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Selected contemporary approaches to music therapy in psychiatry

Interview with Gitta Strehlow

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Can you provide an overview of the article and the topics it explores?

Psychodynamic music therapy

This overview article begins with the psychodynamic approach to music therapy with its musical improvisation. Free and spontaneous musical improvisation creates a connection between patient and therapist through which a complex relationship can become audible. Playing or learning to recover play is a central goal in music therapy. The ability to play is an essential prerequisite for psychologically healthy development. The therapeutic relationship is essentially shaped and understood through improvisation. In improvisation, the possibility of synchronization facilitates
patients’ experience of closeness individually and less threateningly. This opens up a dialogue of action that allows us to experience forms of interaction and at the same time, with the possibility of change, invites us to try things out.

Research

An update on music therapy for adults in a psychiatric context is given with selected results from effect and process research. The effectiveness of music therapy has so far mostly been demonstrated with highly qualitative research studies such as Cochrane studies for depression and schizophrenia. Active music therapy, as opposed to an intervention in which only music is heard, can strengthen the alliance so that patients with schizophrenia continue music therapy rather than drop out. Psychiatric patients value the shared music experience and the positive influence on mood as strengths of music therapy. Process research emphasizes above all, the potential of improvisation through musical attunement and synchronization.

Alliance Ruptures

The realization that relationships are also characterized by inevitable mismatches has gained importance in recent years and led to the concept of alliance ruptures. Difficulties that arise in the therapeutic relationship, such as mismatches, are not seen as obstacles but, on the contrary, as opportunities for change. In music therapy, the alliance with the therapist is challenged by aspects such as dissonant sounds, loudness, or misattunements. The processing of the alliance rupture acquires an immense potential for change through its reparative abilities(repair), which is crucial for the success of music therapy. The successful development of music therapy is decisively influenced by the extent to which the music therapist, together with the patient, succeeds in understanding and working through these discrepancies and interruptions. In the last section of this article, the current psychotherapy concept of alliance ruptures is explained as it relates to music therapy through a case study.

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What was the impetus for writing this article?

The first Conference “Science and Sounds” was organized by the International Society for Music in Medicine e.V. and took place last year in Hamburg, Germany. This article is a summary of my verbal presentation. “Science and Sounds” is new collaboration between the two research leading institutions in Hamburg UKE and HFM, supported by ISMM.

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What future research or areas of exploration would benefit the field and application of what was discussed in this article?

Despite the positive results (effectiveness Cochrane studies and AIHTA Report) already available, further high-quality studies are still needed to prove the effectiveness of music therapy. High-quality research designs are urgently needed for the future, as well as more detailed research on music therapy methods and long-term processes.

Alliance ruptures have not yet been studied in music therapy. However, the concept of the working alliance is receiving more and more attention in psychiatric research projects. The exploration of alliance ruptures in music therapy is still a new and undoubtedly worthwhile topic. Varying therapeutic approaches in particular may find value in subscribing to the transtheoretical concept of therapeutic alliance rupture. Research on alliance ruptures is valuable and may improve the quality of music therapy work, which ultimately also benefits the previous effectiveness research as outlined in this article with its strong, satisfactory results.

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How do you think this article impacts the current understanding of music and medicine?

Music therapy, especially psychodynamic music therapy, focuses on the relationship between patient and therapist. The concept of alliance helps to better understand the challenges that typically occur in the therapeutic relationship and to use them for therapeutic success.

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Table of Contents

Editorial

Where Music meets Medicine

Dorothee van Moreau, Eike Sebastian Debus, Karin Holzwarth, Fred Schwartz

Reflection

A personal reflection on challenges facing music therapy education, training and clinical practice

Amy Clements-Cortes

Full Length Articles

Harvesting integrative music therapy in critical care settings throughout the lifespan

Joanne V. Loewy

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A Synopsis of music based interventions in MusicMedicine: Definitions, standards, research, applications, with special emphasis on anxiety, pain and stress

Ralph Spintge

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Neuroplasticity as a driver of beneficial effects in music interventions in children with developmental disorders

Eckart Altenmüller

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Music therapy for children and adolescents – A brief overview

Thomas Stegemann

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Selected contemporary approaches to music therapy in psychiatry

Gitta Strehlow

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Establishing healing soundscapes through musical soundscape interventions in hospitals

Jan Sonntag, Pia Preißler, Johannes Treß, Eckhard Weymann

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