therapy, Laura thought “the whole
lot” of the other group participants “were mad.” Different peo-
ple attend the session every week, “but once they join they come
back again.” Patience is required in music therapy because “there’s
always someone coming in, coming out like…the fellas come out
to go the toilet, they don’t come to the toilet, the divil [a term of
endearment for someone who is mischievous] knows what…but
I’m the same meself sometimes.” Therefore, Laura’s experiences
of music are set within a restless environment.
Instruments Visually Stimulate. Some instruments in music
therapy visually stimulate Laura, as they resemble various sorts
of objects. The “yellow rattlers” in sessions look like the “jangled
things” on a baby’s “pram,” and the xylophone reminds her of “typ-
ing” on a typewriter. One instrument, whose name is unknown to
her, resembles the stairs in a block of flats, “like little sets of stairs
on the side of it.” These descriptions suggest that some instruments
featured in music therapy are a source of visual stimulation for
Laura.
Summary. Laura’s experiences of music therapy stood apart from
those of other service users in terms of the way in which she visually
engaged with instruments in sessions. In music therapy, particular
Vol. 53, No. 2 143

instruments resemble objects that she has encountered in her past.

She took note of considerable detail about the physical appear-
ance of instruments, including their size and color. This suggested
that the physical environment of music therapy and objects fea-
tured within were for Laura a source of visual stimulation. Laura’s
research contribution turns attention away from primarily focusing
upon the sound world in music therapy toward inquiry into the
visual environment as it is experienced by service users.

Limitations of the Study
Some limitations arose over the course of this research. It was
designed with awareness that there are few mental health ser-
vices in Ireland in which music therapy is offered to service users.
Therefore, this study was carried out with the aim of presenting
detailed accounts of individual experiences to highlight what can
be offered and how it is experienced. It concentrated on the depth,
richness, and complexity of the experiences of the participants.
Additionally, some participants were still attending music therapy
and some were in the process of termination. There may be unac-
counted factors that are present in these accounts that might not
be evident if participants were reflecting on their experience at
some remove. Furthermore, as participants self-selected to be part
of this study, their enthusiasm to do so may indicate a positive bias
toward music therapy. Other possible limitations of this research
design include the variable duration of interviews, which ranged
from approximately 20 to 55 minutes, reflective of the varying
needs and wishes of service user participants. The first author also
notes the challenge encountered within the interview process, par-
ticularly when discussion wandered off-track from the topic of music
therapy.

Conclusion
Each of the six summaries and their related themes above offer
rich snapshots into the lifeworld of people who participated in this
music therapy program. Rather than presenting a form of evalu-
ation that measures program performance, the form of evalua-
tion employed here is described as a process of asking questions
that focus on the impact of care on the individual (Barrett, 2008).
144 Journal of Music Therapy

Such evaluation also provides a way of gaining perspective through

open dialogue (Fortune et al., 2010). Placing such service user per-
spectives “in context,” as suggested by Rolvsjord and Stige (2013,
p. 8), the two practices described in this study varied in therapeutic
approach and encompassed a range of principles from psychody-
namic, humanistic, and/or person-centered traditions. This pro-
vides some dimensions of the ecological context highlighting the
unique and varied perspectives of music therapy among a group of
mental health service users in Ireland.

Implications for Service and Practice

This study serves to illustrate the rich information and learning
that service user evaluation can offer practitioners in the develop-
ment of music therapy practice. Pedersen (2014) has called for
further inclusive dialogue concerning music therapy practice in
psychiatry. Similarly, Thornicroft and Slade (2014) have recom-
mended that future mental health practice focus on “understand-
ing what matters most to people using mental health services,
and on the use of measures rated by service users as the primary
approach to evaluating outcome” (p. 118). This research shows that
a person not associated with the therapy who carefully listens to the
accounts of service user participants can elicit valuable information
to support the ongoing provision of services. In everyday service,
evaluation procedures by which a manager or even a practicum stu-
dent involved in another area of the service can take notes of ver-
bal accounts of participation by service users should be developed.

Implications for Research

Engaging service user evaluation of music therapy responds
to the impetus of the recovery approach in mental health in
which stakeholder involvement in service design and provision
is endorsed. As music therapy practice in mental health contin-
ues to develop, it is essential that practitioners in music therapy
continue to evaluate the programs they provide, and pursue this
evaluation through gaining the perspectives of those who attend.
Without service user evaluation, there is a risk of professional
dominance in relation to the practice of music therapy in mental
health. This is no longer a feasible position in the recognition of
Vol. 53, No. 2 145

recovery that promotes the involvement of service users at each

and every stage of service provision (WHO, 2013). A broader con-
cept of evidence is needed to ensure that the voices of those who
attend music therapy are consistently included in future service
development.

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