The Influence of a Music Therapy

Activity Upon Peer Acceptance, Group

Cohesiveness, and Interpersonal
Relationships of Adult Psychiatric
Patients

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michael david cassity
Loyola University

The study was conducted to determine if participation

in a valued group musical activity (group guitar lessons)
enhances interpersonal relationships to a significantly
greater degree than participation in nonmusic activ­
ities. Interpersonal relationships within two groups
(musical and nonmusical) were compared by measuring
changes in peer acceptance, group cohesiveness, and
general interpersonal relationships (social relationships)
occurring between sociometric pre­ and posttests.
Subjects consisted of institutionalized female psychi­
atric patients. The results indicated the experimental
(musical) group made significant gains in peer ac­
ceptance (p = .01, p = .01, p = .03) and group co­
hesiveness (as indicated by number of reciprocal choices
given on sociograms). The comparison (nonmusical)
group failed to achieve significant gains on these
variables.

Many psychiatric hospitals have been forced to abandon indi­

vidual therapies and to initiate forms of group therapy. Rea­
sons for this change include: lack of adequately trained staff,
increasing numbers of patients, and lack of funds. One form of
group therapy is milieu therapy or therapeutic community. A
therapeutic community may consist of patients in a hospital
setting who meet regularly as a group, and no patient may
receive privileges, such as ground cards and passes, without
first successfully interacting with the community.
A role of the ancillary therapies, such as music therapy, is
to promote the smooth functioning of the therapeutic com­
munity by providing activities which encourage successful

Michael David Cassity, RMT, is Supervisor of Education at Belle Chasse

State School, Belle Chasse, Louisiana.
Vol. XIII, No. 2, Summer, 1976 67

interaction within the group. It is important, therefore, to

establish and evaluate activities which may be successful in
promoting such patient interaction.
The structure of activity groups is also of importance.
Gottheil (1955) used a sociometric quiz to compare social
perceptions in a competitive group with social perceptions

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in a cooperative group. The study found that cooperative
groups, as compared to competitive groups, were more ac­
cepting not only of their own group members but of people
in general. Since cooperative groups facilitate greater peer
acceptance, future research is needed to identify types of
cooperative groups.
The purpose of the study was to determine the influence of
a valued group music activity on interpersonal relationships.
These relationships were observed as a function of the type of
group employed.

Definitions
Interpersonal relationships refers to peer acceptance, group
cohesiveness, isolation, or other group phenomena affecting
group members’ status.
Group cohesiveness refers to the number of “pairs” or mu­
tual choices within the group. This type of reciprocal rela­
tionship occurs in sociometric questionnaires when subject
A chooses subject B, and subject B chooses subject A.
Peer acceptance refers to a subject’s cumulative rank posi­
tion within a group as measured by a sociometric question­
naire. Peer acceptance refers to the score of an individual
subject, whereas interpersonal relationships refers to scores of
all subjects as a group. A subject’s peer acceptance may be
referred to as his status within a group. A significant change
in interpersonal relationships would take into account sub­
jects’ losses as well as gains in status.
Sociometric questionnaire refers to a data sheet consisting
of a statement requiring individuals within a given group to
rank one another according to a number of criteria. The terms
of Moreno (1953) denoting an individual’s position within
the group structure were utilized in the study. According to
Moreno, an “isolate” is an individual who gives or receives no
68 Journal of Music Therapy

choices, an “unchosen” is a member who receives no choices

but gives choices to other members, “stars” are individuals
receiving the most choices, “pairs” are two individuals with a
reciprocal relationship, or who choose each other.

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Method
Subjects
Subjects consisted of female psychiatric patients residing
in a therapeutic community group at the Southeast Louisi­
ana State Hospital, Mandeville, Louisiana.
Diagnoses for subjects in the experimental group were:
J. H., schizophrenia undifferentiated and drug dependency;
M. A., paranoid schizophrenia with schizophrenic episodes;
M. L., hypochondrial neurosis; K. Y., depressive neurosis
and schizophrenia; B. B., schizophrenia, chronic undiffer­
entiated; E. S., schizophrenia, paranoid undifferentiated;
L. L., passive dependent. Diagnoses for subjects in the corn­
parison group were: D. T., paranoid schizophrenia; B. D.,
hysterical neurosis, conversion type; L. K., acute schizophre­
nia episode; C. T., schizophrenia, undifferentiated; L. L.,
paranoid schizophrenia.
Ages of subjects in the experimental group were: J. H.,
18; M. A., 21; M. L., 18; K. Y., 20; B. B., 22; E. S., 19; L. L.,
55. Ages of subjects in the comparison group were: D. T., 19;
B. D., 46; L. K., 22; C. T., 26; L. L., 21.
All subjects were members of a larger community group and
participated in the usual therapeutic program including ward
meetings, occupational therapy, recreational therapy, and
group therapy.

Setting
The study was conducted in a room 20’ x 25’. The room was
used for various patient recreational activities and contained
a piano, air conditioner, two windows, a record player on a
3’ x 10’ table, a large cabinet containing records, and 15
folding chairs.
Materials and equipment used in the study included seven
G55 Yamaha guitars, five musical compositions for each sub-
Vol. XIII. No. 2, Summer, 1976 69

ject, and two identical sociometric questionnaires for each

subject.

Procedure

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During a ward meeting when all patients were present, the
experimenter asked for volunteers to begin group guitar les­
sons. Of 28 volunteers, 14 subjects were chosen who had been
admitted to the unit within the previous two weeks. This pro­
cedure was followed in order to assure that experimental and
comparison subjects would remain as members of the com­
munity for the experimental period.
Volunteers for guitar lessons were distributed randomly
into experimental and comparison groups. The experimental
group met daily for one hour. The control group was not
given guitar lessons but participated with the experimental
group in the usual community treatment program involving
nonmusical activities. These activities lasted six hours daily,
and included therapeutic community meetings, occupational
therapy, recreational therapy, and group therapy, conducted
by hospital psychiatrists and registered recreational and occu­
pational therapists.
At the end of two weeks the experimental group gave a
recital to the community group. Immediately following the
recital, the experimental and control groups were given post­
tests utilizing the same sociometric questionnaire utilized
in the pretest. Two weeks or ten sessions elapsed between
pre- and posttesting.

Method of Instruction
Traditional teaching methods for guitar were not utilized
due to the diagnostic condition of some experimental group
members and the average length of patient residency (four
to six weeks). An alternate method was designed to provide
more immediate reinforcement. The guitar was tuned to the
E major chord because it most closely approximates the usual
tuning of the guitar. The guitar may be played by letting EM
represent the I chord, AM the IV chord and EM the V chord
of a given composition (many popular compositions for
70 Journal of Music Therapy

which patients indicated preferences utilized only I, IV, and

V chords). The I chord may be played in open position, or
with no fingers on the finger board. The IV chord is played
by utilizing the first finger to bar all the strings at the fifth fret.
The V chord is played by utilizing the first finger to bar all
strings at the seventh fret. Each subject was given a copy of the

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music with chord symbols typed above the lyrics. Subjects
learned five popular compositions within two weeks and
performed two compositions, “Games People Play,” and
“Green, Green Grass of Home.”

Collection of Data
Data concerning subjects’ chronological age, diagnosis, and
interpersonal relationships were collected. The sociometric
questionnaire used was constructed with reference to the fol­
lowing sources:
1. Moreno’s six criteria for construction of a sociogram.
2. Mouton, Blake, and Fruchter’s (1955a, 1955b) six ways
of expanding reliability and validity of the sociogram.
3. Bales’ (1970) interpersonal rating forms (only questions
appropriate for measuring leadership in the social do­
main were considered).
The sociogram used in the study consisted of 18 rankings
in order to obtain more information. Subjects were allowed
to choose anyone in the community group for rankings. Data
were collected on the variables of peer acceptance, group
cohesiveness, and interpersonal relationships. A pilot study
indicated that the sociometric questionnaire had an internal
reliability of .83 as measured by a two-way analysis of variance
(Guilford, 1954).

Treatment of Data
Data were analyzed utilizing the sociogram (Moreno), Sign
Test, X2 and the Mann-Whitney U Test (Siegel, 1956).
Sociograms were constructed to represent choices given
among the first five rankings on the sociometric questionnaire.
Group cohesiveness was measured by observing a number of
mutual choices on the posttest as compared to the pretest.
Vol. XIII, NO. 2, Summer, 1976 71

Individual sociograms were constructed to illustrate com­

bined sociometric structure of experimental and comparison
groups on pretest, combined sociometric structure of experi­
mental and comparison groups on posttest, sociometric struc­
ture of experimental group on pretest, sociometric structure of

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comparison group on pretest, sociometric structure of experi­
mental group on posttest, and sociometric structure of com­
parison group on posttest.
Sign tests were computed on scores of each subject to de­
termine any significant changes in rank over both conditions.
A significant decrease in rank would indicate a significant
increase in peer acceptance or status of a particular indi­
vidual, since the rank of 1 represents the highest rank or status
and 18 represents the lowest rank or status. Each member was
rated by the other members in the group. Therefore, each
subject received a rating for each question from everyone in
the group. Sign test scores represented cumulative ratings or
rankings of the three questions on the sociometric question­
naire
x2 tests were computed on scores of both groups to mea­
sure interpersonal relationships. Expected scores represented
cumulative rank received by each subject on the first test.
Observed scores represented cumulative rank received by
each subject on the second sociometric test. The test was given
to determine if changes in status or rank were due to factors
other than chance variation. Because experimental and com­
parison groups each registered a significant change in inter­
personal relationships, the Mann-Whitney U Test was com­
puted to determine if one group changed significantly more
than the other.

Results
Results indicated that comparison subjects (nonmusical)
initiated 50% fewer choices on the posttest and experimental
subjects (musical) initiated 38.7% more choices on the post­
test when data from both groups were combined. Experi­
mental subjects gave 31.4% more choices to members within
their own group and comparison subjects gave 50% fewer
choices to members within their own group (Figures 1, 2,
72 Journal of Music Therapy

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ES

FIGURE 1.
The diagram represents the interpersonal choice of the Experimental Group
on the first test. The subject, MA, was the only star: there were no pairs. The
subjects, ML and BB, were unchosen; the subjects, ES and LL, were isolates.

3, and 4). The number of isolates decreased from two to zero

in the experimental group and remained at two in the com­
parison group. Mutual relationships increased from zero to
five in the experimental group and from one to zero in the
comparison group. Based upon these results, it would appear
that a music therapy activity (group guitar lessons) has a
significant influence on group cohesiveness. Sign tests (Sie­
gel) indicated three experimental subjects significantly gained
in status (ML, p = .01; BB, p = .01; JH, p = .03). The remain­
der of the experimental subjects failed to obtain significant
gains in status.
x2 tests (Siegel) indicated that experimental subjects’ rank
or interpersonal relationships significantly changed (p < .001,
x2 = 28.9), and that comparison subjects’ rank or interpersonal
relationships significantly changed (p < .001, x2 =26.5).
However, the Mann-Whitney U Test (Siegel) indicated that ex-
Vol. XIII, No. 2, Summer, 1976 73

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Figure 2.
The diagram represents the interpersonal choice of the Experimental Group
on the second test. The subjects,
BB and ML, were the stars; there were
five pairs. BETH. BEES. BB-KY. ML-ES, BB-ML. The subjects, LL and
MA, were unchosen; there were no isolates.

perimental subjects failed to change significantly more than

comparison subjects. This finding is consistent with Gron­
lund (1959) who found that social relationships within a
group, unlike peer acceptance, may change with time. It was
concluded that significant differences may have occurred if
the experiment had lasted longer since x2 for experimental
subjects was 28.9 and for comparison subjects was 26.5. It
was observed that subjects receiving the highest status also
possessed the greatest musical skill.

Discussion
In Figure 1, the subjects ML and BB were unchosen. On
the posttest, ML, BB, and JH significantly gained in status;
ML and JH were also the best guitarists in the group. This
finding is consistent with other studies concerning skills and
 74 Journal of Music Therapy

BD

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74 Journal of Music Therapy

Figure 3
The diagram represents the interpersonal choice of the Comparison group
on the first test. There were no stars; subjects, LL and DT were the only
pair. The subjects, LK, CT, and BD, were the isolates

popularity (Wolman, 1956). BB did not learn to play the guitar

well, apparently because of her regressed condition. How­
ever, she was told that by singing loudly she could be a
valuable asset to the group. BB appeared to respect her role
as a vocalist as her rate of participation was high and she
was responsive to reinforcement from the group and the ex­
perimenter. Lacking guitar skills, BB evidently compensated
by specializing in another skill valuable to the group.
The study has a possible weakness which should be con­
sidered in replications. The subjects were chosen randomly
from a group of patient volunteers in an attempt to enhance
group cohesiveness. Because the subjects were chosen from
volunteers rather than from the general population, caution
Vol. XIII, No. 2, Summer, 1976 75

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LL

LK
DT

Figure 4
The diagram represents the interpersonal choice of the Comparison Group
on the second test. The subject, BD, was a star; there were no pairs. The
subject, CT, wasunchosen;three subjects,LK, DT and LL, were isolates.

hancing interpersonal relationships should be fostered. Ac­

cording to previous research, factors enhancing a group
member’s status may be the possession of a valued skill, par­
ticipation in a valued group task, and participation in a
cooperative group effort. Investigating the effect of parti­
cipation in valued group musical activities upon interpersonal
relationships may offer new insights into the problem of
enhancing interpersonal relationships among psychiatric pa­
tients.
In replications of the study it may be useful to employ
an instrument to record verbal interaction of the group. In­
crease in verbal interaction usually is an indication of lowered
communication barriers and may be one factor enhancing
interpersonal relationships.

References
Bales, R. F. Personality and interpersonal behavior. New York: Holt,
Rinehart, & Winston, 1970.
76 Journal of Music Therapy

Gottheil, E. Changes in social perception contingent upon competing or

cooperating. Sociometry, 1955, 18, 132-137.
Gronlund, N. E. Sociometry in the classroom. New York: Harper, 1959.
Guilford, J. P. Psychometric methods (2nd ed.). New York: McGraw-Hill,
1954.
Moreno, J. L. Who shall survive? (Rev. ed.). Beacon, New York: Beacon

Downloaded from http://jmt.oxfordjournals.org/ at New York University on September 11, 2015

House, 1953.
Mouton, J. S., Blake, R. R., & Fruchter, B. The reliability of sociometric
measures. Sociometry, 1955a, 18, 7-48.
Mouton, J. S., Blake, R. R., & Fruchter, B. The validity of sociometric
responses. Sociometry, 1955b, 18, 181-206.
Siegel, S. Nonparametric statistics for the behavioral sciences. New York:
McGraw-Hill, 1956.