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The issues surrounding the evaluation by clients of the impact of two music therapy programmes in an acute

psychiatric setting

Sherelle Dye, B.Mus.(Hons.), RMT, A.Mus.A.

Abstract:

When a client evaluates their own therapy sessions there are advantages for both the client and therapist. The client has the opportunity to reflect upon the session,

perhaps leading to greater insight into the therapy, increase motivation and participation in future sessions. The therapist may discover underlying thoughts and feelings unexpressed by the client during the session but voiced with later

reflection.

This paper examines these and other issues regarding clients' evaluation of the impact of therapy sessions. It examines literature from music therapy and other

fields to find a rationale for the use of client-evaluation. The development, imple

mentation and results of a questionnaire administered to clients in two music

therapy programmes in a psychiatric facility are discussed with a view to demon

strate the advantages and limitations of this evaluation method. Recommendations are made for further research into the area of client-evaluation of the impact of music therapy.

Music therapists have long recognized the importance of evaluation in their field {Healey, 1976). Evaluation determines whether a music therapy programme should be continued, modified or terminated by assessing the changes made by the client in therapy (Peters and MacNamara, 1986). Reliable evaluation allows music therapy to be accountable to other professionals, to the clients and their families, and to music therapists themselves (Hanser, 1984). Evaluation further benefits the field of therapy by giving confidence and certainty in practice by identifying the strengths and weaknesses of the therapy (Preston-Shoot, 1987}.

Evaluation is often carried out by the therapist conducting the programme however other staff members participating in the sessions, observers from outside the sessions and the clients themselves may also evaluate the programme (Lambert, Shapiro and Bergin, 1986). Valuable information may also be obtained from care givers (the family, friends and/or nursing staff} from their observations and discussions with the client both immediately after a session and in the long term.

Dill-Standiford, Stiles and Rover ( 1988) put forward three areas of evaluation the process, impact and outcome of the therapy programme. Process refers to the events within a session a.nd much of the music therapy literature focuses on this area. The Guidelines for Clinical Report Writing (McNamara 1985) suggest checklists, rating scales and/or descriptive notes can be used to record the process or content of a session. Erdonmez ( 1985) suggests the use of an evaluation form that quickly records responses to a range of activities. and allows for a wide range of responses reflecting different levels of participation. Evaluation procedures of this type provide an account of what occurred in sessions and possible explanations of why.

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The evaluation of outcome requires an assessment of the long term effects of therapy measured at a later time (Preston-Shoot, 1987). The follow up required for this type of evaluation may be difficult if the ex-clients cannot or do not wish to be contacted. In the acute wards of a large psychiatric hospital with short stays and frequent turnover, the evaluation of the outcome of therapy, although valuable, would be a huge and perhaps unwieldy task.

This paper will focus on the third area put forward by Dill-Sandiford et al. (1988), the evaluation of the impact of a session. Impact refers to the immediate effects of a therapy session on its participants, reflected in the clients' post-session affective mood and their evaluation of the session (Stiles, 1980). Due to the nature of the often unvoiced thoughts and feelings experienced by each individual client in therapy, impact may be a difficult area to measure. By consulting with the clients however a clearer view of the impact of the therapy may be established. Stiles, Shapiro and Firth-Cozens (1990) suggest impact can be formally measured by rating scales in a client-questionnaire which measures the clients' immediate mood and perception of the session. Very few published music therapy reports include this type of evaluation. Heaney (1992) asks why client-evaluation has been relatively ignored in the field of music therapy. "The poverty of research in patient's regard for music therapy mandates such investigation" (Heaney, 1992, p.83).

There has been growing interest in the area of client-evaluation of psychiatric care since the 1960's (Heaney, 1992). Client-evaluation has many benefits for both the client and the therapist. For the client, therapy involves an emotional experience plus reflection on that experience {Yalom, 1976). A client-questionnaire then may facilitate therapy by asking the client to further reflect on the therapeutic experiences in a session. It may also give the clients further insight into. the meaning the therapy sessions have for them (Rogers, 1976). Increased insight may in tum lead to increased motivation and participation in future therapy sessions. Preston-Shoot (1987) recommends the involvement of clients in evaluation as this may be therapeutic, highly rewarding and motivating for the clients. It may increase morale and self esteem as the clients' opinions are both sought after and valued by the therapist.

A client-questionnaire may reveal to the therapist feelings and experiences not overtly expressed by the clients during the session {Hill, 1992). They may also clarify clients' views expressed in a session, the clients' perceptions of a session and their feelings of progress (Heppner, Rosenberg and Hedgespeth, 1992). It is important to compare clients' views with those of the therapist {Hill, Helms, Spiegel and Tichnor, 1988). In Thompson and Hill's (1991) study of therapist and client perceptions of counselling sessions, in only 50% of the cases did the therapist and client agree. Dill-Standiford et al {1988) also advise that clients and therapists may have distinct differently views about therapy. Therefore, both the clients' and therapist's perceptions should be considered when trying to obtain a clear and accurate view of the therapy.

Some music therapists have commented on the importance of client-evaluation particularly for adults with psychiatric conditions. Goldberg (1989) discusses the need for the involvement of clients in assessment and evaluation, with goals set jointly by the client and the therapist. Bruscia (1988) writes that a music therapist

20 The Australian Journal of Music Therapy Volume 5. 1994

should validate his or her interpretations about a client's behaviour through discussion with the client. Hoskyns (1987) points out the benefits of accessing a client's

emotive and introspective thoughts about therapy, particularly in the field of music therapy where many processes are non-verbal and introspectively perceived. Hoskyns (1987) also suggests that when working with people who are able and willing to express themselves it seems only polite as well as interesting to ask for their views.

Client-evaluation of therapy sessions can be measured in various ways. Openended questions or questions with multiple choice answers are commonly used

methods. Saunders, Howard and Orlinsky provided an extensive question-answer format in their Therapy Session Report, with 145 items asking clients about the content of the session and their feelings toward the therapist. Heaney (1992) used a method of ranking, asking clients to rank different therapies and treatments in order from most to least helpful. Heppner et al. (1992) explored the method of thought listing, where clients were asked to complete given sentences with the first thoughts that came to mind. Rating scales are perhaps the most frequently used method of collecting client-evaluation data. Stiles' (1980) Session Evaluation Questionnaire included an extensive set of bipolar-adjective rating scales that evaluated the sessions and the clients' post-session affective mood. This questionnaire has been used in numerous studies of counselling, psychotherapy and encounter groups including Dill-Standiford et al. (1988) and Stiles et al. (1990).

Published music therapy studies that utilize client-evaluation include Tysmans (1986) who used a post-programme questionnaire in her individual case study of a woman with schizophrenia. The questionnaire asked four open-ended questions about expectations and gains from the programme plus a rating scale to indicate how worthwhile the programme had been. Hoskyns (1987) involved clients in the making of an evaluation questionnaire. The clients' views were incorporated into five bipolar adjective rating scales and the clients were asked to rate different elements of the music therapy session on each of these scales. Heaney (1992) included music therapy in his study of client-rankings of different therapies

and other treatment modalities. He then asked the clients to rate each therapy/ treatment procedure on four bipolar adjective scales to determine which aspects of the therapy programmes were considered by the clients to be the most significant.

Client-questionnaires, although relatively unexplored by music therapists, are considered an effective method of evaluation, especially when measuring the impact

of therapy.

This paper discusses the design, implementation and response to a clientquestionnaire used to evaluate two music therapy programmes. The results of the questionnalre are presented and discussed. However the focus of this paper is on the issues surrounding this method of evaluation rather than being a conclusive study of the two music therapy programmes.

Method

Participants

Participants were inpatients from the acute wards of a large, metropolitan psychiatric hospital. The male and female clients were aged between 20 and 60 years.


Common psychiatric conditions included schizophrenia, bipolar-affective disorder and personality disorders.

The music therapy programmes

A listening based group and a singing group were evaluated. Both programmes took place for one hour, one afternoon a week and were attended voluntarily. The listening group usually involved three to six clients. Each client would select a record from a large collection of popular music from the 1950's to the 1980's and play their chosen track (usually a song but occasionally an instrumental piece) for the group. After listening to the song the music therapist would facilitate a group discussion about the style of music, the lyrical content, applications to self and other issues that arose from listening to the music. The singing group usually involved about eight clients. The songs were prepared and selected by the music therapist for their appropriate mood, tempo, style, lyrical content and/or potential for choral work (e.g. canons or companion songs). The songs were usually accompanied by the therapist and an assistant on the piano and/or guitar. Some songs were performed a capella and some were accompanied by the clients on various percussion instruments. Each song would be rehearsed, discussed in a similar fashion to the songs in the listening sessions, then performed with the group standing and singing completely through the song. A light, familiar song would be used to begin as a warm up and the session usually dosed with a popular and uplifting song.

Design of the client-questionnaire

The questionnaire was devised after an examination of relevant literature, interviews with the social worker and occupational therapy staff and discussion with the supervising music therapist. The final form is included in the Appendix. Question A asked clients to mark on 10 point rating scales how they regarded three factors of the session - the enjoyment, interest and value of the therapy. Question B asked clients to rate on another three scales how they felt at the end of the session measuring their happiness, tension level and outlook. Question C asked clients to nominate which song from the session had the most meaning for them and why. Question D asked whether the clients would join the group again and reasons why/why not. Question E asked for any further comments giving the clients the opportunity to express any final thoughts.

Procedure for the client-questionnaire The evaluation period took place for a month encompassing nine sessions. At the end of each session the therapist passed around the questionnaires and pens. asking the group members to fill out the forms to provide feedback about the sessions. No time limit was enforced however it was expected that clients would spend about two minutes completing their questionnaire. Clients would then hand the completed forms to the therapist or place them on a nearby table. The therapist noted on each completed questionnaire the date and type of music group to keep a record of which forms were completed within the same session.

Results

Attendances at both programmes totalled 51 with 10 clients leaving before the end of a session. Of the 41 clients available to complete a questionnaire 39


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responded (20 from the listening group and 19 from the singing group) a 95% response rate.

All respondents completed Questions A and B. Mean rating values for each scale are presented in Table 1.

Table 1 Mean rating values for Questions A & B for the Listening and Singing Groups

Question Mean rating values

Listening Singing Both . group group groups

A. Unpleasant - Enjoyable 8.53 9.16 8.84 Boring - Interesting 8.70 8.66 8.68 Worthless - Helpful 7.75 9.08 8.41

B. Sad - Happy 7.90 8.97 8.43 Tense - Relaxed 8.65 9.13 8.67 Pessimistic - Hopeful 8.05 9.16 8.61

Note: Unpleasant = 1, Enjoyable = 10

All respondents answered the first part of Question C. Songs receiving two or more nominations in the listening sessions were:

Blowin' in the wind - Bob Dylan. Mean old bed bug blues performed by Bessie Smith on the record That's Jazz by Vogue Music. Catalogue No. VMSOO-2 (no composer given). Jesus Christ Superstar - Andrew Lloyd Webber (Music) and Tim Rice (Lyrics). The long and winding road - John Lennon, Paul McCartney and George Harrison. Mull o f Kintyre - Paul McCartney and Denny Laine. Camptown Races - Stephen Foster. What a wonderful world - George David Weiss and Bob Thiele. The /ion sleeps tonight - Paul Campbell and Solomon Linda (revised by Hugo Peretti, Luigi Creatore, George Weiss, Albert Stanton, Roy Ilene and Paul Campbell. The rainbow connection - Paul Williams and Kenny Ascher. Teach your children - Graham Nash.

Sixty-seven percent of all respondents gave reasons why the nominated song was meaningful. Responses from the listening group included:

"Reminded me of my parents when they were well." "I identified with the words and questions." "Felt pleased to hear the style, not expecting to hear the blues as such, made my day and Inspired me to keep practising at what I enjoy."

Reasons from the singing group included:

"Familiar with it and a popular song." "I've always had a thing for Credence." "Because it makes me realize that I really do have friends, even though I'm down and out. I need to be with my old muso friends."


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Ninety-five percent of all respondents replied in Question D they would join the

group again. Reasons from the listening group included:

''I enjoyed the company and the music." "It gives you an insight into what others feel and get out of the music and it's soothing to the ear."

Reasons from the singing group included:

"It made me feel happy and took my worries away." "Because I love singing and felt comfortable within the whole group."

Two clients suggested they would not return to the group with the following reasons:

"Because I will be discharged." "Not my pleasure."

Fifty-six percent of respondents gave further comments. From the listening group these included:

"Good stuff. But why no Frank Zappa?" "Thanks." "The stereo needs a new needle! I felt rather inspired by the open discussions we had after each piece."

Further comments from the singing group included:

"Well run programme, good music." "Being sad is not negative but positive to be in touch with my feelings which relate to singing with another group I probably won't sing with again." "Keep it up."

Discussion

The results show much information can be obtained from a client-questionnaire. The clients' views of the session, their post-session feelings. the songs they found most meaningful. their reasons for returning to the group and other comments gave the therapist and clients further insight into the impact of each session on individual group members. Although the small sample size affects the validity of the results, they are discussed with a view to demonstrate the benefits and limitations of the client-questionnaire method of evaluation.

The rating scales provided a quick visual reference as to how the clients perceived the enjoyment, interest and worth of a session. and their post-session affective mood, tension level and outlook. By simply looking at the scales one can deter· mine if a client found a session more enjoyable than unpleasant etc.

Mean rating values for each scale from the two groups were calculated. The highest mean scores for the listening group were for the interest of the session (8. 70) and a relaxed feeling state (8.65). For the singing group the most significant factors were enjoyment (9.16) and feelings of hope (9.16). As these two groups consisted of different clients it is difficult to compare these scores but they do appear to reflect the different nature of the two music therapy programmes. In the listen-


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ing group where the clients are seated in large, comfortable armchairs and the nature of the session is more reflective and discussion-based, clients rated the relaxation and interest faators highly. The singing group is more active, with clients singing, standing to perform the songs and sometimes playing percussion instru· ments, perhaps resulting in clients feeling more enjoyment and hope due to this active involvement. Also the structure of the singing group with a lively, cheerful and familiar song usually placed at the end of the session may have affected the clients' ratings by lifting their overall mood in the final song. As client selections form the structure of the listening group, the closing song may not be as uplifting thereby not causing the clients' affective mood and outlook to rise.

In using the scales it must be noted the questionnaire excluded numbers and the numerical values were given only to compare an individual's ratings, ratings between clients and ratings between the groups (see Appendix). The higher scores do not necessarily reflect the more positive or favourable answers. As one client wrote. "Being sad is not negative but positive to be in touch with my feelings."

The rating scales were an easy and viable method of gaining information from clients. The ease of this method is reflected in the results in that all respondents completed the six scales. There was some initial confusion about whether the dients were to mark each scale or just those they felt were the most applicable. A repeat of the written instruction "This session was' and "Right now I feel" for each respective scale may reduce any confusion in future questionnaires.

All but one respondent was able to nominate at least one song that was the most meaningful to them. One dient nominated two songs and two further clients stated all the songs were meaningful (perhaps a genuine response or a reflection of the difficulty in selecting one song above the others). Of interest was the high degree of consensus in many sessions about which songs were the most meaningful. In one session all three clients nominated the "Mean old bed bug blues" as the song most meaningful to them. In another session four out of five clients chose "Blowin' in the wind". As the clients have varying backgrounds and different musical experiences such consensus had not been anticipated. It is difficult to determine whether these songs appealed to each client coincidentally in a personal and individual way, or if the general feeling of the group (perhaps generated by the level of cohesion. arousal and mood) contributed to such agreement. Nevertheless it appears some songs have more impact on group members than others.

Reasons given as to why the songs were meaningful varied in length, style and content. Comments generally related to associated memories, optimism in the song's lyrics, relating the lyrics to own life situations and favourite performers or styles of music. Often these reasons had been discussed by group members during the session but in some cases clients wrote down thoughts that had not been verbally expressed in the session. For example, one client wrote "it makes me realize that I really do have friends even though fm down and out. I need to be with my old muso friends", in reference to the song "What a wonderful world". The discussion following this song had not included the desire and need to renew old friendships. The questionnaire however gave this particular client a chance to express this desire and gave the therapist more insight into why this song had such an impact on this client. Particularly for clients who do not feel able or com-


fortable enough to participate fully in the group discussions of personal feelings and opinions, a questionnaire may provide a valuable outlet for such expression.

Information gathered from this question also provided the therapist with a basis for the selection of songs. The therapist would consider the style, mood, tempo, lyrical content and performers of the songs deemed most meaningful to clients when preparing future sessions.

All but two respondents answering Question D suggested they would return to the group. Reasons for return generally related to the enjoyment of the session, releasing tension, feelings of hope and insight into others' ideas. One client explained he would not return because he was to be discharged. Another, whose heavy metal musical taste was not catered for in the session wrote it was "not my pleasure". This client would appear to be the only one dissatisfied with the session.

The high positive response rate (95%) to this question however is distorted by the fact some clients had left the session before the questionnaire was administered. Of the total 51 participants in the programme during the evaluation period, six left mid-session due to unavoidable circumstances (e.g. doctor's appointments) and four left feeling restless and/ or discontented with the session. These four clients, if available at the end of the session may have indicated they did not intend to return to the group thereby lowering the positive response rate. Two of the clients however did return to later sessions and a third was soon discharged (but had attended numerous sessions before the evaluation period). The high rate of respondents intending to return to later sessions therefore is distorted by the number of clients leaving mid-session, but may not be completely inaccurate as many of these did in fact return.

This question generally gave clients the opportunity to reflect on the positive aspects of the programme asking them to consider reasons why they would attend a similar group again. Hopefully this type of thought and reflection has aided clients' motivation and further participation in music and other therapy programmes. This question also benefitted the music therapist by providing ideas as to why clients chose to attend music therapy voluntarily and gave a clearer view of which clients may attend the following session. In a large acute psychiatric setting with short stays and frequent turnover, anticipating who will attend the next group is a difficult matter. With the information obtained from the questionnaire however the therapist had some indication as to whom she might work with again and was able to plan according! y.

The last section of the questionnaire asked clients for any final thoughts and feelings about the session. The responses ranged from compliments on the session, requests for new stereo equipment and records, comments about musicians and music, to more personal information. These final comments were often lighthearted but quite valuable. They gave the clients the opportunity to vent any unexpressed thoughts and feelings and reflect upon the impact of the session, for example, "I felt inspired by the discussions we had after each piece." As these comments were generally positive and often complimentary (e.g. "Well run programme, good music" and "Thanks") they helped increase the morale and confidence of the music therapist. Furthermore the therapist could use these comments to demonstrate the clients' views of music therapy when being account-

26 The Australian Journal of Music Therapy Volume 5, 1994

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able to other professionals in the facility. Clients' comments such as "The stereo needs a new needle" and "Why no Frank Zappa?" could also be used by the therapist when requesting new equipment and material from the budgeting authorities.

"Rachel" a young female with schizophrenia of the paranoid type chose not to complete a questionnaire explaining to the therapist she had never filled out such forms. The therapist pointed out any feedback, positive or negative was important and would be appreciated but Rachel still declined. It was interesting to see Rachel at the end of the next session claiming she had filled out a form last week so there was no need for her to do so again as her answers would be the same. The supervising music therapist, aware that Rachel had not completed a questionnaire suggested that as the songs and discussion were different from the previous session her responses might also be altered. Rachel hesitated but still declined to answer the questionnaire.

For clients with a history of paranoia in the form of a personality disorder or schizophrenia. behaviour like Rachel's is not uncommon. These clients may be very guarded and reluctant to give out personal information. When administering a questionnaire to clients within a psychiatric setting some resistance to completing the forms should be expected. The use of anonymity may help reduce this problem by giving clients the opportunity to express personal thoughts and feelings without feeling exposed. In this sample, anonymity was important for some clients. One for example, folded his paper over before handing it in so his replies could not be seen by other clients returning their forms. For other clients however, confidentiality did not appear to be so important, with two clients including their full names (and one with the ward number) on their forms.

Anonymity however is not simply an issue about comfort and security for clients. If the questionnaire is intended to facilitate insight into the clients' thoughts about the therapy, names should be included on the forms as it would be useful to know how each individual client responded. If a client however feels uncomfortable about this, they should have the option to complete the questionnaire without giving their name as unowned responses would be more beneficial than no information at all. If anonymity is desired, it should be noted in this small sample, handwriting could be recognized and some clients were given assistance in completing the questionnaire, immediately reducing the level of anonymity.

Two clients asked for assistance to complete their questionnaires. The first had difficulty reading the typed print so the therapist read the questions aloud to him and he wrote down his own responses. Many clients commented on the size of print. especially those experiencing blurred vision as a side-effect of medication. It is recommended future questionnaires use a larger print so the form is easier to read. The second client requiring assistance had difficulties with tremor, another medication side-effect, and asked the therapist to write down verbatim his responses, after marking the rating scales himself. This client only marked at the extremes of each scale. As he had been very enthusiastic about the sessions (as demonstrated by his facial expressions, posture and in his comments to the therapist and nursing staff) it is difficult to determine whether this client only marked


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the ends of scale because of spacial difficulties, an inability to abstract, or a genuine wish to give the highest ratings.

Complications with this method of evaluation include the clients' varying levels of ability in which they can complete a questionnaire. Some difficulties with medica· tion such as blurred vision and tremor are demonstrated above. Thought disorder associated with schizophrenia may also affect a client's ability to organize and write down their views about a session. Limited education, reading and writing disabili· ties may further affect a client's ability to complete a form. Clients from non-English backgrounds may also experience difficulty understanding certain words or questions and in expressing their ideas in English. Because of these difficulties directions on a client-questionnaire should be kept short and fairly simple. Some questions could be provided in different languages for clients with limited English.

The validity of a client-questionnaire depends very much on the clients' abilities to reflect upon and perceive the impact of the session. organize their thoughts and feelings and express them in writing. The influence of liking the therapist may also affect the results. for example clients may rate a session highly in order not to offend the therapist. Client-questionnaires therefore should not be used as the sole evaluation method of a programme. The therapist's descriptive evaluation of the content of the session and goals met should also be recorded and used in conjunction with the client-evaluation.

Despite its limitations there are many reasons why this questionnaire proved to be useful and worthwhile for both the therapist and the clients. The use of client· evaluation supported the hospital's policy to involve the client in all aspects of their treatment. It may have increased the client's insight into the purpose and impact of each therapy session. by asking the clients to think further about a meaningful song and their reasons for attending such a group. The generally responsive and enthusiastic nature of the clients when filling out the questionnaires reflect Preston· Shoot's (1987) views that client-evaluation can be a motivating component of therapy. This increased motivation may have lead to greater participation in future music sessions and in other therapy programmes. increasing the desire of recovery and discharge from the hospital. The questionnaire. by seeking out and valuing personal opinions, may also have enhanced clients' self-esteem. a component so important in the healing and recovery process.

For the therapist the questionnaire gave insight into how the music therapy sessions impacted on clients. It indicated which components of a session were regarded the highest by clients and gave possible reasons why. It gave the therapist the opportunity to compare different responses by the same client in different sessions. between two or more clients. and between the two music groups. Information obtained from the questionnaire, such as which clients may attend another session and what type of song material may have the most impact. could be used when planning future sessions. The therapist could also use the clients' own comments when reporting to other professionals within the facility on the music therapy programme. Finally, the positive feedback given in the questionnaires helped increase the confidence of the therapist in her ability to effectively run the programme and in the value the music therapy sessions had for the clients.


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A larger sample size, a longer evaluation period and a reassessment of the format are needed before the results of this client-questionnaire could be considered conclusive. This paper however has explored the issues surrounding client-evaluation using this questionnaire, its results and material from the relevant literature to highlight the advantages and limitations of this evaluation method. Client-questionnaires can be an effective and valuable means of evaluating the impact of sessions, with benefits for both the therapist and the clients. It is an area relatively unexplored by music therapists that warrants further investigation.

Summary and Recommendations

A client-questionnaire was developed to evaluate the impact of two music therapy programmes for clients with acute psychiatric disorders. The design, implementation and results of this questionnaire were discussed with a view to demonstrate various issues surrounding this method of evaluation. Advantages of using the questionnaire included the opportunity for clients to reflect upon and recognize the impact of the therapy, the increased insight of the therapist into which factors of a session were rated the highest by clients and why, the opportunity to compare the impact of different music therapy programmes, the indications offered by the clients which guided the therapist's use of song material when planning future sessions, the opportunity to report to other clients' perceptions of music therapy and increasing the self-esteem and motivation of clients to attend more therapy programmes. Limitations included the clients' varying levels of ability to complete the questionnaire, unrecorded views of clients leaving mid-session and the need to balance this method of evaluation with measures of the goals set and the content of the programme.

It is recommended questionnaires use large, bold print and simple directions. Different formats for the questions could be explored further. By altering the questions slightly or significantly one might assess the different levels at which information from a questionnaire can be obtained. When devising a new questionnaire it may be beneficial to consult with the clients who will use it, as it appears clients themselves have much to offer in the area of evaluation.

References Bruscia, K ( 1988) . An overview of the improvisation assessment profiles.

Australian Music Therapy Association Bulletin, 11(3), 2-6.

Dill-Standiford, T., Stiles, W. and Rover, L. (1988). Counsellor - client agreement on session impact. Journal of Counselling Psychology, 35(1), 47-55.

Erdonmez, D. (1985). Evaluating a music therapy programme for the confused elderly. 8th Australian Music Therapy Association Conference Proceedings,

40-46.Goldberg, F. (1989). Music psychotherapy in acute psychiatric inpatient and private

practice settings. Music Therapy Perspectives, 6, 3-7. Hanser, S. (1984). Music group psychotherapy. Music Therapy Perspectives, 1(4),

14-17. Healey, B. (1976). The relevancy of measurement in music therapy. 2nd

Australian Music Therapy Association Conference Proceedings, 87-94.


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Heaney, C. ( 1992). Evaluation of music therapy and other treatment modalities

by adult psychiatric inpatients. Journal of Music Therapy. 14(2). 70-76.

Heppner, P., Rosenberg, J., and Hedgespeth, J. (1992). Three methods in

measuring the therapeutic process: client's and counsellor's constructions of the

therapeutic process versus actual therapeutic events. Journal of Counselling

Psychology. 39(1). 20-31.

Hill, C. (1992). An overview of four measures developed to test the Hill process

model. Journal of Counselling and Development. 70. 728-739.

Hill, C., Helmes, J., Spiegel. S. and Tichner, V. (1988). Development of a system

for categorizing client reactions to therapist interventions. Journal of Counsel-

ling Psychology. 35(1). 27-36.

Hoskyns, S. (1987). Studying group music therapy with adult offenders: Research

in progress. Psychology of Music. 16. 25-41.

Lambert. M .. Shapiro. D. and Bergin. A. (1986). The effectiveness of psycho

therapy. In S. Garfield and A. Bergman (eds.) Handbook of psychotherapy

and behaviour change. 3rd ed. Toronto: Wiley and Sons.

MacNamara. J. (ed.) (1985). Guidelines for clinical report writing. Australian Music

Therapy Association Bulletin. 8(3). 3-16.

Peters. H. and MacNamara. J. ( 1986). The functional approach to music therapy

assessment. 12th Australian Music Therapy Association Conference Proceed·

ings. 24-29.Prescott, M. ( 1992). Evaluation of relaxation programme. Unpublished report.

North Eastern Metropolitan Psychiatric Services. Academic Unit.

Preston-Shoot. M. (1987). Effective groupwork. London: MacMillan.

Rogers, C. (1970). Encounter groups. Middlesex: Penguin.

Rothwell. N. (1990). Factors underlying a psychiatric day hospital consumer

survey. British Journal of Clinical Psychology. �9. 337-338.

Saunders. S .. Howard. K.. and Orlinsky. D. (1989). The therapeutic bond scales.

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of Consulting and Clinical Psychologv. 48(2). 176-185.

Stiles. W .. Shapiro. D. and Firth-Cozens. J. ( 1990). Correlations of session evalu·

ation with treatment outcome. British Journal of Clinical Ps�·chologi:. 29(1).

13-21. Thompson. B. and Hill. C. (1991). Therapist perceptions of client reactions.

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York: Basic Books.

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Appendix

A. Please mark (X) on each line to show how you felt about this session.This session was:

Enjoyable Unpleasant

Boring Interesting

Worthless Helpful

B. Please mark (X) on each line to show how you feel now.Right now I feel:

Happy Sad

Tense Relaxed

Hopeful Pessimistic

C. Which song/piece in today's session meant the most to you?

Why?

D. Would you join this group another time? Yes/No

Why/Why not?

E. Further comments:


the issues surrounding the evaluation by clients of the ... · benefits the field of therapy by...

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