Being inspired by client-led thinking as a way into research

Description of sub-theme:

Many participants identified being led to ‘research thinking’ through relationship with, work with, or activity that is generated by - a client field or specific clients. Spontaneous specific ideas were generated and developed naturally from activities in music therapy practice.

On a number of occasions at Site FV– as participants were being invited to comment on their stories

of linking research and practice – they started to talk about specific client work, their engagement in it and how this had led to a research study. People also returned to it later in their stories. The idea of ‘client led-ness’ seemed at first to be a large powerful category for this site, and thence to develop into its own theme, which resonated with other data sets in this study. Every participant at Site FV

contributed to this theme and there are a number of different aspects to consider, which will be outlined in the following paragraphs.

Two lecturer participants at Site FV evoke the voice of the client in influential ways in their journey towards – and then during – their own research projects, before they start to reflect on student learning and the ways they teach. So for themselves as ‘students of research’ the clients’ voices have had a seminal influence. One of them expresses this with real directness. She was involved with an unusual case, where her client was really urging her to research the work, because she personally had found it so meaningful. Although the methodology was not ultimately participatory action research, it could have been so, with the client’s voice and role strongly emphasised.

And my sense of this person, and having worked with her for some time, was… she slightly

‘blew me away’ as a client, you know, she was extraordinarily eloquent. Anyway, before we

ever thought about research… the client, whom I called XXX in my research, she kept saying

‘We should research this, we should research this!’ So she was encouraging me anyway.

(Hope 93-98)

The second lecturer, Anna, responded to the challenge of working with people who have very little voice in society and the research becomes an opportunity to address “very particular and urgent questions about a particular (adult) population who had lived most of their lives in institutional

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care.” She observed the special enticing challenge of creating research where a vulnerable group “could be more a position of equals rather than being a researcher with subjects” and she went on to note that she doubted she would ever have considered undertaking a research degree “…had I not been involved in working with that client group”. So client voice, fairness and advocacy became intimately involved in the reasons and impetus for research suggesting a strong integration between these areas. For both these participants, a sense of relevance to their client work was emphasised in their story about experiencing research.

Alex, a senior researcher at Site KT, illustrated a similar incidence of intimate connection between the practice and the research and in this case identified a clinical conundrum that supervisor and student therapist were trying to solve. It was a genuine problem of practice that the student raised, and she as supervisor was helping to query, and it developed into a very satisfying research topic using practice- based documenting techniques:

And yeah so of course what happened with that was we started discussing about the

differences (between student and supervisor experiences) and it just occurred to me that this was a research question. So the conundrums that sometimes my students bring up, well that people bring up including students, emerge into a research question because I find that that reframing offers a useful and an interesting way to try and find an answer. (Alex 186-191)

In Group-E Quentin, a programme leader and practice researcher noticed how close to research the regular process of reviewing our music therapy practice could be (e.g. documenting notes, and reviewing and indexing recordings):

You sit down, and you listen back. And you spend time, and you have your thoughts and you test them against what you hear,….’ And, you know, there is that, sort of, search for meaning between all of them that is, in a sense, research, in a very practical day-by-day way.

(Quentin: 213-216)

Group-E’s conversation together revolved for some time around the idea of embedding the research in practice, and this was a potent theme for this focus group. The participants discussed in depth making full use of the ways in which research was a natural part of practice or an extension of normal tasks that occur in music therapy practice with people. These might include processes of documenting, reflecting, questioning, and ‘not knowing what to do’ and needing to find a solution, asking other staff and practitioners, reading and inquiring. In considering the application to students, this group

concentrated on their efforts to find ‘embedded’ integrated ways to include research learning, and empowering people rather than ‘teaching research skills’ as a specific skill area.

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particular what could constitute and be defined as practitioner research. This will be covered later in following chapters. A neat example of the potential for integrating processes was afforded almost unconsciously in a rather passionate explosion by Group-E researcher-lecturer Kirsty, who was capturing the importance of early pioneers doing both jobs of working practically and reflecting on the practice, and she did this in a very musical way. She asserted that it was particularly vital that:

They had also experienced the event themselves. Yes! It’s not that there were two people listening to somebody else’s work. And there was something very clear and unambiguous about their use of ‘their own experience in the room; with those children’[Kirsty tapped her pen in rhythm with the words]:

[This] contributed to their thinking about how they were listening and making sense of… So

there wasn’t a kindof… discreetness… between the experience, and the listening and the

thinking … (Kirsty 225-231)

Returning to Site FV (and their universal adoption of this theme) a senior student Florence, was strongly drawn to case study approaches as a foundation to music therapy research. Although her scientific background emphasised experimental research and randomised controlled trials (RCTs), she found the voice of the client in case studies meaningful and a significant way into research. The junior student on the programme wove a story around encounters with clients and patients. This participant was really keen to talk about his practice. He was on placement in a new area and trying to work things out. His engrossed state was palpable and he showed a strong interest in the clash of cultures between the medical model in rehabilitation and his human-centred music therapy training theories. (This seemed like practiced-based thinking in action.)

I think to actually try and apply some of those (medical rehabilitation) interventions into a musical work, I’ve found it very dry actually and quite artificial…. And I suppose it made me

realise actually it’s more important to actually address the relationship and address where

that person is and then the rest of it sort of, as you then work with the music, potentially the

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Student Patrick admitted that at this stage of training, “Research is long way off in my mind” but was excited by the practice questions and theories. The close relationship between regular practice concerns or real-life cases and any research questions they developed in their studies, for both these students, appeared to be important in how they might value the future research they pursued on their programme. I enjoyed taking part in a supervision support class with other students at Site FV, while I was making the visit. This happened to be a class I could observe and the group was welcoming of a visitor. I asked them a few questions informally at the end of the class, but mostly just observed their regular learning. I made this note in my research journal:

It’s very striking observing the clinical seminar classes at Site FV how engaged and curious

all the students are in each other’s cases. They asked good questions and didn’t wait for the

lecturers to lead things. Three people took it in turns to be in the hot seat, and then the others

‘got in there’ after the person had spoken and discussed ideas. They problem-solved together

and thought about the difficulties and what the student could do next. The lecturers just

guided and punctuated, and didn’t say much really. It was great to witness this– I loved their

interest and varied perceptions. RJ 3rd February 2010

A clinical supervisor participant at Site FV was surprised about how moved she could be by the learning about patients through research, and how the meaning of her work was intensified. Practice- wisdom was definitely increased and some photographic imagery of her project “Hands,old hands on a drum –they were just so meaningful” moved her deeply. The project was commissioned by an agency interested in music and older people, and she emphasised the value of undertaking research that was relevant to the agency and institution – everyone’s awareness was raised and new practice could be initiated and trialled. She was also able to transfer her knowledge gained in research with the elderly to a new group work situation with children, quite an unusual and interesting outcome.

Joint ownership of research with their clients was characteristic of the two lecturer-participant stories at Site FV and a strong ethical steer for their work. It seemed there were many opportunities for (iterative) connection between research and practice values in this area; one emphasised how

developing the strict boundaries required in research ethics (including care with informed consent and assent) were great teachers for practice ethics and therapeutic boundary setting; another’s

commitment to client consultation in every step of her research journey overrode her supervisor’s wish for a ‘cleaner’ or simpler methodology for her inquiry. After a rough and humiliating experience on the research journey with another clash of cultures between medical research approaches and arts therapy ones, the participant was reminded to disseminate her study because “the client really wants to publish this’.

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A salutary reminder was offered by a researcher-programme leader from Group-BA that from her perspective, everything reverted back to the practice and people we work with, however much we might enjoy our concepts, theories, teaching or research stance. Students were the first to tell us this:

‘But they always say, you know, without any coaching, they all say exactly the same

thing….They learnt what they needed to learn from working in the field.. and that’s what I

often say to my students. I say ‘You can sit in class after class, but who will teach you? - Your patients will teach you, your clients will teach you what you really need to know about yourself and your capacities, you know, and this is a kind of preparation . we can’t

reproduce what you’re going to experience. We can help you be somewhat prepared for it.

(Hannah 717-723)

Hannah also went on to say that this sort of basis was the ideal starting point for research: “ … that clinical knowing or that clinical wisdom, that is then the best position to start asking questions that develop into research.” (Hannah 269-70)