Response to Gattino’s review of the book ‘The AQR tool – Assessment of the quality of relationship’ — Karin Schumacher

First View – Letter to the Editor (published on 27 February 2023)

Full text [PDF]

Response to Gattino’s review of the book ‘The AQR tool – Assessment of the quality of relationship’

Karin Schumacher

Berlin University of the Arts, Germany


Karin Schumacher, Prof. Dr. rer. sc. mus. has been working since 1974 as a music therapist and child/adolescent psychotherapist with children on the autistic spectrum, and since 1984 as a professor of music therapy, founding and continuing the development of the training for music therapy at the Berlin University of the Arts. Her research focus is on music therapy and infants, especially the development and assessment of interpersonal relationship skills. Together with Claudine Calvet, she developed the AQR Tool, an observation tool to assess the quality of relationship. []

I am writing this letter to add some facts and answers to questions asked in Gattino’s review of ‘The AQR Tool – Assessment of the Quality of Relationship’ which was published in Approaches (Gattino, 2022). The book, ’The AQR Tool – Assessment of the Quality of Relationship. Based on Developmental Psychology’, was authored by three authors. Two of us, Claudine Calvet and I, developed the tool, and Silke Reimer’s role as the third author was very relevant for the revised publication. Reimer added some important ideas, especially for the accompanying DVD. The following themes made in Gattino’s review needed to be commented on: reliability, case study, certification courses, research, and references.

Reliability: The reliability of the AQR tool was mentioned in the book (see page 10). This reliability could therefore be proven by 84 raters from four different cities (Vienna, Berlin, Munich and Sjövig) who were first trained and then did this work. The result of this examination of reliability, carried out by an independent statistician, showed an Intraclass-Correlation (ICC) higher than 0.74, which meant that the reliability was very good (Stallmann, 2006). The validity has not been done because we could not find a comparative tool for assessing the quality of relationship for the first three years of life. This is perhaps an area that could be addressed in the future.

Case study: There were two publications (one with DVD) where you could find a case study analysed with the help of the AQR Tool. In German, readers could find a book (Schumacher, 2017). This book was about the three years of work with an autistic boy called Max, which was published in 1994 before the AQR Tool was developed. In 2016, I re-examined the film material from this work with Max and analysed it with the help of the AQR. This book is published again in German, now with a DVD and is entitled Musiktherapie bei Kindern mit Autismus, Musik-Bewegungs- und Sprachspiele zur Behandlung gestörter Sinnes- und Körperwahrnehmung (2017). In English, readers could find another case study in an article (Schumacher, 2014). This article described the application of the AQR Tool in music therapy work with Steven.

Certification courses: Our training course lasts ninety (90) hours over five weekends and is only for experienced music therapists. Over the past 16 years of running this course, we found that it was necessary to teach practitioners how to use the AQR Tool. Developmental psychology forms the basis of this tool, and it is often not taught in the curriculum of different music therapy training programmes. This knowledge is not only valuable for work with children with social-emotional difficulties, including children with autism, but also for other areas of music therapy clinical practice. In these courses, all participants have to demonstrate how they work and how well they understood the book. To read is one thing, but to show how one practices and explains their interventions indicates if one has understood this tool. The danger of applying this tool without a deep understanding of developmental psychology and supervision is that one might obtain superficial and imprecise results regarding the quality of relationship. Over the last years, I have offered introductions in English and other languages, with the help of translators from many countries including France, Italy, Russia, Ukraine, and Hungary. Colleagues in Japan and Korea were particularly interested, and we have now introduced certification courses in their countries. My impression was and is that we need more time for this complex and important question: Does the therapeutic relationship have a good quality? In other words, does the therapist reach his or her client with their music therapeutic intervention through an appropriate assessment of the state of development? The most common mistake, in my experience, was to expect the capacity for joint attention and the attempt to enter into dialogue with a client who does not have the ability to do so.

Research: The research work with Karin Mössler showed whether the music therapeutic intervention has reached the patient, that means whether a “shared moment” can be observed. Through the Covid-19 pandemic we stopped our plan to give a course in English, but we will see what is possible in the future. At the moment, we offer courses in Berlin, Munich, Vienna, and Zürich. The newest are in Korea and Japan, where colleagues were very interested to profit from our knowledge and to teach the AQR Tool in their countries.

References: The latest revised summaries of the AQR Tool can be found in English (Schumacher et al., 2018) and in German (Schumacher et al., 2021). Two articles mentioned in Gattino’s book review (i.e., Schumacher & Calvet-Kruppa, 1999; Schumacher & Calvet, 2007) are outdated.


Gattino, G. S. (2022). Book review: The AQR tool – Assessment of the quality of relationship (Schumacher & Calvet). Approaches: An Interdisciplinary Journal of Music Therapy, 1-3.

Schumacher, K. (2014). Music therapy for pervasive developmental disorders, especially autism: A case study with a theoretical foundation and an evaluation tool. In J. De Backer & J. Sutton (Eds.), The music in music therapy. Psychodynamic music therapy in Europe: Clinical, theoretical and research approaches (pp. 109–125). Jessica Kingsley Publishers.

Schumacher, K. (2017). Musiktherapie bei Kindern mit Autismus, Musik-Bewegungs- und Sprachspiele zur Behandlung gestörter Sinnes- und Körperwahrnehmung, with DVD in collaboration with C. Calvet und S. Reimer. Reichert.

Schumacher, K., & Calvet-Kruppa, C. (1999). The “AQR – an analysis system to evaluate the quality of relationship during music therapy: Evaluation of interpersonal relationships through the use of instruments in music therapy with profoundly developmentally delayed patients. Nordic Journal of Music Therapy, 8(2), 188-191.

Schumacher, K., & Calvet, C. (2007). The ‘‘AQR-instrument’’ (Assessment of the Quality of Relationship): An observation instrument to assess the quality of a relationship. In T. Wosch & T. Wigram (Eds.), Microanalysis in music therapy. Methods, techniques and applications for clinicians, researchers, educators and students (pp. 79–91). Jessica Kingsley Publishers.

Schumacher, K., Calvet, C., & Reimer, S. (2018). The AQR Tool – Assessment of the quality of relationship. In S. L. Jacobsen, G. Schulz-Gattino & Eric G. Waldon (Eds.), Music therapy assessment: Global perspectives and contemporary issues (pp. 197–214). Jessica Kingsley Publishers.

Schumacher, K., Calvet, C., & Reimer, S. (2021). EBQ – Einschätzung der Beziehungsqualität. In H.-H. Decker-Voigt & E. Weymann (Eds.), Lexikon Musiktherapie (3rd ed., pp. 123-127). Hogrefe.

Stallmann, M. (2006). Zwischenmenschliche Beziehungsfähigkeit: Ergebnisse der Reliabilitätsprüfung eines neu entwickelten Instrumentes zum Wirkungsnachweis der Musiktherapie. In B. Müller-Oursin (Ed.), Ich wachse, wenn ich Musik mache: Musiktherapie mit chronisch kranken und von Behinderung bedrohten Kindern (pp. 75–104). Reichert.