My research uses a mixed methods design, combining quantitative and qualitative data to investigate the effects of music therapy and parent counselling sessions on resilience in young children with ASD and their families. For this study, utilising and integrating different methods is important as it ensures a more holistic approach to the research question, enables multiple perspectives on the complex phenomena of music therapy, parent counselling and resilience, and enhances our understanding and interpretation of results. A comprehensive definition of mixed methods research is given by Creswell, Klassen, Plano Clark, and Smith (2011):
‘- focussing on research questions that call for real-life contextual understandings, multi-level perspectives, and cultural influences;
- employing rigorous quantitative research assessing magnitude and frequency of constructs and rigorous qualitative research exploring the meaning and understanding of constructs;
- utilizing multiple methods (e.g., intervention trials and in-depth interviews);
- intentionally integrating or combining these methods to draw on the strengths of each; and
- framing the investigation within philosophical and theoretical positions’ (p. 4).
Even though the explicit term ‘mixed methods research’ is relatively new3, research
combining and integrating quantitative and qualitative approaches has been conducted in both the natural as well as the social sciences for centuries (Maxwell, 2016). Similarly, in the history of music therapy, the common practice of describing studies as mixed methods research has emerged only in more recent years (e.g. Bradt et al., 2015; Cook & Silverman, 2013; Lindenfelser, Hense, & McFerran, 2012). However, numerous music therapy research studies have integrated quantitative and qualitative methods from an earlier time
3 Creswell and Plano Clark (2011), for example, date the beginning of the formative period of mixed
(Aigen, 2008; Bonde, 2007). It is noteworthy that literature describing the history of mixed methods research in music therapy (e.g. Bradt, Burns, & Creswell, 2013; Burns & Masko, 2016) often only mentions the studies that use the distinct label ‘mixed methods’, and fail to recognise the impact and importance of earlier research.
Creswell and Plano Clark (2011) have identified different variations of mixed methods designs. These are based on decisions regarding, for example, the timing of data strands or the point of data integration. According to their typology, my study uses a convergent parallel design which is characterised by a) collecting quantitative and qualitative data concurrently as opposed to sequentially, b) analysing the data strands independently, and c) integrating data at the level of interpretation. The convergent parallel design facilitates the researcher ‘to obtain different but complementary data on the same topic’ (Morse, 1991, p. 122). One example of a convergent mixed methods design in music therapy is the study by Barry, O’Callaghan, Wheeler, and Grocke (2010) that examined the effect of music therapy CD-creation on distress and coping of children during initial radiation therapy. In my doctoral research study, I concurrently collected quantitative and qualitative data which have been derived from three sources, namely video recordings of music therapy sessions, video recordings of parent counselling sessions, and analogue scales measuring the quality of life of participants at different time points. The different data strands were analysed independently before they were integrated at the level of interpretation. The processes of my research project were structured into the following successive phases: Selection of participants, allocation to different treatment conditions, data collection, data preparation, data analysis, and data interpretation. Whereas the first three stages were adopted from the TIME-A design, the latter three phases were developed specifically for my PhD study. Figure 5 illustrates the full study design of this doctoral research project.
Figure 5: Study design
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Study Design
Children with ASD aged 4;0-6;11 (N = 25)
Music therapy group (n = 14*)
Control group (n = 11)
MT 1x (n = 6) MT 3x (n = 8*)
MT sessions: Video recordings (445) Parent counselling sessions: Video recordings (68)
Quality of life: Scales (74)
MT 1x (109) MT 3x (336)
Session selection (229) Session selection (13)
Excerpt selection Time-sampling analysis ACTR Transcription Thematic analysis Binary analysis, independent samples t-test
Integration of data and reflection
Participants Allocation Intervention/ data collection Data preparation Data analysis Data interpretation Analytical model: GLMM
*One child was excluded from video analysis because of non-existent video recordings
Abbreviations: ACTR, Assessment of child-therapist relationship; GLMM, Generalised linear mixed models; MT, Music therapy
A do pte d fr om T IM E -A Dev el ope d f or P hD s tu dy
The quantitative methods used in my research are a time-sampling video analysis of music therapy session excerpts, assessments of the child-therapist relationship in these excerpts, and statistical analyses of the quality-of-life measurement. Video analysis is a method commonly used by music therapy researchers (e.g. Holck, 2007; Plahl, 2007; Ridder, 2007). It is especially suited to the discipline as video analysis allows for a holistic perspective on what is happening in the session, including musical elements, facial expressions, gestures, movements and spatial aspects. A time-sampling method to detect occurrences of specified behaviour is chosen frequently by music therapists conducting studies with children with ASD (e.g. Davis, 2016; Oldfield, 2004; Tomlinson, 2016) because time-sampling enables the researcher to pick up even the small changes that are typical in this client group. The quality of the client-therapist relationship is assessed by several music therapists (e.g. Nordoff & Robbins, 1977; Raglio et al., 2017; Schumacher & Calvet, 2007) who define the therapeutic relationship as a key element of music therapy. Quality of life is acknowledged by many music therapists as an important outcome of the intervention, and its assessment is thus commonly included in music therapy research studies (e.g. McConnell et al., 2016; Thompson, 2017; Van Bruggen-Rufi, Vink, Achterberg, & Roos, 2018).
The qualitative aspects of my study include applying thematic analysis to transcriptions of parent counselling sessions. In recent years, thematic analysis has been used increasingly by music therapy researchers, both as the main method in interpretivist studies and as one of several methods in mixed methods designs (e.g. Hoskyns, 2013; Loth, 2014; Potvin, Bradt, & Kesslick, 2015). In my study, this qualitative data provided further insight into the effects of the work with autistic children and their families. Finally, the different data strands were combined, and the findings were integrated. This allowed me to approach my research question from different angles and to gain a comprehensive understanding of the phenomena involved. All the data and results were used for a reflection on whether music therapy and parent counselling sessions enhance resilience in young children with ASD.