A theory of change for using musical-aesthetic and therapeutic factors in music therapy with adult trauma survivors

This narrative synthesis reviewed musical-aesthetic and therapeutic factors in music therapy programs for adults with lived experience of trauma. A structured search identified 22 studies describing music therapy interventions which informed a narrative synthesis. The synthesis focused on intervention components and contextual features rather than effectiveness outcomes. Analysis revealed four overarching program aims: healing trauma, treating symptoms, promoting recovery, and fostering empowerment/growth. A wide range of music-based techniques were employed encompassing internal and reflective approaches, towards more expressive and explorative processes. Programs typically favoured emergent, flexible approaches over rigid structures, and foregrounded safety as a key consideration, achieved through various musical and therapeutic techniques. The synthesis informed a proposed theory of change integrating individual, contextual, and aesthetic factors with potential mechanisms of action. This theory will inform the development of a subsequent phase of co-designed research into a music therapy intervention for adult survivors of sexual and intimate partner violence. The narrative synthesis highlights the need for further research to incorporate lived experience perspectives. • Musical-aesthetic factors intersect with therapeutic factors in effective interventions • Program aims included healing trauma, treating symptoms and promoting recovery • Music therapy programs for adult survivors of sexual violence are needed • Further music therapy research should incorporate lived experience perspectives