Reflexivity in Music Therapy Research

Andeline dos Santos (2025). Reflexive Research in Music Therapy. Six Approaches in Practice. Palgrave Macmillan, 297 pages.

Reflexivity must be one of the most challenging topics to write about, I think as I order this latest book by Andeline dos Santos. I have followed dos Santos ever since I evaluated her doctoral dissertation at the University of Pretoria, and immediately understood that we were dealing with an exceptional research talent who would, over time, expand the theoretical field of music therapy. This is something she has already delivered on—through her dissertation, her previous book Empathy Pathways, several articles, and not least through her editorial work in international music therapy journals.

She has now written about reflexivity, both on the basis of an extensive theoretical study of the phenomenon as it appears in the general research literature, and through interviews with a range of music therapists who have contributed reflections on their own reflexive research. Among these informants we note four teachers from Norwegian music therapy education programmes: Claire Ghetti, Simon Gilbertson and Viggo Krüger from the Grieg Academy, University of Bergen, and Gro Trondalen from the Norwegian Academy of Music.

What Is Reflexivity?

In the opening chapter, Andeline dos Santos introduces herself, and we are given a rapid overview of a range of definitions and understandings proposed in the literature. The author offers brief presentations of concepts such as objectivity, subjectivity, intersubjectivity, and interobjectivity. One thing I particularly note is the distinction between reflexivity and reflection. Reflexivity concerns the complex process that unfolds while we make the many choices involved in planning, conducting, and communicating a research project—or the evaluative process that unfolds as we practice music therapy. Reflection, by contrast, takes place retrospectively, with a backward-looking gaze.

We learn more about the difference between reflexivity in research and in clinical practice, about the general value of reflexivity, and its particular importance for music therapy research.

Paradigms

In Chapter Two, dos Santos maps the six approaches she has chosen to illuminate reflexivity. She initially formulates three research questions:

1. Where is reflexivity defined?

2. How are we engaged in reflexivity?

3. What can reflexivity achieve?

Based on the literature, and with modifications following her encounters with her informants, she formulates the following point of departure:

“Reflexivity entails researchers deliberately acknowledging and exploring how they are (or have the potential to be) active role players in creating and shaping knowledge in their studies (and beyond) and how they might respond or be transformed in return.”

She describes how she proceeded in this qualitative process, including literature searches, selection of articles and researchers, and finally the decision to conduct interviews. Already here, there is much to learn for any research student about reflexive research practice.

I find the section on paradigms particularly useful and interesting. She writes about how researchers tend to anchor their research within a particular paradigm. This involves commitments to ontology (what is reality?), axiology (what values do I consider central?), epistemology (how can I know something about reality?), methodology (what overall strategy do I choose to study this reality?), and method (what practical tools will I use?)

Paradigms may involve two ontological positions. A critical realist ontology holds that there is a world that exists independently of our minds. This reality is observable, but we can only observe it in imperfect fragments. Research involves collecting information in order to get closer to the truth. A relativist ontology, on the other hand, claims that reality consists of subjective experience: what we experience is reality. Therefore, there are as many realities as there are people.

Similarly, there are two epistemological positions. An objectivist epistemology holds that objects have essences that exist independently of human influence; an object’s essence does not change depending on who studies it. The goal is to explain, control, and predict. A subjectivist epistemology, by contrast, holds that knowledge is created by our values and is always filtered through language, culture, class, gender, ethnicity, race, and so on. Observations are influenced by the observer, and the observer is influenced by what is observed. Two or more different answers may all be valid.

Dos Santos writes that we can combine an epistemology and an ontology to form a paradigm. She refers to authors who distinguish between three paradigms:

1. Post-positivism (critical realist ontology + objectivist epistemology = there is a real world out there, and I can come to know it objectively).

2. Constructionism (critical realist ontology + subjectivist epistemology = there is a real world out there, but I can only access it through my subjective experience of it).

3. Interpretivism (there is no real world “out there”; my subjective experience is reality).

In addition, dos Santos notes that posthumanist approaches exist that cannot be placed within these three categories, and that a computational paradigm is emerging due to developments in artificial intelligence. Rather than basing her study on these paradigms, she poses four guiding questions for the study of reflexivity: What kind of self am I? What area do I wish to study? What quest am I on? What tools should I use?

Based on these questions, dos Santos differentiates six approaches to reflexivity, which she examines in detail in the following chapters: sentinel, lens, authorial, empathic, restorative, and relational reflexivity.

Sentinel Reflexivity

Before introducing what she calls sentinel reflexivity, dos Santos carefully outlines her own paradigmatic position and its relationship to these six approaches. As for the word sentinel, there is no good Norwegian equivalent beyond “guard” or “watchtower.” The concept refers to well-known discussions about how we can monitor the research process and ensure that our studies are credible and “true.”

The point of departure may be positivism or forms of foundationalism, where data are assumed to have an independent existence and researchers can collect and analyse data objectively by avoiding bias and error. Post-positivism offers a softer version, acknowledging that our access to reality is mediated by concepts, language, and interests. We only have access to segments of the truth and must reflect on how to be as objective as possible.

A phenomenological approach may also fall within this position, insofar as the researcher seeks to bracket their own assumptions in order to understand their informants. We are familiar with this practice of bracketing prejudices and preconceptions. It is primarily where one assumes the existence of an “essence” that phenomenology aligns with sentinel reflexivity.

Dos Santos writes extensively about bias and how it can influence research—and, crucially, how we can avoid potential sources of error. She discusses in detail how various forms of preconception affect all aspects of the research process, what should be bracketed in order to view the phenomenon as impartially as possible, and how opening up to multiple perspectives can reduce blind spots. An appendix at the end of the book provides an extensive list of possible sources of bias that researchers should be attentive to.

Lens Reflexivity

Here the focus shifts to recognising and examining the active role we play in shaping and influencing knowledge from our personal standpoint. Rather than attempting to step aside completely, as in sentinel reflexivity, we acknowledge that we always look through certain lenses that colour our experiences and interpretations. We must therefore explore, monitor, and report how these lenses influence our research, and be transparent about our own perspectives.

The chapter reviews how we are positioned through culture, social class, gender, ethnicity, religion, ability, psychological and emotional factors, musical background, and more. We must account for our positionality and how we relate to our own standpoints—whether they are fixed or flexible. Numerous examples illustrate how we can explore ourselves and our positionality, drawn from music therapy research. The chapter demonstrates how the research process is influenced at every stage, from topic selection to methodology, data collection, and analysis. Ultimately, this approach concerns building trustworthiness in our findings.

Authorial Reflexivity

Here the focus is on being aware, as authors, of our role, our voice, and our influence in the text we write. We acknowledge that our understanding of the world is always shaped by our individual perspective, and that this is a valuable source of insight. Truth is not something “out there” waiting to be discovered, but consists of multiple stories that can be constructed.

I recognise this perspective from my own work with theory, for example when I attempted to formulate connections between music and identity, based on extensive empirical material. Alternative understandings can always be formulated, new categories constructed that add dimensions to concepts such as identity. Meaning-making continues long after categories are established (cf. the word beyond in the definition of reflexivity).

Dos Santos refers to three main theoretical frameworks that can guide such work: interpretivism, radical constructivism, and field theory. Reflexivity here requires deep self-exploration, addressing multiple layers of selfhood: the ecological self, the interpersonal self, the extended self, the private self, and the conceptual self. Bodily experience and pre-verbal awareness are also important. Emotions generate knowledge, and the writing process itself becomes a way of generating understanding. Methods such as autoethnography, heuristic inquiry, and arts-based research are presented as valuable tools.

Empathic Reflexivity

This approach concerns understanding informants as fully as possible—seeing the world from their perspective. Dos Santos distinguishes between cognitive and affective empathy, integrating these into what she calls insightful empathy. This involves relationship-building, listening skills, and theoretical perspectives such as theory of mind, direct social perception, and simulation theory. Numerous examples from music therapy research illustrate this approach, including many references to Norwegian research characterised by strong reflexive practices.

Restorative Reflexivity

A key form of critical reflexivity is described as restorative (or reparative). This approach supports perspectives that can lead to positive social change. While other forms of reflexivity may enhance credibility, they may not necessarily affect social realities or systems that maintain power imbalances, oppression, and discrimination.

Restorative reflexivity entails the potential for social change in collaboration with informants—what dos Santos calls a politics of possibility. Research should do more than describe situations; it should contribute to greater social justice. Important influences include anti-oppressive therapy, critical and activist approaches, and community music therapy.

A central theoretical concept here is epistemic injustice, referring to the systematic marginalisation of certain groups and their knowledge. Two forms are discussed: testimonial injustice (where credibility is unfairly reduced due to prejudice) and hermeneutic injustice (where people lack the interpretive resources needed to make sense of their experiences). Dos Santos provides many examples and highlights methods such as action research, participatory action research, arts-based research, and ethnography.

Relational Reflexivity

The final approach is relational reflexivity, influenced by postmodern theories. Here, meaning is not something to be uncovered by removing bias or managing subjectivity, but something that emerges through relational processes. We co-construct worlds, and relational reflexivity invites us to explore how these worlds are created.

Key concepts include assemblage (Deleuze and Guattari), entanglement, and diffraction (Karen Barad). This approach values flexibility and recognises that data emerge through encounters between researchers, participants, artefacts, materials, and technologies. Research quality is measured by the study’s ability to generate new questions, provoke multiple interpretations, and acknowledge incompleteness.

Combining Perspectives

In a brief concluding chapter, dos Santos outlines possible combinations of reflexive positions. Not all are compatible—for example, sentinel and authorial reflexivity cannot easily be combined. However, many combinations are possible, such as lens and restorative reflexivity, where awareness of one’s lenses is combined with efforts toward social justice.

Required Reading

This book should be required reading for anyone embarking on a research project, or for anyone wishing to engage with music therapy research. It offers a unique overview of music therapy research that focuses not on results, but on how to achieve credibility without oversimplifying the complex contexts in which music therapy practices occur.

What also gives me great pleasure is the extensive reference to Norwegian music therapy research—both in terms of informants and examples. It warms the heart of an old supervisor. We have done—and continue to do—much right in Norwegian music therapy research.