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The Royal College of Psychiatrists Improving the lives of people with mental illness

Music Therapy


Need for a critical perspective

Music TherapyI recently came across this excellent article in the Lancet (co-authored by Professor Desmond O’Neill, who I also plan to interview soon). It calls for a need for a reflective and critical perspective on the role of the humanities in healthcare.

This very point has been on my mind of late. As someone with a strong interest in music in particular and the arts more widely, I realise that I am not without bias in exploring the potential applications of music and arts therapies in clinical settings. These interventions are mostly viewed by the public and doctors as benign and harmless at worst, and as potentially wondrous and life-changing by some. Yet, like all interventions in healthcare settings, they need to be subject to scrutiny for effectiveness, cost analysis and, importantly, potential unwanted outcomes. What works for some may not work for others and pressurising anyone into a potential form of therapy raises ethical questions.

Music TherapyI have touched on some evidence base in the blog before, but mostly the blog has been speculative on this front. With this in mind, I did some further digging on the benefits of music therapy in mental health settings. I was mostly interested in high-quality evidence, from systematic review and metanalysis. I recall having read a 2008 Cochrane review, which suggested that while music therapy may have some benefits, the number of quality studies was very small and caution was required.

I was pleasantly surprised then to find that more recent work in this area, at the level of RCT or systematic review, has suggested benefits not only in depression, but also in other mental disorders including psychosis, dementia, autism, acquired brain injury. As a forensic psychiatrist, I was encouraged to read of work in correctional settings, where high rates of mental disorder are common. Further, music therapy appears to be well tolerated by almost all patients, and no specific adverse effects have been reported on, though it is not always clear if these have been considered.

So the current state of the field looks more promising, thanks to what seems like an increase in better quality research in this area over the last decade or so. Gaps remain however in our knowledge about precisely how these interventions work, what components may be especially useful, and which patients will respond less well. These areas warrant further exploration.

A music therapist’s perspective

A music therapist’s perspectiveI thought readers might also be interested in what music therapy specifically entails. The British Association of Music Therapists website gives an overview, including an historic perspective. Mind’s website provides some useful information also, stating ‘you do not need to have any artistic skill or previous experience of dance, drama, music or visual art to find arts therapies helpful. The aim isn't to produce a great work of art, but to use what you create to understand yourself better.’ This echoes Carl Jung’s view of art therapy, which he quite clearly delineated from actual works of art.

To further our understanding, I spoke with music therapist, Hannah Smith, who has experience across a range of mental health settings.

How did you develop an interest in music therapy? Are you a musician yourself? What qualifications did you pursue?

My personal background stems from having a musical family of sisters playing music, and growing up wanting to be part of the groups they played in having seen them perform and the friendships they made through their music. I learnt violin and bassoon through my school years, and was always motivated by playing with others.

As I got older, I wanted to maintain my music and had a keen interest in psychology and counselling/therapy - someone then uttered the term 'Music Therapist' at a careers evening in my GCSE years, and I looked in to the profession. I started by meeting a Music Therapist in a local hospice, volunteered there and in numerous other relevant settings, and studied Psychology and Music for my Undergraduate Degree, before applying to the Masters in Music Therapy at Guildhall School of Music and Drama. I still play in an orchestra for my own enjoyment and musicianship.

To be a Music Therapist, it is also imperative that you play at least one instrument to a high level (usually diploma or above is required), the psychology and therapy theory and techniques are what are taught and developed during training.

Can you tell us a little about your current work in this area?

I currently work two days a week in secure and forensic services for the NHS, and previously worked in an acute mental health hospital, also for the NHS. In both settings, I have provided a mixture of group and individual sessions, both on and off ward. Sessions are tailored to client need, with thoughts around timing, context, duration, and therapeutic aims. In forensic services, there is also consideration of a client's index offence – both in terms of work to be done in therapy, and aspects of safety and risk.

Some group sessions are open to all patients on a given ward – I run drumming groups to promote engagement in accessible group music, active participation, group cohesion and the widely evidenced benefits that drumming is known to have upon mental and physical health. Others are closed, by referral only, and involve a more ‘classic’ approach of engaging clients in improvised music making, for self-expression, rehabilitation, emotional regulation, building insight and developing relationships with others. I also work in children’s services for another NHS Trust, three days per week.

What are the main challenges you face as a music therapist?

The most common questions asked of Music Therapists, are ‘What is Music Therapy?’ and ‘Does it work?’. I used to find this very frustrating in the early days, feeling like I was constantly having to justify my chosen career, until a colleague made the valid point that as a relatively small profession, for most people we meet in life, we will be the first Music Therapist they have ever met. Realising the weight of this, changed my view, to consider the importance of these questions, and the importance of being open to them in order to nurture individual and societal understanding of the work we do, how, why, and the developments our clients make.

What aspects do you find most interesting and rewarding?

I find group music making with adults can be incredibly rewarding. To facilitate a group of individuals, who may initially be unsure about attending and reticent of making music together, and to support them grow and come together, engaging in improvisation, to share the moment that they may discover or rediscover their own creative capacity, take risks to express themselves authentically, can be very special.

To offer an alternative means of interacting, to gain insight into parts of a person which may not be accessed or observed by other professionals, is a privilege. When these groups ‘let go’ and are able to ‘be’ in the music, in that moment, the significance in the room is palpable. This may take many weeks to achieve, or occur within a single session. At times I can go a step further and break from my own music making, when I am no-longer essential to holding the group sound, and the group has the strength and confidence to maintain its own music. I love to sit out and listen, observe and re-join the music once my clients have hopefully realised what they have achieved together.

Any particular success stories you would like to share?

I would say that the moments of success are what matter to me – the group coming together, the individual managing to stay in the room for the full session time without their anxieties overwhelming them, the individual holding a CD that we have recorded together of songs they may have written or covered which having meaning to them, or even the client that initially couldn’t bear to identify an instrument to play but who manages to be at ease within the room and explore items with a sense of curiosity and trust for the therapeutic space.

 

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Minds in Music

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  John Tully  
 

@MindsinMusic

Dr John Tully is a forensic psychiatrist and researcher at the Institute of Psychiatry, Psychology and Neuroscience, London. He is also a musician and is interested in the role of the arts in mental health.