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Nordic Journal of Music Therapy

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Therapeutic Songwriting in Music

Therapy
Felicity Baker , Tony Wigram , David Stott & Katrina McFerran
Published online: 10 Jul 2009.

To cite this article: Felicity Baker , Tony Wigram , David Stott & Katrina McFerran (2008)
Therapeutic Songwriting in Music Therapy, Nordic Journal of Music Therapy, 17:2, 105-123, DOI:
10.1080/08098130809478203

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 RESEARCH ARTICLE
Nordic Journal of Music Therapy, 17(2) 2008, pp. 105-123.

Therapeutic Songwriting in
Music Therapy
Part I: Who are the Therapists, Who are the Clients, and Why is
Songwriting Used?
Downloaded by [McGill University Library] at 11:19 14 November 2014

Felicity Baker, Tony Wigram, David Stott & Katrina McFerran

Abstract
Songwriting as a therapeutic intervention has received increasing attention in the field of music
therapy over the past decade however much of the publications focus on clinical outcomes rather than
methods of practice. This paper, part of a two-part research report into trends in the clinical practice
of songwriting, aims to describe the most frequently employed goal areas across a range of clinical
populations and compare these findings with the published literature. Responses to a 21-question on-
line survey were obtained from 477 professional music therapists practicing in 29 countries which
focused on approaches to songwriting within their practice with a single clinical population. Chi-
square or comparable Exact tests (Fisher-Freeman-Halton) were applied to the data and significant
associations were found according to different clinical populations particularly with respect to the
aims of songwriting in clinical practice and the frequency with which songwriting is employed in
practice. The data highlights that songwriting is frequently employed in developmental disability and
ASD practice, with reports on songwriting with these diagnostic groups being underrepresented in
the music therapy literature. The survey identified that the most frequently endorsed goal areas align
with the literature base and included a) experiencing mastery, develop self-confidence, enhance self-
esteem; b) choice and decision making; c) develop a sense ofself; d) externalising thoughts, fantasies,
and emotions; e) telling the client's story; andf) gaining insight or clarifying thoughts and feelings.

Keywords: Songwriting, evidence-based practice, music therapy methods.

Editor's note: Part II will be published in Nordic

Journal of Music Therapy 18(\) 2009.

Nordic Journal of Music Therapy 17(2) 2008 JQ^

 FELICITY BAKER, TONY WIGRAM, DAVID STOTT & KATRINA MCFERRAN
Introduction
In 2005, Baker and Wigram published a collection
of chapters where methods of songwriting
practiced by clinicians and researchers with
a range of different clinical populations were
described. By engaging authors from across
the globe, this volume increased the profile of
songwriting as a therapeutic intervention in
music therapy. In Baker and Wigram (2005)
an analysis and synthesis of the content of
their chapters (Wigram, 2005) revealed that
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contributors had developed unique ways of using
songwriting with different clinical populations
while maintaining some common elements in
FELICITY BAKER, PhD, RMT, is senior lecturer
and Program Director of Music Therapy Training
at The University of Queensland, School of Music,
Brisbane, Australia. Her current research interests
include songwriting and developing interventions
that promote coping and adjustment during
transitional stages of life. Felicity is currently Editor
for The Australian Journal of Music Therapy, has
written and edited 2 books, and authored a number
of chapters and articles in peer reviewed journals and
books. Tel.: +61 7 336 53740, fax: +61 7 336 54488.
Email:f.bakerl@uq.edu.au
TONY WIGRAM. PhD, is Professor and Head of
Ph.D. Studies in Music Therapy at the Institute for
Communication and Psychology, Department of
Humanities, University of Aalborg, Denmark. He
is Professor in Music Therapy at Anglia Ruskin
University, Cambridge, and a Principal Research
Fellow in the Faculty of Music,Melbourne University.
DAVID STOTT, D.Phil, has worked since 2002 as a
part-time statistician in applied medical research at
the East of England RDSU Hertfordshire based at
the University of Hertfordshire. For the preceding
34 years he lectured in initially Geography and
subsequently Health Statistics and Epidemiology
at what became the University of Bedfordshire.
KATRINA MCFERRAN, PhD, RMT is lecturer in
Music Therapy in the Faculty of Music, University
of Melbourne, Australia. Her research interests
focus on music therapy with young people, spanning
improvisation and song writing methods for young
people who have disabilities and mental illness.
J Q ^ Nordic Journal of Music Therapy 17(2) 2008
their approaches. The authors of the current
study were interested in establishing whether the
perspectives and approaches of the contributors
in Baker and Wigram's text and those detailed
in other literature, were representative of what
was being implemented in the broader clinical
field. To this end, this study sought to explore
the similarities and differences in songwriting
approaches by surveying clinicians' perspectives
on their practice with data collected via a survey.
This article is the first of two articles that reports
the findings of a survey that collected data on
various aspects of the use of songwriting in
music therapy clinical practice. In particular, this
article focuses primarily on the demographic data
of respondents who report using songwriting, the
frequency with which it is used within their work
and the aims/purpose that songwriting targets
with different diagnostic groups. Discussion
will compare our findings with those reported in
the literature and discuss the findings in relation
to clinical practice. The second article Baker,
Wigram, Stott and McFerran (in press), reports
data on the therapeutic approaches to songwriting
as they are employed with different clinical
populations.
Literature Review
According to Wigram and Baker (2005)
songwriting is defined as "The process of
creating, notating and/or recording lyrics and
music by the client or clients and therapist within
a therapeutic relationship to address psychosocial,
emotional, cognitive, and communication needs
of the client." (p. 16). A search of the literature
published between 1985 and 2006 via MedLine,
CINAHL, Cochrane Library databases and
complemented by a handsearch was undertaken
using the keywords of songwriting, song writing,
song creations, and song parody to identify
articles and book chapters on the subject. All
literature (N = 46) that focused on songwriting
as a therapeutic approach was included in the
review. Table 1 summarises this literature
detailing the authors, their countries of origin,
and the age and diagnostic groups of populations
 THERAPEUTIC SONGWRITING IN MUSIC THERAPY

Child Adolescent Adult/Older adult

Oncology/ Aasgaard 2001, 2005 Dalton & Krout 2005 2006 O'Brien 2005 (Australia)
Palliative Care (Norway) Krout, 2005a, 2005b (USA) O'Callaghan
Abad 2003 (Australia) Kennelly 1999 (Australia) 1990/1996/1997 (Australia)
Hadley 1996 (Australia) Ledger 2001 (Australia) Cordobés 1997 (USA)
Slivka & Magill 1986 McFerran-Skewes 2001 Dileo & Magill 2005(USA)
(USA) (Australia)
Turry 1999 (USA) Robb 1996; Robb & Ebberts
2003a 2003b (USA)
Roberts 2006 (Australia)
Neuro- Baker et al. 2005a/b/c Robb 1996(USA) Baker 2005/Baker et al.
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rehabilitation (Australia) 2005a/b/c (Australia)

Glassman 1991 (USA)
Tamplin 2006 (Australia)
Dementia NA NA Silber&Hes 1995 (Israel)
Psychiatry Davies 2005 (UK) Derrington 2005 (UK) Day 2005 (Australia)
Lindberg 1995#(USA) Edgerton 1990(USA) Baker et al. 2007*
Mayers 1995#(USA) Goldstein 1990(USA) (Australia)
Montello 2003 (USA) Hilliard 2001 (USA) Ficken 1976 (USA)
Oldfield & Franke 2005 McFerran et al 2006 Freed 1987* (USA)
(UK) (Australia) Gallagher & Steele
Robarts 2003# (UK) Rickson & Watkins 2003 2002*(USA)
(NZ) Ghetti 2004* (USA)
Jones 2005* (USA)
Rolvsjord 2005 (Norway)
Silverman 2003 (USA)
Developmental Gfeller 1987(USA) Fischer 1991 (Canada)
Disability/ASD
Other Edwards 1998 (burns)
(Australia)
# paper specifies sexual abuse * paper specifies substance use disorder

Table 1. Authors describing songwriting approaches according to diagnostic group, age group, and
country of origin.

they serve. The literature search indicates that the
majority of authors were from the USA (n = 21)
and Australia (« = 15). Very few were from the
UK and Europe, and no authors were from Asia
or South America. This difference may be due
to the primarily psychodynamic/analytical and
improvisational models practiced in Europe when
compared with the more eclectic approaches
practiced in the USA and Australia. Given this
difference, the authors questioned whether there
were any trends towards using songwriting in
other global regions.
Table 1 also shows that the majority of clinical
work/research documented has been with adults,
particularly in the area of psychiatry. However,
there are a number of studies in the area of
oncology/palliative care, and this tends to be
more focused on child and adolescent age groups.
There was noticeably very little in the area of
developmental disability and autism spectrum
disorder (ASD) particularly given that music
therapy is widely practiced with this diagnostic
group.
Table 2 presents a list of the various goals
identified in the literature and categorises these into
the different diagnostic groups. Psycho-emotional

Nordic Journal of Music Therapy 17(2) 2008 ] Q"7

 Downloaded by [McGill University Library] at 11:19 14 November 2014

Neurore- Developmental Paediatric tfl

o _ . , . Oncology Dementia Psychiatry Total r-
Goal ofr Intervention „, ._ Habilitation Disability Burns
oo N= 17 N=l N=21 N=46 O
N=4 N=2 N=l
H
z3. Externalise thought, fantasies and emotions 12 3 1 14 1 31 <
o' CO
g >
o Experience mastery, enhance self-confidence/esteem 9 1 1 11 1 23
3 Gain insight or clarify thoughts and feelings 5 2 8 15 F
o Reducing anxiety, anger, and tension 3 2 7 1 13 H
—h
c Validating experiences/coping 4 4 4 1 13 oz
o' Relationships closure 2 6 8 ^
<
Develop a sense of self 1 6 1 8 a
Enhance social skills 3 1 1 3 7 >
MS Decrease challenging behaviours 4 4 J5
-4 Stress Management 1 3 4 a>
Telling the client's story 2 2 4 <
hO
o Leisure/fun/humour 2 1 3
o a
00 H
Choice and decision making 1 2 3 O
Motivation/engagement H
2 2 H
Develop cognitive skills 1 1 2
Enhance language, speech, and/or conversational i >
i 1 2
skills
Sending messages to significant others 2 2 z
Life review 2 2 >
Diagnostic purposes 1 1 2 n
Enhancement of spirituality 1 1
Numbers indicate the number of studies taken from Table 1 where specific goal areas were mentioned g
Note: for authors who have more than one paper describing songwriting, goals were only counted once.
z
Table 2: Summary of goals underpinning songwriting choice
 THERAPEUTIC SONGWRITING IN MUSIC THERAPY
goals were the dominating goals emerging from
the literature whereas developmental goals (eg
developing cognitive skills) were identified
as relevant only for neurorehabilitation and
developmental disability. In particular, the
table shows that the most frequently cited goal
- present in two thirds of the literature - was that
of externalising or exploring thoughts, fantasies
and emotions. Fifty percent of the literature also
identified experiencing mastery, developing and
enhancing self-confidence/self-esteem as goals
underpinning the choice to use songwriting.
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Gaining insight/clarifying thoughts and feelings,
validating experiences/coping, reducing anxiety,
anger and tension, offering choice and developing
a sense of self were also prevalent. Songwriting
as used in psychiatry, had the most varied usage
of all the populations (16 goals documented),
partly explained by the greater number of studies
reported but also because the term psychiatry
encompasses a broad range of diagnoses leading
to an extensive list of relevant goals. Literature
surveyed included eating disorders, sexual abuse,
schizophrenia, and substance abuse.
A similar study to that reported here was
conducted by Williamson (2006), with her work
specifically surveyed the songwriting practice
trends of music therapy clinicians in New Zealand.
The self-administered postal questionnaire was
completed by 11 clinicians, 10 of which reported
using songwriting in their clinical work. While
this survey allowed for respondents to nominate
using songwriting with more than one clinical
population, the data showed that clinicians were
using songwriting predominantly with children
and adolescents (particularly special needs, n =
9), aged care (n = 4) and adults in palliative care
(n = 3). So in Williamson's case, the literature was
not representative of what was occurring in New
Zealand practice, i.e. there were no clinicians
using songwriting in the area of psychiatry, and
a heavy emphasis on its use in developmental
disability.
With respect to goals addressed by songwriting,
Williamson found that the most commonly
reported categories in order of ranking were: 1)
socialisation, 2) self expression; communication;
speech and language skills, 3) memory and
Nordic Journal of Music Therapy 17(2) 2008
cognition; decreasing stress, and 4) grief/trauma.
Given that children/adolescents with special needs
and aged care were the predominant diagnostic
groups, it is not surprising that socialisation
was so frequently identified, and that this was
infrequently documented in the songwriting
literature. Similarly, there is an emphasis on
developmental goals particularly communication
and cognition, these being appropriate for the
predominant diagnostic group. Williamson
contextualises the findings by arguing that these
more frequently identified diagnostic groups were
reflective of the development of music therapy
within New Zealand.
The findings from this literature review, and the
methods and techniques already described in the
edited volume published on songwriting (Baker
& Wigram, 2005) provide a clear foundation
for the most relevant areas of enquiry for a
comprehensive survey into current songwriting
practices, and to a large extent inform the method
of that enquiry.
Method
The Survey
The web-based survey comprised 21-questions
(Appendix 1 on NJMT website: www.njmt.
no) seeking information about respondent
demographics and a range of issues pertinent
to songwriting practice. All questions included
forced choices, and the survey could not be
electronically submitted until all questions
were answered. "Other" and/or "not applicable"
choices were given for six questions (#'s 6,
8, 12, 19, 20 and 21). Question #5 asked the
respondent to indicate whether or not songwriting
was employed within their practice. Those
respondents indicating "no" to this question were
then instructed to submit their survey at that point
and did not complete the remaining questions.
Respondents
Responses were sought from clinicians practicing
in a total of 40 nations within North and South
America, Australasia, and Europe. Ethical
approval was granted by the The University of
|Q()
 FELICITY BAKER, TONY W1GRAM, DAVID STOTT & KATR1NA MCFERRAN
Queensland review board, and to meet ethical
requirements, the researchers requested the
information be distributed through countries'
professional organizations to protect privacy.
Contact was made with these organizations via
email requesting that they distribute details of
the survey to their members inviting them to
participate, rather than obtain email addresses
directly from the organizations. Fourteen of the
nations responded indicating their willingness
to distribute the survey (Denmark, Israel,
Iceland, Ireland, Luxembourg, South Africa,
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United Kingdom, Malaysia, Norway, Canada,
China, Taiwan, New Zealand, and Austria). The
United States requested that the researchers
distribute the survey themselves (with emails
but no names of members provided), and the
Australian association publicized the survey on
its web page. After two attempts at making email
contact, no responses came from country contacts
in the seven South American nations, 12 of the
European nations and two Asian nations, and
emails sent to contacts in three other European
nations were returned undeliverable.
Respondents received an information sheet
indicating the purpose of the study and an
electronic link to the webpage where the survey
was being hosted. Priorto commencingthe survey,
respondents were required to check three boxes
indicating that they had read the information
provided about the study and consented to
participate. Respondents were not able to submit
the survey electronically until all questions were
answered. On submitting the survey, respondents
were given an identification number for their
records and instructed to contact the researchers
and quote this number should they choose to
withdraw their contribution at a later date.
Data
All data were stored on The University of
Queensland server and were only available to
the researchers. Data were imported into SPSS
(version 14) for analysis. Due to the small
number of respondents reporting work with some
diagnostic groups, categories were combined into
] J Q Nordic Journal of Music Therapy 17(2) 2008
broader categories resulting in seven categories:
oncology and palliative care, neurorehabilitation,
dementiaandagedcare,psychiatry, developmental
disability, autism spectrum disorder, and other
(details of the recoding see under Table 4).
The responses to questions on use of
songwriting were coded mostly into five-point
ordinal frequency scales (typical options being
"always", "often", "sometimes", "rarely" and
"never"). The question addressing Goals of
Intervention used a ten-point numercial scale
with the opposite ends labelled 1 = "almost
never applies" and 10 = "almost always applies".
The responses to the questions showed marked
tendencies to select at the extreme margins of the
scales and it was considered than neither mean
nor median responses adequately characterized
the distributions. Consequently responses at
the higher frequency end of the scales ("often"
and "always") were combined and are stated as
percentages in the tables. Responses to Goals of
Intervention have used values of "7 and over" to
represent higher frequency responses. For ease
of interpretation these responses are labelled
"often/always" in the Tables 6 and 7. Where
both the explanatory and the response variables
were ordinal the chi-square tests for trends has
been applied. In all the remaining tables which
met the Cochrane criteria, chi-square analysis
has been used to compare the proportion of
'often/always' responses according to nominal
explanatory variables (region, clinical population
etc.). Adjusted standardised residuals < -2 or >
2 are indicated. In those tables where Cochrane
criteria were not met, the Fisher-Freeman-Halton
Exact Test for r x c tables has been applied.
Results
Respondents
Despite only receiving 16 responses from various
countries indicating their willingness to respond,
data were received in total from 29 countries.
Of the additional responses, six came from
countries not in the initial pool of 40. It can be
assumed therefore, that a) some associations had
members on their database from countries other
 THERAPEUTIC SONGWRITING IN MUSIC THERAPY

Country Size of Survey responses Respondents employing

Pool songwriting
USA/Canada 1939 n=305 n=282
16% 92%
UK/Ireland 352 n=37 n=29
11% 78%
Australia/NZ 329 n=58 n=51
18% 88%
Northern Europe 398 n=28 n=21
7% 75%
Central/Southern Europe 41 n=28 n=21
68% 75%
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East Asia/Rest of World 93 n=21 n=15

23% 71%
TOTAL 3152 N=477 N=419
15% 88%
Note that the total pool of participants in the Central/Southern Europe and East Asia/Rest of World categories
are likely to be inaccurate. It was not possible to determine the total number of music therapists who received
the email invitation.

Table 3: Distribution of respondents from global regions.

than their own; and b) despite not responding to
emails, some countries forwarded the request
to some or all of their membership without
informing the researchers. Therefore, the total
pool of respondents (N=3152) who potentially
received the information is an estimate. A total
of 477 (15%) responses were submitted (Table
2). It should be noted however, that based on the
figures obtained from the USA, a further 11 % of
emails were returned undeliverable and suggests
that the percentage response rate is more likely to
be an underestimation. Of the 477 participants,
419 of these indicating that they employed
songwriting in their work, leaving 58 submissions
where the respondents clearly stated they do not
use songwriting. Due to the small numbers of
respondents in some countries, countries were
combined into global regions. Table 3 indicates
that the largest proportion of respondents was
from the USA and Canada, and to an extent
Australia/New Zealand, supporting the literature
base which is largely from these regions (refer
Table 1). There were however, a number of
respondents from other regions suggesting that it
is widely adopted in clinical practice.
Table 4 details the gender, age distribution and
years of clinical experience of the respondents.
Table 4 illustrates that 91% of the respondents
are females. This corresponds with general
trends in gender distribution in music therapy.
For example, males make up only 8.4% of the
Australian Music Therapy population and 18.5%
if the British Music Therapy population. It is
noticeable that females were less predominantly
represented in the neurorehabilitation, and to
a lesser extent psychiatry fields. Differences
between clinical population and age of practioner
are evident though not significant (p = .08).
There is some evidence of younger music
therapists (20-30 years of age) are more likely
to be using songwriting with ASD groups than
older therapists. With respect to the years of
clinical experience, there are some differences
between oncology/palliative care when compared
with ASD and dementia/aged care. In the
oncology/palliative care, clinicians who reported
using songwriting had generally more clinical
experience in contrast to the ASD group and

Nordic Journal of Music Therapy 17(2) 2008 11 J

 FELICITY BAKER, TONY WIGRAM, DAVID STOTT & KATR1NA MCFERRAN

Clinical Population n females age groups (%) years of experience (%)

% 20-30 31-40 40-49 50+ <2 10+
Oncology/Palliative care 51 94 43 22 20 16 8 33 24 35
Neurorehabilitation 26 77 27 39 19 15 12 27 27 35
Dementia/Aged care 36 94 47 28 14 11 25 19 25 31
Psychiatry 103 87 32 42 21 5 15 25 25 35
Developmental Disability 88 96 37 30 21 11 21 20 14 45
ASD 61 95 60 26 10 5 21 36 23 20
Other 53 85 34 32 23 11 17 25 23 35
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2
P values .03 .08' .22'
TOTAL 418 91 40 32 19 9 17 26 22 34

Significance: 1 chi-square; 2 Fisher-Freeman-Halton Exact.

Note: Psychiatry includes the combination of eating disorders (n = 5), depression and suicide (n = 27),
substance abuse (n = 10), schizophrenia (n = 27), trauma (n = 29), and anxiety, forensic psychiatry and
personality disorders (n = 5, partly specified in the free text answers). Other (n = 53) all other populations
listed: 1CU, neonates, early intervention, burns, general hospital, chronic pain, emotional and behavioural
disorders. Developmental disability = those who work with physical disability or intellectual disability.
Table 4: Gender, age, and years of clinical experience of respondents working with different clinical
populations.

the dementia/aged care group, where there were
greater proportions of less experienced clinicians
working with these populations. This suggests that
in general, clinicians may find working with the
sensitive personal issues in oncology/palliative
care to be more challenging and requiring more
years of clinical experience.
Frequency of Songwriting
The frequency with which songwriting was
normally used within respondents' practices are
reported in Table 5, where significant differences
were found according to region (p = .03).
Notably, respondents from the USA/Canada
were less likely to use songwriting as frequently
as respondents from Australia/NZ or northern
Europe. This was surprising given that the largest
proportion of literature was from the USA.
Table 5 also details the frequency with which
songwriting is used according to different
diagnostic groups and significant differences
in usage were found (p <= .01). Noticeably,
songwriting is used the least frequently with
dementia and aged care patients which is
not unexpected given its use has only been
documented by one author. At the same time, a
number of clinicians do employ songwriting at
some stage with this client group (n = 36, 9%
of total sample). Unanticipated was the finding
that 44% of clinicians within the sample working
with ASD clients adopt the intervention in their
work at least 1-2 times per week. This diagnostic
group has been largely underrepresented in
the songwriting literature. Perhaps the limited
literature base reflects the earlier finding that
clinicians in the ASD/disability fields are less
clinically experienced and therefore perhaps less
likely to communicate their work in the music
therapy literature.
Surprising to the authors was the low
frequency of songwriting (28% using it only
1-2 times per week or more often) applied in
oncology/palliative care. There is a substantial
body of songwriting literature supporting its use
with this diagnostic group which would suggest
it is frequently used.

U 2 Nordic Journal of Music Therapy 17(2) 2008

 THERAPEUTIC SONGWRITING IN MUSIC THERAPY

Frequency of use (%)

1-5 times 1-2 times 1-2 times per
« per year per month week or more
Region
Usa/Canada 282 21 43 36
Uk/Ireland 20 31 38 31
Australia/NZ 51 28 20 53
N. Europe 21 24 19 57
Central/S. Europe 21 33 33 33
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East Asia/Other 15 40 20 40
TOTAL 419 24 37 39
P value (chi-square) .03
Clinical Population
Oncology/Palliative Care 51 31 41 28
Neurorehabilitation 26 27 27 46
Dementia/Aged Care 36 44 39 17
Psychiatry 103 21 40 39
Developmental Disability 89 28 30 42
ASD 61 8 48 44
Other 53 17 32 51
TOTAL 419 24 37 39
P value (chi-square) <01
Psychiatry Subcategories
Eating Disorders 5 20 40 40
Depression/Suicide 27 22 33 44
Substance Abuse 10 10 30 60
Schizophrenia/Other Psychoses 27 19 56 26
Trauma 29 28 34 38
Anxiety, forensic psychiatry,
5 20 40 40
personality disorders
TOTAL 103 21 40 39
P value(Fisher-Freeman-Halton) .81
Bold italic values indicate adjusted standardised residuals < -2 or > +2

Table 5: Cross tabulation offrequency ofsongwriting usage across global regions and across different
diagnostic groups.

Nordic Journal of Music Therapy 17(2) 2008 11 3

 FELICITY BAKER, TONY WIGRAM, DAVID STOTT & KATRINA MCFERRAN

Goal of Intervention Neurore-

Oncology habilitation Dementia Psychiatry
» = 51 » = 26 » = 36 « = 103
Externalise thought, fantasies % n/a 0 0 3 1
and emotions % often/always 88 96 63 90
Telling the client's story % n/a 0 0 0 0
% often/always 84 81 72 85
Develop cognitive skills % n/a 18 0 6 10
% often/always 17 58 53 46
Language, speech, and/or % n/a 14 0 0 9
conversational skills % often/always 25 65 64 47
Enhance social skills % n/a 10 0 3 4
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% often/always 35 62 69 66
Leisure % n/a 4 4 6 12
% often/always 31 32 65 42
Experience mastery, enhance self-confidence/esteem % n/a 4 0 3 0
% often/always 61 81 61 88
Develop a sense of self % n/a 4 0 0 0
% often/always 69 81 61 «9
Choice and decision making % n/a 0 0 3 2
% often/always 65 73 94 78
Sending messages to % n/a 0 8 6 6
significant others % often/always 82 67 44 52
Validating experiences % n/a 0 0 0 1
% often/always 90 92 67 78
Enhancing quality of life % n/a 0 0 3 3
% often/always 86 65 91 62
Gain insight or clarify thoughts and feelings % n/a 0 0 3 2
% often/always 84 89 63 S9
Develop awareness of musical/cultural identity % n/a 8 4 8 9
% often/always /5 28 24 ¥5
Life review % n/a 4 4 3 10
% often/always 7/ 44 74 52
Diagnostic purposes % n/a 24 8 17 19
% often/always 21 21 13 33
Relationship closure % n/a 4 4 14 11
% often/always 5J 28 39 44
Enhancement of spirituality % n/a 2 8 8 15
% often/always 56 33 49 32

Bold italic values indicate adjusted standardised residuals < -2 o r > +2

Table 6: Goals according to diagnostic groups.

U 4 Nordic Journal of Music Therapy 17(2) 2008

 THERAPEUTIC SONGWRITING IN MUSIC THERAPY

Developmental As anticipated, and reflective of the body of

Disability ASD Other Total P value literature, songwriting is employed by a large
« = 89 n = 61 « = 53 ,V = 419 Chi-sq. number of clinicians working in psychiatry. A
7.9 16 6 5
breakdown of the subcategories within psychiatry
59 80 68 77 <.01 shows that there were subtle differences in the
6 15 9 5 frequency with which they are employed. This
66 65 73 76 .02 was particularly the case for substance abuse
1 2 9 7 disorder where 6 out 10 employed it 1-2 times
76 77 67 58 <.01 per week or more often. Songwriting is used the
1 0 0 4 least frequently with those with schizophrenia
82 «9 64 63 <,01 and other psychoses. There was no significant
2 2 2 3 difference in its frequency of use according to
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81 92 71 70 <.01 different diagnoses (p = 0.81).

16 12 11 11 Several analyses were performed to describe
47 35 47 42 .04 trends in the goals underpinning the selection of
1 3 2 2
songwriting as an intervention. The percentage
75
of responses and significance levels for goals
80 89 80 <01
addressed using songwriting according to
1 7 0 2
specific diagnostic groups were calculated, and
74 79 83 78 <.01
are reported in Table 6. The table outlines the
1 3 0 1
percentage of responses for those respondents
83 80 83 79 .04
indicating it is not a relevant goal (n/a) and
10 26 11 10 those that endorsed it as often or always being a
35 27 47 49 <.01 relevant goal.
6 15 8 5 The most frequently endorsed goals in rank
52 4« 65 69 <.01 order were:
5 20 4 5 1. Experiencing mastery, develop self-
60 J9 71 66 <,01 confidence, enhance self-esteem;
5 18 4 5 2. choice and decision making;
59 58 75 74 <.01 3. develop a sense of self;
6 28 9 11 4. externalising thoughts, fantasies, and
24 18 31 28 <,01 emotions;
17 39 17 15 5. telling the client's story; and
/« 16 36 43 <.01 6. gaining insight or clarifying thoughts and
18 34 25 22
feelings.
18 15 30 23 .14
Least relevant goals in rank order were:
17 33 13 15
1. Diagnostic purposes;
30 2¥ 50 39 .02
2. developing awareness of musical and/or
19 39 25 18
cultural identity;
21 16 18 31 <.01 3. enhancement of spirituality; and
4. relationship closure.

When compared with the literature, these highly

endorsed goal areas are relatively similar. In the
literature, the most commonly identified goal
was the externalising of thoughts, fantasies, and
emotions, which was ranked 4th in the survey

Nordic Journal of Music Therapy 17(2) 2008 JJ ^

 FELICITY BAKER, TONY WIGRAM, DAVID STOTT & KATRINA MCFERRAN

Gender Test for Years of clinical Test for

trends experience trends
Goals of intervention Females Males p-value <2 2-5 6-10 10+ p-value
Externalise thought, fantasies and 77 79 .69 79 77 81 75 .82
emotions
Telling the client's story 76 71 .20 71 77 74 78 .76
Develop cognitive skills 59 51 .51 66 61 58 53 .06
Enhance language, speech, and/or 65 53 .43 73 60 66 60 .06
conversational skills
Enhance social skills 70 70. .74 72 70 68 70 .42
Leisure 42 44 .68 50 40 35 46 .76
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Experience mastery, develop self- 80 80 .76 79 77 83 81 .87

confidence/esteem
Develop a sense of self 79 77 .58 73 76 83 80 .16
Choice and decision making 80 74 .30 85 73 85 78 .99
Sending messages to significant 48 59 .35 33 44 51 59 <.01
others
Validating experiences 68 72 .62 46 75 65 76 <.01
Enhancing quality of life 66 67 .25 46 64 73 72 <.01
Gain insight or clarify thoughts 73 80 .60 59 82 73 76 .01
and feelings
Develop awareness of musical 26 44 .02 15 30 30 33 <01
and/or cultural identity
Life review 43 52 .30 29 51 42 46 .05
Diagnostic purposes 22 31 .66 7 20 20 34 <.01
Relationship closure 36 63 .13 26 35 41 47 <.01
Enhancement of spirituality 30 44 .28 13 33 33 38 <.01
Note: percentages indicate responses of 7 and over and are labelled as " often/always."

Table 7: Goals by gender and years clinical experience.

findings. Enhancing self-esteem and self-
confidence were ranked 2nd in the literature, with
mastery and achievement ranked 5th. Within the
survey, this was the most highly endorsed goal
area. Gaining insight and clarifying thoughts and
feelings were ranked equal 6th in the literature and
survey. Choice and decision making were ranked
2nd in the survey whereas this goal area was rarely
mentioned within the songwriting literature.
Similarly, developing a sense of self was ranked
3 rd in the survey and not highly endorsed in the
songwriting literature; telling the client's story,
ranked 5th in the survey, was rarely mentioned in
the literature.
Significant association betwen diagnostic
groups and the proportions stating "often/
always" were found for all goal areas except
for "diagnostic purposes." Notably, the goal
areas a) the development of cognitive skills (p
< .01); b) enhancing language, speech, and/or
conversational skills (p < .01); and c) enhancing
social skills (p < .01), revealed a contrast
between ASD and intellectual/physical disability
(frequent use) and in oncology (infrequent

1 U Nordic Journal of Music Therapy 17(2) 2008

 THERAPEUTIC SONGWRITING IN MUSIC THERAPY
use). Choice and decision making (p < .04)
was particularly relevant in treating clients in
the dementia category when compared to other
diagnostic groups. Sending messages to others (p
< .01) and validating experiences (p < .01) were
highly relevant for oncology whereas gaining
insight (p < .01) was most highly endorsed by
those respondents treating clients in psychiatry
field. Life review (p < .01) and enhancement of
spirituality (p < .01) were rarely relevant goals
across the range of diagnostic groups except
for oncology and dementia. Interestingly, the
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use of songwriting for diagnostic purposes was
only relevant for psychiatry, and even so, this
endorsement was low.
For the subcategories of psychiatry, significant
differences across diagnostic groups were found
for some goal areas. In particular, the telling of a
client's story (p < 0.01) was particularly relevant
for the eating disordered group, substance abuse
group, and trauma group where it was a relevant
goal in 100% of respondents' views, this being in
contrast to its less relevant endorsement by other
groups. The goal area of social skills (p = .02)
was more frequently relevant with the substance
abuse and schizophrenia/psychoses populations
than other populations. For the goal of sending
messages to significant others, the association
with diagnostic groups approached significance
(p = .09) and it was most applied by clinicians
working with eating disordered clients. Finally,
validating thoughts and feelings was noticeably
less frequently endorsed when working with
schizophrenia/psychoses clients compared with
others, part of an association with diagnostic
groups that also approached significance (p = .07)
Percentages of respondents and significance
levels (chi-square test for trends) were calculated
for the goal areas according to gender and degree
of clinical experience and are reported in Table 7.
There were minimal gender differences according
to clinical population. Only with respect to
"developing musical and cultural identity" and
"relationship closure" were males significantly
more likely to respond "often/nearly always".
There were however more significant differences
in the goal areas according to clinical experience.
Less experienced clinicians were more likely to
Nordic Journal of Music Therapy 17(2) 2008
use songwriting to facilitate the development
of cognitive skills whereas more experienced
clinicians were more likely to use songwriting
to assist clients to send messages to significant
others, validate clients' experiences, enhance
clients' quality of life, develop awareness of
musical or cultural identity, for diagnostic
purposes, for relationship closure, and to enhance
spirituality. It could be suggested from this, that
more experienced clinicians are more confident
to deal with the more sensitive psycho-emotional
issues. This also aligns with the earlier findings
that clinicians with less experience tended to
work with clients with disability/ASD where
developmental goals may be more central to the
work. At the same time, this may be correlated
with the period of time when these clinicians
underwent their training. For example, it is
possible that historical changes in music therapy
have impacted on the perceived importance of
cognitive, communicative, physical, psychosocial
and psychoemotional aims over the past twenty
years resulting in some aims becoming less
dominant and others more important over time.
Discussion
As anticipated by Baker & Wigram (2005),
this study provides evidence that therapeutic
songwriting is being practiced around the globe
and particularly in the predominantly English
speaking countries of the USA, Canada, UK,
Ireland, Australia, and New Zealand. Therapeutic
songwriting was typically used 1 -2 times per week
or more by the largest proportion of respondents,
particularly those in Australia/NZ or northern
Europe. This high level of use of songwriting
as a therapeutic method is not reflected by an
equal predominance in the literature. The results
of this survey therefore demand an increase in
investigations and discussion of this method in
the music therapy literature.
The survey findings in relation to oncology/
palliative care (particularly children) support the
songwriting literature in that clinicians utilize
songwriting to promote the extemalization/
exploration of feelings, thoughts and fantasies,
j J 7
 FELICITY BAKER, TONY WIGRAM, DAVID STOTT & KATRINA MCFERRAN
and promoting coping through the validation
of experiences. In contrast to the literature,
respondents working with palliative care were
not as likely to endorse the promotion of mastery,
achievement, and enhancing self-esteem/
confidence. This might suggest that there were
a substantial number of respondents working in
palliative care with adults where mastery and
achievement may not be as important to address
as might be the case with children where much
of the songwriting literature in palliative care
focuses on. However, the present study did
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identify sending messages to significant others
and enhancing quality of life, these being goals
identified in O'Callaghan's (1996) study but not
otherwise mentioned in the literature.
Notably, there was an absence of songwriting
literature specifically working with ASD and
developmental disability so comparisons with
this diagnostic group were not possible. One
explanation for this absence in literature could be
that the large number of respondents working with
these populations is less clinically experienced
and therefore less likely to be documenting
their work in music therapy publications.
Alternatively, the bulk of the work with these
populations is more developmental in nature and
only innovative or novel areas of work such as the
more psycho-emotional objectives are considered
interesting to publish. Consequently, this survey
provides new evidence that songwriting can
serve many functions with these diagnostic
groups. Respondents indicated that the most
frequently relevant goal for this population is
the enhancement of social skills. Derrington
advocates the social relevance of the songwriting
experience as important to "...teenagers who
put so much emphasis on social status and
others opinions" (Derrington, 2005, p. 81). Also
relevant to songwriting with clients with ASD
were the developmental goals of: developing
cognitive skills, enhancing language, speech and/
or conversational skills, and choice and decision
making, in addition to psycho-emotional goals
of encouraging the externalization of thoughts,
fantasies and feelings, developing a sense of self
and promoting mastery, self-confidence and self-
esteem. Given the extensive number of clinicians
110 Nordic Journal of Music Therapy 17(2) 20(
using songwriting with AS D, further research into
songwriting with this population to determine its
full potential is recommended.
Given the prevalence of literature documenting
songwriting within the psychiatric groups (see
Table 1); it was not surprising that the survey
found a high usage of the intervention. Aligning
closely with the literature, songwriting was
commonly employed to address emotional and
psychological issues: externalizing thoughts,
fantasies and feelings; developing self-confidence
and enhancing self-esteem, developing a sense of
self and gaining insight or clarifying thoughts
and feelings. In terms of externalising thoughts
and feelings, Davies (2005) reports in her work
in child and adolescent psychiatry that "...many
children who are unable to express themselves
verbally feel able to do so through the medium
of song." Davies offers a case example of a
young adolescent who found it very difficult to
talk verbally about his problems, especially to
his mother, and for whom songwriting offered a
"more socially acceptable and creative form in
which to channel difficult emotional experiences"
(Davies 2005, p. 46). Rolvsjord also addresses
the value a written song can have as a container
for emotions in her work in mental health in
Norway, reporting that "Emotional involvement
is inevitably part of any musical interaction, but
in the process of songwriting this is explicated
within the song product" (Rolvsjord, 2005, p. 98).
For clients with psychiatric diagnoses,
songwriting was considered to provide a medium
for telling the client's story, a point already raised
by Day (2005). When clients have experienced
physical, emotional, psychological, or sexual
abuse, they often have a story to share but
may have difficulty articulating this within the
normal context of verbal therapy. Placing the
client's story within the context of a song may
be experienced as less threatening and a more
appropriate medium to share their story with
significant others.
Therapeutic songwriting can be regarded as an
important intervention within neurorehabilitation
as indicated by the substantial number of
respondents using it 1-2 times per week.
Typically, goals associated with songwriting
 THERAPEUTIC SONGWRITING IN MUSIC THERAPY
were focused on adjustment issues including
the externalization of thoughts, fantasies and
emotions; telling the client's story; developing a
sense of self; validating experiences; and gaining
insight and clarifying thoughts and feelings.
These findings supports the research of Baker et
al. (2005a, 2005b, 2005c) who found adjustment
issues were frequent themes within clients' songs.
Although Baker (2005) and Baker & Tamplin
(2006) described the way songwriting can be
used to redevelop, speech and language skills,
and cognition, these more functional areas were
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less endorsed when compared with the psycho-
emotional goals.
When compared with other diagnostic groups,
songwriting was employed the least frequently
within the aged care/dementia population (17%
of sample indicating using it 1 -2 times per week).
This low endorsement is reflected in the literature
where only one study has been published (Silber
& Hes, 1995). Nevertheless, trends were evident
in its application with this population. The most
frequently endorsed goals were those of choice
and decision making (94%) and enhancing quality
of life (91%). Life review (74%) and telling the
client's story (72%) were also important goals
of the songwriting intervention, this previously
described by Silber & Hes (1995) who suggested
themes to their clients for song lyrics based on
different life stages (life review).
Limitations of the Study
Although the use of survey design has resulted in
a vast array of information regarding clients and
therapists, the implications of these findings have
been constructed by the authors. These subjective
interpretations of the results for each clinical
group should be understood as possibilities, and
have been phrased as such within the article.
Further research could investigate whether these
conclusions have any basis, or identify other
variables that may be at play.
The questionable representativeness of the
sample is the main limitation of the study. Only
a small proportion of music therapists responded
to the study suggesting that the results may be
heavily biased to those with particularly strong
feelings about songwriting. Such biases may be
Nordic Journal of Music Therapy 17(2) 2008
positive or negative. Further, 40% of the sample
was in the 20-30 year old age group which may be
a biased sample of music therapists who may be
more comfortable with using the internet. Further,
only a small number of contributions were from
Europe and an absence of contributions from
South and Central America prevented a more
comprehensive comparison of trends between
regions. In addition, the sample size of clinicians
receiving the invitation to participate is an estimate
due to limited information provided by some
professional bodies with respect to the specific
number of members on their distribution list and
the number of undeliverable email responses.
Therefore, it is unclear whether the sample
obtained for the study is truly representative of
clinicians across the globe. However, it can be
argued that a representative sample of clinicians
who do use songwriting have responded to the
invitation and therefore trends in best practice
can be determined based on the large N obtained.
If there had been more respondents reporting non
use of songwriting, it would have been possible
to clarify the percentage of users of this medium
from the total estimated sample. The study
employed the use of ordinal scales to determine
degree. However, due to small sample size in
subcategories, amalgamation of categories was
undertaken which does to some degree result in a
less detailed analysis.
Conclusions
This study set out to gather information as
comprehensively and internationally as possible
on the goals underpinning songwriting in therapy.
Compared to more documented techniques such
as music making, improvisation and receptive
methods, songwriting is undertaken to a lesser,
but nonetheless significant degree. The results
showed that despite an abundance of literature
in the area of psychiatry (21 authors from 46,
47%) and oncology/palliative care (17 of 46
authors, 37%), they represent only 25% and 12%
respectively of the sample. Moreover, this study
highlights that a substantial number of clinicians
adopt songwriting approaches in developmental
JJO,
 FELICITY BAKER, TONY WIGRAM, DAVID STOTT & KATRINA MCFERRAN

disability and ASD (36% of the sample), and that Themes in songs written by clients with
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