Challenges of working with people aged 60-75 years from culturally and linguistically diverse groups: repertoire and music therapy approaches employed by Australian Music Therapists.

Baker, Felicity ; Grocke, Denise

Introduction

The purpose of this paper was to report on the repertoire RMTs employ during their work with people aged 60-75 years as well as gain a picture of the issues involved in working with people from culturally and linguistically diverse (CALD) groups. Studies have shown that the most appropriate repertoire for older adults comprises selections that were popular during the era that correlated with their early 20s and early 30s (Bartlett, 1980; Gibbons 1997; Jonas 1991; Lathom, Petersen, & Havelick, 1982; Moore, Straum, & Brotons, 1992). Since the 1980s, many music therapy practitioners in Australia have been using two music books, the Ulverscroft Large Print Song Book, Music edition, volumes 1 (Ulverscroft, 1983) and 2 (Donald, 1987) which provided clinicians with repertoire appropriate for use in aged care settings. This collection of music has chiefly included songs popular in the 1900-1930s, suitable for those now 100 years of age or more and focused almost exclusively on music relevant to people from Anglo-Celtic backgrounds (English, Welsh, Scottish, Irish, and [white] Australians). At the time the Ulverscroft books were collated, these songs were relevant for use in nursing home settings and served music therapists well. However, these resources are becoming increasingly inadequate in serving the age and cultural background of today's aged care facilities. People today aged 60-75 were born 1932-1947, and would typically prefer popular music from 1950-1970.

Recently, Vanweelden & Cevasco (2007) surveyed American music therapists and asked them to identify the top 10 selections in five musical categories appropriate for music therapy work with older adults. The method did not specify the age group that the repertoire was intended for; the sole criterion was that the therapists were working with geriatric clients. One hundred and fifty five music therapists responded identifying 522 songs in five categories: popular songs, n=222; patriotic songs, n=32; hymns, n=76; folk songs, n=101; and musicals, n=91. The analysis showed that for the popular song category, 20% of the songs were published before 1910, i.e. this indirectly suggests that around 20% of the clients they were servicing were well over 100 years of age, an unlikely event given the average length of life in 2005 was 77.9 (Centers for Disease Control and Prevention, 2007). It is not clear from their findings why clinicians were not employing the most age appropriate music for their clients.

In reviewing the extensive list presented by Vanweelden & Cevasco (2007), it was noticeable that only 11 of the 522 music selections (2%) were in languages other than English (Table 1). This is rather surprising given the significant proportion of CALD groups in America. For example, a Census in 2000 found that 31 million people (11.1% of the total population) were born outside of America, 52% from Latin America, 26% from Asia, and 16% from Europe (Malone, Baluja, Costanzo & Davis, 2003). Top 10 countries of origin were Mexico, China, Philippines, India, Vietnam, Cuba, Korea, Canada, El Salvador and Germany. Further, 18% of the population spoke languages other than English at home with Spanish and German being the most common languages after English. It is unclear why only a small number of music selections were of non-Anglo-Celtic origin.

In 2003, the Australian Government reported that 43% of the population was born overseas or had a parent born overseas (Aust Government, 2003). A report by Price (1999) found that while 68% of Australians were from Anglo-Celtic origin, 13.8% were from European ethnicity and 11.8% from Asian ethnicity. A 2004 report (ABS, 2004) found that 33% of the Australians aged 65 and over were born overseas. Of these people, 33% were born in England, 13% in Italy, 5% in Greece, 4% in Germany or the Netherlands, 3% in New Zealand, China, or Poland, and 2% in India, Yugoslavia, Malta, Croatia, Ireland or Vietnam. Twenty percent were from other countries including Hong Kong, Philippines, Malaysia, and Lebanon. The Commonwealth Government is committed to supporting and developing a multicultural Australia ensuring that strategies are implemented to maximize cultural diversity (NMAC, 1999) and perceiving "inclusiveness" as a core principle (Australian Government, 2003). One recommendation arising from the National Multicultural Advisory Council (NMAC, 1999) states "all programs should be adjusted to address disadvantage or loss of entitlement arising out of ethnicity or cultural differences, just as other forms of disadvantage suffered by individuals or groups relative to other Australians are addressed" (p.21). This suggests that music therapists need to have a repertoire of appropriate songs for use with people from CALD backgrounds. Access and equity were part of the Government's strategic directions in 2003-2006 (Aust Government, 2003). To this end, the authors constructed a survey to address this need. As previously mentioned, the purpose of this paper was to report on the repertoire RMTs employ during their work with people aged 60-75 years as well as gain a picture of the issues involved in working with people from CALD groups. The questions posed were:

1) To what extent are Australian music therapists working in aged care facilities with people from CALD groups?

2) What repertoire do Australian music therapists provide for clients aged 60-75 years from Anglo-Celtic and other CALD groups?

3) What are the ranges of responses people aged 60-75 years from CALD groups show when receiving music therapy?

4) What are the ranges of techniques Australian music therapists use when working with people from CALD groups?

5) What are the main challenges Australian music therapists face when working with people from CALD groups?

Method

The Survey

The survey comprised a combination of 15 open and closed-ended questions and was divided into two parts. Part 1 focused on the identification of repertoire usage in general. Part 2 focused on trends in repertoire for specific CALD groups and approaches for working with these groups. Questions 1-5 sought information about respondent demographics including gender, age, state/territory of employment, hours of work with people aged 60-75 years and questions 7-9 sought information about the type and frequency of serviced CALD groups. Questions 11-15 were open ended questions addressing clinicians' experiences of working with people from different CALD groups. Question 6 asked respondents to list the "top 10" music selections for five music genres; popular songs, patriotic songs, hymns, folk songs, and musicals, in line with those requested of respondents in Vanweelden & Cevasco's (2007) study. In addition, question 10 asked respondents to list the "top 10" music selections for each of the CALD groups they had previously indicated working with within their workplace. It needs to be reinforced here that they were asked to list musical selections adopted with those in the 60-75 year age bracket. With the aging of the "baby boomers", the researchers considered knowledge related to this age group crucial so that clinicians can anticipate the types of repertoire needed and challenges that they will face in the future. The survey was piloted with two music therapists working within the aged care sector and no changes to the original survey were made. It was estimated that the survey took approximately 20 minutes to complete.

Recruitment of Respondents

Following ethical clearance for The University of Queensland's Ethics committee (#2007000123), responses were sought from Australian clinicians practicing in the aged care/palliative care sector. In October 2007, invitations to participate were distributed via email to members of The Australian Music Therapy Association by the administrators of the Association. Four weeks were given for responses. A reminder email was sent one week before the given deadline. Two weeks after the deadline, an additional reminder was sent extending the deadline by a total of three weeks to maximize the response rate.

Within the distributed email, respondents received three attachments:

1) an information sheet indicating the purpose of the study

2) a consent form

3) the survey

Respondents were asked to download the attachments and either complete and return electronically, or print and return them to the researchers via post.

Data

Quantitative Data

All data pertaining to the song selections identified as frequently chosen by RMTs were stored on a password protected PC owned by author 1. Descriptive statistics including means, standard deviations and frequency counts were used to generate the results.

Qualitative Data

Responses to each of the open-ended questions for each of the CALD groups were transcribed. Author 1 had multiple readings of the data and began to identify the concepts described in the data. Data from these concepts were then reviewed and grouped together to form major themes. These themes were partly guided by the initial research questions and open ended survey questions. Once themes were identified, author 2 verified the themes, subcategories, and respondents' responses.

Results

Respondents

According to the AMTA 2007 directory, 83 RMTs were identified as working in aged care and adult palliative care and received an invitation to participate in the study. Eleven RMTs contacted the researchers indicating that they no-longer worked with people in aged care leaving a total pool of 72. Twenty-four RMTs responded (21 female and 3 male), a 33% return rate, equivalent to that of Vanweelden & Cevasco's (2007) study. Nine responses were returned electronically and 15 respondents returned hard copies by post. The largest group of respondents were in the 51-65 year old age group, had at least 10 years clinical experience and came from either Victoria or Queensland (Table 2). RMTs worked an average 18.0 hours per week in aged care (SD=10.2 hrs, range 2-38hrs). On average 24% (SD=20.4, range 1-70%) of clients serviced were from cultures other than Anglo-Celtic.

From the 24 responses RMTs reported providing music therapy to between 1-15 different CALD groups (NT=127; Mean = 5.6; SD = 3.6). Results indicated that RMTs provide music therapy for Italian clients/patients more frequently than any other ethnic group (70.8%, n=17) and 58.3% (n=13) of RMTs identified Italian people in the top 3 groups most frequently seen (see Table 3). Fifty percent of RMTs provided music therapy to people from Greece, Germany, and the former Yugoslavia. The final column of Table 3 indicates that while some respondents identified working with certain cultural groups in part 1 of the survey, only a proportion of the respondents completed part 2 of the survey, as detailed in the last column. For example, 17 respondents indicated they provide music therapy services to Italians but only 13 of these respondents completed part 2 of the survey. Therefore, for some CALD groups, data on song selections and culturally specific approaches to therapy were limited or not provided at all.

Song Selections Chosen by RMTs

Tables 4-8 provide a comprehensive list of the songs that RMT respondents identified as most often chosen for people aged 60-75 years irrespective of cultural background. The most frequently endorsed selections of popular songs, religious music, patriotic songs, folk songs, and musicals are listed at the top of the tables with subsequent selections presented in alphabetical order. Numbers in brackets following some music selections indicate that more than one respondent endorsed that selection. For popular songs (Table 4), 142 different selections were identified. Thirty-eight songs (27%) were listed by at least two respondents. Fifteen (11%) were songs in languages other than English, seven of these being Italian. Seventy-four (52%) were songs that were released post-1950 or recorded and made popular by artists from 1950 onwards; where known, the year in which these songs were released is listed after the song title.

Table 5 reports on religious repertoire. Sixty-four selections were listed and 22 (34%) were listed by at least two respondents. Only 5% (n=3) of these selections were in languages other than English and 100% of selections were hymns of Christian faiths. No other religious denominations were represented.

Table 6 reports on patriotic songs with 93 selections listed, and 34 songs (37%) listed by at least two respondents. Songs in languages other than English were well represented (n=48, 52%).

Folk songs totaled 81, and 24 of these (30%) were listed by two or more respondents. Twenty songs (25%) were in languages other than English.

Among all the genres, musicals contained the most uniformity in responses. Forty-six songs were listed by respondents and 21 (46%) were listed by at least two respondents. A number of respondents did not list specific songs but listed the musicals: Cabaret, Carmen, Calamity Jane, Grease, High Society, Joseph and the Techicolour Dreamcoat, Les Miserables (2), Lion King, Mary Poppins, Merry Widow (4), My Fair Lady (4), Oliver, Okalahoma (2), Showboat, Sound of Music (6), South Pacific (5), The King and I (3), The Phantom of the Opera (3), Three Penny Opera, and West Side Story (4).

The music selections listed by respondents identified for specific cultural groups are detailed in Table 9. The number of songs for each group varied with the greatest number listed for the Italian (n= 28) and German (n=17) populations. Very few were listed for Spanish and Russian populations and no respondents listed music selections for Vietnamese, Hungarian, Austrian,

Turkish, Filipino, Baltic or Nordic groups, Egyptian, Sri Lankan, Ukrainian, or Romanian populations, despite these being listed as CALD groups seen by respondents.

Analysis of Responses to Open Ended Questions

Questions 11-16 of the survey asked RMTs to comment on their work with CALD groups, and in particular, if there were similarities in the way people of those cultures responded to music, and what the RMT had learnt from working with particular cultural groups. A thematic analysis of the responses generated 32 categories, which were then grouped into seven main themes, namely:

Client responses may vary

1) Some clients seem to be more animated and active in their participation (Yugoslavian, Greek, Dutch, and Italian)

2) Some clients seem to be more reserved and appear to be passive participants (Polish, Russian, German, Chinese)

3) Some client groups do not have general responses that can be linked to cultural background (Greek, Italian, Maltese).

Responses may be musical and non-verbal

1) Expressive body language is apparent when experiencing something meaningful (Italian, Greek, German, Spanish, Russian)

2) Non-verbal responses are influenced by type of music (Italian)

3) Some clients will sing expressively (Italian, Yugoslavian)

4) Clients will use culturally specific greetings and demonstrations of appreciation (Italian, Dutch, Hungarian)

5) Clients physically engage in the music (Greek, Chinese)

6) Culturally specific music can facilitate positive and meaningful responses. (Polish, German, Chinese)

Clients from different backgrounds have varied relationships with music

1) Clients can connect with song/sound source (Italian)

2) Clients' repertoires include songs in languages other than their first languages (Greek, German)

Family influences are evident

1) Family perceptions can present challenges to the therapy process (Italian, Greek)

2) Family involvement in music therapy may occur for European cultures (Italian, Greek, German, Russian)

Therapy approaches are varied

1) Creating a connection is important (Italian, Greek)

2) A knowledge of the music and its culture can facilitate rapport building. (Italian, Maltese, Greek, Polish, German, Chinese, Vietnamese, Yugoslavian, Lebanese, Islanders)

3) Building rapport with people from different cultures can take time (Italian, Maltese, Greek, Polish, German, Chinese, Vietnamese, Yugoslavian, Lebanese, Islanders)

4) Piano accordion (Greek, German, Russian, Yugoslavian), vocals (Italian, Chinese), and guitar (Italian, Chinese) facilitate the best responses

5) Greater use of non-verbal communication is needed when working with different cultural groups. (Italian, Greek, Lebanese, Vietnamese, Dutch)

6) Non language-based interventions are suitable when working with different cultural groups (Italian, Maltese, Greek, Polish, German, Chinese, Vietnamese, Hungarian, Yugoslavian, Lebanese, Islanders)

7) Cultural specific approaches are used when working with different cultural groups (Italian, Maltese, Greek, Polish, German, Chinese, Vietnamese, Hungarian, Yugoslavian, Lebanese, Islanders)

The appropriateness of music therapy interventions is varied

1) Improvisation is useful when working with people from diverse cultural groups (Italian, Maltese, Greek, Polish, German, Chinese, Vietnamese, Hungarian, Yugoslavian, Lebanese, Islanders)

2) Dancing and movement are appropriate for people from Greek backgrounds

3) Reminiscence is a useful technique with CALD groups (German)

4) Humour in sessions can be appropriate for some cultural groups (Dutch)

5) Songwriting is not useful for clients who have no English skills (Chinese)

Many factors impact on the development of the therapeutic relationship

1) Language barriers can challenge the development of the relationship (Italian)

2) Cultural empathy is necessary for the development of the relationship (Italian, Maltese, Greek, Polish, German, Chinese, Vietnamese, Hungarian, Yugoslavian, Lebanese, Islanders)

3) Understanding the music and the context with which it is used is important (Italian, Maltese, Greek, Polish, German, Chinese, Vietnamese, Hungarian, Yugoslavian, Lebanese, Islanders)

4) People from some cultural groups may feel uncomfortable speaking in English (German)

5) Using culturally appropriate greetings and learning some words in their language can help facilitate the development of rapport (German)

6) Differences in personal space/boundaries between RMT and client can challenge the development of rapport (Chinese, Dutch)

Discussion

Song Selections Chosen by RMTs

There were 444 songs listed in Tables 4-8, but only 152 (34%) were published in the Ulverscroft books. This suggests that while the Ulverscroft books may still be useful for older residents, clinicians need to source repertoire from elsewhere to ensure they have songs to cater for the changing demographics of the nursing home residents. Most of these songs published in the Ulverscroft books predate the 1950s which suggests that they are becoming less relevant to RMTs working with residents aged 60-75. These findings suggest that music therapy educators in Australia and music therapy clinical training supervisors should encourage music therapy students to expand their repertoire to include more songs post 1950.

Compared to the findings of Vanweelden & Cevasco's (2007) study, the incidence of songs in languages other than English are substantially higher, representing 20% of all songs when compared with only 2% in the US study. To be patriotic is to feel and express a love for one's country, and 42% of the songs listed in the "patriotic" category were in languages other than English, which suggests that music therapists aim to support older Australians in feeling connected with their original homeland or cultural ancestry. When compared with the findings from Vanweelden & Cevasco's (2007) study, this is quite a significant difference. To be "patriotic" in the United States seems to correlate with singing American songs. In the present study, only three of the most frequently endorsed songs were Australian: "Waltzing Matilda", "I still call Australia Home", and "Home among the Gum trees".

For the songs used with specific cultures, there were a number of songs in Italian/Maltese, German, Polish, and Dutch which is to be expected given that there are greater numbers of people from those cultural groups within the total population of people over 60 years of age when compared to other CALD groups. However, songs known in Cantonese/ Mandarin (Chinese), Russian, Vietnamese, Yugoslavian and Indian were limited. It is clear that there is a significant gap in music therapists' repertoire for songs in these languages. And considering each of these groups make up 2-3% of the population, they are not significantly less represented than the other countries (between 4-5% of the population) in the overall 60+ populations.

The repertoire reported did not contain songs from African, Middle Eastern, and some Eastern European nations, and there was no repertoire suitable for Aboriginal or Torres Strait Islanders. First, it might suggest a small number of residents from these countries reside in the facilities employing a music therapist. Alternatively, RMTs may not select songs for these CALD groups because they may be unfamiliar with their repertoire, and perhaps more importantly, be unsure about the appropriate context in which the repertoire from these cultures are used. Or might it be that they have difficulty with the pronunciation of the lyrics? The best outcomes of therapy are dependent upon using the most appropriate repertoire to connect with our clients, and this is likely to be songs in different languages. These findings suggest that more emphasis be placed on learning repertoire in foreign languages within the music therapy training programs and with more emphasis placed on this as a competency required for AMTA registration.

The findings reported in this survey also indicate that music therapists know a large range of religious repertoire suitable for Christian clients. There were no suggestions of religious repertoire suitable for people identifying themselves as Muslim, Hindu, or Buddhist. It should be noted that some religions (e.g. Islam) do not use singing as part of their religious faith rituals, however a more inclusive awareness of other religions may be needed for RMTs practicing in multi-faith contexts.

A greater understanding of the preferred music of all Australians, and the impact that culturally relevant music has on the effectiveness of music therapy programs, is needed. It is recommended that future research be undertaken to discover the context in which culturally specific repertoire is appropriate. For example, it is understood that certain Australian songs, particularly those meaningful to war veterans, should be used with caution and the music therapist should have some prior understanding of the meaning of those songs before used in practice. The same caution should be emphasized with music from different cultural backgrounds. It is important to understand what the song is about, and what meaning it might have to a person, before it is played.

Music Therapy Approaches with CALD groups

The qualitative data provided the authors with insights into the challenges and experiences of RMTs when they work with people from a range of CALD groups. Most importantly, the themes that emerged indicate that responses of people from various cultural groups are not stereotyped and that clinicians need to be open to a range of potential responses. Cultural empathy is called for as clients' personal and cultural reality, and the norms associated with that cultural group, may be very different to that of the practicing clinician (Brown, 2002; Forrest, 2002). Many comments indicated that it was difficult to make definitive statements, as the symptoms (particularly of dementia) may have influenced the degree or quality of response. One description that best captured the art and challenge of working in a multi-cultural context was the following:

 There is a quality so characteristic of this age group of Russians
 that perhaps you could describe as a combination of emotional
 strength and a pride tempered with reserve. Sharing with them songs
 from their past was very deeply felt and appreciated. With one
 woman, a strong bond was created. The first time I played
 Odnovoochaya gremit kololchik for her, tears streamed down her face
 ... she seldom let me play it again for her. It was clear that the
 song touched her in a way that made her vulnerable and she didn't
 know how to handle it.

While it is desirable for RMTs to be able to play songs from a client's homeland, an emotional response may indicate deeply held emotion. The parallel challenge is to then talk with the client about the meaning of the song. If the client has little English, a meaningful discussion may not be possible, which then raises the discomfort a RMT might experience in not being able to process the response appropriately.

A different type of response was reported by a RMT working with Dutch residents:

 While some Dutch elderly seem very reserved at the first encounter,
 once trust is developed, Dutch elderly can be quite 'physical' in
 contact, for example hugging, kissing on both cheek and on the
 lips, holding therapist's waist, etc. There are many occasions when
 my Dutch clients explain to me that their 'lips are clean' and they
 are European, and 'kissing is normal!'

Other examples of active physical responses included comments on working with Italian residents who, "nearly always sing--no matter how frail or cognitively impaired and more demonstrative with thanks, appreciation, kisses." And with Greek residents, "a lot more spontaneous physical movement such as clapping and dancing."

The influence (both positive and negative) families may have on the music therapy process was noted by a number of RMT respondents. In particular, the RMT needs to "be prepared to include relatives in sessions" when working with people from Italian, German, Russian, and Greek backgrounds. One respondent wrote:

 Families particularly appreciate the RMT using Italian songs and
 making the effort to learn a few greetings and simple words in
 their language. They are delighted to see their loved one doing
 something meaningful.

Creating a connection was identified as important in developing rapport with clients. One RMT suggested this can be achieved by finding a "common space where the therapist and client can work together--a place of shared interest"; another RMT indicated that acknowledging and communicating the similarities and differences between the cultures of the RMT and client assists in creating the connection with the client. This response may suggest that clients are responsive to music therapists when their cultural backgrounds are acknowledged, valued and validated.

When language barriers inhibit the development of rapport between the therapist and client from CALD backgrounds, a number of RMTs employed non language-based interventions including "activities like balloon throwing, choice of Classical music; utilize props like soft toy, painting, photograph" to "compensate [for] the language barrier between therapist and client."

One respondent indicated that understanding the music and the culture is important in the development of rapport:

 Making a connection is about a lot more than just knowing people's
 music: it's about understanding how music is used within their
 context, who sings/plays different styles of music, the
 social/cultural function of the music, whether it is appropriate to
 use it within the context of MT.

This suggests that music therapists, who work in aged care facilities with high proportions of people from CALD backgrounds would benefit from a sound knowledge of the musical practices of people from around the globe. Brown (2002) argues that music therapists should have sound knowledge of the role that music has had in their clients' personal life and culture.

The concept of a client's "patriotism" towards the former homeland or in contrast, towards Australia, is one that RMTs may need to consider. In some instances, clients may be "strong in their opinions and patriotism [of their homeland], so a consistently neutral position and approach may be required, meeting them in their enthusiasm and patriotic pride." In another case, the client had "assimilated the Australian culture very well. Up to now she doesn't show significantly [the] need for recalling German songs." This suggests that RMTs can not assume that the client will want to hear songs from their country/culture of origin, they may indeed choose to hear songs that they associate with being Australian. Consequently, the RMT should liaise closely with the family to determine what repertoire is most appropriate for each specific client if the client is unable to express choices for themselves.

A further aspect of working with people from CALD groups is that there may be differences between therapist and client with respect to acceptable personal relationships. One respondent wrote:

 Patterns of relationship (e.g., young female therapist visiting
 elderly male client)--I have observed this with some European and
 some Asian cultures--sometimes require a 'chaperone' within a
 session. It is sometimes considered inappropriate for me to ask
 questions that may be deemed irreverent, too personal or only to be
 asked by an older person, or a person of the same gender. However,
 this also varies greatly from one person/family to the next.... I
 am sometimes considered to be too young to be a 'healer'(therapist)
 for the person who is sick/dying.

While music therapy training might highlight the need for music therapists to respect and be aware of factors/boundaries/issues that impact on what is possible within music therapy sessions, more detailed understanding about age and gender issues, as well as how health is understood by different cultures, would enable music therapists to be more culturally sensitive.

Limitations and Recommended Future Research

Both the qualitative and quantitative data in this study have been sourced from only 24 respondents. Given this small number of respondents, trends in relation to song selections for different CALD groups and themes relating to the ways clinicians practice with different CALD groups should be viewed with caution. These findings suggest that a greater cultural awareness of concepts of health, family, therapeutic relationships, and musical practices are necessary to ensure RMTs are meeting the needs of the aging Australian population. Music therapy research in this area has been largely absent. Thorough investigations into the factors and dimensions of music therapy practice that affect clients from CALD groups are needed so that RMTs can provide culturally sensitive programs.

Conclusions

The results of the survey reported here indicate that a broad repertoire of songs is needed to serve the needs of older Australians. A substantial repertoire of songs post 1950s is needed as the large population of "baby boomers" reach ages where they are in need of supported accommodation. Songs of Buddy Holly, Bill Haley and the Comets, Elvis, The Beatles, Bob Dylan, and Simon and Garfunkel, will be repertoire that will become increasingly important in the coming years of music therapy practice. Further, this study highlighted that music appropriate to CALD groups and those of non-Christian religions is needed to ensure that multiculturalism within the nursing home environment is promoted. Culturally specific music that is familiar and meaningful (within what may be experienced as an otherwise confusing and unfamiliar environment) can assist people to feel connected with their culture and homeland (Bright, 1997). Music therapists are encouraged to expand their current repertoire so that they can best meet the needs of their clients in nursing home care.

Results from the qualitative analysis also indicate that music therapists need to be aware of multi-cultural approaches when offering music experiences, and in responding within a culturally appropriate manner. The arena of multi-cultural music therapy promises to enrich the professional practice of music therapists and to further expand the ever increasing range of song repertoire needed today.

Acknowledgements

A special thanks to the Australian Music therapy association for distributing the surveys, Richard Thompson and Michelle-Arthy Chan for piloting the survey, and the 24 RMTs who completed the survey.

References

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Donald, M. (Ed). (1987). The second Ulverscroft large print song book. Music edition. Anstey, England: F.A. Thorpe Publishing.

Forrest, L. C. (2002). Addressing issues of ethnicity and identity in palliative care through music therapy practice. In C. Kenny & B. Stige (Eds.). Contemporary voices in music therapy: Communication, culture, and community (pp. 67-82). Oslo, Norway: Unipub forlag.

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Felicity Baker PhD RMT

The University of Queensland, Brisbane

Denise Grocke PhD RMT

The University of Melbourne, Melbourne

(1) Editorial Note: The first author of this article is currently the editor-in-chief for the journal and therefore Dr. Katrina McFerran took responsibility for overseeing the review process of this article.

Table 1.
Songs in languages other than English
from Vanweelden & Cevasco's (2007) study.

SONG LANGUAGE

Guantanamerra Spanish
La Legenda del Piave Italian
O Bella Ciao Italian#
Hava Nagila Yiddish
Jambalaya Spanish
Tu Scendi dalle Stelle Italian

Hevenu Shalom Alechem Yiddish
Cielito Lindo Spanish
De Colores Spanish
Frere Jacques French
Quel Mazzolin di Fiori Italian

# this song has been translated into a number
of other European, Asian, and Middle Eastern languages

Table 2
Background Data on Respondents and Multicultural Groups.

Age of n Years n States n Multicultural n
RMTs clinical groups receiving
 experience music therapy

20-30 7 <2yr 5 Victoria 11 <1 per month 0
31-40 6 2-5yr 6 NSW 2 1-2 per month 1
41-50 3 6-10 3 QLD 8 1-2 per fortnight 2
51-65 8 10+ 10 SA 3 1-2 per week 8
 1-2 per day 3
 > 2 per day 9

Table 3
Multicultural Groups for whom RMTs provide Music Therapy.

Country Total n and % of Rs ranking n of Rs who
 Numbers (n) the group in top 3 completed
 and% of part 2
 Respondents
 (Rs)

Italian 17 71% 14 58% 13
Greek 14 58% 9 38% 8
German 12 50% 6 25% 10
Yugoslav 12 50% 5 21% 5
Polish 10 42% 4 17% 8
Chinese 8 33% 4 17% 4
Russian 7 29% 1 4% 2
Maltese 7 29% 3 13% 2
Vietnamese 6 25% 0 0% 2
Dutch 4 17% 2 8% 2
Hungarian 3 13% 1 4% 1
Spanish 3 13% 2 8% 2
French 3 13% 1 4% 2
Lebanese 3 13% 0 0% 2
Islander 2 8% 1 4% 2
Austrian 2 8% 1 4%
Turkish 2 8% 0 0%
Pilipino 3 13% 0 0%
Sth African 2 8% 0 0%
Baltic 2 8% 0 0%
Nordic 4% 0 0%
Sri Lankan 4% 1 4%
Egyptian 4% 0 0%
Ukraine 4% 0 0%
Romanian 4% 1 4% 1
TOTAL 127 66

Table 4
Popular Songs chosen by RMTs for 60-75 year olds

Most frequently chosen popular songs

Que sera sera (8) 1955
(Whatever will be)
* Love me tender (6) 1956
You are my sunshine (6) 1940
It's a long way to Tipperary (5) 1912
When Irish eyes are smiling (5) 1912
* Edelweiss (5) 1959
Daisy (4) 1892
Show me the way to go home (4) 1925
* Country roads (4) 1971

A-Z
Alice blue gown 1919
April showers 1921
Always 1925
* Are you lonesome tonight (3) 19501
Amazing grace (2) (Trad)
Annie's song (2) 1974
Anniversary song 1946
A nightingale sang in Berkeley square 1940
* Arriverdeci, Roma 1955 (Italian)
As time goes by 1942 (from "Casablanca")
* Banana boat song 1951
* Blueberry hill 195 62
Blue moon (3) 1934
* Blue suede shoes 1955
* Blowing in the wind 1963
* Bridge over troubled water 1970
Buttons and bows 1948
Bye bye blackbird (2) 1926
Bye bye love 1957
Cabaret 1966
Calabrisella mia (Italian)
* Can't help falling in love 1961
* Catch a falling star 1957
* Cara mia 1954 (Italian)
* Charmaine 19513
Click go the shears Folk song 1910-1920
* Close to you 1963
* Cotton fields 1958 4
Dancing cheek to cheek 1935, from movie "Top Hat"
Danny boy (3) 1913
Deep purple 1934
Don't fence me in (2)
* Don't cry for me Argentina 1976
* Dr Zhivago theme 1965
* Everyday 1958
* Fascination 1957
* Fernando 1976
* Fly me to the moon 1954
For the good times 1970
* Get me to the church on time 1956
* Georgie girl 1966
* Girl from Ipanema 1962
Good night sweetheart 1931
* High noon 1952
Home on the range 1870
* I can't help falling in love 1961
* I did it my way (3) 1967
If you were the only girl in the world 1916
* Imagine 1971
In the good old summertime 1949
I'm forever blowing bubbles 1918
I love a lassie 1905
It's a most unusual day 1948
Islands in the sun
I wonder who's kissing her now 1909
John Brown's body (Trad)
Kiss me goodnight Sgt major 1939
* La preghiera (the prayer) (Italian) 1999
La Spagnola (Spanish)
* Leaving on a jet plane 1967
* Let it be(2) 1970
Let me call you sweetheart 1910
Lilli marlene(2) 1943
* Love goes on 1991
* Love letters in the sand 1957
* Michelle 1965
* Moon river 1961
* Morning has broken 1971
* Morningtown ride (2) 1966
* Mull of Kintyre 1977
* Muss ich denn(wooden heart)(2) 1960
(German)
* My blue heaven 1957 5
* My Diane 1978
Night and day 1932
Now is the hour
Oh what a beautiful morning (2) 1943/1955
O mio babbino caro (Italian)
* One day at a time 1975
* One of us 1981
Pack up your troubles (3) 1915
Paper doll
* Perhapslove 1975
* Plaisir d'amour 6 (French)
Pije kuba
* Under the boardwalk 1964
* Unforgettable(2) 1951
Waltzing Matilda (2) (Trad)
* Waterloo 1974
* What a wonderful world (3) 1967
When I grow too old to dream (2) 1935
When the red red robin 1926
Wish me luck (3) 1939
* Pub with no beer 1957
* Put another nickel in 1951
* Ramona 1964
Reginella campagnola (Italian)
Red river valley
-7 * Red sails in the sunset
* Rock around the clock(2) 1952
Roll out the barrel(2) 1934
* Ruby Tuesday 1966
Santa Lucia (Italian)
She'll be comin' round the mountain (2)
Side by side
Silent night
* Six ribbons 1970
* Snowbird 1970
(When it's) Springtime in the Rockies 1929
Somewhere over the rainbow (2) 1939
South of the border 1939
* Stand by me 1961
* Tennessee waltz 1950
* That's amore 1952
* The lion sleeps tonight (2) 19528
* The music of the night 1997
* The loveliest night of the year 1950
* The very thought of you 9
* The way we were 1973
* Three coins in a fountain 1954
* Time to say goodbye 1995
* Too young 1951
* Top of the world 1973
Two little girls in blue
Two sleepy people 1938
* Unchained melody (2) 1955
White cliffs of Dover (2) 1941
* Wings of a dove 1983
* World of our own (2) 1965
Yak szypko
* Yesterday (2) 1965
You raise me up 2003
* You'll never walk alone (2) (10)
* Zorba's dance 1964 (Greek)

NOTES TO TABLE 4 Numbers in brackets indicate the number of
respondents reporting choosing this song for people aged 60-75
years. Songs preceded with an * indicate songs known to be popular
or released post 1950.

(1) 1926 Remake and made most famous by Elvis Presley

(2) 1940 but remade and made most famous by Fats Domino 1956 and
Elvis Presley 1957 and many others during the 1950s, 1960s, 1970s
and 1980s.

(3) 1926 song made famous in 1951 by Mantovani

(4) Made famous by the Johnny Cash (1962) The Seekers (1963), and
Beach Boys (1969)

(5) 1927 song made famous by Fats Domino in 1957

(6) 1931 song made famous by Rossi 1955, Marianne Faithfull 1965,
and Joan Baez 1968

(7) 1937 song made famous by Nat King Cole in 1951 and Fats Domino
in 1963

(8) 1939 song made famous by Pete Seeger in 1951

(9) 1934 song made famous by various people including Doris Day,
Bing Crosby, Nat King Cole, Billy Holiday, and Tony Bennett

(10) 1945 song made famous by Gerry & The Pacemakers, Frank
Sinatra, Judy Garland, Doris Day, Ray Charles, Elvis Presley, Kate
Smith, Olivia Newton-John, Tom Jones.

Table 5
Religious Selections chosen by RMTs for 60-75 year olds

Top religious selections
Amazing grace (20)
The lord's my shepherd (9)
What a friend we have in Jesus (9)
How great thou art (8)
Onward Christian soldiers (6)
Abide with me (5)
One day at a time (4)
Nearer my God to thee (4)
Morning has broken (4)
Jesus loves me (4)
When I survey the wondrous cross (4)
Ave Maria (3) (Latin)
Blessed assurance (3)
Guide me o thou great Jehovah (3)
Green pastures (23rd psalm) (3)
He's got the whole world in his hands (3)
Silent night (3)

A-Z
All people that on earth do dwell
All through the night
A new commandment
Away in a manager
Beautiful isle of somewhere
Because he lives
Be not afraid
Be still my soul
Be thou my vision
Bless this house, oh lord we pray (2)
Count your blessing
Eternal father
Freely, freely you have received
Great is thy faithfulness
Here I am Lord
His eye is on the sparrow
I come to the garden
I'd rather have Jesus
In the garden
Jesu joy of man's desiring
Jesus bids us shine
Just a closer walk with thee (2)
Kum by ya
Lead kindly light
Love divine all love's excelling (2)
Maryjo matko milosierdzia (Polish)
Michael row the boat ashore
O bella regina (Italian)
O come all ye faithful
O darne, kturys yest na nievie (Polish)
O God our help in ages past
Praise my soul (2)
Rock of ages
Shall we gather at the river
Sheep may safely graze
Swing low sweet chariot
Tell me the old old story
The holy city
The old rugged cross (2)
The church's one foundation
To be a pilgrim
Trust and obey
Turn your eyes upon Jesus
Whispering hope
Yes Jesus loves me
You'll never walk alone
You raise me up

Table 6
Patriotic Songs chosen by RMTs for 60-75 year olds

Top Patriotic Songs
Waltzing Matilda (17)
Santa Lucia (11) (Italian)
Still call Australia home (10) (1980)
Advance Australia fair (7)
White cliffs of Dover (5) (English, 1944) (1)
God save the Queen (5) (English)
O sole mio (6) (Italian)
Zorba's dance (3) (Greek, 1964)
Home among the gumtrees (4) (Australian)
La Marseillaise (French Anthem) (3)
God defend New Zealand (Anthem)(3)
Pote tin Kyriaki (Never on a Sunday, 3) (Greek, 1960)
Pub with no beer (3) (Australian, 1957)
I belong to Glasgow (3) (Scottish)
We are Australian (3) (1987)
Scotland the brave (3)
When Irish eyes are smiling (3)

A-Z
America the beautiful
And the band played Waltzing Matilda (Australian, 1972)
A nightingale sang in Berkeley Square (English, 1940) (2)
Arrivederci Roma (Italian, 1958)
Bei mir bist du schon (German, 1937)
Bella ciao (Italian)
Botany Bay (2) (Australian)
Bublichki (Russian/Yiddish)
Calabrisella mia (Italian)
Carnivale di Venezia (Italian) (2)
Collingwood football song
Danny boy (2) (Irish) (3)
Der Herder
De Zilveroot (Dutch)
Edelweiss (German 1965),
Fratelli d'Italia (Italian Anthem)
Funiculi funicula (2) (Italian)
Galway Bay (2) (Irish)
Greece hymn to freedom (Anthem)
Haralambis (Greek)
Hava nagila (Hebrew) (2)
Het Wilhelmus (Dutch Anthem)
Hey sokoly (Polish)
If you're Irish come into the parlor (2)
I left my heart in San Francisco (American, 1952)
I love to have a beer with Duncan (Australian)
It's a long way to Tipperary (2) (Irish)
Jamaica farewell (West Indies, 1956)
Jerusalem (1996)
Jeszcze Polska nie zginela (Polish Anthem) (2)
Kukutezcka, kuka (Polish)
Land of hope and glory (2) (English)
Land of our Fathers (Welsh Anthem)
La paloma (Spanish)
La vie en rose (2) (French, 1946)
Lilli Marlene (2) (English/German)
Lipa zelenela je (Slovenian)
Loch Lomond (Scottish)
Maggie (Scottish)
Matus moja matus (Polish)
Mull of Kintyre (Scotland, 1977)
My Bonnie (Scottish)
Northern lights of old Aberdeen (Scottish, 1950's)
Now is the hour
O du lieber Augustin (Austrian/ Viennese)
Pije kuba (Polish)
Podmoskovnye Vechera (Moscow Nights) (Russian, 1955)
Put vejin (Latvian)
Reginella campagnola (2) (Italian 1976)
Road to Gundagai (2)
Samiotissa (Greek) (2)
Siedz mity kogut (Polish)
Sto lat (Polish, Birthday song)
Star spangled banner (2) (American)
Tarantella (Italian Wedding Dance)
Tautiska giesme (Lithuanian Anthem)
Tenterfield saddler (Australian, 1972)
That's an Irish lullaby (1944) (4)
There'll always be an England (1940)
The girl from Ipanema (Portugese/ Brazilian, 1962)
The Lorelei (German, 1933)
The old bark hut (Australian, 1938)
The red, white and blue (American)
The road to the Isles (Scottish)
The white rose of Athens (Greek)
Till the boys come home (Australian)
Torna a Sorrento (3) (Italian)
Tinafto (Greek, 1957) (5)
Shche ne vmerla Ukrayina (Ukraine Anthem)
Vangelio (Greek, 1959)
Volare (Italian)
Volga boatmen (Russian, 1941)
We'll gather lilacs (English)
Muss ich denn (Wooden Heart, 1960) (German, 2)
Woyenko Polka (Polish)
Ye banks and braes (Scottish)

(1) Song popularized by 1944 movie The White Cliffs of Dover

(2) 1940 song popularized by various singers: Nat King Cole, Glenn
Miller, Harry Connick Jr.

(3) Several artists have recorded a version of this including Harry
Belafonte, Harry Connick Jr 1999, Tom Jones 1969, Elvis Presley
1976.

(4) 1914 song popularized by Bing Crosby in 1944.

(5) Popularized by the 1957 movie Boy on Dolphin, 1957

Table 7
Folk Songs chosen by RMTs for 60-75 year olds

TOP 10 Folk Songs
Oh Danny Boy (5)
Happy wanderer (4)
Waltzing Matilda (4)
I'd love to have a beer with Duncan (3)
A pub with no beer (3)
Home on the range (3)
Loch Lomond (3)
My Bonny (3)
Santa Lucia (Italian) (3)
Click go the shears (3)
The ash grove (3)
Blowin' in the wind (3)
Scarborough fair (3)

A-Z
Allouette (French) (2)
All through the night (2)
And the band played W'zing Matilda
An Irish lullaby
Annie Laurie (Scottish)
Annie's song
Botany bay
Bridge over troubled water
Cockles & mussels (2)
Coming thru the rye
Country road
Daisy Daisy
Early one morning (2)
Edelweiss
Flash Jack from Gundagai
Fuchs du hast die gane gestollen (German)
Greensleeves
Gypsy rover
Haida (Yiddish)
Hava Nagila (Yiddish)
I belong to Glasgow
I do like to be beside the seaside
I'll take you home again Kathleen
Jasmine Flower (Chinese, Mandarin)
Kalinka (Russian Gypsy)
Katusha (Russian/Ukrainian Gypsy)
Kumbaya (2)
L'inverno e Passato (Italian)
Le etait une bergere (French)
Love me tender
Maryanne
Maggie
Mexican hat dance
Morningtown ride (2)
Mr tambourine man
Muss ich denn (wooden heart) (2)
Now is the hour
Ofyn pripetshok (Yiddish)
Samiotissa (Greek)
O sole mio (Italian)
Oh susanna
On top of old smokey
Pentozalis (Greek)
Phil the fluter's ball
Pokarekare (New Zealand/Maori)
Queensland over lander
Raindrops keep falling
Reginella campagnola (italian, woodpecker
song)
Roamin' in the gloamin' (2)
Shenandoah
She'll be coming round the mountain
Skye boat song
Sur Le Pont d'Avingnon (French)(2)
Swanee River
Swing low sweet chariot
The road to Gundagai
The whole world in his hands (2)
The white cliffs of Dover
Those were the days
Tie a yellow ribbon around the old oak tree
Tinafto (Greek)
Volare (Italian)
When Irish eyes are smiling (2)
Where have all the flowers gone
We shall overcome
Wild Colonial boy
Will ye go Lassie, go
Yesterday

Table 8.
Songs from Musicals chosen by RMTs for 60-75 year olds

All I ask of you (2)
As time goes by
Blue moon
Can't help lovin dat man
Climb every mountain (4)
Do-Re-Me (4)
Don't cry for me Argentina (2)
Edelweiss (10)
Fiddler on the roof
Get me to the church on time (4)
Getting to know you (7)
Hello Dolly
I could have danced all night (6)
If ever I should leave you
If I were a rich man
I have often walked
I'm getting married in the morning(2)
I'm going to wash that man right out of my hair
Love and marriage
Love changes everything
Maria (West Side Story)
Memory (cats) (4)
Moon river (2)
Music of the night
Old man river (4)
Oh what a beautiful morning (6)
On the street where you live (2)
Overhead the moon is beaming
Over the rainbow (4)
Secret love (2)
Seventy six trombones
Singing in the rain (4)
Some enchanted evening (6)
Somewhere
Stranger in paradise
Summertime (3)
Sunrise, sunset
The bells are ringing
The desert song
The Easter parade
The rose
Unchained melody
Vilia
Wind beneath my wings
Wouldn't it be lovely (3)
You'll never walk alone (5)

Table 9
Music Selections chosen by RMTs for 60-75 year olds for CALD Groups

Italian and Maltese Songs

Arriverderci Roma (6)#
Ave Maria (3)
Calabrisella mia#
Carnevale di venezia (2)
Ciao ciao bambina
Con ti partiro
Funiculi funicula (3)#
Grazie
Il canto degli italiani (anthem)
La donna e mobille
La paloma
La piccinina (the ferryboat serenede)
La preghiera (the prayer)
L'inverno e passato
Mamma san tanto felice (3)#
Mattinata
O sole mio
Over the waves
Polka Italiana
Que sera sera
Reginella campagnola (4)# (woodpecker song)
Santa Lucia (10)
Senza catene (unchained melody)
Tarantella
That's amore (4)
Torna a Sorrento (5)#
Tu scendi dale stelle
Volare

Songs also relevant to Maltese indicated with #

Greek Songs

Eha nero kiravangelio
Haralambis
Zorba's dance (5)
Little ribbon
Pentozalis
Pote tin kyriaki (never on a sunday) (3)
Psaropoula (fishing boat) (2)
Samiotissa (2)
Tinafto (boy on a dolphin) (2)
White rose of Athens (2)
Yerakina

Polish Songs

Albosmy to jacy, tacy
Hey sokoty
Jeszcze Polska nie zginela
Kokutezcka kika
Krakowiak
Pije kuba
Przepioreczka
Przybyli ulani
Sialem prosno zagonie
Siedz mity kogut
Sto lat (2)
Woj enko woj enko

Chinese Songs

Bamboo flute
Fengyang flower drum
Jasmine flower
Lotus blossoms (2)
Moon represents my heart
Night of Shanghai
The purple bamboo
Yuet Gwong Gwong

German Songs

Auf Wiedersehen (2)
Bei mir bist du Schoen (Yiddish)
Der blaue engel
Blue Danube Waltz (4)
Der mond ist aufgegangen
Die dreigroschenoper
Die Lorelei (2)
Freude schoner gotterfunken
Fuchs du hast die gans gestohlen
Happy wanderer (2)
Lilli Marlene (4)
Muss Ich Den (5)
O mein papa (2)
O Tannenbaum (2)
Stille nacht (4)
WeiBt du wieviel stemlein stehen
Wunderbar

Dutch Songs

Brahms lullaby
De trouwe kameraad
De zilveroot
Edelweiss
Grootvader klok
Het wilhelmus
Holland vlag
Lilli Marlene
Muss ich den
Naar zee
The happy wanderer
Tulips from Amsterdam
Urusg wasgerwoman

Russian Songs

Kalinka
Moscow nights
Ochi chyornye (Dark Eyes)
Volga boatmen (2)

Spanish Songs

Amigos para siempre besame mucho
Espana
La cucaracha
La Paloma
La Spagnola
Lonely bull
Que sera sera (2)
Spanish flea
Spanish eyes

Yugoslavian Songs (Slovenia/Croatia)

Aj de, kato
Djetesce nam se rodilo
Hladan vetar poljem piri
Kad bi ove ruze male

French Songs (including French Polynesian)

Alouette
Au clair de la lune
Le etait une bergere
La vie en rose (2)
Marseillaise
Seggae (Reggae fused with Sega)
Sur le Pont D'Avignon