The purpose of this study was to examine the effect of a family narrative/music therapy intervention (FNMT) on family functioning in families with children or adolescents who have experienced the death of a parent some time in the two years prior to the study. To accomplish this, two families participated in FNMT within the framework of a nonconcurrent multiple baseline design. Both families consisted of a single parent (one female, one male) and two daughters. Pretest/posttest measures were the Family Assessment Device (FAD) for adults and adolescents and the Childrenís Assessment of Family Functioning (CAFF) for children younger than 12. Baseline/postsession measures were a self-rating scale and open-ended questions designed for this study. All family members completed two pretest and one posttest measure and six weekly postsession measures. A random assignment resulted in Family 1 and Family 2 completing baseline measures for six and three days prior to the first session, respectively. In addition to these measures, the therapist completed a behavioral observation form following each session.
FNMT involved the use of music listening, drumming exercises, and drawing to enhance emotional expression and facilitate discussion of loss issues and the writing of a story about each familyís experience of the death. The six sessions took the family through the loss process and included such topics as facts about the death, first hearing about the death, the funeral, memories of the deceased, the family as it is now, and future plans. The primary intention of this intervention was to create an experience through which family members could process their loss experiences with each other and parents could learn about developmentally appropriate responses to loss. This combination was expected to improve family functioning (i.e., decrease parent-child conflict, increase parental nurturance) so that the family units would provide the emotional support necessary for the children to be able to progress in their emotional and cognitive development despite the major loss they had experienced in their family structure.
Data analyses of the different measures showed mixed results. Mean FAD change scores for parents and adolescents showed a trend of improvement in overall family functioning from pretest to posttest. There was, however, no change in the CAFF scores of the younger daughter in Family 1 from pretest to posttest. Interestingly, this same participant who rated no change in family functioning according to the CAFF was the only one whose self-rating scale scores showed significant improvement in parental nurturance during the treatment phase according to the X-moving range-chart analysis. The results for her older sisterís self-rating scale scores showed the opposite effect, indicating a significant increase in parent-child conflict and decrease in parental nurturance. Graphic analyses of the self-rating scales, supplemented by the calculation of an average effect size (ES) for all participants, indicated a small positive effect on parent-child conflict (ES = 0.28) and a small negative effect on parental nurturance, as measured by comfort with emotional expressiveness (ES = -0.31) and communicating about death (ES = -0.42). Therapist observations showed no change in the way parents expressed and handled disagreement in sessions but did show positive change in all family membersí emotional expressiveness during sessions. A chi-square analysis of the ethnographic content analysis of responses to the open-ended questions revealed no statistically significant difference in the participantsí description of sessions as being therapeutic or facilitative of therapeutic ends and a statistical significance in the description of behaviors in the family indicative of more nurturance. A discussion of limitations of this study, recommendations for future research, and implications for practice concludes this paper.