Music therapists' decision-making in music together within therapy

Music therapy clinical decision-making for individual parent-dyads has been guided by clinical reflections and program descriptions. Some research in clinical decision-making has been conducted, albeit not focused on the early childhood population. A growing number of board-certified music therapists offer a quasi-manualized program, Music Together Within Therapy, as an intervention option for their early childhood music therapy work. This study asks the question: What are the clinical decision-making processes music therapists undergo when working with parent-child dyads in a single individual music therapy session? Music therapists engage in a series of decision-making processes throughout the course of therapy. This study concerns only those processes that lead to clinical decisions that occur during the course of one session. To address the possible influences of education, training, and theoretical orientation on clinical decision-making for MTWT providers, one sub-question is: What role, if any, does the Music Together training and philosophy have in the music therapist's process of decision-making that occurs during the course of one session? To address the clinician's attention to parent training (an integral component of supporting child development) within their clinical decision-making process, the second sub-question is: How do music therapists who use MTWT incorporate parent training into their clinical decision-making process when they work with parent-child dyads? Music therapists who work with individual parent-child dyads using Music Together Within Therapy (MTWT) make clinical decisions based upon a set of driving forces: experiencing beauty, creating a musical container, providing opportunities for growth, and providing opportunities for relating. These driving forces and accompanying 14 belief statements regarding decision-making and the impact of the Music Together philosophy on music therapists' clinical work were uncovered using an exploratory sequential mixed methods research design. Constructivist grounded theory method of the QUAL analysis of interview data (N = 3) framed the qualitative analysis; descriptive statistics evaluated the level of agreement among a larger body of music therapists who provide MTWT (N = 22). Respondents to the survey endorsed statements related to the MTWT program's ability to support clinical decision-making: sufficient material for creating interventions, supporting dyad and individual, matching therapist's clinical decision-making, facilitating collaboration between adults, and promoting dyad relation. A comparison of a larger body of MTWT providers situates the responses to the survey and provides context for the demographic assumptions. Based on the findings, a clinical decision-making framework is offered as a way to conceptualize music therapists' decision-making processes when using the MTWT program. Music therapists' approaches to songs and use of musical constructions in the service of supporting relationship development feature prominently in their decision-making. Approaches to songs via the MTWT Five Levels of Music appear to be situated within an articulated goal of empowering families, supported by the implementation of the (often tacit) manipulation of the elements of music (melody, harmony, rhythm, and timbre) to meet clinical aims based upon recognition of the driving forces.