The effect of improvisational music therapy on the treatment of depression: protocol for a randomised controlled trial

Background. Music therapy is frequently offered to individuals suffering from depression. Despite the lack of research into the effects of music therapy on this population, anecdotal evidence suggests that the results are rather promising. The aim of this study is to examine whether improvisational, psychodynamically orientated music therapy in an individual setting helps reduce symptoms of depression and improve other health-related outcomes. In particular, attention will be given to mediator agents, such as musical expression and interaction in the sessions, as well as to the explanatory potential of EEG recordings in investigating emotion related music perception of individuals with depression. Methods. 85 adults (18–50 years of age) with depression (ICD-10: F 32 or F33) will be randomly assigned to an experimental or a control condition. All participants will receive standard care, but the experimental group will be offered biweekly sessions of improvisational music therapy over a period of 3 months. A blind assessor will measure outcomes before testing, after 3 months, and after 6 months. Discussion. This study aims to fill a gap in knowledge as to whether active (improvisational) music therapy applied to people with depression improves their condition. For the first time in this context, the mediating processes, such as changes in musical expression and interaction during the course of therapy, will be objectively investigated, and it is expected that the results will provide new insights into these processes. Furthermore, the findings are expected to reveal whether music related emotional experiences, as measured by EEG, can be utilized in assessing a depressive client's improvement in the therapy. The size and the comprehensiveness of the study are sufficient for generalizing its findings to clinical practice as well as to further music therapy research. Trial registration. ISRCTN84185937peerReviewe

Non-Structured Initial Assessment of Psychiatric Client in Music Therapy

This paper is based on the grounded theory study, in which experienced music therapy clinicians were interviewed and their conception of an initial assessment were examined in detail. The main result of the study is a qualitative synthesis of initial assessment procedures, including the description of the process how a therapist gains his/her understanding of a client during an assessment period. In practice, an overall structure and a setting of assessment sessions enable practical activities, which are client-centered and usually non-structured. Activities can be seen as a chain of interactional conditions, under which the necessary data is collected: acting, experiencing, encountering, sharing and finally, discreet discussion of what happened and what is perceived. This leads furthermore to reflective working of a therapist and forming more whole conception of the client’s situation and the elements related. When summing up an initial assessment period and drawing up conclusions, therapist uses several sources of information. The process of gaining understanding is constructive, and in an ideal situation the whole multidisciplinary team can take advantage of the cumulative knowledge of initial assessment in music therapy.peerReviewe

Alkuarviointi kliinisenä käytäntönä psyykkisesti oireilevien asiakkaiden musiikkiterapiassa : strategioita, menetelmiä ja apukeinoja

Assessment in music therapy refers to the process of collecting and analyzing information about a client for planning and implementing necessary therapeutic interventions, and mapping the possible aims and a course of therapy (e.g. Bruscia 1987). Music therapy assessment may also reveal new information about a client for establishing diagnostic hypotheses, especially if a client’s communication is otherwise very restricted and confined. Conducting an assessment enables a therapist to gain insight into a client’s personal traits, functioning and overall situation, and to further determine possible problems, needs and resources from a clinical viewpoint.Music therapy assessment in its different forms is a relatively little-studied phenomenon, although interest and the number of assessment-related publications has increased in recent years. The pressure and need for developing appropriate assessment methods and clinical procedures – besides the interests of the therapist – arises partly from official health care systems, and from the context of multidisciplinary work. Particularly few studies have been conducted which focus on music therapy assessment on a procedural level, and its methodological processes (Sabbatella 2004). The main interest in the present study is on different practical approaches in initial music therapy assessment, what methods are used and what theoretical framework and viewpoints can be found within the context of psychiatric music therapy assessment.The present work combines three studies, conducted by the author, on music therapy assessment in psychiatry, and presents an integrative qualitative synthesis and a theoretical outline of different strategies, methods and tools used in clinical practice. The first phase was an interview-based phenomenographic investigation of different concepts of experienced clinicians, and how they act and collect the information needed when conducting initial assessments. Grounded theory was used to obtain a deeper analysis, and the description of a non-structured assessment process was presented as a result of the study. The second phase of the study aimed to refine the formulated theory, and modelled the therapist’s process of gaining understanding of a new client in a more detailed way. As a result, a description of the process of producing constructive and cumulative knowledge based on parallel meaning-making of the therapist, client and multidisciplinary team, was presented. The third phase of the study was a focused literature-based review of published assessment methods and models within the psychiatric context. The in-depth qualitative Grounded theory analysis of collected data produced a synthesis of different clinical views and practical choices. The study also revealed the variety of theoretical frameworks and different paradigms behind clinical practice.Psychiatric music therapy assessment is a multifaceted and multi-levelled phenomenon, which offers many alternatives for its conduct in practice. The results of this research can be utilized in training of music therapists, developing the applicable assessment methods, in formulation of related studies and in multidisciplinary work.Musiikkiterapian lähestymistapoja ja keinoja voidaan hyödyntää silloinkin, kun perinteiset keinot selvittää psyykkisesti oireilevien asiakkaiden ongelmia eivät toimi, toteaa Esa Ala-Ruona. Ala-Ruona tarkasteli tutkimuksessaan ennen varsinaista terapiaprosessia tehtävää alkuarviointia ja sen eri toteuttamistapoja. Musiikkiterapia-arviointi tuottaa uutta tietoa muun muassa asiakkaan persoonallisuuden piirteistä, hänen yksilöllisestä tavastaan ilmaista itseään sekä hänen toimintakyvystään ja valmiuksistaan. Tätä tietoa voidaan käyttää diagnosoinnin apuna ja kokonaishoidon ja kuntoutuksen suunnittelussa. Arviointijaksolla tutkitaan keskinäisen työskentelyn sujuvuutta sekä määritellään terapian tavoitteita ja keinoja.- On tärkeää, että eri asiakkaiden yksilölliset piirteet ja edellytykset huomioidaan arviointijaksolla, Ala-Ruona toteaa.Musiikkiterapiassa asiakas ja terapeutti pääsevät vuorovaikutteisen työskentelyn alkuun, vaikka asiakkaalla ei olisikaan vielä valmiuksia ilmaista itseään sanallisesti. Asiakkaan tapa luoda musiikkia sekä hänelle tärkeän musiikin piirteet voivat viestiä monitasoisesti hänen nykytilanteestaan ja historiastaan.- Musiikillinen ilmaisu ja asiakkaan musiikkisuhde tarjoavat mahdollisuuden tarkastella asiakkaan tunne-elämän tilaa ja siihen liittyviä jännitteitä ja latauksia, vaikka asiakas ei niitä vielä pystyisi puhuen käsittelemään, Ala-Ruona kuvailee.Musiikkiterapiassa voidaan käyttää enemmän tai vähemmän strukturoituja lähestymistapoja. Eri arvioinnin strategiat ohjaavat käytännön toimintaa, kuten terapeutin roolia ja miten tarkasti toteutettava arviointi on etukäteen määritelty. Suomalaiseen musiikkiterapian kliiniseen käytäntöön liittyy vapaamuotoisuuden korostaminen, jolloin arviointi tehdään asiakaslähtöisesti ja kunkin asiakkaan edellytyksiä vastaavalla tavalla.- Käytännössä vapaamuotoinen arviointi tarkoittaa sitä, että vaikka sen ulkoiset rakenteet (istunnon kesto, tapaamistiheys jne.) ovatkin määritelty, riippuu käytännön toteutus asiakkaan kiinnostuksen kohteista ja kulloisenkin tilanteen mukaan etenemisestä, Ala-Ruona toteaa. Toiminnan ohessa havainnoidaan monipuolisesti asiakkaan musiikillista, sanallista ja ei-sanallista vuorovaikutusta sekä asiakkaan motivaatioon, toiveisiin ja odotuksiin liittyviä tekijöitä. Ala-Ruonan tutkimus osoittaa, että terapeutin ja hoitavan tahon teoreettinen suuntautuneisuus vaikuttaa siihen, millaisista ilmiöistä arvioinnissa ollaan kiinnostuneita ja miten tarvittavaa tietoa hankitaan ja tulkitaan. Musiikkiterapia-arvioinnissa voidaan painottaa esimerkiksi keskinäisen vuorovaikutuksen piirteitä, asiakkaan kokemusmaailmaa, tunne-elämän dynamiikkaa tai ulkoisesti havaittavaa käyttäytymistä.- Siinä missä suomalainen ja tyypillisesti psykodynaamiseen viitekehykseen pohjautuva kliininen käytäntö korostaa asiakkaan yksilöllisten ominaisuuksien ja jaetuista kokemuksista nousevien merkitysten antoa, painottuu amerikkalaisessa, tyypillisesti behavioristiseen teoriataustaan nojautuvassa käytännössä tiettyjen ennalta määriteltyjen käyttäytymisen piirteiden havainnointi, Ala-Ruona kuvailee.– Musiikkiterapia-arviointi tarjoaa joustavan valikoiman vaihtoehtoista ilmaisua ja luovaa työskentelyä hyödyntäviä keinoja. Olennaista on, että musiikkiterapian keinoin voidaan kohdata luontevasti sekä asiakas, joka voi olla psyykkisesti hyvin haavoittuvainen ja estynyt tai asiakas, jonka kaoottinen itseilmaisu saa musiikillisessa kanssakäymisessä ymmärrettävän muodon, kuvailee Ala-Ruona. Ala-Ruonan väitöstutkimus perustuu kolmeen psykiatrian alueen musiikkiterapia-arviointia käsittelevään tutkimukseen sekä niitä integroivaan synteesiin ja teoreettisen hahmotelman esittelyyn

Efficacy of Music Therapy and Vibroacoustic Therapy for Pain Relief

Introduction: Vibroacoustic therapy (VAT) uses low-frequency sinusoidal sound vibration between 20 and 130 Hz often used in music therapy (MT) practice and rehabilitative settings. Case studies highlight its efficacy but the evidence is fragmented. Seinäjoki Central Hospital, Finland, has used VAT systematically for over 15 years. Methods: A total of 35 VAT case studies of patients from Seinäjoki Hospital were assessed using visual analogue scales and thematic content analysis of the case study records. Results are presented according to general well-being, vitality, mood, pain, relaxation, sleep quality, mobility, body temperature and quality of life, with sub-groups according to referral units (e.g. rehabilitation assessment, physiotherapy, neurological polyclinic and psychiatry), reasons for referral and co-morbid symptoms. Case presentation: The results from each sub-group will be presented with a focus on pain relief. Discussion: These results highlight VAT efficacy; however, the evidence is difficult to generalise due to the single case study format. Randomised controlled trials are needed to systematically assess efficacy. Suggestions for future research are made. [PUBLICATION ABSTRACT

Nurture and play for foster families with young children : Foster-parents’ reflections on attachment-focused group intervention

An insecure attachment history puts foster children at risk for many kinds of difficulties, which may include psychopathology. Nurture and Play (NaP) for foster families–intervention for children aged one to five years of age aims to help the new attachment relationship between foster parents and their young children develop in a secure direction. The aim of this study is to gain deeper understanding on how foster parents use their mentalization skills to reflect the different meanings of the NaP for foster families–intervention. A stimulated recall method was chosen to correspond to these research targets. It was revealed that parents’ reflections were evidently focused on the child, the importance of safety and the meaning of change during the process. Emotional qualities concerning both the child and the adult were also emphasised. The foster parents were able to utilise their reflections within a wider context of place, relationships, and time. The results of the study and the core concepts of attachment theory are strongly related to each other. Furthermore, the study and its outcomes offer suggested priorities and suggestions for future research.peerReviewe

Professional Competences of Music Therapists Working in Post-stroke Rehabilitation

The aim of this qualitative study is to gain more insight into the skills and knowledge that music therapists feel they need, in order to work successfully with people who have had an acute stroke. For this purpose, six music therapists were interviewed about their own particular specialist education. Another interview topic for them was to recount their subjective experiences of poststroke rehabilitation work in hospitals and health care units during the course of two projects that they participated in. The first was a project that specifically used music listening during acute stroke rehabilitation; and the second was a project, which used more active music therapy techniques, like drumming during acute stroke rehabilitation. In the first project, patients who were bedridden in hospitals or health care units could listen to familiar songs that stimulated them in both a physical and cognitive way, and helped them to relax and regulate their moods better. In the second project different therapeutic approaches were observed and reflected upon during the piloting phase of the project and then an ideal combination of the activities was defined for the main phase. The resulting clinical music therapy model was thus created to specifically meet the special needs of stroke patients. Three crucial factors gleaned from the interviews that were seen to affect clinical thinking were: a) knowledge concerning the neurological basis of strokes; b) good patient interaction; and c) accurate observation of the physiological and psychological aspects of music therapy. In this way, these results provide a better understanding of the tacit knowledge possessed by music therapists who work within stroke rehabilitation.peerReviewe

An overview of the music therapy professional recognition in the EU

This article documents the development of the professional recognition of music therapy in the EU. First, a brief history of the origins of modern music therapy in Europe is presented, followed by more detailed analysis of the establishment of training courses and professional associations across Europe. Second, the stages in the professionalization process according to Ridder, Lerner and Suvini (2015) are discussed. Third, the importance of the European Music Therapy Confederation in promoting music therapy recognition in the EU is highlighted.peerReviewe