Improvised music to support interaction between profoundly learning-disabled teenagers and their learning support assistants

In work with clients having profound learning disability, music therapists may include in sessions assistants not trained as music therapists. This study is a qualitative inquiry addressing the questions: 1) How does improvised music influence the interaction between teenagers with profound and multiple disability and learning support assistants? 2) Which aspects of the music are associated with any influences found? A survey of music therapists, exploring how assistants are used and how effectively they perform their role, found that assistants are often used as ‘interaction partners’. To explore how the therapist may facilitate client-assistant interaction, about which little is known, video clips from the writer’s clinical practice were purposively selected in order to illustrate an approach entitled Triadic Support of Interaction by Improvisation (TSII). Seven learning support assistants (LSAs) each viewed a video clip showing her own interaction with a teenager having profound disability, supported by the writer’s improvised music. Semi-structured interviews explored the LSAs’ understanding of the behaviour and inferred mental processes of the teenagers, their own behaviour and mental processes and the music improvised by the therapist to support the interaction. A variant of Interpretative Phenomenological Analysis generated shared themes, which included concern for the teenagers’ autonomy, interest in their communicative behaviour and understanding of the mutuality of interaction. The therapist’s improvisation was seen by the LSAs as influencing only the teenagers. All the clips were also viewed by three music therapists, who used a mechanical continuous response device to register the influence of the therapist’s improvisation on four ‘scenarios’: the teenagers’ behaviour, their inferred mental processes, the LSAs’ behaviour and their inferred mental processes. Inter-rater agreement between the three therapists’ continuous responses was generally low, but some intra-rater correlations were found between pairs of scenarios, which the music was perceived as influencing in similar ways. This finding supports the conclusion that musical influences, although they may be analysed according to the four scenarios, actually function as a mutually inter-related system rather than as four independent processes. Each therapist selected decision points from the graphic record of her/his individual responses to discussed with the other therapists as a panel. Positive evaluations were made of the role of TSII in supporting the observed teenager-LSA interactions and the inferred underlying mental processes. This research design was exploratory, and not intended to test specific hypotheses about the mechanisms of musical influence. Tentative suggestions of associations between influences and musical features are however offered by the writer. Indications for the use of TSII are given and other applications suggested for novel aspects of the methodology developed for this study. A refinement of the continuous response task is proposed, and the requirements for any future formal evaluation of TSII are outlined.