Inside and outside the walls: music therapy supervision in a forensic setting

In this chapter in the book Forensic Music Therapy, Helen Odell-Miller explores the domain of forensic music therapy supervision and looks in detail at the role of the external supervisor workoing across the system boundary with the in-patient music therapist. She explores the multi-layered 'context based' music therapy supervision setting. She uses vignettes and related literature from music therapy and forensic fields to illustrate theory and to explore such phenomena as difficulties in mentalisation; the elusiveness of risk and awareness of danger in certain circumstances; the different sorts of brick wall that can spring up along the border between outside and inside; and the ways in which supervision can parallel the index offense and related areas

An Investigation of Pivotal Moments in Music Therapy in Adult Mental Health

This article describes a study that investigated pivotal moments in music therapy in adult mental health settings. A phenomenological qualitative method was used in order to search for answers to the questions for investigation. It included an extensive literature review, regarding pivotal moments from different fields, including music therapy. Three semi-structured interviews with music therapists investigated their experience of pivotal moments, the role function and importance of pivotal moments in music therapy. Detailed information was analysed using Phenomenological Interpretative Analysis (IPA). A case study supports the evidence gathered in the interviews and literature review, and describes the emergence of a pivotal moment and its contribution within a short-term individual music therapy treatment with a man with schizophrenia. Gathered information and results from the interview analysis highlight distinctive characteristics of pivotal moments and their contribution to the patients’ lives and therapists’ work. Pivotal moments are found to change the music therapy process and lead to a better understanding of the patient. The role of the therapist, the therapist’s qualities and basic features or techniques that support the emergence of pivotal moments, are also discussed

Process and experience of change in the self-perception of women prisoners attending music therapy: The qualitative results of a mixed-methods exploratory study

Women form a minority (4.8%) in the UK prison system, which is predominantly designed for men. A high number of women prisoners bring experiences of trauma and abuse with them into the system. The incidence of mental health problems is inordinately high compared to the general population. Whilst an increasing number of UK music therapists work in forensic psychiatry, providing treatment for mental disordered offenders, there is a dearth of music therapists working in UK prisons. There is correspondingly little research into music therapy and women prisoners. The current article presents the qualitative results of a mixed-methods doctoral study carried out by Dr Helen Leith (2014). Using qualitative data, the study investigates whether there is a change in the self-perception of women prisoners attending music therapy and whether, if this is the case, they show an improved ability to engage with prison resettlement interventions. Findings for 10 participants indicated that women prisoners attending music therapy experience a change in self-perception and engagement in music therapy translated into behavioural change outside the music therapy room. Through adaptive interpretative phenomenological analysis of semi-structured interviews, themes indicated that participants showed an increase in self-confidence, self-esteem, self-efficacy, achievement motivation and a number of other areas relevant to successful resettlement. There was a reduction in the number of self-harm or behavioural incidences and attendance of other programmes improved. For severely disaffected prisoners, music therapy provided an appealing and motivating intervention, which served as an entry point to other programmes required for resettlement. Women prisoners not only showed an enhanced ability to attend the programmes required for their successful resettlement; music therapy created aspirations, which is of significance to downstream outcomes

An audit of music therapy in acute National Health Service (NHS) settings for people with dementia in the UK and adaptations made due to COVID-19

Music therapy research and practice is growing in the field of dementia in residential and community settings. However, less is known about the prevalence and practice of music therapy in acute inpatient settings for people living with dementia. An online survey was distributed to the membership of the British Association for Music Therapy (BAMT) in the UK. Descriptive statistics were generated for quantitative data and thematic analysis was conducted on qualitative data. Fifteen music therapists responded (12.1% of BAMT members working in dementia care). The majority (80%) of respondents were employed by NHS Trusts, and most therapists spent half to one day on acute wards per week. Results showed similarities in patterns of working and theoretical approaches, with live, interactive, instrumental music making used by all and many drawing upon psychodynamic and person-centred approaches to inform their work. Techniques used included singing precomposed songs and instrumental improvisation. All respondents worked during the COVID-19 pandemic, with much variation between NHS Trusts. The challenges and positive aspects of working during the pandemic included a negative impact on staff and patients’ physical and psychological wellbeing, and a raised profile of the arts therapies, respectively. Further research is needed to evaluate the impact of music therapy on people living with dementia in acute NHS settings and raise awareness of how music therapy could help wards to meet the needs of service users as specified in the National Institute for Health and Clinical Excellence (NICE) guidelines

Evaluation of the impact and changes in attitudes to military mental health issues for the audience following The Shell Shock Performance

The Shell Shock theatre production (http://www.shellshock.org.uk) is adapted from Shell Shock: The Diary of Tommy Atkins, a book by a combat veteran (Blower, 2011). The play is a single-person performance that charts the story of a soldier returning to civilian life. The character has been played by both male and female actors. Initially, the person returns, glad to be home and full of hope for finding work and resuming relationships. One by one these hopes fall away. Family members and friends react in different ways and do not necessarily understand the soldier’s experience; they are concerned with their own life problems. The character battles with adjusting to civilian life. Employment applications are rejected. Eventually work is found, but the veteran is unable to maintain it, as anger, depression, and traumatic nightmares all impinge on life. Violent outbursts disrupt relationships. Sources of support melt away. Denial of mental health issues and fear of stigma manifest themselves (Deahl, Klein, and Alexander, 2011; Iverson et al., 2011; Sharp et al., 2015) and preclude the character from seeking help until a last-minute reprieve. The 2017 tour played in the South of England and at the Edinburgh Fringe Festival. A team from Anglia Ruskin University researched the impact of the performance on audience members. The quest for the research team was to evaluate the influence of a performance of Shell Shock on audience members. Firstly, whether the play made an impact on audience members. Secondly, whether the play could act as a catalyst for change in behaviour and attitude towards mental health problems in military personnel and veterans. Eighty audience members volunteered to participate in an anonymous electronic survey; paper copies of the survey were also available. Nine research participants volunteered for a telephone interview, which consisted of a set questions to provide a framework for discussion. The interview provided the opportunity for the person to provide more detailed views to inform the study. The data from the electronic survey produced quantitative results and participants also had the opportunity to add additional comments. The telephone interviews were transcribed and then themes emerged through scrutiny of the interviews

Characteristics, outcomes, facilitators and barriers for psychosocial interventions on inpatient mental health dementia wards: a systematic review

Background The National Institute for Health and Care Excellence guidelines state that psychosocial interventions should be the first line of treatment for people with dementia who are experiencing distress behaviours, such as agitation and depression. However, little is known about the characteristics and outcomes of psychosocial interventions or the facilitators and barriers to implementation on inpatient mental health dementia wards which provide care for people with dementia who are often experiencing high levels of distress. Methods A systematic search was conducted on MEDLINE, CINAHL, PsycINFO, Psychology and Behavioural Sciences Collection, and Scopus in May 2023, following PRISMA guidelines. Reference and citation searches were conducted on included articles. Peer-reviewed literature of any study design, relating to psychosocial interventions in inpatient mental health dementia wards, was included. One author reviewed all articles, with a third of results reviewed independently by a second author. Data were extracted to a bespoke form and synthesised using a narrative review. The quality of included studies was appraised using the Mixed Methods Appraisal Tool. Results Sixteen studies were included in the synthesis, which together included a total of 538 people with dementia. Study methods and quality varied. Psychosocial interventions delivered on wards included music therapy (five studies), multisensory interventions (four studies), multicomponent interventions (two studies), technology-based interventions (two studies), massage interventions (two studies) and physical exercise (one study). Reduction in distress and improvement in wellbeing was demonstrated inconsistently across studies. Delivering interventions in a caring and individualised way responding to patient need facilitated implementation. Lack of staff time and understanding of interventions, as well as high levels of staff turnover, were barriers to implementation. Conclusion This review highlights a striking lack of research and therefore evidence base for the use of psychosocial interventions to reduce distress in this vulnerable population, despite current healthcare guidelines. More research is needed to understand which psychosocial interventions can reduce distress and improve wellbeing on inpatien

Individual music therapy for managing neuropsychiatric symptoms for people with dementia and their carers: a cluster randomised controlled feasibility study

Background: Previous research highlights the importance of staff involvement in psychosocial interventions targeting neuropsychiatric symptoms of dementia. Music therapy has shown potential effects, but it is not clear how this intervention can be programmed to involve care staff within the delivery of patients’ care. This study reports initial feasibility and outcomes from a five month music therapy programme including weekly individual active music therapy for people with dementia and weekly post-therapy video presentations for their carers in care homes. Methods: 17 care home residents and 10 care staff were randomised to the music therapy intervention group or standard care control group. The cluster randomised, controlled trial included baseline, 3-month, 5-month and post-intervention 7-month measures of residents’ symptoms and well-being. Carer-resident interactions were also assessed. Feasibility was based on carers’ feedback through semi-structured interviews, programme evaluations and track records of the study. Results: The music therapy programme appeared to be a practicable and acceptable intervention for care home residents and staff in managing dementia symptoms. Recruitment and retention data indicated feasibility but also challenges. Preliminary outcomes indicated differences in symptoms (13.42, 95 % CI: [4.78 to 22.07; p = 0.006]) and in levels of wellbeing (−0.74, 95 % CI: [−1.15 to −0.33; p = 0.003]) between the two groups, indicating that residents receiving music therapy improved. Staff in the intervention group reported enhanced caregiving techniques as a result of the programme. Conclusion: The data supports the value of developing a music therapy programme involving weekly active individual music therapy sessions and music therapist-carer communication. The intervention is feasible with modifications in a more rigorous evaluation of a larger sample size