Varies from brief interviews to extended engagement and observation.
Recording and Communication:
Varies in how the assessment is recorded and communicated.
More information:
Refer to Music Therapy Assessment (Wheeler, 2013) in Feder’s The Art and Science of Evaluation in the Arts Therapies, 2nd edition, and Music Therapy Assessment (Lipe, 2015) in Music Therapy Handbook.
Importance of Music Therapy Assessment
Reveals the strengths and needs of the music therapy client.
Enables observation and interpretation of how clients use musical media to identify treatment goals within the media.
Enables decisions about beneficial music therapy experiences.
Improvising, performing/re-creating, composing, or listening to music.
Structured, semistructured, or spontaneous sessions.
Assessment outcomes are not only treatment goals but also the musical modality that best facilitates these goals.
Provides guidance for the structure and sequence of sessions.
Provides a baseline for evaluating changes in client response over time.
Clients may perform differently in music than in other modalities (Bruscia, 1988; Coleman & Brunk, 2003).
Children with autism or Rett syndrome may respond differently to musical activities.
Older adults, especially those with cognitive deficits, may respond in the presence of music when they have been unresponsive in other settings (Keough, King, & Lemmerman, 2016).
Some service providers require a music therapy assessment and treatment plan for justification or reimbursement (Scalenghe & Murphy, 2000).
A clinician cannot ethically provide services without assessing the client’s needs and appropriate interventions.
Process of Assessment
Receiving a Referral
Begins with a referral from a staff member or agency, self-referral, or a referral from a family member.
Referral is made because the client is experiencing a symptom or overall goals can be addressed in music therapy.
Purpose is to determine suitability for music therapy.
The music therapist is responsible for establishing criteria and a system for referral.
Ghetti and Hannan (2008) provide an example of referral criteria for a pediatric intensive care unit.
Gathering Background Information
Involves:
Reading the client’s chart or file.
Interviewing the client.
Interviewing family members.
Discussing the client with staff members.
Purpose:
Understanding the person.
Knowledge of major life events and their impact.
Medical conditions and medications.
Understanding of programs (educational, therapeutic, etc.) and their outcomes.
Understanding the client’s relationship with music and previous music experiences.
Awareness of spiritual or religious values and beliefs.
Knowledge of current needs and goals.
Understanding therapeutic methods used with the client, such as behavioral interventions or reward systems.
The breadth and depth of information vary with each stage of the assessment process.
Build an understanding of the client to contextualize the music therapy assessment and subsequent goals of treatment.
Determining the Purpose and Type of Assessment
Complex due to the number of variables to consider.
Overall purpose of the assessment (Bruscia, 1993, 2003):
Diagnosis, interpretation, description, prescription, and evaluation.
Domains of the assessment (Bruscia, 2003):
Aspects or facets of the human being that the music therapist is trying to understand.
Examples: physical skills or music preferences.
Examples of domains:
Cognitive, communicative, emotional, musical, physiological, psychosocial, sensorimotor, and spiritual domains, along with biographical and medical information.
Sources of musical information (Bruscia, 1993):
Types of musical experiences for assessment data.
Improvising, performing/re-creating, composing, or listening to music. Each allows gathering different kinds of information.
Summary of considerations:
Overall purpose of the assessment.
The domains.
The sources of musical information.
Overall Purpose of the Assessment
May be diagnostic, interpretive, descriptive, prescriptive, or evaluative.
Common for assessments to have more than one purpose.
Diagnostic Assessment
Efforts to “detect, define, explain, and classify the client’s pathology, focusing primarily on its causes, symptoms, severity, and prognosis” (Bruscia, 1993, p. 5).
Musical criteria are used to determine if the client has a condition, the type of condition, or how the client experiences or perceives the condition.
Music therapists are not allowed by law to diagnose formally.
Information discovered can be used to understand the client and may assist those who are charged with making a formal diagnosis.
Information a music therapist provides can be uniquely discovered through music therapy.
The MATADOC (Music Therapy Assessment Tool for Awareness in Disorders of Consciousness) has been researched and is robust compared to similar measures currently used to diagnose awareness in persons with disorders of consciousness (Magee, Siegert, Daveson, Lenton-Smith, & Taylor, 2014; Magee, Siegert, Taylor, Daveson, & Lenton-Smith, 2016).
Validity has been established with MATADOC for use with adults only; research continues to explore its validity with children with disorders of consciousness (Magee, Ghetti, & Moyer, 2015) and its clinical utility with adults with end-stage dementia (W. Magee, personal communication, September 12, 2016).
Interpretive Assessment
“Efforts are made to explain the client’s problems in terms of a particular theory, construct, or body of knowledge” (Bruscia, 1988, p. 5).
Gather samples of the client’s music-making or responses to music, and make inferences about these responses with reference to the chosen construct or theory.
Assessment may be designed according to a particular theory or may be a general inventory that allows interpretation according to a variety of theories.
Rider (1981) sought to discover if the ages at which children could perform musical tasks correlated with the difficulty of the tasks with relation to Piaget's theory.
Priestley’s (1975, 1994) work in Analytical Music Therapy (see also Scheiby, 2015) was grounded in the psychoanalytic constructs of Freud, Klein, and Jung, wherein she would interpret the musical improvisations of her clients.
Descriptive Assessment
Efforts are made to understand the client and the client’s world in reference only to him- or herself (Bruscia, 1993).
The client’s musical experiences are meaningful in and of themselves and in relation to other facets of the client’s life.
Scalenghe and Murphy (2000) provide a sample music therapy assessment for managed care that is descriptive (pp. 28–29), which is divided into nine major areas:
History of present illness, behavioral observations, motor skills, communication skills, cognitive skills, auditory perceptual skills, social skills, specific musical behaviors, and summary and recommendations.
Chlan and Heiderscheit (2009) developed the music assessment tool (MAT) to be used in intensive care units with mechanically ventilated patients to gather music preference and experience information due to severe communication problems.
Prescriptive Assessment
Intended to determine the treatment needs of the client and to provide a database for formulating goals, placing the client in the appropriate programs, and identifying the most effective methods of treatment (Bruscia, 1993, p. 5).
Determines:
Whether music therapy is needed and whether the client wants music therapy.
Whether there are any contraindications for participating in music therapy.
Which methods of music therapy are most suitable.
The kinds of materials that are appropriate for the client’s age, maturity, and interests.
Whether the client has the prerequisites for participating in existing music therapy programs.
The Special Education Music Therapy Assessment Process (SEMTAP, Brunk & Coleman, 2000; Coleman & Brunk, 2003) compares the child’s performance on musical and nonmusical tasks that are part of the Individual Education Program (IEP) goals and objectives.
Carpente (2013) developed a process designed to assess musical-play interactions with individuals with neurodevelopmental disorders (IMCAP-ND).
Evaluative Assessment
Establish a basis for determining progress.
Gather data on the client prior to beginning music therapy and then use these data as a baseline for determining the effects of treatment.
McDermott, Orrell, and Ridder (2015) developed the Music in Dementia Assessment Scales (MiDAS), a series of five visual analog scales to measure the responses of persons with dementia in music therapy groups.
According to Chase (2002), one purpose of an evaluative assessment is to “document the positive impact of music therapy” (p. 25) by using the results of the initial assessment as a baseline from which to measure changes in the children’s abilities as a result of music therapy.
Carpente (2013) states that the IMCAP-ND is also designed to be used for pre- and post-treatment measurement, thus indicating progress.
Domains of Assessment
Specific goals of your assessment.
Each domain has its own specific character and focus.
Some assessments focus comprehensively on only one domain, while others contain elements of multiple domain areas.
Biographical
Gathering background information on the client, including family, education, interests, life experiences, relationship to music, medications, clinical diagnoses, and previous experiences in therapy.
Gathering biographical information often occurs prior to undertaking a music therapy assessment, but it can also occur within the assessment itself.
Somatic
Gathering information about the client’s physiological and psychophysiological responses to music (Bruscia, 2003).
Includes physical responses to music-making and listening, such as measurements of heart rate, respiration, blood pressure, EEG, and EMG.
Also includes psychophysiological responses to music-making and listening, such as pain perception, consciousness, tension, fatigue, and anxiety.
Wigram (1997) assessed the effects of vibroacoustic therapy (Skille, 1997) on arousal levels, hedonic tone, blood pressure, pulse rate, and mood using a variety of mechanical (such as a blood pressure monitor) and self-report measures (UWIST Mood Adjective Check List; Matthews, Jones, & Chamberlain, 1990).
Assessments in this area are often not unique to music therapy.
Sandrock and James (1989) reviewed assessment instruments used to measure various psychophysiological responses to music and identified 10 distinct inventories, scales, and checklists, none of which had been designed by a music therapist.
Behavioral
Deals with the client’s observable behaviors.
Bruscia (1993):
"Behavioral assessment is the process of observing and analyzing what the client does or how the client conducts him-/herself. This includes overt action, reaction to stimulation, or interaction with the environment that can be seen, heard, or otherwise noted by the therapist."
Four main approaches to behavioral assessment in music therapy:
Measuring clearly defined isolated behaviors (e.g., eye contact).
Charting the behavioral interactions between clients.
Rating clients according to their tendencies to exhibit behaviors.
Recording entire sequences of behaviors and then analyzing them.
Music therapists who have developed assessments that focus on clients’ behavior:
Bitcon (2000), Boxill (1985), and Merle-Fishman and Marcus (1982) for children and Hanser (1999) for general use.
The General Behavior Checklist, developed by Bruscia (1993), considers broad areas of client behavior and responses.
Motivation, nonverbal interaction, communication skills, relationships, adaptive behaviors, aggressiveness, energy, physical capabilities, reality orientation, and motor deviances.
Other methods for behavioral assessment (Bruscia, 1993):
Measuring targeted behaviors.
Measuring interactive behaviors.
Documenting a behavior stream.
Skill
Entails a broad range of musical and nonmusical skills demonstrated by the client (Bruscia, 2003):
Sensorimotor skills.
Perceptual motor skills.
Cognitive skills.
Creative abilities.
Musical skills.
Liberatore and Layman (1999) developed the Cleveland Music Therapy Assessment of Infants and Toddlers to assess the skills of infants and toddlers who were at risk.
Numerous other skill assessments have been developed, including Nordoff and Robbins’s (1971) Categories of Response.
Sabbatella and Lazo (2015) designed the Music Therapy Assessment Protocol for assessing the sound–musical development of children, ages 3-6 years, diagnosed with developmental disorders.
Personality or Sense of Self
Gathering information on the psychological nature of one’s self, including self-awareness, self-esteem, identity formation, and unconscious aspects of personality (Bruscia, 1993).
Personality assessments also fall within this category (e.g., Cattell & Anderson, 1953).
The vast majority of assessments in music therapy focused on one’s sense of self have been projective in nature, and many of these have their origins outside music therapy.
Projective assessments are based upon the premise that clients can project conscious and unconscious aspects of themselves onto or into musical materials.
Several projective assessments have been developed, all of which use recorded music or sounds to elicit responses from listeners.
Emerging from his clinical experiences with both adults and children, Bruscia (1987) developed the Improvisation Assessment Profiles (IAPs).
Affective
Gathering information on the ways in which a client responds emotionally while listening to music or expresses him- or herself emotionally when making music.
Also involves the preferences clients have for listening to music.
Priestley (1994) developed The Emotional Spectrum to map out the emotional responses of clients to improvising music in Analytical Music Therapy.
Nordoff and Robbins’s (1971) Categories of Response look at the musical skills of the child and the ways in which the child responds to the mood or changes of mood in the music.
Baxter, Berghofer, MacEwan, Nelson, Peters, and Roberts (2007) created an assessment instrument using therapist-created music experiences for use with children and adolescents with multiple disabilities.
Various other assessment scales are concerned with understanding how a person responds emotionally while listening to or performing music (Hoffren, 1964; Robazza, Macaluso, & D’Urso, 1994; Steinberg & Raith, 1985).
Interactional
Music-making in therapy is a shared experience.
Domain is primarily concerned with four interactional dimensions (Bruscia, 2003):
Communicativeness—the extent to which the client communicates with others.
The client–therapist relationship.
Peer relationships and group skills in music therapy.
Family relationships.
Interactional assessments have been approached in a variety of ways (Goodman, 1989; Hough, 1982; Pavlicevic & Trevarthen, 1989).
Broucek (1987) developed an interactional assessment based upon the theory of Harry Stack Sullivan.
Pavlicevic and Trevarthen (1989) took a similar approach to assessing the joint musical improvisations of clients with schizophrenia and depression.
Jacobsen and McKinney (2015) demonstrated the reliability and validity of the use of the APC-R (Assessment of Parenting Competencies-Revised).
Nordoff and Robbins (2007) also developed three additional evaluation scales that can be viewed as primarily interactional in nature, although the affective and skill components are also apparent.
Sources of Musical Information
The same musical experiences used to assess clients for music therapy are used in music therapy treatment: improvising, performing or re-creating, composing, and listening (Bruscia, 1993).
Each kind of music experience offers a different way of gathering information about the client.
Listening assessments are primarily concerned with gathering information about the ways in which a client hears, receives, or reacts to sound (Bruscia).
Improvisational assessments are primarily concerned with the ways in which “the client extemporaneously makes up music or creates expressive sound forms while singing or playing” (Bruscia, p. 16).
Musical media themselves are important because of the nature of the tasks and challenges contained within each experience.
Improvising Assessments
When improvising is used as the vehicle for assessment, the therapist is concerned with the ways in which the client creates music while playing or singing.
Suited for projective assessment because the ways in which the person creates and produces his/her own music extemporaneously is a manifestation of how the person relates to self and others at conscious and unconscious levels (Bruscia, 1993, p. 16).
Appropriate for people who have trouble expressing themselves verbally, for those with identity and self-awareness issues, for those with interpersonal and communication problems, and for those who lack spontaneity (Bruscia, 1993).
Loewy (2000) describes an improvisation assessment for use in music psychotherapy wherein the therapist gains an understanding of the client through expression and interaction in music-making.
Performing or Re-creating Assessments
Concerned with assessing the ways in which the “client learns or performs vocal or instrumental music or reproduces any kind of sound form or musical pattern presented as a model” (Bruscia, 1993, p. 13).
Three primary media: vocal, instrumental, and movement.
Re-creative assessments are particularly well suited to assessing within the skill domain.
Bruscia (1993) identifies two main objectives to skills assessments:
To identify a developmental delay or disability.
To identify loss of function due to organic injury or disease, delay, or disability.
A third objective in skills assessment is the identification of baseline knowledge and abilities that may serve as evaluative measures in treatment.
Composing Assessments
Concerned with examining the ways in which the client composes a song or instrumental piece, usually with the help of the therapist.
The therapist may be interested in how the client creates and organizes the composition (skill domain).
These experiences are appropriate for projective assessments.
Useful for people who have problems focusing on a task, making decisions, and taking responsibility for them; problems in organizing and sequencing ideas; and a need for documenting inner feelings or achievements (Bruscia, 1993).
Listening Assessments
Experiences are those in which the client hears, receives, or reacts in some way to an auditory stimulus, which may be music or any of its components.
Address a broad range of domains.
Can also be used for the somatic domain, where the therapist observes the physiological and psychophysiological responses to music, or in the skill domain, where the therapist is concerned with the receptive skills of the client.
The Computer-Based Music Perception Assessment for Children (CMPAC) (Wolfe, Waldon, & Bilbe, 2006, as cited in Wolfe & Waldon, 2009) is designed to assess children’s musical preferences using a laptop computer and preprogrammed musical genres/selections.
The Music Attentiveness Screening Assessment (MASA) (Wolfe & Waldon, 2009) is used to assess a child’s ability to focus attention for a period of time during a music listening task.
According to Bruscia (2003), listening assessments are indicated for clients who need to:
Be activated or soothed physically or emotionally.
Learn how to listen.
Examine their own feelings and ideas.
Reminisce.
Have spiritual experiences.
Conducting the Assessment
Once you have established the overall purpose, domains, and sources of musical information for your assessment, several procedural steps follow naturally:
Gathering the data.
Summarizing and/or interpreting the findings.
Reporting the findings.
Two main elements should be considered: space and time.
Find a physical space that allows uninterrupted privacy with a minimum of extraneous noise.
Choose a time of day that gives the client his or her best opportunity of responding to the assessment tasks.
Gathering the Data
Actual way in which you collect information about the client.
Methods of gathering data (Bruscia, 2003):
Record survey: Gathering information from written sources such as files and charts.
Tasks and activities: Gathering information by observing the ways in which the client completes various tasks and activities.
Verbal inquiry: Interviews, in-therapy conversations, and questionnaires.
Observations: Observing the way the client conducts him- or herself in and sometimes outside music therapy.
Tests: Objective and projective tests.
Physical measurements: Heart rate, blood pressure, and so forth, measured by machines.
Analysis of materials: Analyzing musical materials such as improvisations; interpreting these according to specific theories or constructs.
Indirect methods: Interviewing family, staff members, and so on.
Summarizing and/or Interpreting the Findings
In some assessments, this involves collating and summarizing scores or ratings or indicating whether a skill or behavior is present or absent. Examples include Bruscia’s (1993) General Behavior Checklist and Liberatore and Layman’s (1999) Cleveland Music Therapy Assessment.
Taking a different approach, Priestley (1994) developed the Patient Questionnaire for use in Analytical Music Therapy.
Loewy (2000) emphasizes the importance of using language to convey the meaning in the music created in the assessment process.
Taking yet another approach, Shultis (1995) developed the Music Therapy Assessment and Initial Treatment Plan.
Reporting the Findings
In some clinical situations, the report is given to other team members, while in others, it is communicated verbally during a team or family meeting.
It is essential that music therapists follow HIPAA (Health Insurance Portability and Accountability Act) regulations when sharing client information with others.
If Music Therapy Is Not Recommended
Is client suitable for music therapy?
Client may not be responsive to music, may not be engaged or interested in the music therapy strategies, or may not respond in a way that is sufficiently different from other, nonmusical therapies.
To examine thoughtfully, consider several factors:
While a client may not be responsive during the music therapy assessment, this does not necessarily mean that he or she is not suitable for music therapy.
The MATADOC assessment was developed specifically to assess responsiveness in people who are minimally responsive and have complex problems.
While resistance, agitation, avoidance, or even aggression may be indicators that music therapy is not recommended.
The purpose of the assessment process may be to observe the client’s aggressiveness and agitation in music therapy and examine the ways in which various musical interventions mediate, reduce, or otherwise change the client’s behavior.
Assessing the suitability of a client for music therapy is therefore context-bound.
Issues in Music Therapy Assessment
Taking a Quantitative or Qualitative Approach
The extent to which your assessment needs to be approached from a quantitative or a qualitative perspective (Bruscia, 1993).
Quantitative assessment: gathering information about various aspects of the client’s behavior or condition and attempting to do this using numbers, inventories, or other methods that provide a numerical measure of the person’s skill, attribute, or response.
Qualitative assessment: more concerned with describing the ways in which clients respond to or work with various music experiences.
Reliability and Validity Issues
Reliability and validity are associated only with quantitative assessments.
“Reliability” refers to the extent to which the data collected are free from measurement errors (Meadows, 2000).
“Validity” refers to the extent to which the assessment measures the construct under investigation and is an “indication of its utility and meaningfulness in clinical and research situations” (Meadows, p. 9).
Norm-Referenced or Criterion-Referenced
Norm- referenced assessments allow comparison to some known group.
Since many tests in psychology are norm-referenced, it seems important for music therapists to consider the need for more norm-referenced music therapy assessments.
The MATADOC (Magee et al., 2014) has been compared to a standardized reference measure, the Sensory Modality Assessment and Rehabilitation Technique (SMART).
Assessment for Various Populations
Children with Special Needs
Carpente’s IMCAP-ND assessment (2013), based on the Developmental, Individual-Difference, Relationship (DIR)/Floortime model of Greenspan (1992), offers another innovative approach to work with children.
The Individualized Music Therapy Assessment Profile, or IMTAP (Baxter et al., 2007), was developed to assess strengths and needs of children and adolescents with special needs and is used in schools and by many music therapists working in private practice.
The Special Education Music Therapy Assessment Process (SEMTAP, Brunk & Coleman, 2000; Coleman & Brunk, 2003) was developed in response to the need of music therapists working in public school settings.
Layman, Hussey, and Laing (2002) designed the Beech Brook Music Therapy Assessment for Severely Emotionally Disturbed Children, which measures four domains.
Adolescents and Adults with Developmental Disabilities
Polen (1985) developed an assessment for adults with developmental disabilities, the Music Therapy Assessment for Adults with Developmental Disabilities.
Snow (2009) developed an assessment and piloted it with eight adults, ages 20–40, with developmental disabilities.
Adults with Psychiatric Disorders
Braswell, Brooks, DeCuir, Humphrey, Jacobs, and Sutton (1983, 1986) used the Music/Activity Therapy Intake Assessment for Psychiatric Patients.
Cohen and Gericke (1972) devised an assessment that combined clinical observation with information on musical ability.
Cassity and Cassity (2006) surveyed clinical training directors for information on areas of nonmusic behavior that they assessed.
Baker, Silverman, and MacDonald (2016) developed a scale for assessing the meaningfulness of the songwriting experience to clients.
Older Adults with Age-Related Needs
Hintz (2000) describes a music therapy assessment that addresses client strengths, needs, and functioning levels and can be utilized in both long-term care and rehabilitation settings.
The Musical Assessment of Gerontologic Needs and Treatment: The MAGNET Survey (Adler, 2001) was designed to correlate with the Minimum Data Set (MDS), a multidisciplinary assessment used for treatment planning in long-term care facilities.
Norman (2012) has developed a more concise assessment for use with older adults in nursing care which complements the MDS process and can be done in an individual or group music therapy session.
Keough, King, and Lemmerman (2016) used a demonstration project to develop a small group approach to assessment of persons with Alzheimer’s disease that has been used as an evaluative assessment to measure change.
People in Medical Settings
Approaches to assessment in medical settings include biographical interview, rating scales, interpretation of musical materials, and standardized physiological and psychological measures.
Scalenghe and Murphy’s (2000) music therapy assessment in the managed care environment provides a comprehensive descriptive assessment of clients.
Zabin (2005), Dileo and Bradt (1999), and Loewy (1999) describe qualitative, semistructured interview approaches to assessing clients.
The Computer-Based Music Perception Assessment for Children (CMPAC) and Music Attentiveness Screening Assessment (MASA) (Wolfe & Waldon, 2009) can be used to gather “initial information on children admitted to pediatric services."
Thompson, Arnold, and Murray (1990) describe a systematic, hierarchical assessment for patients who have recently suffered a cerebrovascular accident (CVA).
Jeong and Lesiuk (2011) used melodic contour as a basis for the Music-Based Attention Assessment (MAA), created for use with patients after traumatic brain injury (TBI).
Medical Music Therapy for Pediatrics in Hospital Settings (2008) and Medical Music Therapy for Adults in Hospital Settings (2010), both edited by Hanson-Abromeit and Colwell, include many examples of assessment for different medical diagnoses.
Assessments of music-related medical conditions have also been developed, including the diagnostic assessment of amusia (Berman, 1981), musicogenic epilepsy (Critchley, 1977), and music alexia (Horikoshi et al., 1997).
Summary of Music Therapy Assessment Information
A process of observing the client making or listening to music under specific musical conditions that enable the therapist to assess the client’s abilities.
Has one or more of the following goals:
Diagnosis, prescription, interpretation, description, or evaluation (Bruscia, 1993, 2003).
Involves focusing on one or more of the following domain areas:
Biographical, somatic, behavioral, skill, affective, or interactional (Bruscia, 1993).
Assessment information is gathered from one or more of the following four musical sources:
Improvising, performing or re-creating, composing, listening.
The assessment process usually involves the following procedural steps:
Receiving a referral.
Gathering background information.
Determining the goals and type of assessment.
Implementing the assessment.
Interpreting the data.
Creating a report and communicating the findings.
Once the assessment is completed, the therapist can make a number of decisions about how to proceed with the client.
Assessment is usually an ongoing part of the treatment process.