Music Therapy Sessions With Older Adults on YouTube: A Content Analysis for Academic Instruction

Abstract

Prior research in music therapy has examined the availability and content of YouTube videos overall and in relation to veterans with post-traumatic stress disorder and pediatric medical music therapy. Anecdotally music educators use YouTube videos to provide students with clinical examples of music therapy sessions. It is unclear what clinical video content about music therapy with older adults is available. Therefore, this descriptive study aimed to examine the content of YouTube videos related to the clinical practice of music therapy with older adults for academic instruction. After conducting an initial search for music therapy clinical videos with older adults on YouTube, the authors completed a descriptive analysis of 23 videos that included clinical footage. Videos were analyzed to describe video-specific and therapy-specific content. In addition, the authors completed an exploratory analysis of diversity-specific content. Finally, the authors investigated the presence of American Music Therapy Association’s (AMTA) Competencies in clinical videos from the past 5 years (2018–2022). Results demonstrate varying amounts of video-specific, therapy-specific, and diversity-specific content leading to clinical and educational implications. The authors identify a need for future investigation of the use of videos in teaching by music therapy faculty, as well as student perceptions of music therapy content provided in clinical video clips.

YouTube is a video-sharing website that can be used by educators to further illustrate certain concepts or ideas (Everson et al., 2013). YouTube (2023) states a user must be at least 13 years old, but individuals of all ages may access YouTube if enabled by a parent or guardian. Entities uploading videos to YouTube are responsible for its content, and the content must comply with the YouTube Community Guidelines and the Policy, Safety, and Copyright Policies (YouTube, 2023). As educators, the authors value YouTube as a classroom resource for its accessibility, as YouTube provides the opportunity to bring the outside world into the classroom.

Music faculty and staff in institutions of higher education also utilize YouTube in the classroom. A survey by Dougan (2014) of music faculty and music librarians found that 55% of the music faculty used YouTube to supply listening examples in the classroom. Of these respondents, 8% indicated using YouTube in the classroom for “something else,” and “music therapy examples” was one subtopic of the “something else” category. in addition, a 2021 survey by Short and Heiderscheit (2023) found 72.13% of music therapy faculty “utilize videos” (p. 78) to support the teaching of a topic when literature about the topic is not available.

Because the title, description, and overall content of YouTube videos are the responsibility of the uploader, videos with a variety of content appear in searches for “music therapy.” Some researchers in music therapy have explored music therapy-related YouTube videos. An analysis by Gregory and Gooding (2012) found that online documentaries about music therapy found on YouTube included clinical interactions between clients and music therapists. However, credentials and therapeutic approaches were not identified in over half of the videos analyzed, missing an opportunity to educate viewers about the education and clinical training of, and therapeutic approaches utilized by music therapists. Gooding and Gregory (2011) completed a descriptive analysis of music therapy-related videos on YouTube using a 16-item rubric to evaluate video-specific and therapy-specific information. The top five videos were further analyzed alongside the American Music Therapy Association’s (AMTA) Professional Competencies. Results showed extreme variation in content, with some videos meeting standards set by the AMTA, whereas others did not. Furthermore, some videos included misinformation about the field of music therapy. The researchers also reported on the types of clinical session videos that were available and found that sessions with older adults were more frequent than videos featuring other age groups and settings.

There has been limited research related to the presence and content of clinical music therapy videos available on YouTube. Lerew (2020) conducted a content analysis of pediatric music therapy videos found on YouTube. The 41 videos found in Lerew’s (2020) search were analyzed for video- and therapy-specific categories. Video-specific categories included patients, parents, or guardians seen in the video, identification of and contact information for the music therapist, and adequate audio and visual quality. Therapy-specific categories included the therapist’s qualifications, patient goals, music therapy interventions, explanation of music therapy, and research referenced. Lerew (2020) found that only 46% of videos accurately explained music therapy. Fernandez (2019) analyzed 75 music therapy clinical videos on YouTube featuring veterans with post-traumatic stress disorder. Using a content rubric, Fernandez (2019) analyzed the videos for six categories, including music therapy, board-certified music therapist, veteran personnel, goals and objectives, interventions, and research. Only 14% of the videos analyzed accurately explained music therapy.

So, while there have been some analyses of YouTube videos and music therapy, the authors did not find any analyses of YouTube videos featuring music therapy clinical work with older adults. Therefore, the purpose of this study was to describe the content of YouTube videos related to the clinical practice of music therapy with older adults for academic instruction.

The following research questions were addressed in the current study:

• (1) What clinical examples of music therapy with older adults are available on YouTube?

• (2) What is the content of YouTube videos with a majority of clinical session video (≤50% of video length) for academic instruction?

• (3) For academic instruction, how do clinical session videos from the past 5 years (2018–2022) represent examples of the AMTA Professional Competencies?

Method

The Authors

In this content analysis of music therapy clinical session YouTube videos, the authors’ experiences influenced the interest in and the viewed importance of this research. Both authors identify as white cisgender females and had prior experiences as students and music therapists working with older adults in community and residential settings. The first author completed their educational training in the southeastern United States, worked as a music therapist in the southeastern, southwestern, and midwestern regions, and is currently a music therapy educator in the southeastern region. The second author completed their educational training in the midwestern and western United States, worked as a music therapist in the midwestern region, and is currently a music therapy educator in the midwestern region. Both authors have extensive clinical and research experience working with older adults and teach courses focused on music therapy practice with older adults.

Initial Search

Procedures used in this study were adapted from a descriptive analysis of YouTube music therapy videos conducted by Gooding and Gregory (2011). The initial search for public videos was conducted by the authors between February 28, 2022, and March 26, 2022. Because the authors were interested in finding music therapy clinical videos with older adults, “music therapy” was paired with “older adult,” “elderly,” “senior,” “geriatric,” “dementia,” or “Alzheimer’s” in the YouTube search box. Quotation marks were used for all search terms. The search procedure is illustrated in Figure 1. Following the initial screening process, the authors confirmed that the music therapists in the videos had the clinical credentials necessary to be a music therapist in their respective countries.

Preliminary Descriptive Analysis

As the purpose of this investigation was to find clinical video to be used in the education of music therapy students in the United States, the authors screened the videos for content to supplement classroom lectures on the topic of music therapy with older adults. Preliminary screening resulted in 56 videos with clinical examples of music therapy with older adults divided into the following categories: promotional for an agency, project, or program, news story, standalone clinical video present for 50% or more of the total video length, a documentary, and a combination of clinical and promotional components within the video. Authors excluded videos in the promotional, news story, and documentary categories, leaving 23 videos remaining.

A descriptive analysis of the remaining 23 videos in the “standalone clinical video” and “clinical video within promotional” categories was conducted using a rubric created by the authors based on the rubrics reported in previous studies of music therapy sessions available on YouTube (Fernandez, 2019; Gooding & Gregory, 2011; Gregory & Gooding, 2012; Lerew, 2020). The rubric included video-specific (Table 1) and therapy-specific (Table 2) information. The authors also completed an exploratory analysis of diversity-specific content for the remaining 23 videos. Criteria analyzed included:

• therapist and client (gender expression, race)

• able-bodiedness (how clients are presented, range of abilities, and use of assistive equipment)

• music diversity (date of publication or recording, lyric-based vs. instrumental music, language, spiritual tradition affiliation)

• geographic location of the music therapist facilitating clinical services.

This analysis was considered exploratory as there are no examples of this type of analysis in prior studies of music therapy content on YouTube. This exploratory analysis was limited to what could be seen in the videos. The authors acknowledge the potential for bias in an exploratory diversity-related analysis. Prior experiences as clinicians and the authors’ personal identities influenced how videos were viewed. To minimize the effects of these biases the authors engaged in reflexive discussion and memoing throughout the analysis and limited all analysis categories to elements of diversity that can be outwardly observed.

Competency Evaluation

Upon completion of the descriptive analysis, the authors completed a competency evaluation and wrote brief video abstracts for videos for nine videos (Table 3). These videos were selected as they were uploaded within the last 5 years (2018–2022). The competency evaluation was completed by reviewing the content of each video for evidence of competencies as stated by the AMTA Professional Competencies (AMTA, 2013). Both authors reviewed the nine videos separately and identified AMTA competencies that were demonstrated in each video. The authors then compared the identified competencies and any differences were resolved through reviewing the video and discussion. In light of ongoing conversations about the ethical use of YouTube videos in research, the authors contacted each of the uploaders of the nine videos in the competency evaluation to inform them that their videos would be included in the results section of this manuscript.

Results

What Clinical Examples of Music Therapy with Older Adults are Available on YouTube?

Fifty-six YouTube videos were identified that met the inclusion/exclusion criteria and included synchronous clinical videos of music therapy with older adults. Videos were classified by type and are reported in Figure 1. The largest number of videos were promoting a specific agency or program (n = 27) and 10 of the promotional videos included standalone clinical video consisting of at least 50% of the total video duration. News stories featuring clinical clips were the next most frequent, followed by standalone clinical videos, and documentaries. The 13 standalone clinical videos and 10 promotional videos with clinical videos lasting at least 50% of the total duration were analyzed further.

What is the Content of YouTube Videos with a Majority of Clinical Session Video (≥50% of Video Length) for Academic Instruction?

Video-Specific Content

The 23 clinical videos ranged in length from 0:51 to 26:22 (M = 4:22) and had been uploaded between 2008 and 2022. The number of views each video received at the time of the final search varied greatly from 14 to 57,979. In general, more recently uploaded videos had fewer views than those uploaded at an earlier date with all but three videos having less than 10,000 views. Tables 1 and 2 summarize the descriptive analysis of the 23 examples of music therapy clinical videos with older adults organized into 5-year intervals for video-specific and therapy-specific characteristics. Across the three time periods, video-specific factors remained consistent except for the inclusion of contact information for the music therapist for videos from 2013 to 2017 (12.50%). Of the 23 videos, only half included the clinician’s contact information in the video or video description. The audio quality was identified as adequate for all videos and in all but one video the video quality was considered adequate. One or more older adults could be seen in all the videos and in nearly all videos the music therapist could also be seen (95.65%).

Therapy-Specific Content

There was more variation in the therapy-specific categories (Table 2) across the videos. The re-creative method was featured most often (82.61%) and individual sessions (60.87%) were more common than group sessions (39.13%). However, there appears to be a trend of an increasing number of videos portraying group sessions across the three time periods with two-thirds of the videos from 2018 to 2022 being group sessions in contrast with earlier periods. Very few of the videos cited or discussed music therapy research (13.04%) or provided a definition of music therapy (13.04%). Just over one-third of the videos (39.13%) identified the specific qualifications of the music therapist or identified the specific types of music therapy applications being shown in the video.

Diversity-Specific Content

The exploratory analysis of diversity-specific content for the music therapist and client(s) is as follows.

Therapist Diversity.

Twenty-one videos included images of the music therapist(s) and were included in the exploratory analysis. The music therapist(s) appeared to be white in 19 (90.47%) and BIPOC in 2 (9.52%) videos; 17 (80.95%) videos featured female-presenting therapists and 8 (38.09%) male-presenting therapists. The total number of female-presenting and male-presenting music therapists in this analysis equals more than 21 because 2 videos included more than 1 music therapist.

Client Diversity.

Twenty-three videos were included in the exploratory analysis of client diversity-related content. Sixteen (69.6%) videos featured clients who appeared to be white, two (8.7%) featured clients who appeared to be BIPOC, and five (21.5%) featured groups that appeared to include both BIPOC and white individuals. Of the 13 videos that featured female-presenting clients, 12 instances were individual sessions, and 1 was a group session. Three videos featured male-presenting clients in individual sessions and eight videos featured groups of both female- and male-presenting clients. In most videos, clients were seated with the exception being three videos with clients standing and one video of a client lying down in bed. Assistive equipment featured in the videos included wheelchairs (11), walkers (5), portable oxygen concentrators (3), and canes (1). Older adults in the videos demonstrated the ability to engage in movements/exercises, singing, and playing percussion instruments.

Music Diversity.

The publication dates for music used in the videos divided into 5-year increments are presented in Figure 2. The videos included music from the 1800s (e.g., “My Bonny,” “Cielito Lindo,” “Amazing Grace”), 1900s (e.g., “Rockin’ Robin,” “Don’t Sit Under the Apple Tree,” “When the Saints Go Marching In”), and 2000s (i.e., “Smooth Grandma” parody of “Smooth Criminal”). Videos from the most recent 5-year period utilized music representing the 1800s through the 1990s. This is similar to the earliest 5-year period which included music from the 1800s through the 2000s. It is interesting to note, which while the range of publication dates for music from these two time periods are similar, the proportion of music from the 1800s is greatest for videos uploaded from 2018 to 2022. When considering other types of diversity possible in music, one video (4.3%) featured a song in Spanish (linguistic diversity) and one video (4.3%) included a Hanukkah song (religious diversity). All other examples of lyric-based music were in English and if spiritual music was used it was from a Christian viewpoint. Few examples of instrumental music (nonlyric based) were observed in this study.

Geographic Diversity.

The geographic location of the music therapists in the videos represented 11 states and 3 different countries. The representative states were distributed across the seven regions of the AMTA and the countries included were Canada, England, and the United States. It was not possible to identify a geographic location for the music therapists in three of the videos.

For Academic Instruction, how do Clinical Session Videos from the Past 5 Years (2018–2022) Represent Examples of the AMTA Professional Competencies?

Examples of the AMTA Professional Competencies (2013) were identified by the authors in the final nine videos from the past 5 years (2018–2022; Table 3). Of the 25 “Music Foundations” competencies, 12 (48%) competencies were demonstrated in the videos. Elements of competency 4.1.1, “Lead and accompany proficiently on instruments including, but not limited to, voice, piano, guitar, and percussion,” were identified by the authors as present in all nine videos. Eight (67%) of the 12 “Clinical Foundations” competencies were present in the videos. Competency 9.2, “Establish and maintain interpersonal relationships with clients and team members that are appropriate and conducive to therapy” was identified by the authors as present in all nine videos. Finally, of the 80 “Music Therapy” competencies, 21 (26%) competencies were identified in the videos. Overall, there was an average of 13 competencies present across the “Music Foundations,” “Clinical Foundations,” and “Music Therapy” categories in the videos analyzed.

Discussion

YouTube videos are a way educators can bring clinical music therapy examples into the classroom. This descriptive project focused on the presence and content of YouTube videos featuring music therapy with older adults through an educational lens. Due to the nature of the YouTube algorithm as well as how videos can be uploaded and removed, it is not possible to recreate the exact search results identified in this study which means this search represents one moment in time. Fifty-six examples of videos were identified and 23 of the videos included examples of music therapists and older adults in clinical sessions. Based on the educational purpose of this study, the researchers chose to only include videos where the therapist/facilitator was confirmed to have completed the education and training to be a credentialed music therapist in the United States or another country. This choice may explain some of the differences between the findings in this study and previous studies. Findings from this study are compared with four prior studies related to music therapy videos on YouTube in Table 4.

The video-specific criteria used for this study were based on prior studies (Fernandez, 2019; Gooding & Gregory, 2011; Gregory & Gooding, 2012; Lerew, 2020), and, in general, the content of videos in this study demonstrated similar or in some cases higher prevalence of these criteria compared with previous studies (see Table 4). Perhaps of most importance for educational use is that the audio and visual quality of the clinical videos in this study was deemed adequate in all but one of the videos. All the video-specific criteria were present in at least half of the videos in this study; the criteria least prevalent was contact information that was available in 52% of the videos. However, the prevalence was higher (78%) for the most recent videos (2018–2022) that is higher than all prior reported research and may indicate a shift in what uploaders are including when posting music therapy session videos to YouTube (see Table 2).

The therapy-specific criteria used for this study were also based on prior studies with the addition of the unit of delivery (individual or group session) and music therapy method criteria. The prevalence of therapy-specific content varied with less than half of the older adult videos showing a group session, the identification or discussion of music therapy applications, a definition of music therapy, a discussion of related research, and the compositional, improvisational, and receptive methods. When compared with prior studies, the prevalence of a definition of music therapy being included is lower in this study while the discussion of research and music therapy applications is similar (Table 4). One consideration related to the therapy-specific content areas of therapeutic area of focus, music therapy applications, related research, and a definition of music therapy is that these would require the inclusion of an interview with the client and/or clinician or additional editing and formatting beyond clinical session footage. While the inclusion of these types of therapy-specific content (type of application, definition, related research) is especially important when educating about the profession (professional advocacy) it may be less important when using videos in the context of music therapy education as this information can be provided through other sources. Perhaps the most interesting findings related to therapy-specific content of videos in this study are the possible longitudinal trends related to the unit of delivery (increase in group sessions and decrease in individual sessions), identification or discussion of music therapy application (increase over time), and the inclusion of the compositional music therapy method in the more recent videos (Table 2). Future research would be needed to identify whether these trends remain consistent.

An exploratory analysis of diversity-specific content revealed that therapist, client, and music-related diversity was limited. Most videos featured therapists who appeared to be white females and older adults who appeared to be white with few examples of therapists and clients who appeared to be BIPOC. It is important to note that the exploratory analysis of gender and race was limited to what was shown in the video. Therefore, it is likely that more diverse identities were present without being explicitly identified by the viewers. The linguistic and spiritual traditions represented in the music were also limited with one song not in English and one example of music from a spiritual tradition other than Christianity. This lack of apparent diversity in the videos may limit the usefulness of these videos within the educational context.

The most recently uploaded videos featured a range of AMTA Professional Competencies with examples from the music foundations, clinical foundations, and music therapy categories that indicates that these videos could be used in educational settings to demonstrate some competencies in each of the categories. A further discussion of advocacy and educational implications is provided in the following sections.

Professional Advocacy and Educational Implications

Professional Advocacy Implications

Due to the nature of YouTube’s uploading policies, music therapists have a unique opportunity to educate and advocate for the field of music therapy when sharing videos of clinical music therapy sessions. Through this investigation, the authors found that just over one-third of the videos identified the specific qualifications of the music therapist or identified the specific types of music therapy applications being shown in the video. This is higher than the rates reported by Gooding and Gregory (2011) and like those reported by Gregory and Gooding (2012), Fernandez (2019), and Lerew (2020). The authors recommend that future videos include qualifications of the music therapist, identification of music therapy applications, references to music therapy research and a definition of music therapy to advance advocacy efforts. The authors also recommend that future videos uploaded to YouTube include a statement of consent indicating that the clients and therapists featured consented to the clinical session(s) being videoed and to the videos being posted publicly on YouTube or other social media platforms.

Educational Implications

As music therapy faculty members, the authors examined the video clips through the lens of possible classroom use. For example, educators can use Table 2 to discuss with students what information could be beneficial to include with clinical video used for advocacy. Educators may also choose to facilitate a discussion surrounding informed consent and the ethical considerations for uploading clinical videos to YouTube. Because the music therapy curriculum centers around the AMTA competencies, the authors investigated the presence of the AMTA competencies in clinical videos from the past 5 years (2018–2022). Clinical videos are a viable educational resource (Everson et al., 2013) and the authors hope that the video abstracts and identified professional competencies in Table 3 can serve as a resource for educators interested in using clinical videos of older adults in music therapy that are present on YouTube. Practically speaking, Table 3 serves as a quick reference for educators seeking clinical examples of specific music therapy methods, a summary of the video content, and list of relevant competencies when developing lesson plans.

An additional consideration is representation in clinical videos that are used in the classroom, and how video content may influence students’ perceptions of the field of music therapy. For example, most videos included in this study showed older adults seated, rather than standing or lying down. This is not fully representative of this age group, as many well older adults participate in music therapy and are actively mobile throughout sessions and in medical settings. In examining the demographics of the music therapists present in the clinical video, music therapists were mostly female presenting and white. Geographically, videos were from 11 different states, distributed across all 7 regions of the AMTA, as well as 3 countries outside of the United States. There was one video that included a song with lyrics in Spanish and all other examples of lyric-based music were in English. Notably, in the videos uploaded in the 5 years from 2018 to 2022, the largest proportion of music featured in sessions was from the 1800s. These diversity-specific representations have significant implications when preparing students to provide multicultural care, as well as providing representation of diverse cultural backgrounds through classroom materials and content. The authors recommend that music therapy educators continue to seek clinical videos that include diverse music, music therapists, and clients for academic use.

Limitations and Future Considerations

The authors recognize the near impossibility of obtaining a complete list of clinical videos displaying music therapy with older adults, due to a variety of factors including the capabilities of YouTube at the time of the initial search, being unable to recreate the exact search that took place, and the changing status of videos that can be uploaded and taken down at any time. Another limitation of this investigation was the potential for bias based on the authors’ background clinical experiences. Examples of where these biases may be most apparent are in the inclusion of only videos in English, the exploratory diversity analysis, and the analysis of AMTA competencies. Due to the subjective interpretation of some of the competencies, it can be difficult to objectively determine whether a competency is displayed within a clinical video.

Finally, for researchers interested in examining social media content including YouTube videos, care should be taken to consider the ethics of using this content for research. One resource that could be helpful for future researchers is the Code of Ethics: YouTube Observation webpage from the University of Chicago (https://voices.uchicago.edu/202003sosc20224/2020/06/25/code-of-ethics-youtube-observation/). Future research could examine the use of videos in teaching, specifically by music therapy faculty. In addition, the music therapy educational community may benefit from receiving input directly from students about students’ perceptions of music therapy content presented via clinical video clips.

Conclusion

Videos posted to YouTube and other social media platforms have the potential to increase student understanding of the profession of music therapy and supplement course materials. Specific to this study, clinical session videos with older adults are available on YouTube, though with a limited variety of representation in clinicians, older adults, music therapy methods, and music. The authors suggest considering best practices for using videos in classroom instruction including viewing the videos before showing them in class to ensure video quality, considering the purpose of the video (what clinical skills are present or missing), and evaluating how the content of the video may benefit and be perceived by the students in the class. Based on ongoing conversations related to the ethics of how content posted on YouTube is used, educators and researchers would benefit from using ethical decision-making tools to guide how videos are used.

Jennifer Denk Stull, MM, LPMT, MT-BC, is an Assistant Professor of Music Therapy at the University of Georgia in Athens, Georgia.

Dr. Lindsey Stradt Wilhelm, PhD, MT-BC, is an Associate Professor of Music Therapy at Colorado State University in Fort Collins, Colorado.

Conflicts of interest

None declared.

The authors, Jennifer Denk Stull (she/her) and Lindsey Stradt Wilhelm (she/her), thank the music therapists and individuals featured in the videos analyzed in this study for their willingness to share clinical footage.

Funding

None declared.

References