Beyond Individual Well-being: A Participatory Action Research Study on Self-Care, Psychoeducation, and Radical Acceptance in Music Therapy Education

Beyond Individual Well-being: A Participatory Action Research Study on Self-Care, Psychoeducation, and Radical Acceptance in Music Therapy Education | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Beyond Individual Well-being: A Participatory Action Research Study on Self-Care, Psychoeducation, and Radical Acceptance in Music Therapy Education Chi-Yen Chang This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6999522/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 12 You are reading this latest preprint version Abstract Situated within a feminist educational framework and participatory action research, this empirical study explores pathways for facilitating self-care in music therapy education through participatory, arts-based group processes that centre student voices and lived experience. Across two cycles of collaborative groups, music therapy students co-created spaces that supported emotional presence, creative expression, and integration of personal and professional identities. Data were collected through observation, questionnaires, group dialogue, artistic works, and interviews. Thematic analysis identified six overlapping phases in students’ self-care journeys, shaped by ambiguity, vulnerability, and mutual care. Key challenges included navigating diverse learning preferences, sustaining autonomy within collaboration, and establishing psychological safety in institutional settings. The findings suggest that self-care in education is a relational and embodied process that resists fixed technique and invites educators and students to co-create ethical spaces for presence, reflection, and growth. Rather than framing self-care as relaxation or personal enjoyment, the study highlights its role as a form of psychoeducation that involves personal experience, pedagogical practice, and systemic conditions. Figures Figure 1 Figure 2 1. Introduction Social shifts, austerity measures, and rapid technological change have disrupted the resonance among individuals, culture, and nature, subjecting people to unprecedented levels of pressure and anxiety [1]. These challenges affect both private and public life. They are particularly acute in healthcare, where professionals such as doctors, nurses, and therapists face severe emotional burdens and rising mental-health crises. According to the World Health Organization [2], between January 2020 and April 2022, at least 25% of healthcare workers worldwide reported symptoms of anxiety, depression, and burnout during the COVID-19 pandemic. Although the global emergency has ended, many clinicians continue to experience these symptoms, exacerbated by staff shortages, low pay, and chronic stress [3]. In recognition of the problem, burnout has been classified as an occupational phenomenon in the latest revision of the International Classification of Diseases [4]. The urgency of the situation is further underscored by initiatives such as Healing the Healers , a 29-country mental-health survey paired with stress-management workshops [5]. Music therapists, although often overlooked in mainstream healthcare discourse, occupy the same care ecosystem. The profession has long faced elevated levels of stress and attrition, an issue that predates the pandemic and remains prevalent today [6–8]. While musicking is celebrated as a powerful self-care practice that fosters health and well-being [9], music therapy students and p ra ctitioners still report higher stress and burnout than many other health professionals [10,11]. Despite repeated calls to embed self-care training in music therapy curricula [12,13], responsibility for well-being remains highly individualised. Self-care is framed as a personal task rather than a pedagogical or ethical imperative, leaving learners and practitioners to manage emotional exhaustion in isolation. Empirical studies on this problem within music therapy education and educational research continue to be limited [14,15]. This persistent gap reflects not only the magnitude of the global crisis but also a deeply rooted and damaging myth within healthcare education and culture: healthcare providers should neither seek nor require care themselves [16]. Such expectations perpetuate the notion that helping professionals must remain selfless and “professional,” even at the expense of their own well-being. Challenging this belief is essential for safeguarding healthcare practitioners and sustaining quality care across the health sector. Importantly, I also acknowledge that educators are also part of the caring professions. As an educator and therapist, I recognise that supporting faculty well-being is vital for shifting the cultural narratives that shape educational practice and professional development across disciplines. Although psychoeducation and radical acceptance were not the guiding concepts at the outset, the group process gradually revealed patterns of learning that fostered students’ psychological insight, emotional regulation, and relational awareness. This realisation led me to reconsider how self-care might be understood and facilitated within educational settings, not simply as an individual practice but as a pedagogical process. Before moving forward, I clarify how self-care is defined in this study. Drawing on my fourteen years of clinical experience, as well as the work of Shulman [17], Bressi and Vaden [18], and the American Psychological Association [19], I define self-care as an ethical obligation to safeguard personal well-being and maintain professional competence. It entails purposeful activities that regulate emotion, promote health, and support work performance, while also cultivating self-awareness and reflexivity so that personal and professional realms may be integrated and transformed. Research Aim and Question As part of a broader response to the current crisis, this empirical study examines how self-care can be facilitated in music therapy education. Guided by a feminist educational framework and a participatory action research (PAR) design, I work collaboratively with music therapy students to co-create self-care practices that foster personal well-being, support professional development, and challenge persistent “caregiver myths,” while centring reflexivity in the research process. Through two iterative cycles of arts-based self-care groups, we move collectively through reflection, action, and evaluation, exploring how experiential structures can enhance students’ learning and agency. This study approaches self-care not merely as a form of coping, but as a practice of radical presence —being with discomfort, uncertainty, and imperfection as part of the learning process. Grounded in our shared lived experience, the study therefore asks: What experiences and challenges do music therapy students encounter in self-care collaborative groups, and how can these insights inform the facilitation of self-care within music therapy education? Overview of the Collaborative Groups The self-care collaborative groups developed in this study intentionally distinguish between personal self-care in daily life (e.g., rest), leisure-based activities (e.g., hiking), and professional self-care (e.g., supervision). Using experiential and arts-based methods, these groups aim to bridge the gap between personal and professional self-care within music therapy education. Instead of following a rigid agenda preset by me as researcher, group content and direction emerge organically through student participation, contribution, and shared reflection. This flexible design responds to the complex and layered nature of self-care by offering varied opportunities for social engagement, artistic expression, and interactive learning. 2. Background 2.1 Self-care in Healthcare Education Self-care is increasingly recognised as a prerequisite for sustainable caregiving, yet its practical meaning in healthcare professional education remains contested. Caring benefits recipients, and many professionals and informal caregivers report profound satisfaction, personal growth, and meaning through their acts of care [ 20 , 21 ]. Nonetheless, the very qualities that enable effective and compassionate caregiving—empathy, sensitivity, and dedication—can also heighten vulnerability to emotional fatigue and burnout when self-care is inadequate [ 22 ]. A growing body of research documents the multidimensional toll of providing care. Adverse outcomes encompass physical illness, financial strain, disrupted relationships, diminished leisure, reduced work performance, and even elevated mortality risk [ 23 ]. Among practising professionals, inadequate self-care is linked to emotional exhaustion, depersonalisation, cognitive impairment, and a diminished sense of accomplishment, jeopardising both practitioner well-being and service quality [ 24 – 26 ]. These risks emerge well before graduation. In healthcare programmes, heavy coursework, rigid competency standards, structural inequities, and limited institutional provisions converge to place students at heightened risk of premature burnout. Music therapy students, for instance, report higher stress levels than peers in other disciplines [ 15 ], while medical and nursing students similarly exhibit elevated rates of psychological distress and sleep disorders during clinical training, with up to 63% reporting at least one sleep-related symptom [ 27 ]. For learners, the consequences mirror those observed in the workforce, including early burnout, cognitive decline, and disengagement from learning [ 25 ]. Collectively, these findings highlight that self-care is not only a clinical concern but also an educational imperative within healthcare education. In music therapy, despite repeated calls for explicit self-care training and structural reform [ 12 , 13 ], curricula often frame self-care as an individual responsibility, providing minimal pedagogical or organizational guidance [ 28 ]. Very few studies foreground students’ own perspectives on self-care, especially in music therapy education [ 14 ], leaving unanswered questions about how learners experience, negotiate, and co-construct sustainable practices. This persistent gap between institutional claims and day-to-day educational realities crystallises a broader paradox. Care providers are praised for their empathy, yet the emotional and moral burdens generated by empathy are silently shifted onto individual practitioners. This helps explain both the high incidence of burnout among healthcare professionals and the especially precarious position of music therapists, whose practice demands sustained affective attunement,often without the institutional safeguards available to larger medical disciplines. From an ethics-of-care viewpoint, self-care is not a private coping tactic but a shared responsibility woven through professional teams, institutions, and social structures [ 29 ]. Unlike traditional ethical models that prioritize impersonal duties or universal rules, a care perspective centres concrete relationships, mutual dependence, and the power imbalances that shape every caring encounter,thereby making vulnerability a collective concern rather than an individual failure. 2.2 Music Therapy Students’ Views on Self-Care Since the 1990s, student voice has been framed not merely as a courtesy but as a learner’s right to participate in shaping education [ 30 ]. Informed by constructivist, critical, and feminist pedagogies, collaboration with students can enrich learning, challenge power relations, promote inclusion, and stimulate meaningful reform [ 31 , 32 ]. At the same time, misrepresentation, bias, and tokenism remain persistent risks [ 33 ]. Cook-Sather [ 30 ] cautions against treating students as a single, homogeneous group; Lincoln [ 34 ] calls for engagement that is both ethical and credible; and Haraway [ 35 ] advocates for reflexive, situated inquiry that rejects the illusion of neutrality. These principles guide the present review. Comprehensive searches of English, Norwegian, and Chinese language databases have identified only eight studies that explicitly or implicitly examine self-care from the perspective of music therapy students. These studies fall into three geographical strands, each illuminating a distinct facet of self-care within music therapy education. United States A small but growing body of empirical research has begun to examine self-care in music therapy programmes, with early studies focusing on individual-level experiences and more recent work addressing systemic factors. Although Jackson and Gardstrom [ 36 ] did not frame their work explicitly in terms of self-care, their experiential music therapy groups for undergraduates heightened students’ awareness of the need to look after themselves. However, the authors did not investigate whether this insight persisted over time. Kaiser [ 28 ] found that expressive-arts workshops fostered self-care, yet participants reported limited autonomy, insufficient information, and a gap between personal and professional well-being. Two online surveys of approximately 400 students each [ 13 , 14 ] portrayed self-care as multidimensional, encompassing personal growth, balance, social connection, and clear study–life boundaries. While these studies offer a valuable baseline portrait of students’ perspectives, their cross-sectional and self-report nature invites further inquiry into how such practices are integrated into daily life. Finally, Boeser and Silverman [ 15 ] used qualitative interviews to expose systemic barriers, particularly racial inequities,and recommended earlier curricular integration alongside greater student agency. Latin America Araneo and his colleagues [ 37 ], working in Argentina, applied a critical pedagogy perspective to music therapy education by engaging students in community health projects that fostered agency, reflexivity, and collective responsibility. Although the study did not explicitly employ the language of "self-care," its findings underscore how thoughtfully designed curricula can enhance both personal and communal well-being. Norway Two student-initiated master’s theses from the University of Bergen — the same educational context as the present study — offer rare, critical reflections on how self-care was addressed in the very training they received. Kolbeinsen [ 38 ] interviewed five early-career music therapists, all graduates of the University of Bergen, who described themselves as “wounded healers.” They reported feeling unprepared and overwhelmed upon entering the profession, noting that the lack of structured self-care education left them inadequately equipped to manage the psychological demands and pressures of clinical work. The study highlights a broader pedagogical gap: insufficient attention to therapists’ inner experiences, professional identity, and self-care strategies during training. Persistent mental health stigma and a sense of isolation further compounded these challenges, undermining both personal well-being and professional development. Though trained to care for others through music, participants questioned whether their education truly supported their own psychological well-being. Skauge [ 39 ], in a study on burnout prevention, reached similar conclusions through interviews with early-career music therapists trained in Norway. Participants described patterns of over-exertion and self-doubt shaped by a culture of performance pressure, limited autonomy, and the constant need to justify the value of music therapy. Skauge argues that educators must explicitly affirm self-care, warning that silence on the topic risks creating a “burnout trap.” Identified Gaps Across these contexts, four key gaps emerge. First, student-partnered inquiry, where learners co-design and evaluate self-care initiatives, remains rare. Second, there is limited longitudinal evidence tracing how self-care skills develop over the course of training. Third, curriculum-embedded models that integrate personal well-being with professional competence are almost entirely absent. Addressing these shortcomings will require collaborative, practice-grounded research that positions students as active partners rather than passive respondents. Lastly, a systematic search of major Chinese-language databases (Airiti Library, Google Scholar, and NDLTD) identified no studies on self-care or student voice in music therapy education. Alongside the absence of research from other English-speaking and European countries, this reveals global imbalances in how these topics are studied and represented. Together, these gaps underscore the need for broader, cross-contextual inquiry into music therapy students’ experiences of self-care. 2.3 Author’s Positionality As a Taiwanese woman with a queer identity, raised and primarily educated in Taiwan, I completed my master’s degree in the UK and now work as a PhD research fellow in Norway. I situate myself at the intersection of multiple cultural, social, and geopolitical lenses. Coming from a Confucian-influenced educational culture shaped by multiple colonial histories, and now working within a Euro-American-dominated research environment, I am constantly reminded that knowledge is not neutral. Growing up in a context shaped by hierarchical, patriarchal, and collectivist values has compelled me to critically reflect on the tensions between individual and collective identities, gender roles, and the power structures that uphold inequality. My 14 years of clinical experience as a psychodynamically informed music therapist have attuned me to how unconscious, relational, and sociocultural forces shape well-being, distress, and patterns of care. My positionality as a researcher working from a Global South knowledge position reflects my education and upbringing in Taiwan, a society often excluded from dominant Euro-American academic discourses. Operating within a predominantly Western academic structure influences what I notice, what I prioritise, and what I resist. I have struggled with the dissonance between embodied, relational ways of knowing and dominant academic ideals of objectivity, a tension further shaped by my academic journey through Taiwan, the UK, and Norway. Each of these educational systems embodies distinct power relations in how knowledge is produced and legitimised. This awareness informed my decision to adopt a participatory action research methodology, which aligns with my values of shared authority, embodied knowledge, and co-created meaning. In this study, reflexivity was not only a methodological imperative but also a practice of relational ethics and self-care. To reduce bias and stay attuned to the lived experiences of student research partners, I engaged in sustained classroom involvement, collaborative teaching, and methodological triangulation. This work is grounded in the hope that more equitable, relational, and responsive forms of knowledge can emerge through co-learning and mutual care. 3. Research Method and Data Analysis 3.1 Research Design This study explores the facilitation of self-care in music therapy education through a feminist educational research framework [ 20 ] combined with participatory action research (PAR). In this design, students are positioned as research partners, actively contributing to the design of the self-care collaborative groups, shaping facilitation practices, and offering continuous process feedback. Spanning two semesters, the PAR cycles enable sustained engagement within the learning environment, allowing us to trace how contextually grounded self-care practices take shape and evolve over time. Building on valuable elements identified in previous research, namely the experiential, arts-based, and complex nature of self-care, this study addresses persisting gaps, including how to foster student autonomy, integrate the personal and professional dimensions of self-care, and confront systemic inequalities. Informed by feminist principles, the research design challenges hierarchical educational models by promoting non-hierarchical relationships. PAR offers a collaborative and context-sensitive methodology that centers students’ voices and positions researchers as co-learners. This facilitates both situated understanding and the co-creation of practical solutions [ 40 ]. The framework foregrounds humanization and holism, replacing top-down instruction with dialogic, co-learning processes that foster introspection and shared knowledge creation. Through iterative cycles of collaboration and reflection, the study aims to enhance the effectiveness of self-care facilitation and cultivate sustainable learning practices [ 41 ]. It aligns with care-centered pedagogy [ 42 ] and feminist pedagogical approaches in music therapy [ 43 ], reimagining the classroom as a collaborative and egalitarian space where teachers and students actively learn together. 3.2 Setting, Recruitment and Participants Approved by the Sikt ethical review board in Norway, student participants were recruited from the University of Bergen’s five-year integrated music therapy master’s program (approximately 75 students). Recruitment began in November 2023 through both online and in-person outreach. Participation was voluntary and independent of coursework. Student involvement occurred in two phases: (1) a one-time initial group in January 2024, and (2) a three-month ongoing main group from April to June 2024, consisting of eight weekly sessions, each lasting 150 minutes. Both groups met in music therapy classrooms equipped with a variety of instruments and diverse artistic materials. English served as the primary language of communication. There were a total of 18 enrollments across the two phases, with some students participating in both. The initial group included 7 students (6 master’s and 1 bachelor’s), providing preliminary experience and data. The main group began with 9 students; one participant withdrew after the first session, resulting in 8 regular participants (4 master’s and 4 bachelor’s) representing all program years. 3.3 Facilitation method in Collaborative Groups Both the initial and main phases of the self-care collaborative groups followed a participatory approach, with students actively contributing to the direction and content of each session. Participation was flexible; students could choose how to engage, suggest changes, and reflect on the process. This fostered an ongoing cycle of feedback and adaptation, reinforcing both individual expression and group cohesion over time. The researcher served as facilitator, facilitating group dynamics, designing experiential activities in response to participant input, and bridging the personal and professional dimensions of self-care. For instance, after students reflected on negative associations with their instruments, the facilitator invited them to engage in music improvisation to explore tensions between personal and professional intentions in music-making. These experiential activities included both verbal and non-verbal artistic forms such as visual arts, paper cutting, dance, movement, music, and drama. The study initially planned to use the quantitative Mindfulness Self-Care Scale (MSCS) to measure effectiveness, but students found it unsuitable. Instead, a Self-Assessment Scale was introduced, where participants rated the group’s helpfulness from 1 (not helpful at all) to 10 (extremely helpful). It is important to clarify that the self-care collaborative groups were not therapy groups. While personal sharing was welcome, therapeutic processing was not part of the sessions, and external assistance was available when needed. The facilitator did not act as a therapist or educator, but instead facilitated group autonomy and co-creation. Although a working definition of self-care was provided, participants were encouraged to explore and define self-care on their own terms. 3.4 Participatory Action Process Participatory Observation (Researcher) During the first six months (Aug 2023 – Jan 2024), the researcher primarily. served as a teacher, attending classes and participating in meetings to better understand the educational culture and observe students' self-care experiences. Observations and reflections continued throughout the project and were recorded in a log for data triangulation. (2) Questionnaire (Initial Group) An electronic questionnaire was used to explore students’ perceptions of self-care, educational experiences, and facilitation preferences in the initial group. The responses helped shape the design of the main group. (3) Focus Groups & Artistic Works (Main Group) Ongoing group discussions were conducted to collect feedback and guide. adjustments to the sessions. In addition, participants' artistic works were gathered as non-verbal data sources. (4) Individual Interviews (Main Group) One-hour semi-structured interviews were conducted to provide space for deeper individual reflection beyond the group setting. 3.5 Analytical Approach This study employed thematic analysis, following an editing analytical approach [ 44 ], which allowed themes to emerge inductively from the data. Given the underexplored nature of the topic, a broad descriptive approach was considered appropriate [ 45 ]. This inductive, bottom-up strategy aimed to capture participants’ lived experiences and nuanced understandings of self-care within music therapy education. All data were transcribed and imported into NVivo 20 for systematic coding using in vivo, open, and axial techniques. Patterns and relationships were identified through constant comparison and iterative refinement. To ensure analytical rigor, the process was strengthened by sustained researcher reflexivity, regular supervisory discussions, and occasional participant clarification to verify transcription accuracy. Themes were developed directly from participants’ language, artistic expressions, and lived experiences to ensure authenticity. Credibility was further strengthened through data triangulation, incorporating observational notes, participant feedback, and documentary sources [ 46 ]. To protect participants' privacy, letter identifiers (e.g., Student A) were used throughout the study. Although concepts such as psychoeducation and radical acceptance were not introduced at the outset, they later emerged during the analytic process as meaningful interpretive lenses. Psychoeducation integrates psychological knowledge with educational methods to build insight and coping skills beyond the therapy room. In both community and professional training contexts, it can bolster autonomy, confidence, and the collective prevention of mental health problems [ 47 ]. Radical acceptance, rooted in both Eastern philosophy and Western psychology, entails embracing discomfort and perceived failure without denial. By challenging perfectionism and internalised expectations of productivity and worth, it offers not resignation but a stance that acknowledges reality while opening space for recovery and flourishing [ 48 ]. 4. Findings : Generating Knowledge Through Collaboration 4.1 Motivation, Participation and Effectiveness The findings reveal a shared recognition of the need for self-care resources during training. Many students had never encountered a structured space for this purpose; as Student E said, “It’s such a good opportunity and concrete framework… which is not often provided here.” An 85% carry-over rate from the initial to the main group signalled strong commitment. Students openly shared challenges, experimented with new activities, and offered feedback, modelling a culture of emotional reflexivity and mutual care. Yet questionnaire and narrative data showed that those outside the groups who most needed help sometimes lacked the capacity to attend because of stress or overwhelm. In the initial group, 71% reported difficulty practising self-care when unwell, underscoring how distress can hinder access to support. Because participation and impact were cumulative, the analysis of participation and effectiveness focused on the main group. Attendance averaged 54%, while effectiveness rated 77% overall (82% in professional, 72% in personal). Attendance, however, did not necessarily predict benefit: Less frequent attendees H and D reported higher gains than more regular participants A, C and F, suggesting quality of engagement outweighs frequency. Personal resonance Students B, D and H described deep personal impact. Student D reflected, “There is a relation to group therapy… I never joined a group like this before but really enjoyed it.” Student B added that personal integrity nurtures professional practice. Professional inspiration Students A, C and F valued professional insights but found personal application harder. Student A noted, “ There are too many directions I could take… it’s hard to apply in my own life because my schedule is packed and the concept feels a bit abstract.” Integrated benefit : Student E, with moderate attendance, reported full effectiveness in both domains: “The free structure suits me… focusing on yourself but with another person helped me prepare for improvisation exams.” These patterns underscore the varied ways students engage with and benefit from self-care groups. The next section examines how these experiences shaped participants’ evolving self-care frameworks. 4.2 Self-care Framework Figure 1 illustrates how knowledge was co-constructed through iterative cycles of art-making and dialogue, represented metaphorically by an evolving tree. Participants used words such as “flourish,” “grounded,” and “reconnect” to describe their experiences. To encompass these expressions and their interrelated meanings, I used a unifying metaphor: soil (group support and grounding), sun, and water (personal and professional dimensions), emphasising that growth requires all three elements. Participants’ self-care journeys unfolded in spiral phases. Early stages (1–3) focused on expressing the inner self and building connection. As Student B shared: “Coming here feels like coming home… In our hustle culture, self-care is neglected—you must be a human doing, not a human being.” Phase 4 introduced tension, prompting reflection on internal conflicts and the evolving meaning of self-care. Later stages (5–6) involved efforts to integrate and redefine this understanding. As the group progressed, the process began to align with both psychoeducation and radical acceptance. While psychoeducation facilitates the development of psychological understanding and coping, radical acceptance encourages presence with discomfort, uncertainty, and imperfection, without the need to fix or explain. Student A noted, “I felt confused at times… But since many others were going through the same thing, we could explore it together. The group helped me stay and keep coming back.” Student G added, “I didn’t understand the meaning of the artistic activities at first… but I realised the group taught me that self-care was something beyond what I expected.” This process reflected a shift toward radical acceptance, grounded in not knowing, not performing, and being fully present with oneself and others. Student D emphasised the value of shared experience: “I never talked about this stuff with friends or family… but here, we’re all from music therapy, we get it… The collaboration aspect is important,it’s in those moments that we feel most connected.” In addition, the main group structure helped bridge personal and professional realms, keeping the self-care process connected to participants’ everyday lives. It supported reflection on how inner experience intersects with professional roles. After an activity on musical identity, Student H shared a placement-related struggle: “I felt crap that day, but my autistic client loved playing drums… I tuned into him, but my arm cramped and I wanted to cry.” This opened a discussion on self-sacrifice versus self-care, including ways to balance boundaries and advocate for one’s needs. The facilitator’s role also helped link the group space with professional realities. As Student C reflected: “You [the facilitator] helped a lot by bringing the discussion of what we experience here toward personal or professional life.” 4.3 Artistic and Experiential Space Artistic and experiential approaches enhanced self-care by enabling reflection beyond purely verbal or cognitive expression. In session six, For instance, participants combined visual cards and painting to explore recent challenges, then shared their insights with the group; the process helped them move from tension (Phase 4) to a sense of balance (Phase 5). The following conversation, centred on Student E’s artwork (Fig. 2 ), shows how the space was used in the group. Student E reflected: I feel like there is a spectrum of creating, we have the rational and feeling parts, it is process of balancing outside and inside. When I create, it feels whole,like an automatic pattern of thinking that leads to spontaneous expression. There isn’t really a plan. If you looked at the cards without me saying anything, you would see how all the parts come together. Then, student F responded: It is impressive and creative. You create a window for us to go into your consciousness. Your flow really captures the movement of your thoughts in that moment... You don’t force it ; you simply respond to it as it unfolds. It makes me wonder how it feels to be you, how does that feel like? This conversation shows how arts-based and experiential methods let students remain with ambiguity instead of rushing to solutions. The artwork becomes a visible, lasting form that nurtures peer connection and social support. Participants also discovered that varied materials deepen links to music and encourage a growth mindset. Student C, initially hesitant and preferring guidance, gradually gained confidence in creative expression: “I felt most connected to the art station with its variety of materials. It felt freeing to create without needing to be perfect.” Starting with visual art, she then improvised a solo flute piece: “Improvising was scary, but this safe space energised me and helped me cope with earlier chaos.” Her experience illustrates how diverse artistic options, tailored to individual needs, foster autonomy, self-care, and transferable confidence for professional practice. 4.4 Challenges (1) Gap Between Cognitive and Embodied Learning The concept and terms emerged from participant narratives. Student participants often experienced cognitive and embodied learning separately and used these phrases to describe their experiences, indicating that full integration takes time; insight may begin as cognitive without embodiment or as a bodily experience before cognitive articulation. For example, Student B reflected in session 4: I used to think I was good at self-care, but I realized I wasn’t. It was mostly cognitive and didn’t really feel valid inside. It only became real when self-care was done to me and I could feel it in my body, then it became embodied... Previously, I tended to link self-care with doing something useful, rather than simply being present and listening to my body. It is important to note that the challenge impacts individuals and is intensified by diverse learning styles, which complicates the group’s direction. Some students (B, E, G) thrived with embodied learning by directly experiencing it, while others (A, C, F) preferred cognitive approaches for clarity and understanding. For example, Student B said, “I’m used to going with the flow... I feel more than I think. Cognition is like additional information. I prefer to listen to my intuition.” Similarly, Student G shared, “Free flow in artistic activities gives me an opportunity to recognise my needs... like children play, spontaneously and intuitively.” Conversely, others preferred cognitive guidance: “Although these activities are fun, I very much like guidance and being able to predict what is going to happen” (Student A). “I would like to talk more about what self-care is... because you’re doing a PhD on this topic, and I imagine you know a lot about the science behind it” (Student F). Cognitive preference may also have cultural underpinnings. Student G noted, “Norwegians are quite rigid; we don’t use a lot of expressive body language... Maybe it is related to the Jante Law—no one is supposed to be special.” Cognitive-based learners prefer structured, theory-driven learning and may struggle with experiential methods, causing discomfort. Conversely, embodied learners can feel restricted by overly cognitive approaches that limit natural expression. However, these learning styles are complementary. With careful facilitation, students unfamiliar with embodiment gradually attuned through experience, while those less comfortable with theory engaged more deeply with cognitive perspectives. For example, cognitive-based learner student C shared: “Early on, I used this scarf to cover my eyes... I felt tense and couldn’t find my place... Slowly, I dared to move between all of you, to the piano, and just play quietly.” Embodied-based learner Student G asked a theoretical question in last session: “I'm wondering whether authenticity is an essential part of self-care, as I'm trying to understand how Jungian psychology relates to it through self-study.” The students’ experiences show that while the challenge may be unavoidable, fostering mutual learning between embodied and cognitive learners can help bridge the gap and promote a more integrated understanding. Nevertheless, Uncertainty may arise for both learning styles before integrating cognitive and embodied learning. Student B, favoring embodied learning, reflected after session 4: “Last session hit me deeply... self-care became elusive... I’m no longer ‘good’ at it... but now it’s grounded somatically…something shifted in my brain and body.” Similarly, Student C inclined to mind-based learning noted: “When given freedom here, I often feel unsure... social settings can be hard... but here I learned to take care of myself in groups and realized I don’t always have to lead a conversation.” This ambivalence reflects the challenge of stepping outside comfort zones, evoking conflicting emotions essential for growth, underscoring the need to support students through this transition for effective self-care facilitation. (2) Balancing Autonomy and Collaboration Another key challenge in the self-care collaborative groups was balancing individual autonomy with collaboration, shaped by the group’s format and collaborative dynamics. Practising self-care in a shared space proved difficult for some participants. Although each session offered both social and individual zones, mismatches still occurred. During session 3, for example, Student F chose the social zone, but the others opted for solitude: “I preferred to socialize with others, but when no one is there, it feels uncomfortable, and this often happens in daily life.” Student E added, “I think I’m used to practicing self-care alone… I focus too much on wanting to interact with others when I’m with people.” Student C reflected, “It was kind of weird to do my own thing in a group, but sitting in our bubbles and doing what felt natural was freeing… it’s a nice feeling.” These reflections reveal the challenge of honoring personal space while navigating social dynamics. In education, self-care requires a delicate balance: it is neither entirely private nor wholly collective. Students grappled with common questions—how to stay connected to oneself in a group, and how to be with others when solitude is needed. These tensions became opportunities to practise staying centred amid distraction and social pull. The groups emphasised shared power, with facilitators supporting self-exploration rather than providing answers. Yet this autonomy sometimes led to uncertainty. Student C remarked, “When given the freedom, I often feel unsure of what I want to do or where I want to be.” Educational culture often conditions students to expect structure. As Student A noted, “In an educational setting, we are used to knowing what we will learn before signing up for a course.” This highlights the inherent tension between autonomy and collaboration. While a group framework can support self-care, the practice remains highly personal; no single formula fits everyone. It implies that true growth arises when learners fully own both freedom and responsibility, recognising them as inseparable forces that shape the self, relationships, and care. (3) Psychological Safety Establishment The third challenge from student experiences is that, although most participants built trust within collaborative groups by sharing openly, psychological safety in the wider learning and work environment remained a key issue. Psychological safety means feeling included and free to express ideas without fear of judgment or punishment [ 49 ]. While related, it differs from trust, which centers on interpersonal reliability [ 50 ]. This challenge was explicitly discussed in Sessions 2 and 4 of the main group. Using the metaphor of a sunflower at the heart of a spiral surrounded by wilted roses, Student H questioned the link between inner self-expression and psychological safety: “If you were a sunflower instead of a rose, how would you know you were allowed to show yourself…? Maybe that’s not even allowed.” Student A resonated, asking, “When am I allowed to say it? When can I do that (within the school context)?” Student E added, “We should make being ourselves less taboo.” Such psychological tension also affects students’ professional identity. Student I described being a student as facing “more pressure to be cheerful, patient, and musical superstar, along with the need to market the profession, uncertainty in the job market, and favoritism among faculty and those in power." Student H shared struggling during clinical placement: “I was feeling crap personally…but my client was playing so loud... I managed to give my all, but I was exhausted and it impacted my next client.” Student G noted, “I tend to self-sacrifice…sacrifice tuning in myself.” These student reflections reveal pressure to conform to educational and professional expectations, creating fear around expressing personal traits and attending to their inner selves amid concerns of rejection or exclusion. This fear undermines their psychological safety. In addition to external forces, personal histories also influence students’ sense of psychological safety. Student G shared, “I wanted to smash the piano and make ugly music, but I couldn’t… expressing emotions was not allowed in my family.” This illustrates how both performance pressure and ingrained beliefs can restrict self-expression. Such moments highlight the need for facilitators to model openness, reassure students of their freedom to express themselves, and recognise the importance of connecting them to external professional support, such as individual counseling, when needed. Importantly, the challenge of establishing psychological safety not only affects students’ learning and self-care but also extends into their professional work with clients. Student F shared discomfort when clients cried: “I try to let the clients stop crying… but that feels kind of wrong.” Student E reflected on how relational challenges can disrupt inner peace: “You are very okay to be alone, but there’s a difference when there is relationship from the external world.” These narratives illustrate that some students feel uncertain about how to respond to clients’ psychological needs in clinical settings, while simultaneously being emotionally impacted by these experiences. This highlights how personal psychological safety directly influences professional practice. As such, fostering psychological competency is a crucial aspect of self-care in healthcare education. 5. Discussion This discussion examines the experiences of student participants, following the same thematic structure as the findings section and integrating their reflections throughout. 5.1 Motivation, Participation & Effectiveness: Hidden Value Revealed Through Experience Many students discovered a deeper, embodied understanding of self-care only after joining the group. The two-phase design, beginning with a brief exploratory stage and followed by a longer engagement, invited cautious entry and then encouraged sustained commitment. Collaboration, experiential learning, and artistic exploration built trust, while linking personal with professional practice helped students translate lived experience into professional growth. Motivation developed through a balance of ease and challenge. Moments of discomfort often sharpened insight: Student C gained confidence in flute improvisation through the initial “chaos,” and Student A, though initially unsure, kept returning as progress became tangible. Enjoyable experiences also reinforced engagement: Student J continued after a positive experience in the initial group, and Student E found the group helpful when preparing for an improvisation exam. Paradoxically, students who were not motivated to join the groups were often those most in need of support. Fatigue, limited readiness, and an unrecognised need for care kept some away. Wilhelm and Moore [ 14 ] similarly report that higher perceived stress predicts lower self-care, underscoring the importance of cultivating both readiness and practical capacity so that resources can reach those who need them most. Attendance alone did not determine effectiveness. Individual learning styles and group dynamics played a central role: some students struggled to translate abstract ideas into personal practice, while others successfully integrated them into both personal and professional life. Those who reported stronger personal engagement also noted greater professional benefits, echoing Student B’s view that personal self-care serves as the root that enhances professional capabilities. For students who found it difficult to connect with personal self-care, or for whom facilitation methods, such as experiential learning, did not resonate, additional assistance such as individual mentoring or alternative approaches tailored to their learning preferences proved essential. Finally, the groups thrived on diversity. Students developed varied approaches to self-care, each seen not as deviation but as meaningful contribution. This diversity also prompted a shift from standardised measures of effectiveness toward individual self-assessment, highlighting the inherently subjective nature of self-care and the facilitator’s vital role. By recognising each student’s unique strengths and remaining responsive to their differing needs, facilitators help create an environment where students can engage in personally meaningful ways while contributing to the group’s collective growth. 5.2 Psychoeducation Framework: for Learners and Curricula The framework aligns with psychoeducational models of learning that emphasise reflection and emotional processing, and it resonates with the principle of radical acceptance as a stance of presence and non-judgment. A significant implication is that self-care facilitation in education extends beyond relaxation or enjoyment; it falls within the broader scope of psychoeducation. It enables students to develop self-awareness and build the psychological capacities needed to navigate challenges more effectively. The self-care collaborative groups revealed a developmental process shaped by six organically emerging phases, driven by student participants. Central to this process was the exploration of the inner self, including one’s thoughts, emotions, motivations, and identity. This involved introspection, emotional understanding, identity development, and the pursuit of self-knowledge. Anchored in a foundation of trust, students navigated both internal and external pressures, ultimately arriving at a redefined and more integrated understanding of self-care. Several foundational elements contributed to a supportive learning environment: safety, connection, playfulness, creativity, equality, care, and compassion. These qualities grounded students during moments of uncertainty. The integration of personal and professional identities, symbolised by the imagery of sun and water, enabled genuine growth. Without such integration, development risked becoming superficial, often marked by emotional dissonance or professional stagnation [ 51 ]. An artistic and experiential approach closely aligned with music therapy education and reflected the essence of students’ professional training. Students experienced first-hand how to move beyond verbal expression, enabling holistic and embodied self-exploration. Artistic processes helped integrate cognitive and emotional dimensions, fostered group cohesion, and deepened interpersonal understanding. Engaging with a wide range of artistic materials also reinforced professional identity, with many students reporting increased flexibility and personal growth in their practice. Overall, this process enhanced resilience and strengthened the capacity to tolerate ambiguity in learning. These elements facilitated the development of sustainable self-care and long-term growth across personal and professional domains. Through social learning, group settings validated individual experiences, normalised shared challenges, and strengthened support networks [ 47 ]. Within education, psychoeducation has been shown to enhance academic performance, promote emotional well-being, prevent behavioural difficulties, and inform more effective and resource-conscious policies [ 52 ]. In this context, facilitators played a pivotal role as catalysts. Rather than acting as caregivers or knowledge providers, they supported students’ autonomy and self-exploration. This student-centred approach fostered responsibility, empowerment, and reciprocal growth between students and facilitators. 5.3 Challenges This section explores three key challenges students encountered, progressing from personal to relational and systemic levels, along with practical implications and recommendations. (1) Personal: Gap Between Cognitive and Embodied Learning A key challenge lies in the contrast between students’ learning styles. Some resonate more with an embodied approach, experiencing self-care as a way of being, rooted in movement, creativity, and somatic awareness. Others prefer a more mind-based orientation, viewing self-care as a set of practical actions grounded in knowledge, such as a desire to understand the theoretical basis of self-care. These differences can lead students to feel uncertain or discouraged when others respond in unfamiliar ways, increasing the risk of demotivation or disengagement. This dynamic echoes feminist perspectives in education, which challenge cognition-centred, male-dominated epistemologies and advocate for including embodied experience as a vital part of holistic development [ 53 ]. However, these two approaches are not in conflict but are interconnected. Integrating both allows self-care to be intentional as well as embodied. Balancing lived experience with cognitive understanding enables students to expand their comfort zones and apply knowledge meaningfully. Cognitive approaches offer structure and motivation, while embodied practices promote autonomy and deeper insight. Facilitators must be attentive to varied learning preferences and balance structure with flexibility through dialogue and ongoing reflection. This also aligns with the evolving nature of the self within the self-care collaborative groups. Exploration and dialogue foster growth, yet transformation often brings ambiguity and uncertainty. This highlights the importance of cultivating ambiguity tolerance and resilience. Ambiguity tolerance refers to the ability to face uncertainty without avoidance or excessive reliance on authority, while resilience refers to the capacity to adapt and recover from challenges, shaped by both internal and external conditions [ 54 ].These capacities are essential in educational settings and connect directly to the broader framework discussed earlier. They help students move beyond binary thinking toward more pluralistic, constructive understandings, better manage academic demands, and support both professional and personal development [ 55 ]. (2) Relational: Balancing Autonomy and Collaboration The second challenge emerges at the relational level: finding a balance between individual autonomy and group collaboration. While the group format promotes shared learning and emotional support, it may at times distract from personal self-care, even when opportunities for individual reflection are present. This tension illustrates the need for students to develop skills in navigating social expectations around self-care. Facilitators play a critical role in transforming these moments into learning opportunities, ensuring that the group setting strengthens, rather than undermines, individual well-being. A key implication is that some students view facilitators as experts expected to provide answers, reflecting patterns shaped by traditional educational structures. When facilitators step back to encourage equality, certain participants struggle to engage independently and instead seek external validation. This reveals a deeper challenge in fostering learning autonomy. Students who are accustomed to authority-led environments may develop learned helplessness, which impedes self-directed learning. Biesta [ 56 ] highlights this contradiction, noting that emancipation often still depends on the educator’s permission to "set the student free." In other words, liberation occurs within a persistent power imbalance, where the educator grants rather than enables autonomy. Moore and Wilhelm [ 13 ] further critique systemic tendencies in music therapy education to prioritise theoretical and technical training at the expense of students’ personal well-being, limiting opportunities to develop meaningful self-care practices. These critiques raise important questions about how to decolonise educational authority and truly foster learner agency. This presents a complex task for facilitators: to honour diverse needs while encouraging students to take ownership of their self-care journeys. Addressing this challenge requires facilitators to remain highly aware of how their presence and actions shape group dynamics and student agency. Their role is not to direct, but to support and empower. Ultimately, cultivating shared responsibility between facilitators and learners is essential for meaningful and sustainable self-care development in higher education. (3) Systemic: Psychological Safety Establishment The third challenge within the self-care collaborative groups concerns the establishment of psychological safety, a process shaped by systemic forces that extend beyond the group itself. Institutional norms, cultural expectations, and power dynamics deeply influence students’ willingness to share and explore their inner experiences. While facilitators play a key role in creating supportive environments, addressing these broader issues requires advocacy and transformation at the institutional level. As students reported, dominant expectations within their learning and professional environments pressured them to conceal their differences. Cultural, social, and academic norms often fuel internal conflict and self-suppression, contributing to structural violence that restricts self-care practices grounded in honesty, personal relevance, and emotional integrity. Over time, these constraints can lead to burnout [ 57 ]. Clark [ 49 ] outlines four stages of psychological safety, beginning with “inclusion safety,” in which individuals feel secure enough to express difference without fear of exclusion. Without this foundation, genuine learning, contribution, and growth become difficult to initiate or sustain. Biesta [ 56 ] warns that when education privileges socialisation and qualification over subjectification, it becomes a tool of social reproduction,reinforcing existing hierarchies and discouraging the emergence of unique voices. Such systems push students toward conformity, marginalising dissent and maintaining injustice. This concern is echoed by Lundberg and Chen [ 60 ], who argue that healthcare systems actively reproduce exclusion and preserve control. Even while claiming to advocate for marginalised groups, healthcare professionals often remain embedded in systems shaped by racial capitalism and coloniality. Beyond environmental influences, personal histories and psychological trauma also shape students’ relationships with self-care, in ways closely entangled with structural inequality. Courtois and Gold [ 59 ] stress the importance of integrating personal background into professional education, recognising that many challenges are rooted in, or exacerbated by, ableism, racial hierarchies, and neoliberal pressures. Similarly, Norcross [ 16 ], drawing on 25 years of research on health professionals, challenges the persistent belief that practitioners do not require therapy. He argues that treating professionals as mere instruments and ignoring their humanity undermines both their well-being and their capacity to offer ethical, effective care. In music therapy education, addressing these systemic challenges involves more than curriculum content. It requires a commitment to holistic student development, the creation of emotionally safe spaces, and the recognition that personal growth is inseparable from professional learning. This approach affirms the complexity of self-care as both a personal and collective practice, shaped by broader social conditions and embedded power structures. 6. Conclusion and Future Actions This empirical study, situated within a feminist educational framework and participatory action research, explores pathways for facilitating self-care in music therapy education through participatory, arts-based group processes that centre student voices and lived experience. The knowledge generated reveals that self-care in education cannot be reduced to individual coping or surface-level well-being. Rather, it emerges through sustained, relational, and reflective practices that unfold across personal, educational, and systemic dimensions. Students’ experiences demonstrate that meaningful self-care is a process of learning through action, uncertainty, and dialogue. This process calls for the development of ambiguity tolerance and resilience, especially as students encounter discomfort, difference, and emotional vulnerability. This journey requires flexible structures that accommodate diverse learning styles and lived realities. Facilitating self-care, then, is not about delivering fixed skills. It involves co-constructing a dynamic practice rooted in experience, critical inquiry, and reciprocal support. These insights offer a foundation for implementing and adapting self-care initiatives across educational settings. From an individual perspective, each student still carries personal responsibility. Cultivating self-care in an educational setting requires a commitment to self-development and a willingness to engage with the discomfort that learning may bring. It involves self-reflection, critical thinking, and the courage to navigate challenge and change. Autonomy therefore entails responsibility. Taking ownership of one’s learning not only strengthens independence but also enables meaningful contributions to academic, social, and professional life. At the same time, recognising how social structures and institutional logics shape these experiences helps prevent students from internalising systemic problems as personal shortcomings. From an educational perspective, psychoeducation offers a valuable framework for self-care facilitation. It nurtures self-exploration and supports the development of psychological competencies such as ambiguity tolerance, emotional regulation, and adaptive coping. Offering diverse options accommodates different learning styles and modes of expression. Facilitators must remain attuned to the ethical dimensions of educational relationships, as the boundary between guidance and control is often thin. Within a supportive group setting that weaves together cognitive and embodied learning with social and creative connection, students learn to stay with uncertainty and deepen their emotional grounding. Encouraging intrapersonal curiosity, bridging personal and professional realms, and using experiential methods all contribute to holistic well-being. While grounded in music therapy education, these insights are relevant across disciplines and contexts. From a systemic perspective, we must critically reconsider what constitutes a genuinely supportive learning community. As Spivak [ 61 ] urges in Teaching for a Broken World , educational standards are never neutral. They carry power, ideology, and social meaning. Education must therefore move beyond narrow goal-orientation and reclaim its mission as a space for freedom, exploration, and reflective transformation. Embracing the contingency of knowledge,what Spivak calls a slow, humanity-centred preparation,guards against defensiveness and cultivates deeper understanding. Yet many people may not immediately perceive the need for self-care. Those with greater access to resources may overlook deeper struggles because of privilege, while those with fewer resources often understand the importance of care, yet face structural barriers that make sustained practice difficult. Facilitating self-care in music therapy education, as well as in higher education more broadly, is therefore not only a matter of personal well-being but also a question of social and relational ethics. We must learn to recognise how systemic inequities shape both our own vulnerabilities and those of the people we seek to support. Sustainable self-care practices equip us to navigate these realities with resilience, humility, and compassion. Silence in the face of structural violence is never neutral. It becomes complicity. Healthcare education that neglects its own health cannot credibly inspire change in others. Radical acceptance invites us to face systemic harm with clarity and resist the urge for quick fixes. In these unsettled times, self-care must be understood as a collective responsibility rooted in interdependence. Caring for ourselves and one another lays the foundation for enduring change and genuine flourishing. Amplifying students’ voices is therefore essential. Their strength and agency are vital to building learning communities grounded in justice, compassion, and care. Looking ahead, three priorities emerge. First, co-design self-care modules with students and integrate them throughout the curriculum, supported by staff development that embodies the same practices. Second, advocate for institutional policies that protect the time and resources required for psychoeducational self-care, making it a sustainable and integrated element of professional training. Third, sustain the spirit of participatory action research by extending it across diverse cultural and disciplinary contexts, ensuring that strategies remain responsive, context-sensitive, and open to ongoing transformation. Acting on these fronts enables music therapy education to fulfil the promise of Beyond Individual Well-being , reclaiming education’s “beautiful risk” [ 56 ] and preparing future practitioners to engage their work and the world with depth, clarity, and relational responsibility. Lastly, it is important to emphasise that while many of the approaches presented in this study, such as participatory reflection, embodied learning, and collaborative facilitation, may appear familiar, their impact does not come from their form alone. What matters is not simply adopting these methods, but how their underlying principles are brought to life through intentional practice, relational presence, and ethical engagement. Without this depth, even well-known approaches risk becoming superficial or performative. What students taught us is that transformation does not arise from quick solutions or prescriptive frameworks. It unfolds slowly, through moments of uncertainty, discomfort, and relational vulnerability. Their experiences remind us that self-care is not a set of predefined techniques, but an ongoing practice of staying present with what is difficult and responding with care. In this light, radical acceptance is not a passive stance. It is a courageous and intentional commitment to remain present with what is painful, uncertain, or imperfect, and to respond with care,for oneself, for others, and for the shared space we inhabit as learners and professionals. Through this orientation, self-care is no longer a private act of preservation. It becomes a pedagogical and political practice rooted in resistance, responsibility, and renewal. Ultimately, facilitating self-care in education requires knowledge that reaches the very roots of life. It teaches us how to settle ourselves, foster vitality, and cultivate a sense of wholeness. As student participants in this study showed, embracing the “beautiful risk” of education means allowing ourselves to be transformed together. In doing so, we move beyond individual well-being and toward an education rooted in care, justice, and collective transformation. This is both an invitation and a challenge: to walk with care, not alone, but together. Declarations Funding Declaration This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. E thic al Approval This study was approved by the Norwegian Agency for Shared Services in Education and Research (Sikt) under reference number 548582, and it was also registered in the University of Bergen’s internal system for research involving the processing of personal data (RETTE) under reference number R3344. At the University of Bergen, no institutional ethics committees/IRBs exist at the faculty or university level; Sikt and RETTE approval together constitute the formal and full ethical approval process. The study was conducted in accordance with the ethical principles outlined by the National Committees for Research Ethics in the Social Sciences and the Humanities (NESH). Consent to Participate Informed consent was obtained from all participants prior to their inclusion in the study, in accordance with ethical guidelines and approval procedures established by Sikt. Data availability statement This study generated audio recordings, full transcripts from the self-care collaborative groups, questionnaire responses, digital images of participants’ artwork, and transcripts from both focus groups and individual interviews. In line with participant consent and the ethical approval granted by Sikt, all materials are securely stored on encrypted servers at the University of Bergen and are additionally backed up within the Services for Sensitive Data (TSD) system. The dataset contains sensitive information, including potentially identifiable narratives, images, and health-related reflections closely tied to personal experience. As classified Confidential by Sikt, these materials present a risk of re-identification and therefore cannot be made publicly available. Anonymised excerpts are included in this publication. Requests for access to de-identified material may be considered upon reasonable inquiry and are subject to appropriate ethical clearance. 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Perry WG Jr. Forms of intellectual and ethical development in the college years: a scheme. San Francisco: Jossey‑Bass; 1999. Biesta GJJ. The beautiful risk of education . New York: Routledge; 2015. Shaw, C., et al. ‘Lived Experience Perspectives on Ableism within and beyond Music Therapists’ Professional Identities’. Music Therapy Perspectives , vol. 40, no. 2, 2022, pp. 143–151. doi:10.1093/mtp/miac001 Belingheri, M., et al. ‘Self-Reported Prevalence of Sleep Disorders among Medical and Nursing Students’. Occupational Medicine , vol. 70, no. 2, 2020, pp.127–130.doi:10.1093/occmed/kqaa011 orcid.org+15boa.unimib.it+15pdfs.semanticscholar.org+15 Courtois, C. A., and S. N. Gold. ‘The Need for Inclusion of Psychological Trauma in the Professional Curriculum: A Call to Action’. Psychological Trauma: Theory, Research, Practice, and Policy , vol. 1, no. 1, 2009, pp. 3–23. doi:10.1037/a0014074 Lundberg, D. J., and J. A. Chen. ‘Structural Ableism in Public Health and Healthcare: A Definition and Conceptual Framework’. The Lancet Regional Health-Americas , vol. 30, 2024. doi: 10.1016/j.lana.2023.100650 Spivak, G. C. ‘Teaching for a Broken World’. Anglica: An International Journal of English Studies , vol. 33, no. 3, 2024, pp. 11–26. doi:10.7311/0860-5734.33.3.02 Additional Declarations Competing interest reported. This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors. The author is currently a PhD stipendiat at the Department of Music, University of Bergen, where the study was conducted. While this role involves institutional support in the form of employment and affiliation, there are no additional financial or commercial interests related to this research. This situation may present a potential non-financial competing interest, which has been mitigated by ensuring transparency and ethical conduct throughout the study. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-6999522","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":530502516,"identity":"43ae980b-641f-44f9-a024-3b53e7b0987f","order_by":0,"name":"Chi-Yen 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05:15:46","extension":"html","order_by":8,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":157497,"visible":true,"origin":"","legend":"","description":"","filename":"earlyproof.html","url":"https://assets-eu.researchsquare.com/files/rs-6999522/v1/d2c29fa1e11f5abffa0dd692.html"},{"id":93741304,"identity":"6ea69762-c9c0-4045-b056-2ecacccfbfe5","added_by":"auto","created_at":"2025-10-17 05:15:46","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":306350,"visible":true,"origin":"","legend":"\u003cp\u003eEvolving Process: Key Phases and Elements\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-6999522/v1/1d54ebf0554e395873856d41.png"},{"id":93741864,"identity":"767e33c8-27fa-4e9b-aa0e-fc602ef603e0","added_by":"auto","created_at":"2025-10-17 05:23:46","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":346604,"visible":true,"origin":"","legend":"\u003cp\u003eArtwork by Student E\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-6999522/v1/d38ce9675f84dcac51a61da8.png"},{"id":93742683,"identity":"7844a809-fb33-4518-a46c-51e003c84d07","added_by":"auto","created_at":"2025-10-17 05:39:47","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1899738,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6999522/v1/7f7d2272-f2cb-4383-8ce3-95c813495e66.pdf"}],"financialInterests":"Competing interest reported. This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors. The author is currently a PhD stipendiat at the Department of Music, University of Bergen, where the study was conducted. While this role involves institutional support in the form of employment and affiliation, there are no additional financial or commercial interests related to this research. This situation may present a potential non-financial competing interest, which has been mitigated by ensuring transparency and ethical conduct throughout the study.","formattedTitle":"Beyond Individual Well-being: A Participatory Action Research Study on Self-Care, Psychoeducation, and Radical Acceptance in Music Therapy Education","fulltext":[{"header":"1.\tIntroduction ","content":"\u003cp\u003eSocial shifts, austerity measures, and rapid technological change have disrupted the resonance among individuals, culture, and nature, subjecting people to unprecedented levels of pressure and anxiety [1]. These challenges affect both private and public life. They are particularly acute in healthcare, where professionals such as doctors, nurses, and therapists face severe emotional burdens and rising mental-health crises.\u003c/p\u003e\n\u003cp\u003eAccording to the World Health Organization [2], between January 2020 and April 2022, at least 25% of healthcare workers worldwide reported symptoms of anxiety, depression, and burnout during the COVID-19 pandemic. Although the global emergency has ended, many clinicians continue to experience these symptoms, exacerbated by staff shortages, low pay, and chronic stress [3]. In recognition of the problem, burnout has been classified as an occupational phenomenon in the latest revision of the \u003cem\u003eInternational Classification of Diseases\u003c/em\u003e [4]. The urgency of the situation is further underscored by initiatives such as \u003cem\u003eHealing the Healers\u003c/em\u003e, a 29-country mental-health survey paired with stress-management workshops [5].\u003c/p\u003e\n\u003cp\u003eMusic therapists, although often overlooked in mainstream healthcare discourse, occupy the same care ecosystem. The profession has long faced elevated levels of stress and attrition, an issue that predates the pandemic and remains prevalent today [6–8]. While \u003cem\u003emusicking\u003c/em\u003e is celebrated as a powerful self-care practice that fosters health and well-being [9], music therapy students and p\u003cstrong\u003era\u003c/strong\u003ectitioners still report higher stress and burnout than many other health professionals [10,11].\u003c/p\u003e\n\u003cp\u003eDespite repeated calls to embed self-care training in music therapy curricula [12,13], responsibility for well-being remains highly individualised. Self-care is framed as a personal task rather than a pedagogical or ethical imperative, leaving learners and practitioners to manage emotional exhaustion in isolation. Empirical studies on this problem within music therapy education and educational research continue to be limited [14,15].\u003c/p\u003e\n\u003cp\u003eThis persistent gap reflects not only the magnitude of the global crisis but also a deeply rooted and damaging myth within healthcare education and culture: healthcare providers should neither seek nor require care themselves [16]. Such expectations perpetuate the notion that helping professionals must remain selfless and “professional,” even at the expense of their own well-being. Challenging this belief is essential for safeguarding healthcare practitioners and sustaining quality care across the health sector. Importantly, I also acknowledge that educators are also part of the caring professions. As an educator and therapist, I recognise that supporting faculty well-being is vital for shifting the cultural narratives that shape educational practice and professional development across disciplines.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eAlthough psychoeducation and radical acceptance were not the guiding concepts at the outset, the group process gradually revealed patterns of learning that fostered students’ psychological insight, emotional regulation, and relational awareness. This realisation led me to reconsider how self-care might be understood and facilitated within educational settings, not simply as an individual practice but as a pedagogical process.\u003c/p\u003e\n\u003cp\u003eBefore moving forward, I clarify how self-care is defined in this study. Drawing on my fourteen years of clinical experience, as well as the work of Shulman [17], Bressi and Vaden [18], and the American Psychological Association [19], I define self-care as an ethical obligation to safeguard personal well-being and maintain professional competence. It entails purposeful activities that regulate emotion, promote health, and support work performance, while also cultivating self-awareness and reflexivity so that personal and professional realms may be integrated and transformed.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResearch Aim and Question\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAs part of a broader response to the current crisis, this empirical study examines how self-care can be facilitated in music therapy education. Guided by a feminist educational framework and a participatory action research (PAR) design, I work collaboratively with music therapy students to co-create self-care practices that foster personal well-being, support professional development, and challenge persistent “caregiver myths,” while centring reflexivity in the research process.\u003c/p\u003e\n\u003cp\u003eThrough two iterative cycles of arts-based self-care groups, we move collectively through reflection, action, and evaluation, exploring how experiential structures can enhance students’ learning and agency. This study approaches self-care not merely as a form of coping, but as a practice of \u003cstrong\u003eradical presence\u003c/strong\u003e—being with discomfort, uncertainty, and imperfection as part of the learning process. Grounded in our shared lived experience, the study therefore asks:\u003c/p\u003e\n\u003cp\u003eWhat experiences and challenges\u0026nbsp;do music therapy students encounter in self-care collaborative groups, and how can these insights inform the facilitation of self-care within music therapy education?\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eOverview of the Collaborative Groups\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe self-care collaborative groups developed in this study intentionally distinguish between personal self-care in daily life (e.g., rest), leisure-based activities (e.g., hiking), and professional self-care (e.g., supervision). Using experiential and arts-based methods, these groups aim to bridge the gap between personal and professional self-care within music therapy education. Instead of following a rigid agenda preset by me as researcher, group content and direction emerge organically through student participation, contribution, and shared reflection. This flexible design responds to the complex and layered nature of self-care by offering varied opportunities for social engagement, artistic expression, and interactive learning.\u0026nbsp;\u003c/p\u003e"},{"header":"2. Background","content":"\u003cdiv id=\"Sec2\" class=\"Section2\"\u003e\u003ch2\u003e2.1 Self-care in Healthcare Education\u003c/h2\u003e\u003cp\u003eSelf-care is increasingly recognised as a prerequisite for sustainable caregiving, yet its practical meaning in healthcare professional education remains contested. Caring benefits recipients, and many professionals and informal caregivers report profound satisfaction, personal growth, and meaning through their acts of care [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. Nonetheless, the very qualities that enable effective and compassionate caregiving\u0026mdash;empathy, sensitivity, and dedication\u0026mdash;can also heighten vulnerability to emotional fatigue and burnout when self-care is inadequate [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eA growing body of research documents the multidimensional toll of providing care. Adverse outcomes encompass physical illness, financial strain, disrupted relationships, diminished leisure, reduced work performance, and even elevated mortality risk [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]. Among practising professionals, inadequate self-care is linked to emotional exhaustion, depersonalisation, cognitive impairment, and a diminished sense of accomplishment, jeopardising both practitioner well-being and service quality [\u003cspan additionalcitationids=\"CR25\" citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eThese risks emerge well before graduation. In healthcare programmes, heavy coursework, rigid competency standards, structural inequities, and limited institutional provisions converge to place students at heightened risk of premature burnout. Music therapy students, for instance, report higher stress levels than peers in other disciplines [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e], while medical and nursing students similarly exhibit elevated rates of psychological distress and sleep disorders during clinical training, with up to 63% reporting at least one sleep-related symptom [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e]. For learners, the consequences mirror those observed in the workforce, including early burnout, cognitive decline, and disengagement from learning [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]. Collectively, these findings highlight that self-care is not only a clinical concern but also an educational imperative within healthcare education.\u003c/p\u003e\u003cp\u003eIn music therapy, despite repeated calls for explicit self-care training and structural reform [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e], curricula often frame self-care as an individual responsibility, providing minimal pedagogical or organizational guidance [\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e]. Very few studies foreground students\u0026rsquo; own perspectives on self-care, especially in music therapy education [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e], leaving unanswered questions about how learners experience, negotiate, and co-construct sustainable practices.\u003c/p\u003e\u003cp\u003eThis persistent gap between institutional claims and day-to-day educational realities crystallises a broader paradox. Care providers are praised for their empathy, yet the emotional and moral burdens generated by empathy are silently shifted onto individual practitioners. This helps explain both the high incidence of burnout among healthcare professionals and the especially precarious position of music therapists, whose practice demands sustained affective attunement,often without the institutional safeguards available to larger medical disciplines. From an ethics-of-care viewpoint, self-care is not a private coping tactic but a shared responsibility woven through professional teams, institutions, and social structures [\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e]. Unlike traditional ethical models that prioritize impersonal duties or universal rules, a care perspective centres concrete relationships, mutual dependence, and the power imbalances that shape every caring encounter,thereby making vulnerability a collective concern rather than an individual failure.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\u003ch2\u003e2.2 Music Therapy Students\u0026rsquo; Views on Self-Care\u003c/h2\u003e\u003cp\u003eSince the 1990s, student voice has been framed not merely as a courtesy but as a learner\u0026rsquo;s right to participate in shaping education [\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e]. Informed by constructivist, critical, and feminist pedagogies, collaboration with students can enrich learning, challenge power relations, promote inclusion, and stimulate meaningful reform [\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e, \u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e]. At the same time, misrepresentation, bias, and tokenism remain persistent risks [\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e]. Cook-Sather [\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e] cautions against treating students as a single, homogeneous group; Lincoln [\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e] calls for engagement that is both ethical and credible; and Haraway [\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e] advocates for reflexive, situated inquiry that rejects the illusion of neutrality. These principles guide the present review.\u003c/p\u003e\u003cp\u003eComprehensive searches of English, Norwegian, and Chinese language databases have identified only eight studies that explicitly or implicitly examine self-care from the perspective of music therapy students. These studies fall into three geographical strands, each illuminating a distinct facet of self-care within music therapy education.\u003c/p\u003e\u003cp\u003e\u003cb\u003eUnited States\u003c/b\u003e\u003c/p\u003e\u003cp\u003eA small but growing body of empirical research has begun to examine self-care in music therapy programmes, with early studies focusing on individual-level experiences and more recent work addressing systemic factors. Although Jackson and Gardstrom [\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e] did not frame their work explicitly in terms of self-care, their experiential music therapy groups for undergraduates heightened students\u0026rsquo; awareness of the need to look after themselves. However, the authors did not investigate whether this insight persisted over time. Kaiser [\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e] found that expressive-arts workshops fostered self-care, yet participants reported limited autonomy, insufficient information, and a gap between personal and professional well-being. Two online surveys of approximately 400 students each [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e] portrayed self-care as multidimensional, encompassing personal growth, balance, social connection, and clear study\u0026ndash;life boundaries. While these studies offer a valuable baseline portrait of students\u0026rsquo; perspectives, their cross-sectional and self-report nature invites further inquiry into how such practices are integrated into daily life. Finally, Boeser and Silverman [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e] used qualitative interviews to expose systemic barriers, particularly racial inequities,and recommended earlier curricular integration alongside greater student agency.\u003c/p\u003e\u003cp\u003e\u003cb\u003eLatin America\u003c/b\u003e\u003c/p\u003e\u003cp\u003eAraneo and his colleagues [\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e], working in Argentina, applied a critical pedagogy perspective to music therapy education by engaging students in community health projects that fostered agency, reflexivity, and collective responsibility. Although the study did not explicitly employ the language of \"self-care,\" its findings underscore how thoughtfully designed curricula can enhance both personal and communal well-being.\u003c/p\u003e\u003cp\u003e\u003cb\u003eNorway\u003c/b\u003e\u003c/p\u003e\u003cp\u003eTwo student-initiated master\u0026rsquo;s theses from the University of Bergen \u0026mdash; the same educational context as the present study \u0026mdash; offer rare, critical reflections on how self-care was addressed in the very training they received.\u003c/p\u003e\u003cp\u003eKolbeinsen [\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e] interviewed five early-career music therapists, all graduates of the University of Bergen, who described themselves as \u0026ldquo;wounded healers.\u0026rdquo; They reported feeling unprepared and overwhelmed upon entering the profession, noting that the lack of structured self-care education left them inadequately equipped to manage the psychological demands and pressures of clinical work. The study highlights a broader pedagogical gap: insufficient attention to therapists\u0026rsquo; inner experiences, professional identity, and self-care strategies during training. Persistent mental health stigma and a sense of isolation further compounded these challenges, undermining both personal well-being and professional development. Though trained to care for others through music, participants questioned whether their education truly supported their own psychological well-being. Skauge [\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e], in a study on burnout prevention, reached similar conclusions through interviews with early-career music therapists trained in Norway. Participants described patterns of over-exertion and self-doubt shaped by a culture of performance pressure, limited autonomy, and the constant need to justify the value of music therapy. Skauge argues that educators must explicitly affirm self-care, warning that silence on the topic risks creating a \u0026ldquo;burnout trap.\u0026rdquo;\u003c/p\u003e\u003cp\u003e\u003cb\u003eIdentified Gaps\u003c/b\u003e\u003c/p\u003e\u003cp\u003eAcross these contexts, four key gaps emerge. First, student-partnered inquiry, where learners co-design and evaluate self-care initiatives, remains rare. Second, there is limited longitudinal evidence tracing how self-care skills develop over the course of training. Third, curriculum-embedded models that integrate personal well-being with professional competence are almost entirely absent. Addressing these shortcomings will require collaborative, practice-grounded research that positions students as active partners rather than passive respondents. Lastly, a systematic search of major Chinese-language databases (Airiti Library, Google Scholar, and NDLTD) identified no studies on self-care or student voice in music therapy education. Alongside the absence of research from other English-speaking and European countries, this reveals global imbalances in how these topics are studied and represented. Together, these gaps underscore the need for broader, cross-contextual inquiry into music therapy students\u0026rsquo; experiences of self-care.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec4\" class=\"Section2\"\u003e\u003ch2\u003e2.3 Author\u0026rsquo;s Positionality\u003c/h2\u003e\u003cp\u003eAs a Taiwanese woman with a queer identity, raised and primarily educated in Taiwan, I completed my master\u0026rsquo;s degree in the UK and now work as a PhD research fellow in Norway. I situate myself at the intersection of multiple cultural, social, and geopolitical lenses. Coming from a Confucian-influenced educational culture shaped by multiple colonial histories, and now working within a Euro-American-dominated research environment, I am constantly reminded that knowledge is not neutral.\u003c/p\u003e\u003cp\u003eGrowing up in a context shaped by hierarchical, patriarchal, and collectivist values has compelled me to critically reflect on the tensions between individual and collective identities, gender roles, and the power structures that uphold inequality. My 14 years of clinical experience as a psychodynamically informed music therapist have attuned me to how unconscious, relational, and sociocultural forces shape well-being, distress, and patterns of care.\u003c/p\u003e\u003cp\u003eMy positionality as a researcher working from a Global South knowledge position reflects my education and upbringing in Taiwan, a society often excluded from dominant Euro-American academic discourses. Operating within a predominantly Western academic structure influences what I notice, what I prioritise, and what I resist. I have struggled with the dissonance between embodied, relational ways of knowing and dominant academic ideals of objectivity, a tension further shaped by my academic journey through Taiwan, the UK, and Norway. Each of these educational systems embodies distinct power relations in how knowledge is produced and legitimised.\u003c/p\u003e\u003cp\u003eThis awareness informed my decision to adopt a participatory action research methodology, which aligns with my values of shared authority, embodied knowledge, and co-created meaning. In this study, reflexivity was not only a methodological imperative but also a practice of relational ethics and self-care. To reduce bias and stay attuned to the lived experiences of student research partners, I engaged in sustained classroom involvement, collaborative teaching, and methodological triangulation. This work is grounded in the hope that more equitable, relational, and responsive forms of knowledge can emerge through co-learning and mutual care.\u003c/p\u003e\u003c/div\u003e"},{"header":"3. Research Method and Data Analysis","content":"\u003cdiv id=\"Sec6\" class=\"Section2\"\u003e\u003ch2\u003e3.1 Research Design\u003c/h2\u003e\u003cp\u003eThis study explores the facilitation of self-care in music therapy education through a feminist educational research framework [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e] combined with participatory action research (PAR). In this design, students are positioned as research partners, actively contributing to the design of the self-care collaborative groups, shaping facilitation practices, and offering continuous process feedback.\u003c/p\u003e\u003cp\u003eSpanning two semesters, the PAR cycles enable sustained engagement within the learning environment, allowing us to trace how contextually grounded self-care practices take shape and evolve over time. Building on valuable elements identified in previous research, namely the experiential, arts-based, and complex nature of self-care, this study addresses persisting gaps, including how to foster student autonomy, integrate the personal and professional dimensions of self-care, and confront systemic inequalities.\u003c/p\u003e\u003cp\u003eInformed by feminist principles, the research design challenges hierarchical educational models by promoting non-hierarchical relationships. PAR offers a collaborative and context-sensitive methodology that centers students\u0026rsquo; voices and positions researchers as co-learners. This facilitates both situated understanding and the co-creation of practical solutions [\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e]. The framework foregrounds humanization and holism, replacing top-down instruction with dialogic, co-learning processes that foster introspection and shared knowledge creation.\u003c/p\u003e\u003cp\u003eThrough iterative cycles of collaboration and reflection, the study aims to enhance the effectiveness of self-care facilitation and cultivate sustainable learning practices [\u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e]. It aligns with care-centered pedagogy [\u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e] and feminist pedagogical approaches in music therapy [\u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e], reimagining the classroom as a collaborative and egalitarian space where teachers and students actively learn together.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec7\" class=\"Section2\"\u003e\u003ch2\u003e3.2 Setting, Recruitment and Participants\u003c/h2\u003e\u003cp\u003e Approved by the Sikt ethical review board in Norway, student participants were recruited from the University of Bergen\u0026rsquo;s five-year integrated music therapy master\u0026rsquo;s program (approximately 75 students). Recruitment began in November 2023 through both online and in-person outreach. Participation was voluntary and independent of coursework.\u003c/p\u003e\u003cp\u003eStudent involvement occurred in two phases: (1) a one-time \u003cem\u003einitial group\u003c/em\u003e in January 2024, and (2) a three-month ongoing \u003cem\u003emain group\u003c/em\u003e from April to June 2024, consisting of eight weekly sessions, each lasting 150 minutes. Both groups met in music therapy classrooms equipped with a variety of instruments and diverse artistic materials. English served as the primary language of communication.\u003c/p\u003e\u003cp\u003eThere were a total of 18 enrollments across the two phases, with some students participating in both. The initial group included 7 students (6 master\u0026rsquo;s and 1 bachelor\u0026rsquo;s), providing preliminary experience and data. The main group began with 9 students; one participant withdrew after the first session, resulting in 8 regular participants (4 master\u0026rsquo;s and 4 bachelor\u0026rsquo;s) representing all program years.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e\u003ch2\u003e3.3 Facilitation method in Collaborative Groups\u003c/h2\u003e\u003cp\u003eBoth the initial and main phases of the self-care collaborative groups followed a participatory approach, with students actively contributing to the direction and content of each session. Participation was flexible; students could choose how to engage, suggest changes, and reflect on the process. This fostered an ongoing cycle of feedback and adaptation, reinforcing both individual expression and group cohesion over time.\u003c/p\u003e\u003cp\u003eThe researcher served as facilitator, facilitating group dynamics, designing experiential activities in response to participant input, and bridging the personal and professional dimensions of self-care. For instance, after students reflected on negative associations with their instruments, the facilitator invited them to engage in music improvisation to explore tensions between personal and professional intentions in music-making. These experiential activities included both verbal and non-verbal artistic forms such as visual arts, paper cutting, dance, movement, music, and drama. The study initially planned to use the quantitative Mindfulness Self-Care Scale (MSCS) to measure effectiveness, but students found it unsuitable. Instead, a Self-Assessment Scale was introduced, where participants rated the group\u0026rsquo;s helpfulness from 1 (not helpful at all) to 10 (extremely helpful).\u003c/p\u003e\u003cp\u003eIt is important to clarify that the self-care collaborative groups were not therapy groups. While personal sharing was welcome, therapeutic processing was not part of the sessions, and external assistance was available when needed. The facilitator did not act as a therapist or educator, but instead facilitated group autonomy and co-creation. Although a working definition of self-care was provided, participants were encouraged to explore and define self-care on their own terms.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec9\" class=\"Section2\"\u003e\u003ch2\u003e3.4 Participatory Action Process\u003c/h2\u003e\u003cp\u003e\u003col\u003e\u003cspan\u003e\u003cli\u003e\u003cp\u003e\u003cb\u003eParticipatory Observation (Researcher)\u003c/b\u003e\u003c/p\u003e\u003c/li\u003e\u003c/span\u003e\u003c/ol\u003e\u003c/p\u003e\u003cp\u003eDuring the first six months (Aug 2023 \u0026ndash; Jan 2024), the researcher primarily. served as a teacher, attending classes and participating in meetings to better understand the educational culture and observe students' self-care experiences. Observations and reflections continued throughout the project and were recorded in a log for data triangulation.\u003c/p\u003e\u003cp\u003e\u003cb\u003e(2) Questionnaire (Initial Group)\u003c/b\u003e\u003c/p\u003e\u003cp\u003eAn electronic questionnaire was used to explore students\u0026rsquo; perceptions of self-care, educational experiences, and facilitation preferences in the initial group. The responses helped shape the design of the main group.\u003c/p\u003e\u003cp\u003e\u003cb\u003e(3) Focus Groups \u0026amp; Artistic Works (Main Group)\u003c/b\u003e\u003c/p\u003e\u003cp\u003eOngoing group discussions were conducted to collect feedback and guide. adjustments to the sessions. In addition, participants' artistic works were gathered as non-verbal data sources.\u003c/p\u003e\u003cp\u003e\u003cb\u003e(4) Individual Interviews (Main Group)\u003c/b\u003e\u003c/p\u003e\u003cp\u003eOne-hour semi-structured interviews were conducted to provide space for deeper individual reflection beyond the group setting.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec10\" class=\"Section2\"\u003e\u003ch2\u003e3.5 Analytical Approach\u003c/h2\u003e\u003cp\u003eThis study employed thematic analysis, following an editing analytical approach [\u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e], which allowed themes to emerge inductively from the data. Given the underexplored nature of the topic, a broad descriptive approach was considered appropriate [\u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e45\u003c/span\u003e]. This inductive, bottom-up strategy aimed to capture participants\u0026rsquo; lived experiences and nuanced understandings of self-care within music therapy education.\u003c/p\u003e\u003cp\u003eAll data were transcribed and imported into NVivo 20 for systematic coding using in vivo, open, and axial techniques. Patterns and relationships were identified through constant comparison and iterative refinement. To ensure analytical rigor, the process was strengthened by sustained researcher reflexivity, regular supervisory discussions, and occasional participant clarification to verify transcription accuracy.\u003c/p\u003e\u003cp\u003eThemes were developed directly from participants\u0026rsquo; language, artistic expressions, and lived experiences to ensure authenticity. Credibility was further strengthened through data triangulation, incorporating observational notes, participant feedback, and documentary sources [\u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e46\u003c/span\u003e]. To protect participants' privacy, letter identifiers (e.g., Student A) were used throughout the study.\u003c/p\u003e\u003cp\u003eAlthough concepts such as psychoeducation and radical acceptance were not introduced at the outset, they later emerged during the analytic process as meaningful interpretive lenses. Psychoeducation integrates psychological knowledge with educational methods to build insight and coping skills beyond the therapy room. In both community and professional training contexts, it can bolster autonomy, confidence, and the collective prevention of mental health problems [\u003cspan citationid=\"CR47\" class=\"CitationRef\"\u003e47\u003c/span\u003e]. Radical acceptance, rooted in both Eastern philosophy and Western psychology, entails embracing discomfort and perceived failure without denial. By challenging perfectionism and internalised expectations of productivity and worth, it offers not resignation but a stance that acknowledges reality while opening space for recovery and flourishing [\u003cspan citationid=\"CR48\" class=\"CitationRef\"\u003e48\u003c/span\u003e].\u003c/p\u003e\u003c/div\u003e"},{"header":"4. Findings : Generating Knowledge Through Collaboration","content":"\u003cdiv id=\"Sec12\" class=\"Section2\"\u003e\u003ch2\u003e4.1 Motivation, Participation and Effectiveness\u003c/h2\u003e\u003cp\u003eThe findings reveal a shared recognition of the need for self-care resources during training. Many students had never encountered a structured space for this purpose; as Student E said, \u0026ldquo;It\u0026rsquo;s such a good opportunity and concrete framework\u0026hellip; which is not often provided here.\u0026rdquo; An 85% carry-over rate from the initial to the main group signalled strong commitment. Students openly shared challenges, experimented with new activities, and offered feedback, modelling a culture of emotional reflexivity and mutual care. Yet questionnaire and narrative data showed that those outside the groups who most needed help sometimes lacked the capacity to attend because of stress or overwhelm. In the initial group, 71% reported difficulty practising self-care when unwell, underscoring how distress can hinder access to support.\u003c/p\u003e\u003cp\u003eBecause participation and impact were cumulative, the analysis of participation and effectiveness focused on the main group. Attendance averaged 54%, while effectiveness rated 77% overall (82% in professional, 72% in personal). Attendance, however, did not necessarily predict benefit: Less frequent attendees H and D reported higher gains than more regular participants A, C and F, suggesting quality of engagement outweighs frequency.\u003c/p\u003e\u003cp\u003e\u003cstrong\u003ePersonal resonance\u003c/strong\u003e\u003cp\u003eStudents B, D and H described deep personal impact. Student D reflected, \u0026ldquo;There is a relation to group therapy\u0026hellip; I never joined a group like this before but really enjoyed it.\u0026rdquo; Student B added that personal integrity nurtures professional practice.\u003c/p\u003e\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eProfessional inspiration\u003c/strong\u003e\u003cp\u003eStudents A, C and F valued professional insights but found personal application harder. Student A noted, \u0026ldquo;\u003cem\u003eThere are too many directions I could take\u0026hellip; it\u0026rsquo;s hard to apply in my own life because my schedule is packed and the concept feels a bit abstract.\u0026rdquo;\u003c/em\u003e\u003c/p\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003eIntegrated benefit\u003c/b\u003e: Student E, with moderate attendance, reported full effectiveness in both domains: \u0026ldquo;The free structure suits me\u0026hellip; focusing on yourself but with another person helped me prepare for improvisation exams.\u0026rdquo;\u003c/p\u003e\u003cp\u003eThese patterns underscore the varied ways students engage with and benefit from self-care groups. The next section examines how these experiences shaped participants\u0026rsquo; evolving self-care frameworks.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec13\" class=\"Section2\"\u003e\u003ch2\u003e4.2 Self-care Framework\u003c/h2\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003eFigure\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e illustrates how knowledge was co-constructed through iterative cycles of art-making and dialogue, represented metaphorically by an evolving tree. Participants used words such as \u0026ldquo;flourish,\u0026rdquo; \u0026ldquo;grounded,\u0026rdquo; and \u0026ldquo;reconnect\u0026rdquo; to describe their experiences. To encompass these expressions and their interrelated meanings, I used a unifying metaphor: soil (group support and grounding), sun, and water (personal and professional dimensions), emphasising that growth requires all three elements.\u003c/p\u003e\u003cp\u003eParticipants\u0026rsquo; self-care journeys unfolded in spiral phases. Early stages (1\u0026ndash;3) focused on expressing the inner self and building connection. As Student B shared: \u0026ldquo;Coming here feels like coming home\u0026hellip; In our hustle culture, self-care is neglected\u0026mdash;you must be a human doing, not a human being.\u0026rdquo; Phase 4 introduced tension, prompting reflection on internal conflicts and the evolving meaning of self-care. Later stages (5\u0026ndash;6) involved efforts to integrate and redefine this understanding.\u003c/p\u003e\u003cp\u003eAs the group progressed, the process began to align with both psychoeducation and radical acceptance. While psychoeducation facilitates the development of psychological understanding and coping, radical acceptance encourages presence with discomfort, uncertainty, and imperfection, without the need to fix or explain.\u003c/p\u003e\u003cp\u003eStudent A noted, \u0026ldquo;I felt confused at times\u0026hellip; But since many others were going through the same thing, we could explore it together. The group helped me stay and keep coming back.\u0026rdquo; Student G added, \u0026ldquo;I didn\u0026rsquo;t understand the meaning of the artistic activities at first\u0026hellip; but I realised the group taught me that self-care was something beyond what I expected.\u0026rdquo; This process reflected a shift toward radical acceptance, grounded in not knowing, not performing, and being fully present with oneself and others. Student D emphasised the value of shared experience: \u0026ldquo;I never talked about this stuff with friends or family\u0026hellip; but here, we\u0026rsquo;re all from music therapy, we get it\u0026hellip; The collaboration aspect is important,it\u0026rsquo;s in those moments that we feel most connected.\u0026rdquo;\u003c/p\u003e\u003cp\u003eIn addition, the main group structure helped bridge personal and professional realms, keeping the self-care process connected to participants\u0026rsquo; everyday lives. It supported reflection on how inner experience intersects with professional roles. After an activity on musical identity, Student H shared a placement-related struggle: \u0026ldquo;I felt crap that day, but my autistic client loved playing drums\u0026hellip; I tuned into him, but my arm cramped and I wanted to cry.\u0026rdquo; This opened a discussion on self-sacrifice versus self-care, including ways to balance boundaries and advocate for one\u0026rsquo;s needs. The facilitator\u0026rsquo;s role also helped link the group space with professional realities. As Student C reflected: \u0026ldquo;You [the facilitator] helped a lot by bringing the discussion of what we experience here toward personal or professional life.\u0026rdquo;\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec14\" class=\"Section2\"\u003e\u003ch2\u003e4.3 Artistic and Experiential Space\u003c/h2\u003e\u003cp\u003eArtistic and experiential approaches enhanced self-care by enabling reflection beyond purely verbal or cognitive expression. In session six, For instance, participants combined visual cards and painting to explore recent challenges, then shared their insights with the group; the process helped them move from tension (Phase 4) to a sense of balance (Phase 5). The following conversation, centred on Student E\u0026rsquo;s artwork (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e), shows how the space was used in the group.\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003eStudent E reflected:\u003c/p\u003e\u003cp\u003eI feel like there is a spectrum of creating, we have the rational and feeling parts, it is process of balancing outside and inside. When I create, it feels whole,like an automatic pattern of thinking that leads to spontaneous expression. There isn\u0026rsquo;t really a plan. If you looked at the cards without me saying anything, you would see how all the parts come together.\u003c/p\u003e\u003cp\u003eThen, student F responded:\u003c/p\u003e\u003cp\u003eIt is impressive and creative. You create a window for us to go into your consciousness. Your flow really captures the movement of your thoughts in that moment... You don\u0026rsquo;t force it ; you simply respond to it as it unfolds. It makes me wonder how it feels to be you, how does that feel like?\u003c/p\u003e\u003cp\u003eThis conversation shows how arts-based and experiential methods let students remain with ambiguity instead of rushing to solutions. The artwork becomes a visible, lasting form that nurtures peer connection and social support.\u003c/p\u003e\u003cp\u003eParticipants also discovered that varied materials deepen links to music and encourage a growth mindset. Student C, initially hesitant and preferring guidance, gradually gained confidence in creative expression: \u0026ldquo;I felt most connected to the art station with its variety of materials. It felt freeing to create without needing to be perfect.\u0026rdquo; Starting with visual art, she then improvised a solo flute piece: \u0026ldquo;Improvising was scary, but this safe space energised me and helped me cope with earlier chaos.\u0026rdquo; Her experience illustrates how diverse artistic options, tailored to individual needs, foster autonomy, self-care, and transferable confidence for professional practice.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec15\" class=\"Section2\"\u003e\u003ch2\u003e4.4 Challenges\u003c/h2\u003e\u003cp\u003e\u003cb\u003e(1) Gap Between Cognitive and Embodied Learning\u003c/b\u003e\u003c/p\u003e\u003cp\u003eThe concept and terms emerged from participant narratives. Student participants often experienced cognitive and embodied learning separately and used these phrases to describe their experiences, indicating that full integration takes time; insight may begin as cognitive without embodiment or as a bodily experience before cognitive articulation. For example, Student B reflected in session 4:\u003c/p\u003e\u003cp\u003eI used to think I was good at self-care, but I realized I wasn\u0026rsquo;t. It was mostly cognitive and didn\u0026rsquo;t really feel valid inside. It only became real when self-care was done to me and I could feel it in my body, then it became embodied... Previously, I tended to link self-care with doing something useful, rather than simply being present and listening to my body.\u003c/p\u003e\u003cp\u003eIt is important to note that the challenge impacts individuals and is intensified by diverse learning styles, which complicates the group\u0026rsquo;s direction. Some students (B, E, G) thrived with embodied learning by directly experiencing it, while others (A, C, F) preferred cognitive approaches for clarity and understanding.\u003c/p\u003e\u003cp\u003eFor example, Student B said, \u0026ldquo;I\u0026rsquo;m used to going with the flow... I feel more than I think. Cognition is like additional information. I prefer to listen to my intuition.\u0026rdquo; Similarly, Student G shared, \u0026ldquo;Free flow in artistic activities gives me an opportunity to recognise my needs... like children play, spontaneously and intuitively.\u0026rdquo; Conversely, others preferred cognitive guidance: \u0026ldquo;Although these activities are fun, I very much like guidance and being able to predict what is going to happen\u0026rdquo; (Student A). \u0026ldquo;I would like to talk more about what self-care is... because you\u0026rsquo;re doing a PhD on this topic, and I imagine you know a lot about the science behind it\u0026rdquo; (Student F). Cognitive preference may also have cultural underpinnings. Student G noted, \u0026ldquo;Norwegians are quite rigid; we don\u0026rsquo;t use a lot of expressive body language... Maybe it is related to the Jante Law\u0026mdash;no one is supposed to be special.\u0026rdquo;\u003c/p\u003e\u003cp\u003eCognitive-based learners prefer structured, theory-driven learning and may struggle with experiential methods, causing discomfort. Conversely, embodied learners can feel restricted by overly cognitive approaches that limit natural expression. However, these learning styles are complementary. With careful facilitation, students unfamiliar with embodiment gradually attuned through experience, while those less comfortable with theory engaged more deeply with cognitive perspectives.\u003c/p\u003e\u003cp\u003eFor example, cognitive-based learner student C shared: \u0026ldquo;Early on, I used this scarf to cover my eyes... I felt tense and couldn\u0026rsquo;t find my place... Slowly, I dared to move between all of you, to the piano, and just play quietly.\u0026rdquo; Embodied-based learner Student G asked a theoretical question in last session: \u0026ldquo;I'm wondering whether authenticity is an essential part of self-care, as I'm trying to understand how Jungian psychology relates to it through self-study.\u0026rdquo; The students\u0026rsquo; experiences show that while the challenge may be unavoidable, fostering mutual learning between embodied and cognitive learners can help bridge the gap and promote a more integrated understanding.\u003c/p\u003e\u003cp\u003eNevertheless, Uncertainty may arise for both learning styles before integrating cognitive and embodied learning. Student B, favoring embodied learning, reflected after session 4: \u0026ldquo;Last session hit me deeply... self-care became elusive... I\u0026rsquo;m no longer \u0026lsquo;good\u0026rsquo; at it... but now it\u0026rsquo;s grounded somatically\u0026hellip;something shifted in my brain and body.\u0026rdquo; Similarly, Student C inclined to mind-based learning noted: \u0026ldquo;When given freedom here, I often feel unsure... social settings can be hard... but here I learned to take care of myself in groups and realized I don\u0026rsquo;t always have to lead a conversation.\u0026rdquo; This ambivalence reflects the challenge of stepping outside comfort zones, evoking conflicting emotions essential for growth, underscoring the need to support students through this transition for effective self-care facilitation.\u003c/p\u003e\u003cp\u003e\u003cb\u003e(2) Balancing Autonomy and Collaboration\u003c/b\u003e\u003c/p\u003e\u003cp\u003eAnother key challenge in the self-care collaborative groups was balancing individual autonomy with collaboration, shaped by the group\u0026rsquo;s format and collaborative dynamics. Practising self-care in a shared space proved difficult for some participants. Although each session offered both social and individual zones, mismatches still occurred.\u003c/p\u003e\u003cp\u003e During session 3, for example, Student F chose the social zone, but the others opted for solitude: \u0026ldquo;I preferred to socialize with others, but when no one is there, it feels uncomfortable, and this often happens in daily life.\u0026rdquo; Student E added, \u0026ldquo;I think I\u0026rsquo;m used to practicing self-care alone\u0026hellip; I focus too much on wanting to interact with others when I\u0026rsquo;m with people.\u0026rdquo; Student C reflected, \u0026ldquo;It was kind of weird to do my own thing in a group, but sitting in our bubbles and doing what felt natural was freeing\u0026hellip; it\u0026rsquo;s a nice feeling.\u0026rdquo;\u003c/p\u003e\u003cp\u003eThese reflections reveal the challenge of honoring personal space while navigating social dynamics. In education, self-care requires a delicate balance: it is neither entirely private nor wholly collective. Students grappled with common questions\u0026mdash;how to stay connected to oneself in a group, and how to be with others when solitude is needed. These tensions became opportunities to practise staying centred amid distraction and social pull.\u003c/p\u003e\u003cp\u003eThe groups emphasised shared power, with facilitators supporting self-exploration rather than providing answers. Yet this autonomy sometimes led to uncertainty. Student C remarked, \u0026ldquo;When given the freedom, I often feel unsure of what I want to do or where I want to be.\u0026rdquo; Educational culture often conditions students to expect structure. As Student A noted, \u0026ldquo;In an educational setting, we are used to knowing what we will learn before signing up for a course.\u0026rdquo; This highlights the inherent tension between autonomy and collaboration. While a group framework can support self-care, the practice remains highly personal; no single formula fits everyone. It implies that true growth arises when learners fully own both freedom and responsibility, recognising them as inseparable forces that shape the self, relationships, and care.\u003c/p\u003e\u003cp\u003e\u003cb\u003e(3) Psychological Safety Establishment\u003c/b\u003e\u003c/p\u003e\u003cp\u003eThe third challenge from student experiences is that, although most participants built trust within collaborative groups by sharing openly, psychological safety in the wider learning and work environment remained a key issue. Psychological safety means feeling included and free to express ideas without fear of judgment or punishment [\u003cspan citationid=\"CR49\" class=\"CitationRef\"\u003e49\u003c/span\u003e]. While related, it differs from trust, which centers on interpersonal reliability [\u003cspan citationid=\"CR50\" class=\"CitationRef\"\u003e50\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eThis challenge was explicitly discussed in Sessions 2 and 4 of the main group. Using the metaphor of a sunflower at the heart of a spiral surrounded by wilted roses, Student H questioned the link between inner self-expression and psychological safety: \u0026ldquo;If you were a sunflower instead of a rose, how would you know you were allowed to show yourself\u0026hellip;? Maybe that\u0026rsquo;s not even allowed.\u0026rdquo; Student A resonated, asking, \u0026ldquo;When am I allowed to say it? When can I do that (within the school context)?\u0026rdquo; Student E added, \u0026ldquo;We should make being ourselves less taboo.\u0026rdquo;\u003c/p\u003e\u003cp\u003eSuch psychological tension also affects students\u0026rsquo; professional identity. Student I described being a student as facing \u0026ldquo;more pressure to be cheerful, patient, and musical superstar, along with the need to market the profession, uncertainty in the job market, and favoritism among faculty and those in power.\" Student H shared struggling during clinical placement: \u0026ldquo;I was feeling crap personally\u0026hellip;but my client was playing so loud... I managed to give my all, but I was exhausted and it impacted my next client.\u0026rdquo; Student G noted, \u0026ldquo;I tend to self-sacrifice\u0026hellip;sacrifice tuning in myself.\u0026rdquo; These student reflections reveal pressure to conform to educational and professional expectations, creating fear around expressing personal traits and attending to their inner selves amid concerns of rejection or exclusion. This fear undermines their psychological safety.\u003c/p\u003e\u003cp\u003eIn addition to external forces, personal histories also influence students\u0026rsquo; sense of psychological safety. Student G shared, \u0026ldquo;I wanted to smash the piano and make ugly music, but I couldn\u0026rsquo;t\u0026hellip; expressing emotions was not allowed in my family.\u0026rdquo; This illustrates how both performance pressure and ingrained beliefs can restrict self-expression. Such moments highlight the need for facilitators to model openness, reassure students of their freedom to express themselves, and recognise the importance of connecting them to external professional support, such as individual counseling, when needed.\u003c/p\u003e\u003cp\u003eImportantly, the challenge of establishing psychological safety not only affects students\u0026rsquo; learning and self-care but also extends into their professional work with clients. Student F shared discomfort when clients cried: \u0026ldquo;I try to let the clients stop crying\u0026hellip; but that feels kind of wrong.\u0026rdquo; Student E reflected on how relational challenges can disrupt inner peace: \u0026ldquo;You are very okay to be alone, but there\u0026rsquo;s a difference when there is relationship from the external world.\u0026rdquo; These narratives illustrate that some students feel uncertain about how to respond to clients\u0026rsquo; psychological needs in clinical settings, while simultaneously being emotionally impacted by these experiences. This highlights how personal psychological safety directly influences professional practice. As such, fostering psychological competency is a crucial aspect of self-care in healthcare education.\u003c/p\u003e\u003c/div\u003e"},{"header":"5. Discussion","content":"\u003cp\u003eThis discussion examines the experiences of student participants, following the same thematic structure as the findings section and integrating their reflections throughout.\u003c/p\u003e\u003cdiv id=\"Sec17\" class=\"Section2\"\u003e\u003ch2\u003e5.1 Motivation, Participation \u0026amp; Effectiveness: Hidden Value Revealed Through Experience\u003c/h2\u003e\u003cp\u003eMany students discovered a deeper, embodied understanding of self-care only after joining the group. The two-phase design, beginning with a brief exploratory stage and followed by a longer engagement, invited cautious entry and then encouraged sustained commitment. Collaboration, experiential learning, and artistic exploration built trust, while linking personal with professional practice helped students translate lived experience into professional growth.\u003c/p\u003e\u003cp\u003eMotivation developed through a balance of ease and challenge. Moments of discomfort often sharpened insight: Student C gained confidence in flute improvisation through the initial \u0026ldquo;chaos,\u0026rdquo; and Student A, though initially unsure, kept returning as progress became tangible. Enjoyable experiences also reinforced engagement: Student J continued after a positive experience in the initial group, and Student E found the group helpful when preparing for an improvisation exam.\u003c/p\u003e\u003cp\u003eParadoxically, students who were not motivated to join the groups were often those most in need of support. Fatigue, limited readiness, and an unrecognised need for care kept some away. Wilhelm and Moore [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e] similarly report that higher perceived stress predicts lower self-care, underscoring the importance of cultivating both readiness and practical capacity so that resources can reach those who need them most.\u003c/p\u003e\u003cp\u003eAttendance alone did not determine effectiveness. Individual learning styles and group dynamics played a central role: some students struggled to translate abstract ideas into personal practice, while others successfully integrated them into both personal and professional life. Those who reported stronger personal engagement also noted greater professional benefits, echoing Student B\u0026rsquo;s view that personal self-care serves as the root that enhances professional capabilities. For students who found it difficult to connect with personal self-care, or for whom facilitation methods, such as experiential learning, did not resonate, additional assistance such as individual mentoring or alternative approaches tailored to their learning preferences proved essential.\u003c/p\u003e\u003cp\u003eFinally, the groups thrived on diversity. Students developed varied approaches to self-care, each seen not as deviation but as meaningful contribution. This diversity also prompted a shift from standardised measures of effectiveness toward individual self-assessment, highlighting the inherently subjective nature of self-care and the facilitator\u0026rsquo;s vital role. By recognising each student\u0026rsquo;s unique strengths and remaining responsive to their differing needs, facilitators help create an environment where students can engage in personally meaningful ways while contributing to the group\u0026rsquo;s collective growth.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec18\" class=\"Section2\"\u003e\u003ch2\u003e5.2 Psychoeducation Framework: for Learners and Curricula\u003c/h2\u003e\u003cp\u003eThe framework aligns with psychoeducational models of learning that emphasise reflection and emotional processing, and it resonates with the principle of radical acceptance as a stance of presence and non-judgment. A significant implication is that self-care facilitation in education extends beyond relaxation or enjoyment; it falls within the broader scope of psychoeducation. It enables students to develop self-awareness and build the psychological capacities needed to navigate challenges more effectively.\u003c/p\u003e\u003cp\u003eThe self-care collaborative groups revealed a developmental process shaped by six organically emerging phases, driven by student participants. Central to this process was the exploration of the inner self, including one\u0026rsquo;s thoughts, emotions, motivations, and identity. This involved introspection, emotional understanding, identity development, and the pursuit of self-knowledge. Anchored in a foundation of trust, students navigated both internal and external pressures, ultimately arriving at a redefined and more integrated understanding of self-care.\u003c/p\u003e\u003cp\u003eSeveral foundational elements contributed to a supportive learning environment: safety, connection, playfulness, creativity, equality, care, and compassion. These qualities grounded students during moments of uncertainty. The integration of personal and professional identities, symbolised by the imagery of sun and water, enabled genuine growth. Without such integration, development risked becoming superficial, often marked by emotional dissonance or professional stagnation [\u003cspan citationid=\"CR51\" class=\"CitationRef\"\u003e51\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eAn artistic and experiential approach closely aligned with music therapy education and reflected the essence of students\u0026rsquo; professional training. Students experienced first-hand how to move beyond verbal expression, enabling holistic and embodied self-exploration. Artistic processes helped integrate cognitive and emotional dimensions, fostered group cohesion, and deepened interpersonal understanding. Engaging with a wide range of artistic materials also reinforced professional identity, with many students reporting increased flexibility and personal growth in their practice. Overall, this process enhanced resilience and strengthened the capacity to tolerate ambiguity in learning. These elements facilitated the development of sustainable self-care and long-term growth across personal and professional domains.\u003c/p\u003e\u003cp\u003eThrough social learning, group settings validated individual experiences, normalised shared challenges, and strengthened support networks [\u003cspan citationid=\"CR47\" class=\"CitationRef\"\u003e47\u003c/span\u003e]. Within education, psychoeducation has been shown to enhance academic performance, promote emotional well-being, prevent behavioural difficulties, and inform more effective and resource-conscious policies [\u003cspan citationid=\"CR52\" class=\"CitationRef\"\u003e52\u003c/span\u003e]. In this context, facilitators played a pivotal role as catalysts. Rather than acting as caregivers or knowledge providers, they supported students\u0026rsquo; autonomy and self-exploration. This student-centred approach fostered responsibility, empowerment, and reciprocal growth between students and facilitators.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec19\" class=\"Section2\"\u003e\u003ch2\u003e5.3 Challenges\u003c/h2\u003e\u003cp\u003eThis section explores three key challenges students encountered, progressing from personal to relational and systemic levels, along with practical implications and recommendations.\u003c/p\u003e\u003cp\u003e\u003cb\u003e(1) Personal: Gap Between Cognitive and Embodied Learning\u003c/b\u003e\u003c/p\u003e\u003cp\u003eA key challenge lies in the contrast between students\u0026rsquo; learning styles. Some resonate more with an embodied approach, experiencing self-care as a way of being, rooted in movement, creativity, and somatic awareness. Others prefer a more mind-based orientation, viewing self-care as a set of practical actions grounded in knowledge, such as a desire to understand the theoretical basis of self-care. These differences can lead students to feel uncertain or discouraged when others respond in unfamiliar ways, increasing the risk of demotivation or disengagement.\u003c/p\u003e\u003cp\u003eThis dynamic echoes feminist perspectives in education, which challenge cognition-centred, male-dominated epistemologies and advocate for including embodied experience as a vital part of holistic development [\u003cspan citationid=\"CR53\" class=\"CitationRef\"\u003e53\u003c/span\u003e]. However, these two approaches are not in conflict but are interconnected. Integrating both allows self-care to be intentional as well as embodied. Balancing lived experience with cognitive understanding enables students to expand their comfort zones and apply knowledge meaningfully. Cognitive approaches offer structure and motivation, while embodied practices promote autonomy and deeper insight. Facilitators must be attentive to varied learning preferences and balance structure with flexibility through dialogue and ongoing reflection.\u003c/p\u003e\u003cp\u003eThis also aligns with the evolving nature of the self within the self-care collaborative groups. Exploration and dialogue foster growth, yet transformation often brings ambiguity and uncertainty. This highlights the importance of cultivating ambiguity tolerance and resilience. Ambiguity tolerance refers to the ability to face uncertainty without avoidance or excessive reliance on authority, while resilience refers to the capacity to adapt and recover from challenges, shaped by both internal and external conditions [\u003cspan citationid=\"CR54\" class=\"CitationRef\"\u003e54\u003c/span\u003e].These capacities are essential in educational settings and connect directly to the broader framework discussed earlier. They help students move beyond binary thinking toward more pluralistic, constructive understandings, better manage academic demands, and support both professional and personal development [\u003cspan citationid=\"CR55\" class=\"CitationRef\"\u003e55\u003c/span\u003e].\u003c/p\u003e\u003cp\u003e\u003cb\u003e(2) Relational: Balancing Autonomy and Collaboration\u003c/b\u003e\u003c/p\u003e\u003cp\u003eThe second challenge emerges at the relational level: finding a balance between individual autonomy and group collaboration. While the group format promotes shared learning and emotional support, it may at times distract from personal self-care, even when opportunities for individual reflection are present. This tension illustrates the need for students to develop skills in navigating social expectations around self-care. Facilitators play a critical role in transforming these moments into learning opportunities, ensuring that the group setting strengthens, rather than undermines, individual well-being.\u003c/p\u003e\u003cp\u003eA key implication is that some students view facilitators as experts expected to provide answers, reflecting patterns shaped by traditional educational structures. When facilitators step back to encourage equality, certain participants struggle to engage independently and instead seek external validation. This reveals a deeper challenge in fostering learning autonomy. Students who are accustomed to authority-led environments may develop learned helplessness, which impedes self-directed learning.\u003c/p\u003e\u003cp\u003eBiesta [\u003cspan citationid=\"CR56\" class=\"CitationRef\"\u003e56\u003c/span\u003e] highlights this contradiction, noting that emancipation often still depends on the educator\u0026rsquo;s permission to \"set the student free.\" In other words, liberation occurs within a persistent power imbalance, where the educator grants rather than enables autonomy. Moore and Wilhelm [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e] further critique systemic tendencies in music therapy education to prioritise theoretical and technical training at the expense of students\u0026rsquo; personal well-being, limiting opportunities to develop meaningful self-care practices. These critiques raise important questions about how to decolonise educational authority and truly foster learner agency.\u003c/p\u003e\u003cp\u003eThis presents a complex task for facilitators: to honour diverse needs while encouraging students to take ownership of their self-care journeys. Addressing this challenge requires facilitators to remain highly aware of how their presence and actions shape group dynamics and student agency. Their role is not to direct, but to support and empower. Ultimately, cultivating shared responsibility between facilitators and learners is essential for meaningful and sustainable self-care development in higher education.\u003c/p\u003e\u003cp\u003e\u003cb\u003e(3) Systemic: Psychological Safety Establishment\u003c/b\u003e\u003c/p\u003e\u003cp\u003eThe third challenge within the self-care collaborative groups concerns the establishment of psychological safety, a process shaped by systemic forces that extend beyond the group itself. Institutional norms, cultural expectations, and power dynamics deeply influence students\u0026rsquo; willingness to share and explore their inner experiences. While facilitators play a key role in creating supportive environments, addressing these broader issues requires advocacy and transformation at the institutional level.\u003c/p\u003e\u003cp\u003eAs students reported, dominant expectations within their learning and professional environments pressured them to conceal their differences. Cultural, social, and academic norms often fuel internal conflict and self-suppression, contributing to structural violence that restricts self-care practices grounded in honesty, personal relevance, and emotional integrity. Over time, these constraints can lead to burnout [\u003cspan citationid=\"CR57\" class=\"CitationRef\"\u003e57\u003c/span\u003e]. Clark [\u003cspan citationid=\"CR49\" class=\"CitationRef\"\u003e49\u003c/span\u003e] outlines four stages of psychological safety, beginning with \u0026ldquo;inclusion safety,\u0026rdquo; in which individuals feel secure enough to express difference without fear of exclusion. Without this foundation, genuine learning, contribution, and growth become difficult to initiate or sustain.\u003c/p\u003e\u003cp\u003eBiesta [\u003cspan citationid=\"CR56\" class=\"CitationRef\"\u003e56\u003c/span\u003e] warns that when education privileges socialisation and qualification over subjectification, it becomes a tool of social reproduction,reinforcing existing hierarchies and discouraging the emergence of unique voices. Such systems push students toward conformity, marginalising dissent and maintaining injustice. This concern is echoed by Lundberg and Chen [\u003cspan citationid=\"CR60\" class=\"CitationRef\"\u003e60\u003c/span\u003e], who argue that healthcare systems actively reproduce exclusion and preserve control. Even while claiming to advocate for marginalised groups, healthcare professionals often remain embedded in systems shaped by racial capitalism and coloniality.\u003c/p\u003e\u003cp\u003eBeyond environmental influences, personal histories and psychological trauma also shape students\u0026rsquo; relationships with self-care, in ways closely entangled with structural inequality. Courtois and Gold [\u003cspan citationid=\"CR59\" class=\"CitationRef\"\u003e59\u003c/span\u003e] stress the importance of integrating personal background into professional education, recognising that many challenges are rooted in, or exacerbated by, ableism, racial hierarchies, and neoliberal pressures. Similarly, Norcross [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e], drawing on 25 years of research on health professionals, challenges the persistent belief that practitioners do not require therapy. He argues that treating professionals as mere instruments and ignoring their humanity undermines both their well-being and their capacity to offer ethical, effective care.\u003c/p\u003e\u003cp\u003eIn music therapy education, addressing these systemic challenges involves more than curriculum content. It requires a commitment to holistic student development, the creation of emotionally safe spaces, and the recognition that personal growth is inseparable from professional learning. This approach affirms the complexity of self-care as both a personal and collective practice, shaped by broader social conditions and embedded power structures.\u003c/p\u003e\u003c/div\u003e"},{"header":"6. Conclusion and Future Actions","content":"\u003cp\u003eThis empirical study, situated within a feminist educational framework and participatory action research, explores pathways for facilitating self-care in music therapy education through participatory, arts-based group processes that centre student voices and lived experience. The knowledge generated reveals that self-care in education cannot be reduced to individual coping or surface-level well-being. Rather, it emerges through sustained, relational, and reflective practices that unfold across personal, educational, and systemic dimensions.\u003c/p\u003e\u003cp\u003eStudents\u0026rsquo; experiences demonstrate that meaningful self-care is a process of learning through action, uncertainty, and dialogue. This process calls for the development of ambiguity tolerance and resilience, especially as students encounter discomfort, difference, and emotional vulnerability. This journey requires flexible structures that accommodate diverse learning styles and lived realities. Facilitating self-care, then, is not about delivering fixed skills. It involves co-constructing a dynamic practice rooted in experience, critical inquiry, and reciprocal support. These insights offer a foundation for implementing and adapting self-care initiatives across educational settings.\u003c/p\u003e\u003cp\u003eFrom an individual perspective, each student still carries personal responsibility. Cultivating self-care in an educational setting requires a commitment to self-development and a willingness to engage with the discomfort that learning may bring. It involves self-reflection, critical thinking, and the courage to navigate challenge and change. Autonomy therefore entails responsibility. Taking ownership of one\u0026rsquo;s learning not only strengthens independence but also enables meaningful contributions to academic, social, and professional life. At the same time, recognising how social structures and institutional logics shape these experiences helps prevent students from internalising systemic problems as personal shortcomings.\u003c/p\u003e\u003cp\u003e From an educational perspective, psychoeducation offers a valuable framework for self-care facilitation. It nurtures self-exploration and supports the development of psychological competencies such as ambiguity tolerance, emotional regulation, and adaptive coping. Offering diverse options accommodates different learning styles and modes of expression. Facilitators must remain attuned to the ethical dimensions of educational relationships, as the boundary between guidance and control is often thin. Within a supportive group setting that weaves together cognitive and embodied learning with social and creative connection, students learn to stay with uncertainty and deepen their emotional grounding. Encouraging intrapersonal curiosity, bridging personal and professional realms, and using experiential methods all contribute to holistic well-being. While grounded in music therapy education, these insights are relevant across disciplines and contexts.\u003c/p\u003e\u003cp\u003eFrom a systemic perspective, we must critically reconsider what constitutes a genuinely supportive learning community. As Spivak [\u003cspan citationid=\"CR61\" class=\"CitationRef\"\u003e61\u003c/span\u003e] urges in \u003cem\u003eTeaching for a Broken World\u003c/em\u003e, educational standards are never neutral. They carry power, ideology, and social meaning. Education must therefore move beyond narrow goal-orientation and reclaim its mission as a space for freedom, exploration, and reflective transformation. Embracing the contingency of knowledge,what Spivak calls a slow, humanity-centred preparation,guards against defensiveness and cultivates deeper understanding.\u003c/p\u003e\u003cp\u003eYet many people may not immediately perceive the need for self-care. Those with greater access to resources may overlook deeper struggles because of privilege, while those with fewer resources often understand the importance of care, yet face structural barriers that make sustained practice difficult. Facilitating self-care in music therapy education, as well as in higher education more broadly, is therefore not only a matter of personal well-being but also a question of social and relational ethics. We must learn to recognise how systemic inequities shape both our own vulnerabilities and those of the people we seek to support. Sustainable self-care practices equip us to navigate these realities with resilience, humility, and compassion.\u003c/p\u003e\u003cp\u003eSilence in the face of structural violence is never neutral. It becomes complicity. Healthcare education that neglects its own health cannot credibly inspire change in others. Radical acceptance invites us to face systemic harm with clarity and resist the urge for quick fixes. In these unsettled times, self-care must be understood as a collective responsibility rooted in interdependence. Caring for ourselves and one another lays the foundation for enduring change and genuine flourishing. Amplifying students\u0026rsquo; voices is therefore essential. Their strength and agency are vital to building learning communities grounded in justice, compassion, and care.\u003c/p\u003e\u003cp\u003eLooking ahead, three priorities emerge. First, co-design self-care modules with students and integrate them throughout the curriculum, supported by staff development that embodies the same practices. Second, advocate for institutional policies that protect the time and resources required for psychoeducational self-care, making it a sustainable and integrated element of professional training. Third, sustain the spirit of participatory action research by extending it across diverse cultural and disciplinary contexts, ensuring that strategies remain responsive, context-sensitive, and open to ongoing transformation. Acting on these fronts enables music therapy education to fulfil the promise of \u003cem\u003eBeyond Individual Well-being\u003c/em\u003e, reclaiming education\u0026rsquo;s \u0026ldquo;beautiful risk\u0026rdquo; [\u003cspan citationid=\"CR56\" class=\"CitationRef\"\u003e56\u003c/span\u003e] and preparing future practitioners to engage their work and the world with depth, clarity, and relational responsibility.\u003c/p\u003e\u003cp\u003eLastly, it is important to emphasise that while many of the approaches presented in this study, such as participatory reflection, embodied learning, and collaborative facilitation, may appear familiar, their impact does not come from their form alone. What matters is not simply adopting these methods, but how their underlying principles are brought to life through intentional practice, relational presence, and ethical engagement. Without this depth, even well-known approaches risk becoming superficial or performative.\u003c/p\u003e\u003cp\u003eWhat students taught us is that transformation does not arise from quick solutions or prescriptive frameworks. It unfolds slowly, through moments of uncertainty, discomfort, and relational vulnerability. Their experiences remind us that self-care is not a set of predefined techniques, but an ongoing practice of staying present with what is difficult and responding with care. In this light, radical acceptance is not a passive stance. It is a courageous and intentional commitment to remain present with what is painful, uncertain, or imperfect, and to respond with care,for oneself, for others, and for the shared space we inhabit as learners and professionals. Through this orientation, self-care is no longer a private act of preservation. It becomes a pedagogical and political practice rooted in resistance, responsibility, and renewal.\u003c/p\u003e\u003cp\u003eUltimately, facilitating self-care in education requires knowledge that reaches the very roots of life. It teaches us how to settle ourselves, foster vitality, and cultivate a sense of wholeness. As student participants in this study showed, embracing the \u0026ldquo;beautiful risk\u0026rdquo; of education means allowing ourselves to be transformed together. In doing so, we move beyond individual well-being and toward an education rooted in care, justice, and collective transformation. This is both an invitation and a challenge: to walk with care, not alone, but together.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eFunding Declaration\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eE\u003c/strong\u003e\u003cstrong\u003ethic\u003c/strong\u003e\u003cstrong\u003eal Approval\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was approved by the Norwegian Agency for Shared Services in Education and Research \u0026nbsp;(Sikt) under reference number 548582, and it was also registered in the University of Bergen’s internal system for research involving the processing of personal data (RETTE) under reference number R3344.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eAt the University of Bergen, no institutional ethics committees/IRBs exist at the faculty or university level; Sikt and RETTE approval together constitute the formal and full ethical approval process. The study was conducted in accordance with the ethical principles outlined by the National Committees for Research Ethics in the Social Sciences and the Humanities (NESH).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent to Participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eInformed consent was obtained from all participants prior to their inclusion in the study, in accordance with ethical guidelines and approval procedures established by Sikt.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData availability statement\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study generated audio recordings, full transcripts from the self-care collaborative groups, questionnaire responses, digital images of participants’ artwork, and transcripts from both focus groups and individual interviews. In line with participant consent and the ethical approval granted by Sikt, all materials are securely stored on encrypted servers at the University of Bergen and are additionally backed up within the Services for Sensitive Data (TSD) system.\u003c/p\u003e\n\u003cp\u003eThe dataset contains sensitive information, including potentially identifiable narratives, images, and health-related reflections closely tied to personal experience. As classified Confidential by Sikt, these materials present a risk of re-identification and therefore cannot be made publicly available. Anonymised excerpts are included in this publication. Requests for access to de-identified material may be considered upon reasonable inquiry and are subject to appropriate ethical clearance. Please contact the corresponding author for more information.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent to Publish\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eConsent to publish anonymised excerpts from interviews, group discussions, and artistic materials was obtained from all participants as part of the informed consent process. All identifying information was removed to ensure confidentiality in the published material.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eRosa, H. \u003cem\u003eResonance: A Sociology of Our Relationship to the World\u003c/em\u003e. John Wiley \u0026amp; Sons, 2019. doi:10.1177/02685809211057655\u003c/li\u003e\n\u003cli\u003eWorld Health Organization Regional Office for Europe. Why are so many health and care workers suffering poor mental health and what can be done about it? \u0026ndash; Perspectives from Finland [Internet]. Copenhagen: WHO Regional Office for Europe; 2024 Aug 21 [cited 2025 Jun 28]. 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San Francisco: Jossey‑Bass; 1999. \u003c/li\u003e\n\u003cli\u003e\u003cstrong\u003eBiesta GJJ.\u003c/strong\u003e\u003cem\u003eThe beautiful risk of education\u003c/em\u003e. New York: Routledge; 2015.\u003c/li\u003e\n\u003cli\u003eShaw, C., et al. \u0026lsquo;Lived Experience Perspectives on Ableism within and beyond Music Therapists\u0026rsquo; Professional Identities\u0026rsquo;. \u003cem\u003eMusic Therapy Perspectives\u003c/em\u003e, vol. 40, no. 2, 2022, pp. 143\u0026ndash;151. doi:10.1093/mtp/miac001\u003c/li\u003e\n\u003cli\u003eBelingheri, M., et al. \u0026lsquo;Self-Reported Prevalence of Sleep Disorders among Medical and Nursing Students\u0026rsquo;. \u003cem\u003eOccupational Medicine\u003c/em\u003e, vol. 70, no. 2, 2020, pp.127\u0026ndash;130.doi:10.1093/occmed/kqaa011 orcid.org+15boa.unimib.it+15pdfs.semanticscholar.org+15\u003c/li\u003e\n\u003cli\u003eCourtois, C. A., and S. N. Gold. \u0026lsquo;The Need for Inclusion of Psychological Trauma in the Professional Curriculum: A Call to Action\u0026rsquo;. \u003cem\u003ePsychological Trauma: Theory, Research, Practice, and Policy\u003c/em\u003e, vol. 1, no. 1, 2009, pp. 3\u0026ndash;23. doi:10.1037/a0014074\u003c/li\u003e\n\u003cli\u003eLundberg, D. J., and J. A. Chen. \u0026lsquo;Structural Ableism in Public Health and Healthcare: A Definition and Conceptual Framework\u0026rsquo;. \u003cem\u003eThe Lancet Regional Health-Americas\u003c/em\u003e, vol. 30, 2024. doi: 10.1016/j.lana.2023.100650\u003c/li\u003e\n\u003cli\u003eSpivak, G. C. \u0026lsquo;Teaching for a Broken World\u0026rsquo;. \u003cem\u003eAnglica: An International Journal of English Studies\u003c/em\u003e, vol. 33, no. 3, 2024, pp. 11\u0026ndash;26. doi:10.7311/0860-5734.33.3.02\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"discover-education","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"diedu","sideBox":"Learn more about [Discover Education](https://www.springer.com/journal/44217)","snPcode":"44217","submissionUrl":"https://submission.nature.com/new-submission/44217/3","title":"Discover Education","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Discover Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"","lastPublishedDoi":"10.21203/rs.3.rs-6999522/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6999522/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eSituated within a feminist educational framework and participatory action research, this empirical study explores pathways for facilitating self-care in music therapy education through participatory, arts-based group processes that centre student voices and lived experience.\u003c/p\u003e\u003cp\u003eAcross two cycles of collaborative groups, music therapy students co-created spaces that supported emotional presence, creative expression, and integration of personal and professional identities. Data were collected through observation, questionnaires, group dialogue, artistic works, and interviews. Thematic analysis identified six overlapping phases in students\u0026rsquo; self-care journeys, shaped by ambiguity, vulnerability, and mutual care. Key challenges included navigating diverse learning preferences, sustaining autonomy within collaboration, and establishing psychological safety in institutional settings.\u003c/p\u003e\u003cp\u003eThe findings suggest that self-care in education is a relational and embodied process that resists fixed technique and invites educators and students to co-create ethical spaces for presence, reflection, and growth. 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