The Impact of Invisible Illness and Invisible Disability On Music Therapy Practica Students

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Journal of Music Therapy, XX(XX), 2020, 1–26
doi:10.1093/jmt/thaa004
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The Impact of Invisible Illness and

Invisible Disability on Music Therapy
Practica Students
Rebecca J. Warren, MM, MT-BC
State University of New York at Fredonia, Fredonia, NY
A variety of factors affect the success of music therapy students in

practica. Many music therapy students may have invisible illnesses or
invisible disabilities (II/ID) that affect their work. II/ID have physical or psy-
chological effects but are not apparent to an observer. Such illnesses may
include chronic illnesses, mental illnesses, and developmental disabil-
ities. Although researchers have studied the success of post-secondary
students with II/ID and the success of music therapy students without
II/ID, there is a lack of research on music therapy students who identify
with having II/ID. This researcher used an exploratory online survey to
investigate the prevalence of II/ID among music therapy students and
how it may affect their success in music therapy practica. Quantitative
responses were compiled and analyzed into frequencies and percent-
ages, and open-ended responses were coded and analyzed for pat-
terns and themes. Results indicated that music therapy students with
II/ID have various reasons for disclosure or nondisclosure. Some music
therapy students with II/ID required accommodations, while many did
not. Additionally, the effects of II/ID on music therapy practica students
included physical, psychosocial, and cognitive symptoms, which led
to various choices for disclosure/nondisclosure and the request/use of
individualized accommodations. Music therapy students with II/ID self-
reported that making decisions regarding appropriate disclosure and
determining their need for accommodations or not allowed them to be
more successful in practica.
Keywords: academic training; education, music therapy; self-care;
disabilities
Rebecca J. Warren, MM, MT-BC, is a music therapist, clinical supervisor, and ad-
junct professor in Western New York. This study was completed in partial fulfillment
of the Master of Music in Music Therapy program at the State University of New
York at Fredonia, NY. Address correspondence concerning this article to Rebecca
J. Warren, MM, MT-BC, Fredonia School of Music, Mason Hall, Fredonia, NY 14063.
Phone: 585-935-1578. E-mail: rebecca.warren@fredonia.edu
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2 Journal of Music Therapy
Invisible illnesses and invisible disabilities (hereafter referred to

as II/ID) affect the body and mind of an individual but are not
noticeable to others (Bassler, 2014). There are three main types of
II/ID: (a) chronic illnesses, (b) mental illnesses, and (c) develop-
mental disabilities. Such diseases, disorders, and syndromes cause
short-term and long-term physiological and psychological symp-
toms that affect an individual’s functioning. Although some invis-
ible illnesses are acute, other II/ID can evolve into disability over
time. Invisible illnesses do not inherently make someone disabled;
disabilities result from a lack of accommodation, an inaccessibility
of services, and the unreasonable expectations of others (LaCom &
Reed, 2014). In the United States, 17.7% of undergraduates iden-
tified as having a documented disability (Zehner, 2018). Disability
can include the debilitating bodily effects of one’s illness or dis-
order, but it can also be impacted by social oppression and exclu-
sion (Shakespeare, 2013). In the current study, this researcher ex-
plored the experiences of music therapy students with II/ID and
how such illnesses and disabilities affect success in practica during
post-secondary education. Researchers have explored accommoda-
tions, disclosure, and factors affecting success for post-secondary
students with mental illnesses, chronic illnesses, and various disabil-
ities (Coduti, Hayes, Locke, & Youn, 2016; Ennals, Fossey, & Howie,
2015; Vande Kemp, Shiomi Chen, Nagel Erickson, & Friesen, 2003;
Weiner, 1999), including II/ID (Kiesel, DeZelar, & Lightfoot, 2018;
Wilbur, Kuemmel, & Lackner, 2019).
Accommodations
Training in the helping professions and the demand for con-
tinual reflexivity can be rigorous and challenging. It is essential
for students to recognize the ways in which these demands interact
with any challenges from their II/ID to determine the need for
accommodations. Students reported managing their mental illness
through various types of support including: (a) academic, (b) psy-
chosocial, (c) support services for mental illness, (d) peer support,
and (e) inner resources (Weiner, 1999). These types of support
can be provided by the university’s disabilities office, by professors,
or by other students. However, both students and supervisors re-
ported misunderstanding regarding who should initiate the ac-
commodations process (Kiesel et al., 2018; Wilbur et al., 2019).
Vol. XX, No. XX 3
Wilbur et al. (2019) surveyed 143 supervisors of psychology

trainees with disabilities about their experiences, attitudes, and
biases. Compared to experienced supervisors, “inexperienced
supervisors . . . were more likely to indicate that the supervisor
should be responsible for establishing accommodations in the vi-
gnette that presented a trainee with an invisible disability” (p. 114).
However, Chi-square analysis revealed that experienced super-
visors were more likely to ask about disability or accommodations
needed for training than inexperienced supervisors. Though this
study emphasized the confusion surrounding who is responsible
for initiating the accommodations process, the researchers sug-
gested that the supervisor “has the most responsibility of collab-
orating and implementing accommodations with the student”
(Wilbur et al., 2019, p. 115). Jung (2003) confirmed accommoda-
tions should “be negotiated, adapted and arranged with each indi-
vidual instructor. This is the process that is referred to as the indi-
vidualization of accommodation” (p. 103). In interviews with social
workers with various disabilities, Kiesel et al. (2018) discovered the
need for social work supervisors to be transparent regarding the
accommodations process.
The Americans with Disabilities Act (ADA) of 1990 requires that
educators provide reasonable accommodations for post-secondary
students with disabilities. Vande Kemp et al. (2003) stated, “the
ADA is grounded in the principle of reasonable accommodations,
which involves the implicit assumption that disability is socially con-
structed (Fine & Asch, 1988), and can be “deconstructed” by pro-
viding a less disabling environment” (p. 157). Post-secondary edu-
cators must consider both formal and informal accommodations to
remove the social barriers to practica success. Kiesel et al. (2018)
outlined the process for obtaining formal accommodations under
ADA. A student must (a) secure documentation of their disability,
(b) become certified with the campus disability office, and, lastly,
(c) have the office negotiate accommodations with the instructor.
Although there are various ways to request accommodations, in-
formal accommodations may be arranged directly with the pro-
fessor or clinical supervisor on a case-by-case basis, if allowed under
university policies. Although students may feel there is a clear pro-
cess for requesting classroom accommodations, Kiesel et al. (2018)
indicated that students did not feel these translated to the field
placement. Additionally, regarding students with II/ID, Kiesel

et al. (2018) reported that participants equated disclosure of their
disability with a request for accommodations and often wished pro-
fessors would offer accommodations without the student needing
to ask. The students’ fear of judgment or nonacceptance caused
feelings of uncertainty when deciding to request accommodations.
Disclosure
Students with mental illness reported self-disclosure as a barrier
to success (Weiner, 1999). Kiesel et al. (2018) completed interviews
with 15 Caucasian, female social workers with mental illness, phys-
ical limitations, sensory limitations, or neurological/behavioral
disorders regarding their challenges, barriers, and opportunities
in field education. Thematic coding revealed “experiences with a
visible versus invisible disability, confusion about accommodation,
field as a learning opportunity, and a sense of isolation in being a
social worker with a disability” (Kiesel et al., 2018, p. 700). As stu-
dents, social workers reported frequently waiting to disclose their
disability until already in their field placement or, more frequently,
chose not to disclose. The social workers expressed “feelings of
shame, fear, and the need to hide a disability” (Kiesel et al., 2018,
p. 701).
In a systematic review of studies related to disability disclosure
and accommodations for youth with various disabilities in post-
secondary education, Lindsay, Cagliostro, and Carafa (2018) re-
ported, “youth with invisible disabilities (e.g., learning disability)
specifically noted feelings of inadequacy and fear of disclosing
due to stigma related to society’s limited tolerance to learning
and mental health disabilities” (Thompson-Ebanks, 2014, p. 545).
Additionally, Lindsay et al. (2018) discovered another barrier to
disclosure that the students were not aware of the support available
and how to access them. When students disclosed their II/ID, they
were able to self-advocate and receive supports and resources as
well as mentorship.
Factors in Post-Secondary Success

Post-Secondary Students With II/ID. Individuals with II/ID
may pursue post-secondary education for intellectual and voca-
tional goals. Weiner (1999) interviewed eight university students
Vol. XX, No. XX 5
with mental illness regarding their purpose and goals for pursuing
post-secondary education. Students reported that post-secondary
education may normalize their lives, provide structure and routine,
and bring a sense of hope. Students with II/ID in post-secondary
education may experience challenges related to physical symp-
toms, psychological symptoms, and the decision to disclose their
illness. Students with mental illness reported many types of bar-
riers to educational success, including (a) technical, (b) medical,
(c) educational, (d) external social, (e) internal social, (f) self-
disclosure, and (g) social interactions (Weiner, 1999). Students
with psychological disabilities reported higher rates of suicidal
ideation, suicide attempts, and non-suicidal self-injury than those
with learning, sensory, or physical disabilities (Coduti et al., 2016).
Music Therapy Students. Wheeler (2002) used open-ended
interviews to investigate the lived experiences and potential chal-
lenges of eight undergraduate music therapy students completing
a practicum. The students described being scared to fail and put-
ting up “a really good front” to cope with feelings of inadequacy
(Wheeler, 2002, p. 293). Students in music therapy practica re-
ported a fear of new experiences, difficulty in session planning, dif-
ficulty addressing the needs of clients, and difficulty maintaining
adequate music skills.
Music therapy educators and internship directors reported they
observed students with severe professional competency problems
(SPCP), including psychological, intrapersonal, and interpersonal
problems, as well as demonstrating clinical skill deficiencies, eth-
ical violations, a lack of professionalism, and having supervision
conflicts (Hsiao, 2014). Music therapy educators and internship
directors reported the most common remediation strategies for
music therapy students with SPCP included “referral to personal
therapy, increased supervision, repeating academic coursework/
practicum, leave of absence, and remedial lessons” (Hsiao, 2014,
p. 189). When compared with internship directors, music therapy
program directors were significantly more likely and most fre-
quently suggested students with SPCP seek personal therapy to ad-
dress SPCP. Hsiao (2014) recognized that gatekeeping practices in
the helping professions allow educators to determine the suitability
of students for engaging in practica and the profession. Although
educators reported using remediation strategies for students with
identified difficulties, there was no information regarding the

prevalence of disability in students showing SPCP. Therefore, it is
unknown if there is any relationship between competency difficul-
ties, the use of remediation strategies, and the prevalence of II/ID
in music therapy.
Although researchers have explored the success and experience
of students with II/ID in post-secondary education and the success
and experience of music therapy students who do not have II/ID,
there is a lack of research investigating the experience of music
therapy students with II/ID and the factors that contribute to their
success in practica.
The purpose of this exploratory study was to investigate the ef-
fects of II/ID on students’ success in music therapy practica. Four
specific questions guided the investigation:
1) How many music therapy practica students reported an II/
ID?
2) What accommodations, if any, do music therapy students re-
ceive for their II/ID?
3) What are music therapy students’ reasons for disclosure or
nondisclosure of their II/ID?
4) How, if at all, does II/ID affect success in music therapy
practica?
The researcher expected many music therapy students with II/ID
will respond to the survey with a variety of experiences in practica.
Based on the current literature, students are likely to report issues
and concerns related to symptom management, accommodations,
and disclosure.
Method
Researcher Lens
The researcher of this study recognizes the influence of her own
practica experiences, philosophical assumptions, and interpretive
frameworks. The researcher completed three practica placements
during her undergraduate music therapy education in a retire-
ment home, a dialysis unit in a hospital, and a pediatric psychiatric
center. She has experience in internship at a children’s hospital
and completed a six-month internship at an integrated preschool.
Vol. XX, No. XX 7
At the time the research was conducted, the researcher was a

board-certified music therapist working at a skilled nursing facility,
in private practice, and as a clinical supervisor while completing
graduate music therapy education. Based on her own experiences
as a music therapy student and as a music therapist with invisible
illnesses, this researcher believes that music therapy students with
II/ID may have unique interactions with music therapy professors,
clinical supervisors, and other music therapy students that may af-
fect their success in music therapy practica.
Social constructivism, utilizing the respondents’ experiences
within society and their interactions with others to shape meaning,
underscores this research (Creswell & Poth, 2018). The researcher
utilized a disability interpretative lens which focuses “on disability
as a dimension of human difference and not as a defect” (Creswell
& Poth, 2018, p. 32). Researchers in psychology often conceptu-
alize disability as a deviation from the able-bodied norms of psy-
chosocial development. However, researchers in disability studies
utilize “the interests of sociology (e.g. how different social groups
define and interact with disability) . . . [and] medical anthropology
(e.g. finding commonalities and uniqueness in the experiences of
families with specific impairments” to “legitimize the study of dis-
ability as a universal human condition” (Olkin & Pledger, 2003,
p. 296).
This researcher chose to collect both quantitative data and
qualitative data related to experiences with II/ID in music therapy
practica through an online survey. Although II/ID are individual
to each music therapy student, the researcher used the survey in
order to begin an initial inquiry into the experiences of students
with II/ID. Learning more about student experiences may help
to inform music therapy education practices and develop strat-
egies for success for music therapy students with a wide range of
diagnoses.
Research Design
The researcher collected both quantitative and qualitative data
concurrently to explore music therapy students’ experiences with
II/ID in music therapy practica through an exploratory survey. The
researcher compiled frequencies and percentages on the preva-
lence of II/ID, disclosure, and accommodations. The researcher
coded and analyzed narrative comments related to students’ dis-

closure or nondisclosure to professors and clients and their experi-
ences with II/ID in practica. Students provided qualitative data to
further describe the quantitative responses given.
Procedure
The researcher used a descriptive, exploratory online internal
survey using a convenience sample of undergraduate music
therapy students from the American Music Therapy Association
(AMTA) electronic mailing list. The researcher obtained names
and email addresses for undergraduate music therapy students
(n = 977) upon approval of the research study by the Institutional
Review Board and AMTA. There were 101 invalid e-mail addresses.
Twenty-eight individuals emailed to state they were no longer music
therapy practica students, resulting in a potential respondent pool
of 848 music therapy students Figure 1.
Participants
Participants were 136 undergraduate music therapy students,
who had completed at least one semester of practica, and who were
over 18 years of age. Students chose to participate in the study after
being informed electronically by email of the purpose and expect-
ations of the study. The students gave electronic consent on the
first page of the survey.
Instrument
The online survey was developed in Google Forms. The re-
searcher created questions related to three core processes re-
lated to successful post-secondary participation: “(a) knowing and
managing oneself and managing one’s illness, (b) negotiating the
social space, and (c) doing the academic work” (Ennals et al., 2015,
p. 113). These processes motivated the researcher to ask questions
related to accommodations, disclosure, as shown in the survey
(see Supplementary Appendix). The researcher also created each
Likert scale question based on a factor contributing to her own suc-
cess in practica with an II/ID: (a) energy level, (b) ability to focus,
(c) session attendance, (d) time completing post-session notes, (e)
time preparing session plans, and (f) coping skills. The researcher
reviewed the questions with a content expert, who was a music
Vol. XX, No. XX 9
therapy educator. Individual survey responses were saved into an

Excel Workbook that required a secure login. See Supplementary
Appendix online for the entire survey.
Data Analysis
The researcher used Excel to compute frequencies and percent-
ages for yes/no questions and medians and modes for Likert scale
questions. The researcher used deductive and inductive coding to
analyze all qualitative responses for patterns and themes (Miles,
Huberman, & Saldaña, 2014). Qualitative analysis consisted of the
following process: (a) reading and re-reading all written comments
to identify significant codes, (b) clustering similar themes, and
(c) providing a summary of the data. Quantitative and qualitative
data were merged in joint displays for disclosure/nondisclosure ra-
tionales and to report other effects of II/ID from the open-ended
questions.
Results
Demographics
Findings were based on a convenience sample of 849 AMTA
undergraduate student members with 136 total respondents. The
response rate was approximately 16%. Demographics are reported
for 136 students from 56 undergraduate colleges and universities.
Email addresses received from AMTA (n = 977)
Invalid Email Addresses (n = 101)
Excluded individuals (n = 28) who emailed to state they were no longer in music therapy practica
Survey e-mailed again two weeks later (n = 848)
Students responded to the survey (n = 136)
Excluded students (n = 17) who had not yet completed any music therapy practica
Excluded students (n = 48) who did not have an invisible illness or invisible disability
Individuals who had an invisible illness or invisible disability who completed

the entire survey (n = 71)
Figure 1
Flow of participants in the survey study.
The researcher excluded individuals who had not yet completed

any semesters of practica (n = 17), as well as individuals who in-
dicated they did not have an II/ID diagnosis (n = 48), leaving 71
individuals who completed the entire online survey beyond demo-
graphics. Participants were primarily female (n = 125, 91.9%), age
18–24 years old (n = 116, 85.3%), and White (n = 113, 83.1%).
Detailed demographics are shown in Table 1 (N = 136).
Prevalence of Invisible Illness and Invisible Disability in Sample

In this survey, 71 out of 136 respondents (59.7%) indicated they
have an II/ID diagnosis based on the description of invisible illness
used in the survey. This description (found in Supplementary
Appendix) only described invisible illness. The researcher in-
cluded invisible disability in the manuscript and analysis to be in-
clusive of diagnoses. Students indicated either a chronic illness
(n = 20, 43.7%), a mental illness (n = 32, 59.2%), or a develop-
mental disability (n = 5, 14.1%) (Figure 2). Two students included
other illnesses (n = 2, 4.2%), such as “bereavement” and “visual
impairment.” Several students (n = 13, 18.3%) also had comorbid
invisible illness diagnoses. Students with II/ID (n = 71) reported
quantitative and qualitative data on accommodations, disclosure,
factors that contribute to practica success, and narrative comments
on their II/ID.
Accommodations
The researcher asked closed-end questions in the survey re-
garding accommodations. The majority of students with II/ID
reported not needing accommodations (n = 60, 84.7%) and not
receiving accommodations during practica (n = 56, 82.1%). Some
students with II/ID reported needing accommodations (n = 11,
15.3%). Figure 3 indicates the types of accommodations students
reported receiving from the given list. Canceling or rescheduling
a session was the highest reported accommodation (n = 8). In the
open-ended “other” response, students (n = 3) reported receiving
assistance carrying instruments, needing adapted transition
lengths, using large print, receiving extended time for assignments,
and having professors allow more time to complete instrument
competencies. Using a 5-point Likert scale, students (n = 27) indi-
cated their satisfaction with accommodations (Table 2). This result
Vol. XX, No. XX 11
Table 1
Participant Demographics
Demographics n %
Gender
Male 10 7.40
Female 125 91.90
Missing 1 0.01
Age
18–24 years 116 85.30
25–29 years 8 5.90
30–39 years 7 5.10
40–59 years 4 2.90
60+ years 1 0.70
Ethnicity
White 113 83.10
Hispanic/Latinx 5 3.70
African-American 2 1.50
Native American 2 1.50
Asian/Pacific Islander 11 8.10
Middle Eastern 1 0.70
Other 2 1.50
Current Employment Status
Not Employed 40 29.65
1–10 hr 38 28.10
11–20 hr 34 25.20
21–30 hr 11 8.10
31–40 hr 12 8.90
Region
Great Lakes 27 19.90
Mid-Atlantic 32 23.50
Midwestern 22 16.20
New England 8 5.90
South Eastern 23 16.90
South Western 9 6.60
Western 15 11
Practicum (semesters)
0 17 12.50
1 9 6.60
2 42 30.90
3 20 14.70
4 17 12.50
5 10 7.40
6+ 21 15.40
Other (n = 1)
Comorbid (n = 13) 2%
18% Chronic Illness (n = 20)
28%
Developmental
Disability (n = 5)
7%
Mental Illness (n = 32)

45%
Chronic Illness (n = 20) Mental Illness (n = 32)

Developmental Disability (n = 5) Comorbid (n = 13)
Other (n = 1)
Figure 2
Type of invisible illness or invisible disability reported by participants (n = 71).
Location of Practicum 1
Time/Day of the Placement 0
Length of Session 0
Population Change 0
Co-leading with supervisor 0
Co-leading with SMT 1
Cancel a session/ Reschedule a session 8
Extend a paperwork deadline 4
NA/ Did not have accomodations made 54
Other 4
0 10 20 30 40 50 60
Figure 3
Types of accommodations provided to music therapy students with invisible illness
or invisible disability (n = 68).
Vol. XX, No. XX 13
Table 2
Student Reported Ratings for Satisfaction with Accommodations (n = 27)
Somewhat Somewhat Extremely

Not Satisfied Not Satisfied Neutral Satisfied Satisfied
Response Statement n (%) n (%) n (%) n (%) n (%)
Were you satisfied with 1 (3.7) 2 (7.4) 11 (40.7) 2 (7.4) 11 (40.7)

the accommodations
made (if any)? (If
none, do not answer).
may have been skewed, as students who did not report receiving
accommodations responded to the question on satisfaction.
Disclosure
Disclosure to Program Director and Clinical Supervisor. Survey
responses indicated that students disclosed their II/ID to their
program director (n = 45), clinical supervisor (n = 37), or both
(n = 29). Qualitative themes related to reasons for disclosure in-
cluded wanting to receive accommodations, to receive aid in per-
sonal and professional development, and to encourage open com-
munication. See Table 3 for the frequencies and percentages of
qualitative themes and subthemes related to disclosure.
Accommodation. The most common reason for disclosure of an
invisible illness was to receive accommodations (n = 28). Some stu-
dents who listed accommodation as a reason for disclosure also re-
ported receiving accommodations (n = 6). Though students listed
accommodation as a reason for the disclosure, not all 28 students
reported receiving accommodations. This may be due to the types
of accommodations required and the use of informal or formal
accommodations.
Personal and Professional Development. Students disclosed their
II/ID, so their program director and clinical supervisor could assist
with personal and professional development (n = 36). Students re-
ported that their professors verbally processed concerns with phys-
ical and psychosocial limitations in day-to-day functioning. Some
students reported that their II/ID were exposed by their profes-
sors or classmates involuntarily during classroom discussions or
symptoms occurring during practica (n = 5). Students described
discussing the recommendation for personal therapy with their
Table 3
Participant Reasons for Disclosure or Nondisclosure (n = 71)
Quantitative Responses Qualitative Themes n (%)
Disclosure to: Accommodation 28 (39)

Program director (n = 45) Personal and Professional 36 (51)
Clinical supervisor (n = 37) Development
Both (n = 29) Open Communication 16 (23)
Nondisclosure to: Stigma/Stereotypes 18 (25)
Program director (n = 26) Independence 35 (49)
Clinical supervisor (n = 34)
Neither (n = 16)
Disclosure to: clients (n = 2) Rapport 2 (3)
Nondisclosure to: clients (n = 68) Professionalism 31 (44)
Subtheme: Client-centered 17 (24)
Subtheme: Personal 11 (16%)
Independence 26 (37)
Subtheme: Unnecessary 17 (24)
professors or being asked privately by their professor to disclose

their II/ID if comfortable (n = 3). Students suggested that students
with II/ID should tell their professors the reasons for their self-care
practices related to their II/ID (n = 3).
Open Communication. Several students expressed they would
prefer to speak openly with their professors regarding their II/ID to
advocate for themselves and others with similar diagnoses (n = 16).
Some students indicated they disclosed their II/ID due to the be-
lief that it is just a part of life (n = 10). Students also indicated that
they wanted their professors to know more about them (n = 14).
One student stated that their II/ID was a motivating factor for be-
coming a music therapist. Another student wanted to be a mental
health advocate and spread awareness about mental health and II/
ID issues. Students felt safer knowing that their program director
or clinical supervisor could monitor their triggers and give advice
for managing symptoms (n =10).
Nondisclosure to Program Director and Clinical Supervisor.
Survey responses indicated students chose not to disclose to their
program director (n = 26), their music therapy supervisor (n = 34),
or neither director/supervisor (n = 16). Qualitative themes re-
lated to nondisclosure included avoiding stigma and stereotypes
and proving their independence. See Table 3 for the frequencies
Vol. XX, No. XX 15
and percentages of qualitative themes and subthemes related to

nondisclosure.
Stigma/Stereotypes. Several students indicated that they did
not disclose their II/ID to avoid being treated differently (n = 9).
Students expressed anxiety and worry about being pulled from
their practica or from their program (n = 6). Students expressed
that they did not want their professor to hold back criticism, to think
that they were not competent, or to distrust their abilities (n = 10).
One student suggested that they did not want to be “therapized” by
their professors. Students expressed frustration that II/ID are dif-
ficult to explain to others and that accommodations might not be
possible due to professors misunderstanding the students’ needs
(n = 11). One student expressed that cultural reasons were behind
the choice not to disclose.
Independence. Students stated that independently maintaining
an II/ID is personal, making disclosure not necessary (n = 35).
Some students stated that II/ID is just a part of life, that it has not
come up during music therapy practica or conversation with their
professors, or that it does not affect their clients (n = 22). Students
stated that their II/ID does not affect their practicum or their ability
to be a good therapist (n = 5). One student suggested that their II/
ID can be handled independently, whether on their own or in per-
sonal therapy, and that there are no accommodations in “real life.”
Students indicated that they were not asked to disclose their II/ID
and felt that they could handle their II/ID independently (n = 17).
Disclosure and Nondisclosure to Clients. Survey responses in-
dicated that a few students disclosed their II/ID to their clients
(n = 2). Qualitative responses revealed that the students wanted
to build rapport, to develop the therapeutic relationship through
appropriate self-disclosure, and wanted the clients to know them
better. More students chose not to disclose their II/ID to their
clients (n = 68). Some students recognized the potential for dis-
closure in certain contexts but did not have the opportunity (n = 3).
Students who chose not to disclose to their clients indicated they
wanted to maintain professionalism and believed that their II/ID
does not affect their ability to work with clients. See Table 3 for the
frequencies and percentages of qualitative themes and subthemes
related to disclosure and nondisclosure to clients.
Professionalism. Students stated it was not professional to dis-
close personal information (n = 31). One student stated there are
contraindications of sharing personal information related to issues

that arise from transference and countertransference. Some stu-
dents stated that they did not want to be judged or treated dif-
ferently by clients (n = 6). These students felt that clients would
mistrust their abilities (n = 6) if they were to disclose their II/ID.
Several students emphasized client-centered care and how the
focus in music therapy should remain on the client (n = 17).
Independence. Students stated that their II/ID does not affect
their work or their clients; therefore, it was unnecessary to disclose
their II/ID (n = 26). They recognized the need to take respon-
sibility for their II/ID symptoms and determine how best to ad-
dress them. Many students felt it was irrelevant to the client’s music
therapy treatment and not necessary to discuss (n = 17).
Factors in Music Therapy Practica Success

The researcher asked students to rate if they believe their II/
ID affected their success in practica. The researcher identified six
factors from her own practica experience contributing to success
in practica: (a) energy level, (b) ability to focus, (c) session attend-
ance, (d) time completing post-session notes, (e) time preparing
session plans, and (f) coping skills. Students rated each factor on
a 5-point Likert scale. Response frequencies and percentages are
shown in Table 4. The responses for each question ranged from
strongly disagree (1) to strongly agree (5) or from almost never (1) to
almost always (5).
Students rated “often” having enough energy to do their best
in practicum (n = 38). Students reported they “often” could focus
on their client’s responses (n = 33). In response to the question
regarding leaving a session to accommodate their II/ID, students
reported they had “almost never” left a session for this reason
(n = 61). However, there were two outliers who reported they “al-
most always” had to leave a session to accommodate their invisible
illness. Students reported “almost always” being able to complete
their post-session notes in less than an hour (n = 29), and students
reported “often” being able to complete their session plans in less
than an hour (n = 27). Students reported they had coping strategies
in place while at their music therapy practicum (n = 32). When asked
to rate if their II/ID affects their ability to complete and succeed in
music therapy practicum, students “strongly disagreed” (n = 25).
Table 4
Likert Scale Responses on Practica Responsibilities
Vol. XX, No. XX
Almost Never Rarely Sometimes Often Almost Always

Response Statement n (%) n (%) n (%) n (%) n (%)
I have enough energy to do my best in 0 (0) 2 (2.8) 16 (22.5) 37 (52.1) 16 (22.5)

practicum.
I can focus on my client(s)’ responses. 1 (1.4) 1 (1.4) 8 (11.1) 33 (45.8) 29 (40.3)
I have had to leave a session to accommodate 60 (83.3) 9 (12.5) 0 (0) 1 (1.4) 2 (2.8)
my invisible illness.a
I complete my post-session notes in less than 6 (8.3) 5 (6.9) 10 (13.9) 22 (30.6) 29 (40.3)
1 hr.
I complete my session plans in less than 1 hr. 7 (9.9) 7 (9.9) 15 (21.1) 26 (36.6) 16 (22.5)
Response Statement Strongly Disagree Disagree Neutral Agree Strongly Agree

n (%) n (%) n (%) n (%) n (%)
I have ways of coping with my invisible illness 1 (1.4) 3 (4.3) 13 (18.6) 32 (45.7) 21 (30)
at my practica.
Does invisible illness affect your ability to 24 (34.3) 17 (24.3) 11 (15.7) 17 (24.3) 1 (1.4)
complete/succeed in music therapy
practicum?
a
Indicates a reverse-scored question.
17

Student Reported Effects of Invisible Illness and Invisible

Disability
Students provided open-ended narrative comments regarding
any other experiences they had with II/ID in music therapy
practica (n = 34) at the end of the survey. Students noted that their
II/ID does not affect their music therapy practica (n = 5). Students
reported a variety of experiences and issues that created barriers to
success and noted a variety of coping strategies and supports that
have assisted in their success in music therapy practica. Some stu-
dents described the benefits of having an II/ID in music therapy
practica (n = 4). See Table 5 for frequencies and percentages of
qualitative themes and subthemes.
Barriers. Students reported barriers to their success in music
therapy practica. Students expressed feeling frustrated, feeling over-
whelmed, and feeling burdened by responsibilities during music
therapy practica (n = 27). These barriers were created by physical
symptoms, psychosocial symptoms, and cognitive symptoms.
Physical Symptoms. Students reported a variety of physical symp-
toms (n = 7), including flare-up of illness, episodes of dizziness, low
energy, nausea, ear pain, nystagmus, shoulder issues, singing ability
affected by respiratory issues, and decreased fine and gross motor
skills. A few students reported needing to adapt guitar and piano
due to the physical parameters required for playing during music
therapy practicum (n = 3). Students also reported fatigue and not
having enough energy to prepare for practica (n = 4).
Psychosocial Symptoms. Students reported psychosocial prob-
lems including anxiety and stress (n = 12). Students also reported
a lack of timeliness (n = 8). For example, one student said they
Table 5
Participant Narrative Comments on the Effect of Invisible Illness and Invisible Disability
Category Qualitative Themes n (%)
Reported effects of invisible Barriers 27 (79)

illness or invisible disability Subtheme: Physical Symptoms 7 (21)
(N = 34) Subtheme: Psychosocial Symptoms 12 (35)
Subtheme: Cognitive Symptoms 9 (26)
Coping Strategies 19 (56)
Benefits 4 (12)
Vol. XX, No. XX 19
had times when they did not want to get out of bed, which led to
session cancelations and needing to miss classes. Some students
disclosed feelings of self-doubt, perfectionism, and anxiety over
having symptoms during sessions, about upcoming sessions, during
preparation for sessions, and during social situations (n = 7). A few
students reported issues interpreting interactions with their clin-
ical partners and organizing meeting times (n = 2). Students re-
ported that peers and professors were insensitive and had general
misunderstandings about II (n = 7). Students expressed concern
with professors not knowing how to make appropriate accommo-
dations (n = 3). One student was concerned with transference and
countertransference with clients who have similar personal trauma
histories.
Cognitive Symptoms. A small number of students reported cog-
nitive symptoms that affected their ability to complete practica
(n = 3). The ability to focus on practica responsibilities when faced
with external stressors impacted the ability to complete documen-
tation in a timely manner (n = 5). A few students had difficulty
focusing their mindset on the session and not on mental illness or
other symptoms (n = 2). One student reported difficulty remem-
bering details of sessions. Another student had difficulty clarifying
important information when their professor talked too quickly and
did not provide visual notes. One student stated that it was more
difficult to read music when tired.
Coping Strategies. Students utilized coping strategies to aid
their success in music therapy practica (n = 19). Students reported
utilizing formal and informal accommodations as a coping strategy
(n = 4). One student mentioned the need to prepare for the adult
world by completing music therapy practicum without extensive
accommodations. One student stated that their II/ID is well con-
trolled with medication. A few students reported “sleeping it off” or
ignoring the symptoms and trying to get through sessions (n = 2).
When having pain, one student reported switching mediums for
accompaniment or singing without accompaniment.
Benefits. Students felt their II/ID helped them to understand cli-
ents, raised their awareness and empathy for clients, and provided
rare profound insights that can be incorporated into their music
therapy practice (n = 4). One student found support when profes-
sors were able to adapt teaching styles to promote participation
to the fullest extent possible. Some students wanted to be advo-

cates for students with health challenges and spread awareness
to decrease the stigma surrounding mental illness (n = 4). A few
students found motivation from their experiences with II/ID to
pursue a music therapy career to help others like them (n = 2).
Discussion
The purpose of this exploratory study was to investigate the
impact of II/ID on students’ success in music therapy practica.
Students provided quantitative and qualitative data focused on ac-
commodations, disclosure, and factors for success. The researcher
sought to learn more about student experiences with II/ID, which
may help to inform music therapy education practices and develop
strategies for success for music therapy students with a wide range
of diagnoses. The results will be discussed in relation to accommo-
dations, disclosure, and success in practica.
Accommodations
In the Code of Ethics, AMTA requires music therapy students to
function and adapt as needed to not impair their ability to work
with clients (AMTA, 2019). Music therapy students who experi-
ence difficulty meeting required competencies in clinical skills,
music skills, and music therapy skills may request accommodations
and supports from their professors or formal accommodations
from their university’s disability office in order to be successful.
Educators could become aware of the barriers and challenges that
students with II/ID have when pursuing post-secondary education
(Ennals et al., 2015; Weiner, 1999).
Music therapy educators and clinical supervisors should also be
aware that not all students disclose their II/ID and the majority
in this study did not seek accommodations. Music therapy educa-
tors and clinical supervisors may consider referring all students to
their university’s disabilities office to explore specific, individual-
ized supports. Faculty may inquire as to the supports and services
available on campus and consider general ways of communicating
this information to all students in order to decrease individual
pressure. Providing a general referral to seek support may help
Vol. XX, No. XX 21
decrease stigma related to these services, as well as to promote suc-

cess in music therapy practica.
Disclosure
In the current study, though most students disclosed their II/
ID to their program director or clinical supervisor (75%), the
remaining students chose not to disclose due to the fear of dis-
crimination and judgment by their professors, peers, and clients
(25%). Many students reported disclosing their II/ID to their
program director and/or supervisor to receive accommodations,
to receive assistance in their personal and professional develop-
ment, or to maintain open communication with their professors.
Students who maintained nondisclosure with their program dir-
ector, supervisors, and/or clients reported doing so to avoid stigma
and stereotypes or to manage their II/ID independently. Though
one student in the current study disclosed their II/ID to spread
awareness for mental health, some students chose not to disclose
to avoid the prevailing stigma/stereotypes surrounding II/ID and
being treated differently by professors, peers, and clients (12.7%).
These findings confirm prior findings by Coduti et al. (2016) and
Ennals et al. (2015) indicating that students are required to dis-
close a disability to receive services and accommodations but are
hesitant to do so due to stigma, discrimination, and not wanting to
be treated differently. Music therapy faculty and supervisors may
consider that students may be hesitant to disclose their illness, to
seek out counseling, and to obtain individualized accommodations
(Coduti et al., 2016; Jung, 2003). Therefore, music therapy educa-
tors could provide opportunities for open communication related
to issues that affect practica success (Hsiao, 2014).
In the current study, students indicated different views about dis-
closure to their clients, with most indicating that they chose not to
disclose to prioritize client-centered care and to avoid transference
or countertransference. However, two students disclosed their in-
visible illness to their clients to build rapport and develop the thera-
peutic relationship. These results may indicate that music therapy
students with II/ID are navigating how their II/ID relates to using
“oneself effectively in the therapist role in both individual and
group therapy, for example, appropriate self-disclosure, authenti-
city, empathy, etc. toward affecting desired therapeutic outcomes”
in (AMTA, 2013). This may also indicate that students will look to
music therapy professors and supervisors to help guide their pro-
fessional development as it relates to self-disclosure.
Factors in Music Therapy Practica Success

Wheeler (2002) revealed themes that also applied to music
therapy students with II/ID in this study, including the fear of new
experiences, difficulty planning sessions, impaired musical skill
development, and coping skills for dealing with challenges. In
the current study, students reported difficulty with physical symp-
toms from their II/ID that affected their ability to play guitar and
piano. Students reported anxiety over session preparation, per-
formance, and symptom management. Students also reported
cognitive symptoms that affected their ability to focus, read music,
and recall session details. Music therapy students with II/ID who
experience difficulty meeting required competencies in clinical
skills, music skills, and music therapy skills may request remedi-
ation strategies and supports from their professors or formal ac-
commodations from their university’s disability office. Faculty may
consider that what may appear as SPCP (Hsiao, 2014) could be an
undisclosed II/ID.
Limitations and Future Suggestions

Although the response rate for this survey was 16%, a higher
return rate would have been preferable. This rate may be higher
as this was an internal survey, because student members of AMTA
may be more motivated to participate in research. Volunteer bias
may have affected the percent of individuals who reported an II/
ID (59.7%) as some music therapy students may be more pas-
sionate about II/ID than others and more likely to respond to this
internal survey. Not all undergraduate music therapy students are
members of AMTA; therefore, the prevalence of II/ID cannot be
acquired through the list from AMTA. Due to the response rate
and participant recruitment methods, the prevalence of II/ID
cannot be generalized to all music therapy practica students. The
response rate may have obscured or minimized the effects of II/
ID on music therapy practica students. Future researchers might
consider emailing each program director to have them send out
the survey to their students as well as asking program directors to
Vol. XX, No. XX 23
report their experiences with students with II/ID. The results of

this study can be viewed as exploratory and require further study
for students to expand on the qualitative themes found. Though
only some students reported that their II/ID affects their practica
success (25.7%), future researchers might explore the qualita-
tive themes found in this study. Future researchers might ex-
plore survey methods, detailed quantitative or mixed methods, or
in-depth qualitative interviews to explore other effects on practica
success and determine the significance of the effect of II/ID.
Though the current study included only undergraduate music
therapy practicum students, future researchers may include in-
terns, graduate students, and equivalency students with II/ID to
explore potential differences in practica experiences across edu-
cation levels. To increase the validity and potential generalizability
of the findings, future researchers could utilize a randomized pool
of post-secondary students of varying levels from multiple univer-
sities to obtain more data for music therapy students with II/ID
who may not be registered with the disabilities’ office. While these
studies (Coduti et al., 2016; Ennals et al., 2015; Jung, 2003; Weiner,
1999) included students with a variety of academic majors and a
variety of illnesses, this researcher investigated music therapy stu-
dents with II/ID to reveal similar barriers and experiences related
to their education and illness. II/ID may also be prevalent in pro-
fessional music therapists. Music therapists with II/ID may con-
sider providing mentorship to students with II/ID to further sup-
port student development and success in practica. Music therapists
with II/ID may also consider providing workshops through AMTA
about how to maintain an II/ID while providing music therapy.
Future researchers could explore the prevalence and effect of II/
ID on professional music therapists’ practice.
Future researchers might focus on the perspective of program
directors, clinical supervisors, and internship directors who teach
and collaborate with students with II/ID. Future researchers could
explore gatekeeping practices and policies of educators in a variety
of helping professions including music therapy. Further research
is imperative to discover what types of accommodations (formal or
informal) may be necessary for success in music therapy practica
for students with II/ID and what accommodations music therapy
educators currently provide. Future researchers might focus on
current music therapy educator practices for music therapy stu-

dents with II/ID.
Conclusion
The goal of this exploratory study was to promote awareness and
stimulate dialog regarding the impact of II/ID on students’ music
therapy practica success. The information derived from this study
informs the development of strategies for success in music therapy
practica as well as exposes the potential barriers in post-secondary
education. The prevalence of II/ID in music therapy practica stu-
dents was 59.7% in this online survey questionnaire, but it is not
indicative of the prevalence for all music therapy practica students
in the United States.
Overall, many students in the study highlighted that their II/
ID did not affect their music therapy practica; therefore, it was not
necessary to disclose their invisible illness or receive accommoda-
tions for success in practica. Music therapy students with II/ID in
the current study reported their own experiences with barriers to
succeeding in practica, including issues with physical symptoms,
psychological symptoms, the need for individualized accommoda-
tions, and navigating disclosure decisions. In addressing these bar-
riers, music therapy educators could be prepared to utilize open
communication and collaboration to assist students in professional
development and appropriate self-disclosure as well as coordinate
individualized accommodations to promote success in practica.
Music therapy students with II/ID in this study reported feeling
able to succeed in music therapy practica regardless of their II/ID
diagnoses.
Supplementary Data
Supplementary data are available at Journal of Music Therapy
online.
Acknowledgments
The author acknowledges and thanks the students who par-
ticipated in this project and shared their experiences for the
benefit of others. The author also wishes to acknowledge Dr. Joni
Vol. XX, No. XX 25
Milgram-Luterman, MT-BC, LCAT, State University of New York at

Fredonia; Dr. Jill Reese, State University of New York at Fredonia;
and Dr. Christian Bernhard, State University of New York at
Fredonia for their support and guidance during the project
Conflicts of interest
None declared.
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The Impact of Invisible Illness and Invisible Disability On Music Therapy Practica Students

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The Impact of Invisible Illness and

A variety of factors affect the success of music therapy students in

Invisible illnesses and invisible disabilities (hereafter referred to

Wilbur et al. (2019) surveyed 143 supervisors of psychology

placement. Additionally, regarding students with II/ID, Kiesel

Factors in Post-Secondary Success

identified difficulties, there was no information regarding the

At the time the research was conducted, the researcher was a

coded and analyzed narrative comments related to students’ dis-

therapy educator. Individual survey responses were saved into an

Email addresses received from AMTA (n = 977)

Invalid Email Addresses (n = 101)

Survey e-mailed again two weeks later (n = 848)

Students responded to the survey (n = 136)

Individuals who had an invisible illness or invisible disability who completed

The researcher excluded individuals who had not yet completed

Prevalence of Invisible Illness and Invisible Disability in Sample

Mental Illness (n = 32)

Chronic Illness (n = 20) Mental Illness (n = 32)

Time/Day of the Placement 0

Co-leading with supervisor 0

Co-leading with SMT 1

Cancel a session/ Reschedule a session 8

Extend a paperwork deadline 4

NA/ Did not have accomodations made 54

Somewhat Somewhat Extremely

Were you satisfied with 1 (3.7) 2 (7.4) 11 (40.7) 2 (7.4) 11 (40.7)

Quantitative Responses Qualitative Themes n (%)

Disclosure to: Accommodation 28 (39)

professors or being asked privately by their professor to disclose

and percentages of qualitative themes and subthemes related to

contraindications of sharing personal information related to issues

Factors in Music Therapy Practica Success

Almost Never Rarely Sometimes Often Almost Always

I have enough energy to do my best in 0 (0) 2 (2.8) 16 (22.5) 37 (52.1) 16 (22.5)

Response Statement Strongly Disagree Disagree Neutral Agree Strongly Agree

Downloaded from https://academic.oup.com/jmt/advance-article-abstract/doi/10.1093/jmt/thaa004/5810916 by Carleton University Library user on 28 March 2020

Student Reported Effects of Invisible Illness and Invisible

Category Qualitative Themes n (%)

Reported effects of invisible Barriers 27 (79)

to the fullest extent possible. Some students wanted to be advo-

decrease stigma related to these services, as well as to promote suc-

Factors in Music Therapy Practica Success

Limitations and Future Suggestions

report their experiences with students with II/ID. The results of

current music therapy educator practices for music therapy stu-

Milgram-Luterman, MT-BC, LCAT, State University of New York at

post-secondary education. International Journal of Disability, Development and

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