Music therapy techniques as predictors of change in mental health care ¬リニ

The application of music in therapy is realised through different working modalities which can be categorised into three types of techniques: production, reception, and reproduction. These techniques are commonly used in mental health settings in music therapy practice and previous research suggests that specific working modalities might be important predictors of change in music therapy. However, little is known about which ingredients specifically contribute to the outcomes of music therapy. This study aimed to investigate the application of music therapy techniques and whether they predict changes in clinical outcomes in mental health settings with individuals displaying a low therapy motivation. Participants (N = 31) were assessed before, during, and after participating in individual music therapy. Music therapy techniques were assessed for three selected therapy sessions per participant. Associations between music therapy techniques and outcomes were calculated using linear models with repeated measures. Results showed that reproduction techniques were used most intensely. In addition, relational competencies (interpersonal and social skills) amongst the participants improved when focusing on reproducing music (e.g. singing or playing familiar songs, learning musical skills). Results indicated that reproduction music therapy techniques may foster the development of relational competencies in individuals with low motivation. © 2012 Elsevier Inc. All rights reserved. Individuals afflicted with a mental illness may often display difficulty in the areas of emotional responsiveness and social interaction, verbally and non-verbally. Challenges in interpersonal and intrapersonal skills can result in individuals experiencing low motivation for verbal therapies such as psychotherapy or psychological counselling. To that end, mental health care clients with low motivation are frequently referred to music therapy, as the primary medium of interaction is music rather than verbal language (Hannibal, 2005). Although, music therapy has been indicated as an effective intervention with regard to fostering motivation, emotional expression, and relatedness (Gold, Mössler, et al., submitted for publication) additional process-outcome research is needed to identify the most effective music therapy techniques with this particular client group. [ClinicalTrials.gov Identifier: NCT00137189]. ∗ Corresponding author. Present address: GAMUT, Uni Health, Uni Research, Postboks 7810, 5020 Bergen, Norway. Tel.: +47 97479289. E-mail addresses: [email protected] (K. Mössler), [email protected] (J. Assmus), [email protected] (T.O. Heldal), [email protected] (K. Fuchs), [email protected] (C. Gold). In music therapy, musical experiences and the therapeutic relationship developing through them are used as dynamic forces producing therapeutic change (Bruscia, 1998). Relational musical experiences that deepen the therapeutic relationship are fostered by the use of music therapy techniques which are applied within a systematic process between the client and therapist. Music therapy techniques can be understood as working modes offering different musical and relational experiences. These techniques work in tandem with psychotherapeutic techniques (e.g. mirroring, holding, confronting) within specific use of musical parameters (e.g. rhythm, sound, tonality) (Storz, 2000a; Wigram, 2004). Music therapy techniques can be assigned to the following categories: Production techniques focus on emotional expression and the creation of the relationship through musical improvisation (e.g. structured, thematic, communicative, trying out, free improvisation) in which the client and therapist create something musically new. Reproduction techniques involve the client and therapist playing or singing precomposed pieces of music as well as learning or practicing musical skills (e.g. guitar chords, melodies on the piano). They may provide a holding structure and framework in which the actualisation of memories can be supported and explored within the context of relationship. Reception techniques involve the client listening to live (e.g. music played by the therapist) or recorded music. These 0197-4556/$ – see front matter © 2012 Elsevier Inc. All rights reserved. http://dx.doi.org/10.1016/j.aip.2012.05.002 334 K. Mössler et al. / The Arts in Psychotherapy 39 (2012) 333– 341 musical experiences may be used to focus on conscious awareness of the client’s current mental state, emerging associations, as well as to facilitate relaxation or pain management (Storz, 2000a, 2011). In each of the three categories of music therapy techniques, both the therapist and client contribute mutually and are engaged in a therapeutic process within the context of relating and communicating. Thus, the choice of techniques will also be the result of this mutual process. Previous research in mental health care has provided supporting evidence that specific factors in music therapy are of importance. According to these findings, techniques focusing on musical communication, expression, and transformation may be of relevance (Danner & Oberegelsbacher, 2001) when working with clients with psychosomatic problems in mental health care. Another study found that music therapy-specific techniques (e.g. free improvisation, songs) were associated with bigger improvement compared to less specific techniques not unique to music therapy (e.g. free play, puppet play) in children and adolescents (Gold, Wigram, & Voracek, 2007). Although psychotherapy research has demonstrated that specific factors are of little importance to produce psychotherapeutic change (Cooper, 2008; Lambert & Ogles, 2004; Wampold, 2001), music therapy research is sparse in this area and more research is needed in order to support or challenge this notion. Outcome studies in adult mental health care have mainly investigated music therapy techniques in one of the two ways: (a) either several techniques were applied within individual or group music therapy but were not statistically tested in terms of their particular impact on outcomes (De l’Etoile, 2002; Tang, Yao, & Zheng, 1994; Yang, Li, Weng, Zhang, & Ma, 1998), or (b) one main technique applied within a session was investigated for various outcomes (Grocke, Bloch, & Castle, 2009; Silverman & Marcionetti, 2004; Talwar et al., 2006). In terms of external validity, focusing on only one technique when investigating music therapy may not appropriately reflect effective common clinical practice in mental health care. In this setting it is more common to implement production, reproduction as well as reception techniques as they are related to differing therapeutic topics and goals which may all be vital within the same therapeutic process (Storz, 2004). In the present study we aimed to examine whether different types of music therapy techniques can explain some of the variance in outcomes of clients in mental health care with low therapy motivation. In this context, it was important to first understand which music therapy techniques are being used within this client population. Examining music therapy techniques in this field is of clinical interest as it may contribute to a better understanding of how clients can improve their engagement into therapeutic processes. Specifically, the main objectives of this study were to explore: • which music therapy techniques are applied within music therapy in clients with mental illness presenting with a low therapy motivation, and • whether music therapy techniques predict changes in clinical outcomes related to the development of ego-strength, relational competencies, and quality of life.