Supervision for music therapists: an Australian cross-sectional survey regarding views and practices.

Kennelly, Jeanette D. ; Baker, Felicity A. ; Morgan, Kylie A. 等

Introduction

Professional music therapy associations around the world regard supervision as important (AustMTA, 2008, 2005; APMT, 2009; AMTA, 2009a; AMTA, 2009b), and supervision guidelines to support therapists and supervisors are available (e.g., the Ethical Code of the European Music Therapy Confederation, 2005; APMT, 2008). The Association of Professional Music Therapists in the UK (APMT) has a structured and formalised approach to the practice of supervision (APMT, 2009), and criteria for becoming an APMT registered music therapy supervisor are identified. Other guidelines and recommendations from music therapy professional organisations are available, for example within Canada (Canadian Association of Music Therapy, 2009), the US (AMTA, 2009a; AMTA, 2009b), Australia (AustMTA, 2008), and Europe (EMTR, 2010).

Guidelines from professional organisations have aided the development of diverse and sophisticated supervision practices which have been explored in descriptive literature (for further reading see Odell-Miller, 2009; Forinash, 2001; Jackson, 2008; McClain, 2001). For example, practice elements of supervision have been described, including the importance of the supervisor's knowledge, their background and the impact of the supervisory relationship (Oldfield, 2009), boundaries and guidelines (Brown, 2009; Daveson & Kennelly, 2011; Davies & Sloboda, 2009; Edwards & Daveson, 2004; Levinge, 2002), and the differences between individual and group supervision (Ahonen-Eerikainen, 2003; O'Callaghan, Petering, Thomas, & Crappsley, 2009; Shultis, 2006). Research closely aligned with existing practices has been conducted, and these studies have helped our understanding of the benefits of supervision. The formal investigation of music therapists' experiences in the context of peer and reflexive group supervision provide evidence of benefits from supervision.

The use of guided imagery and music for peer supervision was examined with a group of four music therapists based in Korea (Kang, 2007). Analysis of field notes, participant interviews, journals and mandalas together with video and audio recordings of supervision sessions, revealed that therapists benefited both professionally and personally by participating within a peer supervision group. Participants advocated the use of this type of supervision in everyday practice. A second qualitative study investigated supervision within the field of palliative care in Australia. Data showed that reflexive group supervision was helpful in processing unresolved issues related to clinical work (O'Callaghan, Petering, Thomas, & Crappsley, 2009). The findings revealed perceptions of improved and extended clinical practice due to supervision.

In addition to investigating benefits to individual practitioners, national surveys have helped us understand the practice of supervision within the field of music therapy. A cross-sectional survey in the USA, which achieved a response rate of 41%, showed that supervision is not always widely accessed (Jackson, 2008). Of 677 survey respondents, 62% indicated that they did not participate in clinical music therapy supervision. Also, when supervision was used, it was frequently provided by a professional not qualified in music therapy (i.e., a non-music therapist). The highest-ranking reason provided for not participating in any form of supervision was related to access.

The issue of access in relation to supervision was also identified in survey findings from Australia. A postal survey showed that a substantial minority of music therapists received supervision from a RMT (Edwards, 2000). The majority of those who received supervision found it too expensive and a substantial group thought that the employer should provide supervision. These findings contrast with the current Australian Music Therapy Association (AustMTA) Code of Ethics and Continuing Professional Development Handbook. The Code of Ethics states that regular supervision is normal practice, and it aids skill development, performance monitoring and governance requirements through aiding accountability (AustMTA, 2008). The Continuing Professional Development (CPD) Handbook includes supervision as an activity for points accrual (AustMTA, 2009).

Given the time, effort and resources that have been devoted to the development of supervision at an international level, our survey was designed to examine the views and practices of professional supervision for music therapists working in Australia in order to aid practice and research. Our survey investigated the profile of those who access supervision, the reasons for accessing supervision, the factors that influence supervisor selection, and views about the service they receive. The main research question was: What are the views and practices of music therapists working in Australia regarding supervision?

Methods

Survey methods have been used previously to examine supervision within music therapy, allowing for a broad scope of investigation (Edwards, 2000; Jackson, 2008) and the low cost collection of a large amount of data over a short period of time (Kelley, Clark, Brown & Sitzia, 2003). With this knowledge, we examined the most recent survey by Jackson (2008) to inform construction of an on-line survey within Australia and to develop a cross-national body of literature regarding supervision. The specific survey items were designed by the authors, based on a formal review and structured adaptation of Jackson's questions to accommodate for the Australian context. Prior to implementation, the survey was piloted with four RMTs.

The final version of the survey consisted of 33 questions (14 open- and 19 closed-ended) (Appendix). One section sought data on participant profiles: gender, age, years of music therapy practice, education, hours in practice, clinical population, theoretical orientation, support systems accessed by these therapists (12 questions). Sixteen questions examined the reasons participants sought supervision, the process and factors guiding supervisor selection, supervision practice, and views about supervision. A further five open-ended questions were posed but as these were included to inform the design of a subsequent study, an analysis of their data is not reported in this article. The survey was posted on-line for five weeks (September-October 2009) and was open to all Australian RMTs. Due to data protection and privacy requirements the survey link was distributed by the National Office of the AustMTA. Two reminder messages were sent via email--one at two weeks after the initial invitation and a second a week before the closure of the survey.

The survey was accessed via a weblink directing RMTs to the web-based survey service Survey Monkey. Survey Monkey is an on-line survey administration company who provide the tools for researchers to construct on-line surveys. To ensure anonymity of the data and secure transmission of the survey responses, a Sockets Layer (SSL) encryption was provided for the survey link.

Sampling

Inclusion criteria for the survey were RMTs working and residing in Australia at the time of completing this survey. Those not working in Australia were excluded from the study. At the time of the survey 393 music therapists were registered with the AustMTA. An email invitation to participate in the on-line survey was sent to the 360 RMTs who received AustMTA correspondence electronically. A hard copy of the survey was also made available for all RMTs attending the 2009 AustMTA National Professional Development Seminar to capture those who had not received the survey electronically (n = 33). It was flagged to participants that if they had already completed the on-line copy they were not to proceed with the completion of the hard copy of the survey.

Data collection

Data generated by the survey was downloaded and saved to a secure server, and then imported into the PASW Statistics 18 software. Hard copy responses were inputted into Survey Monkey by the first author (JK). This data was checked for accuracy at the time of data analysis by a second researcher (KM) and double-checked and cleaned by a third researcher (BD).

Analysis

Only surveys with at least 50% of items answered were included in analysis. Means and standard deviations were calculated for continuous data (i.e. for age). Categorical data were collapsed for analysis when required. Descriptive statistical analysis using frequencies and percentages of categorical data were calculated. PASW Statistics 18 software was used to analyse the quantitative data. The primary researcher was responsible for the analysis of the data. An independent researcher double-checked the findings for accuracy.

Ethics

The study was approved by the human ethics committee of the University of Queensland, Australia (SoM-ETH09-01/010/JDK) in accordance with the National Health and Medical Research Council's guidelines.

Results

Survey respondents

Seventy-one music therapists responded to the survey (61 electronically, 10 hard copy). Eleven surveys were excluded as they were less than 50% complete, reducing the data-set to 59 surveys.

Fifty-five respondents were female (93%). Eighteen respondents had practiced music therapy for a period of one to five years (26%), 15 between 6-10 years (25%) and 17 had been practicing between 11-19 years (29%). Nineteen respondents indicated that their highest level of education was a Masters in Music Therapy (30%) however a wide variety of additional credentials were reported such as allied health sciences, education, nursing and psychology. Fifteen respondents (25%) worked less than 10 hours per week as a music therapist, nine (15%) worked 11-20 hours per week, 17 (29%) worked 21-30 hours per week and 18 (31%) worked between 31-40 hours per week. The three most common areas of practice were medical (surgical and cancer) and rehabilitation (22%), physical or intellectual impairment (20%), and mental health (15%). The most frequent theoretical orientations used by respondents were humanistic (44%; n = 28), behavioural (14%; n = 9) and creative music therapy (9%; n = 6). Professional supervision (21%) was the most frequently used support system by respondents however other support systems were endorsed by some participants (Figure 1).

Profile of those who received supervision and those who did not

Fifty-eight percent (n = 34) participated in some form of professional supervision. Twenty-three respondents who participated in supervision were aged between 21-40 years. Nineteen had been practicing for less than 10 years. Twenty-nine of these participants held either a Masters / Postgraduate Diploma in Music Therapy or a PhD and 22 worked over 20 hours per week. Of those that received supervision, three groups were identified: 1) those who received supervision from a music therapist (n = 6); 2) those who received supervision from someone not qualified in music therapy (n = 22); 3) those who received supervision from two supervisors at separate times, one qualified in music therapy and one not qualified in music therapy (n = 6).

Forty-two percent (n=25) did not receive supervision. Thirteen respondents who did not participate in supervision were aged between 21-40 years. Eighteen had been practicing for less than 10 years. Eighteen of these participants held either a Masters / Postgraduate Diploma in Music Therapy or a PhD and 13 worked over 20 hours per week. No statistical differences were found in any of the analyses between those that received supervision and those that did not receive supervision.

[FIGURE 1 OMITTED]

Reasons for selecting a supervisor and the process of selecting a supervisor

For those that received supervision from a music therapist, trust and prior knowledge of the music therapy supervisor (50%) was the most frequent reason for receiving supervision from this person, followed by workplace arrangements (17%), and the type of supervision needed (17%). Those who received supervision from two supervisors (i.e., from a music therapist and someone not qualified in music therapy throughout the same period of time but within separate supervision sessions) indicated that workplace arrangements (38%) and the type of supervision needed (38%) were the most frequent reasons for receiving supervision from the music therapy qualified supervisor. Most frequently, the selection of a music therapy qualified supervisor was self-initiated (40%) however this was a requirement by the facility for a substantial number of respondents (30%). Other factors included the supervisor's qualifications and experience (20%), and recommendations or referrals (10%). The provision of a supervisor by the facility (50%) and the supervisor's qualifications and experience (50%) were equally endorsed by those respondents who used both a supervisor qualified in music therapy and one not qualified in music therapy. For respondents who did not access supervision, the most common reasons for not accessing supervision was that it was not required in their work setting (38%; n = 9). Twenty-five percent of respondents (n = 6) reported that receiving supervision was not necessary for the population with whom they worked.

Supervision practice

Thirty-seven percent of respondents who received supervision from a music therapist did so every two to three months. Sixty-seven percent paid for supervision costs themselves and accessed supervision offsite. Individual supervision (67%) was more commonly used than group supervision. In relation to those who accessed supervision from a supervisor not qualified in music therapy, most received supervision once per month (64%), and the costs were covered by the workplace (52%). This supervision was generally accessed onsite and individual supervision was the most common type of supervision provided (74%). Fifty percent of those who accessed supervision from two different supervisors at separate times received supervision once per fortnight (50%). The cost of this supervision was shared equally between the supervisee and the workplace (33%). Supervision received from these two supervisors was accessed onsite (100%). Regardless of the professional background of the supervisor, the philosophical orientation of supervision was person-centered / humanistic (20%; n = 14), solution focused (17%; n = 12) and strengths based (17%; n = 12).

Views of supervision

Eighty-four percent of respondents that received supervision from a music therapist indicated that their needs were met. Sixty-eight percent of those receiving supervision from a supervisor not qualified in music therapy reported that their needs were met. Sixty-seven percent of those receiving supervision from two supervisors reported that their needs were met.

Respondents were also asked to rate the importance of supervision on a 5-point scale with 1 indicating 'not really necessary' and 5 indicating 'is important for anyone working in the profession regardless the type of work setting'. Most indicated that supervision can often be helpful for many clinicians (rating of 4, n = 19) and is important for anyone working in the profession regardless of their type of work setting (rating of 5, n = 31) (Table 1). Those who did not receive supervision rated supervision as only necessary when a problem exists (rating of 2, n = 2), helpful in some cases or only with certain populations (rating of 3, n = 3). No respondent rated supervision as not really necessary (rating of 1).

Discussion

This is the first national on-line survey conducted on the topic of supervision for the Australian music therapy profession. Our data revealed that even though 58% of respondents received some form of professional supervision, this means a substantial proportion of clinicians do not. This result is similar to recent findings from the USA which showed that 55.8% accessed some form of supervision (Jackson, 2008). Our finding highlights a discrepancy between what is described within the AustMTA Code of Ethics in Australia with what is happening in the field. The current Code of Ethics indicates that it is normal for therapists to participate in supervision, yet in relation to our respondent group a substantial proportion do not participate in supervision. These findings also contrast with the current CPD handbook where supervision is acknowledged as a professional development activity. No respondent rated supervision as not really necessary, including those that did not receive supervision. Only a small number of those who did not receive supervision reported that supervision is necessary only when a problem exists or with certain populations. Thus, even though supervision is mostly viewed as important, a substantial number still do not access supervision.

Our findings regarding cost and location of supervision may help understand this finding. In our study, access to supervision between groups varied. When supervision was provided by a music therapist, the supervisee usually paid for the supervision and accessed it away from the workplace. In contrast when supervision was provided by a supervisor qualified in something other than music therapy, or when it was provided by two supervisors at separate times, the cost of supervision was usually paid for by the employer and accessed at the place of work. Supervision occurred less frequently when provided by a music therapy qualified supervisor (usually every 1-2 months) as compared to the two other groups (once a month, or once a fortnight, respectively). Our finding builds upon research in Australia where the majority of therapists identified cost and access as issues concerning supervision practice (Edwards, 2000). Additionally the issue of access was highlighted as a factor that prevented the use of supervision in the USA (Jackson, 2008). Our findings highlight differences in cost and location in relation to a supervisor's professional background, and may help in understanding the logistics that influence therapists' decision of whether or not to access supervision, and from whom. Our research does not allow for causal factors to be identified but rather our descriptive findings highlight factors that may preclude access. These factors should be examined in future research and may help bridge the gap between what professional bodies recommend as important and what happens in practice.

The majority of our respondents received supervision from a supervisor not qualified in music therapy (65%). This finding contrasts with survey findings from the USA where substantially fewer (19.8%) received supervision from a supervisor not qualified in music therapy (Jackson, 2008). Our data showed that it was a requirement of the facility or workplace to access supervision from this professional as they were their immediate line manager/supervisor. This finding highlights questions raised previously by the first author (Daveson & Kennelly, 2011) regarding the maintenance of boundaries and potential power imbalances in these dual roles. Guidelines regarding the expectations and responsibilities of the supervisor and supervisee in these relationships could assist in addressing this issue. It is not clear from the data why music therapy supervisors are accessed less often. In addition to cost and offsite location, the small size of the Australian profession may prevent the access and use of music therapy qualified supervisors for various reasons including issues of boundary maintenance and confidentiality. Formalised training programs for music therapy supervisors within Australia might assist with encouraging MTs to access supervision from a music therapy qualified supervisor. The primary author has explored issues related to the provision of supervision for music therapists by healthcare professions other than music therapists previously (Daveson & Kennelly, 2011). This area needs further attention.

The majority of respondents indicated that supervision is important. Needs were met by the majority of those that receive supervision, regardless of the professional background of the supervisor. This finding supports the view that supervision can be successfully provided to a music therapist by a supervisor who does not have training in music therapy, and that supervision is generally useful to those who access it. Formal guidance provided by a national music therapy body could assist supervisors and their workplaces in understanding music therapists' supervision requirements, and its role in maintaining best and ethical practice. Based on our findings, guidance regarding the scenario of dual supervision should be included in national guidelines. Consideration of the most common types of supervision accessed might also help shape the content (i.e., person-centered / humanistic, solution-focussed, and strengths-based).

Trust and prior knowledge of the supervisor were important factors when selecting a supervisor. This finding aligns with the work of Oldfield (2009) where familiarity when working with a music therapy supervisor was described as important. The valuing of trust and prior knowledge of the supervisor highlights a need for further research into the qualities of supervisors which may influence supervision access. While directories of supervisors may be useful in connecting supervisees with supervisors, opportunities for networking between supervisors and potential supervisees within special interest group forums may be helpful in improving supervision access as a proportion of our respondents also used special interest groups as a forum of support. The finding that clinical caseload was not a determinant of whether or not supervision should be accessed speaks to the issue of perceptions of the role and purpose of supervision and warrants further investigation.

Even though all music therapists on the electronic correspondence database of the Australian Music Therapy Association were invited to participate in our study our low response rate needs to be considered when reviewing our findings as there is a risk of bias in our study. The small majority of those who completed this survey do participate in supervision and this has influenced our findings. It is possible that those who were more likely to participate in supervision also responded to our survey. The decision to utilise a web-based survey may have also impacted upon the response rate. For example, we are unsure how many email addresses used in this survey were current, accurate or active. No technical support was arranged for respondents and the provision of technical support may have aided response rate if difficulties with the survey were encountered. The small size of the Australia music therapy profession may have also influenced response rates. Even though anonymity was ensured, the possibility of identification of survey respondents was high. The need for socially desirable responses must also be considered given the nature of this topic and its relevance within the music therapy profession.

Further recommendations

The authors recommend that this study be repeated with emphasis on strategies to help improve the response rate. This may include revisions of the survey for ease of responding and additional provisions for follow up. Also, the content validity for the survey should be established before it is used. Should response rates remain low, investigations into the demographics of the sample compared with the entire population of Australian RMTs could be carried out in order to determine whether the sample was representative of the profession.

Revision of current supervision guidelines in terms of definitions, roles, models and frameworks of practice, types and frequency of supervision and responsibilities of the supervisory relationship could prove useful for both supervisor and supervisee. Such guidelines could be of benefit to all supervisors of music therapists regardless of their professional background and training. We encourage the AMTA to explore options for accredited training courses for music therapists wanting to supervise other music therapists. Registers of suitably trained and qualified supervisors would also provide an additional resource for supervisees. An investigation into the need for ongoing discussion and networking between supervisors and supervisees may also assist to bridge the gap between the importance placed on supervision by participants in this survey and how it is practised within the profession.

Conclusions

This on-line survey has identified gaps between supervision practice and professional recommendations. Based on the answers provided by the 59 Australian RMTs who participated in this study, we recommend that revisions to current supervision guidelines are required and guidelines for supervisors not qualified in music therapy should be established. Novel ways of introducing supervisors and supervisees should be explored as trust and prior knowledge of a supervisor appears to be instrumental in supervision access. Issues regarding access (cost and location) to supervisors who are qualified music therapists warrant attention. Cross-national surveys are recommended in the future to enable larger sample sizes and comparisons between those who do and those who don't access supervision. We believe that the use of supervision is an important part of a music therapist's professional practice. It requires a framework containing clear guidelines and educational opportunities that can support both supervisor and supervisee in the maintenance and development of competent and ethical practice.

Appendix

(2) Professional supervision: a survey for Australian REGISTERED MUSIC THERAPISTS (formatting removed)

The aim of the following survey is to explore the past experiences and current trends of supervision practice for Australian music therapists. A definition of supervision has not been included so that you may answer these questions using your own understanding of what supervision entails for you individually.

Please note: The online version of this survey contains logic links that take the participant to the next applicable question based on his/her previous answer. For this hard copy, the links are indicated in italics.

This survey will take you approximately 30 minutes to complete.

1. What is your gender?

2. What is your age?

3. How many years have you been a practicing music therapist?

4. What is your level of education?

5. What other credentials do you maintain?

6. In what state in Australia or country do you practice?

7. Select the number of hours you currently work as a MT

8. Are these hours directly related to clinical work?

If no, then please state the type of work you are currently doing:

9. Please specify the clinical population with whom you most often work

10. Please indicate the theoretical orientation from which you most often work.

11a). Please identify any of the following support systems you have used or are currently using for your own professional development.

11b). Which one do you receive the most benefit from and why?

11c). Which of these support systems are you no longer currently using and why?

12. In relation to # 11, please describe the workings of each system you highlighted, i.e., frequency, costs, venue.

If you ticked supervision, there is no need to make further comment on this support system at this time.

13. Do you currently participate in some form of professional supervision? (If no go to # 15)

14. Is this supervision provided by a music therapist? (If yes, go to #17) (If no, go to #16) (If both MT and non MT go to #16)

15. When was the last time you participated in some form of supervision? (please label the type of supervision experienced ie peer, individual, group, and the type of professional who led the supervision (Go to # 21)

16. In what field is the person (non music therapist) from whom you receive professional supervision?

17a) Why do you receive professional supervision from this person? For those receiving supervision from both MT and non MT, tick 'other' and give details of both types

17b) What process did you use to select this supervisor?

18. Please give some details about this supervision (MT or non-MT), i.e., frequency, costs, venue, type of supervision

19. Please identify the theoretical model/framework used most often in your supervision sessions (if more than one, please rank from 1-5)

20. Does this supervision from a MT and/or non-MT meet your supervision needs? (If needs are met go to #24) (If needs unmet go to #23)

21. Please indicate why you do not currently participate in professional supervision

22. If this past experience of supervision was a negative one for you, please describe what would have assisted in changing this experience to a more positive one? (Then go to #25and continue with survey)

23. If no, please comment on why you feel that this supervision does not meet your supervision needs?

24. Why do you participate in supervision? Please list/describe your reasons

25. How has your supervision changed since you first commenced having supervision sessions?

26. Name three features of a positive supervisory relationship/process you have experienced:

27. Name three features of a negative supervisory relationship/process you have experienced:

28. Describe a key pivotal moment in your supervision experience (from the perspective of the supervisor or supervisee) where a significant change (positive or negative) occurred in the process. What happened in the leadup to this pivotal point and how did the supervisory process change afterwards?

29. Do you think music therapists should only access supervision if they are working clinically? Please explain your answer.

30. Do you provide supervision to any staff? If yes, please describe the type of professionals you provide this service to:

31. On a scale of 1 to 5, how important do you think it is that professional music therapists receive some form of supervision?

32. Please feel free to add any comments that you would like to make related to professional supervision. (Please remember not to make any comment that will identify you personally)

Thank you for your time in filling out this survey.

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Jeanette D. Kennelly GradDipMThy

School of Music, The University of Queensland, Australia

Felicity A. Baker PhD

School of Music, The University of Queensland, Australia

Kylie A. Morgan PhD

School of Music, The University of Queensland, Australia

Barbara A. Daveson PhD

King's College London, Department of Palliative Care, Policy and Rehabilitation, School of Medicine, Cicely Saunders Institute

(2) This survey has been adapted with permission from Jackson, N. (2008). Professional music therapy supervision: a survey. Journal of Music Therapy, 45(2), 192-216.

A response to Kennelly, Baker, Morgan and Daveson's article. (AJMT 2012, Vol 23)

It is quite exciting to see how much attention music therapy supervision has received over the past 10 years. The early publications on music therapy supervision focused on the practice of supervision and the theories on which those practices were based. Clinicians wrote about their models of music therapy supervision, they discussed how and when to use experiential or didactic methods in supervision, they described how knowledge in other fields, from feminism to psychology, influenced their practices or theories. More recent publications, such as this one, have focused on examining, measuring, and evaluating what is actually happening, not just what we think is happening. Do clinicians access supervision? Do they think it is important? Who is providing supervision? Is it helpful? This move from theory and practice to actual research is important in furthering our understanding of supervision.

This current study uncovers some important information regarding attitudes toward supervision. It is interesting that while none of the respondents thought supervision was "not necessary" a small number thought it was necessary only when there was a problem or if one works with "certain populations." This attitude is in stark contrast to what I think most supervisors and music therapy educators believe--that supervision is a life long process that not only helps one do good enough therapy but also prevents burn out and increases one's career life expectancy. It is also, as pointed out by the authors, in contrast with various music therapy associations who encourage supervision or consider "normal" to have ongoing supervision.

This leads to another point that the authors make regarding the power differentials that can occur in supervision. It is different to accesses supervision on site, from an immediate supervisor, rather than off site with someone not connected with the employer. Certainly further study of what issues music therapists are willing to bring to supervisors in these different settings would be useful.

Furthering that idea, this study reignited my curiosity about the differences between music therapy and non-music therapy supervisors. Having received and provided supervision that was in a traditional verbal format and supervision, which included the arts, I'm well aware of the differences of how issues can be explored and believe that this article provides momentum for further exploration of that issue.

The authors' discussion of the schism between what is recommended regarding supervision and what happens in practice is important. Their recommendations for increasing access to music therapy supervision, replicating the study with more participants, balancing the number of research participants who do and do not receive supervision are all appropriate and useful avenues. I hope to see more studies like this as we increase our knowledge base about music therapy supervision.

As with any good study, one is left with more questions than answers! This study has filled in important landscape around the topic of music therapy supervision and identified future directions of research.

Michele Forinash DA, MT-BC, LMHC

Lesley University, Cambridge, MA USA