Karin Mössler

Individual Music Therapy for Mental Health Care Clients with Low Therapy Motivation: Multicentre Randomised Controlled Trial

Background: Music therapy (MT) has been shown to be efficacious for mental health care clients with various disorders such as schizophrenia, depression and substance abuse. Referral to MT in clinical practice is often based on other factors than diagnosis. We aimed to examine the effectiveness of resource-oriented MT for mental health care clients with low motivation for other therapies. Method: This was a pragmatic parallel trial. In specialised centres in Norway, Austria and Australia, 144 adults with non-organic mental disorders and low therapy motivation were randomised to 3 months of biweekly individual, resource-oriented MT plus treatment as usual (TAU) or TAU alone. TAU was typically intensive (71% were inpatients) and included the best combination of therapies available for each participant, excluding MT. Blinded assessments of the Scale for the Assessment of Negative Symptoms (SANS) and 15 secondary outcomes were collected before randomisation and after 1, 3 and 9 months. Changes were analysed on an intention-to-treat basis using generalised estimating equations in longitudinal linear models, controlling for diagnosis, site and time point. Results: MT was superior to TAU for total negative symptoms (SANS, d = 0.54, p < 0.001) as well as functioning, clinical global impressions, social avoidance through music, and vitality (all p < 0.01). Conclusion: Individual MT as conducted in routine practice is an effective addition to usual care for mental health care clients with low motivation.

Effects of Improvisational Music Therapy vs Enhanced Standard Care on Symptom Severity Among Children With Autism Spectrum Disorder: The TIME-A Randomized Clinical Trial

Importance Music therapy may facilitate skills in areas affected by autism spectrum disorder (ASD), such as social interaction and communication. Objective To evaluate effects of improvisational music therapy on generalized social communication skills of children with ASD. Design, Setting, and Participants Assessor-blinded, randomized clinical trial, conducted in 9 countries and enrolling children aged 4 to 7 years with ASD. Children were recruited from November 2011 to November 2015, with follow-up between January 2012 and November 2016. Interventions Enhanced standard care (n = 182) vs enhanced standard care plus improvisational music therapy (n = 182), allocated in a 1:1 ratio. Enhanced standard care consisted of usual care as locally available plus parent counseling to discuss parents’ concerns and provide information about ASD. In improvisational music therapy, trained music therapists sang or played music with each child, attuned and adapted to the child’s focus of attention, to help children develop affect sharing and joint attention. Main Outcomes and Measures The primary outcome was symptom severity over 5 months, based on the Autism Diagnostic Observation Schedule (ADOS), social affect domain (range, 0-27; higher scores indicate greater severity; minimal clinically important difference, 1). Prespecified secondary outcomes included parent-rated social responsiveness. All outcomes were also assessed at 2 and 12 months. Results Among 364 participants randomized (mean age, 5.4 years; 83% boys), 314 (86%) completed the primary end point and 290 (80%) completed the last end point. Over 5 months, participants assigned to music therapy received a median of 19 music therapy, 3 parent counseling, and 36 other therapy sessions, compared with 3 parent counseling and 45 other therapy sessions for those assigned to enhanced standard care. From baseline to 5 months, mean ADOS social affect scores estimated by linear mixed-effects models decreased from 14.08 to 13.23 in the music therapy group and from 13.49 to 12.58 in the standard care group (mean difference, 0.06 [95% CI, −0.70 to 0.81]; P = .88), with no significant difference in improvement. Of 20 exploratory secondary outcomes, 17 showed no significant difference. Conclusions and Relevance Among children with autism spectrum disorder, improvisational music therapy, compared with enhanced standard care, resulted in no significant difference in symptom severity based on the ADOS social affect domain over 5 months. These findings do not support the use of improvisational music therapy for symptom reduction in children with autism spectrum disorder. Trial Registration isrctn.org Identifier: ISRCTN78923965

“I am a psychotherapeutically oriented music therapist”: theory construction and its influence on professional identity formation under the example of the Viennese School of Music Therapy

Music therapists provide a variety of definitions about what music therapy is and how it is used, dependent on its development of theory construction, and the paradigms of the therapeutic community. Within the Viennese School of Music Therapy a psychotherapeutic approach is the leading paradigm, which has been determining the music therapeutic working modes, reflexions and terminology of the School since the 1980s. Two surveys have shown that the psychotherapeutic paradigm is able to strengthen as well as weaken concurrently ones music therapeutic identity. This author assumes that the upcoming obstructive effect on the professional identity formation can be referred to a missing reflexion of the musical frame of references in music therapy, and their connections to the psychotherapeutic mindsets within the present generation of music therapists. Accordingly, this article aims to define correlating paradigms between the musical background theories and the psychotherapeutic orientation within the Viennese music therapy due to a historical analysis of those theory constructions serving as main identification models within the last 50 years. Five correlating paradigms that link musical and psychotherapeutic backgrounds are going to be itemized. They are able to show essential mindsets in relationship-oriented music therapy.

The Clinical Application and Relevance of Resource-Oriented Principles in Music Therapy within an International Multicentre Study in Psychiatry

This article is based on an international randomised controlled trial (RCT) in psychiatry investigating the effects of music therapy on difficult to treat psychiatric clients who show a lack of motivation to attend therapy. Previous research has shown that music therapy can be an alternative therapeutic treatment for this client group and this RCT aimed to address this observation. The RCT was a collaboration between music therapists from different therapeutic cultures - Norway, Austria and Australia. Consequently, the music therapy provided was influenced by different training backgrounds. To provide a common methodological basis the therapists also focused on resource-oriented principles. These were especially developed for the study to ensure treatment fidelity, yet first of all have an important impact on the practical work. Five case vignettes depict how different therapists made use of these principles and in which ways these affected the therapeutic process. It will be shown how these principles serve as a methodological tool for reflecting the therapists attitude towards the client. The relevance of the principles in terms of the establishment of a therapeutic relationship as well as the importance of a resource-oriented focus both in long-term and short-term therapeutic settings is highlighted. Finally, it can be assumed that resource-oriented principles exist at least implicitly throughout music therapeutic cultures and that these emphasise the relationship between therapist and client.

Reliability and validity of a scale to measure interest in music among clients in mental health care

Contextual and relational models of music therapy suggest the relevance of music-related outcomes in clients’ everyday life, but no standardized instruments exist for that purpose. We aimed to develop and test the reliability and validity of a self-report questionnaire to measure interest in music (IiM). Twelve Likert-scaled items reflecting pro-social and socially avoidant aspects of interest in music were developed and translated into three languages (English, Norwegian, German). A total of 144 adults with a mental disorder and low therapy motivation completed the IiM questionnaire and adjacent self-report measures (self-esteem, social relationships). Interest in music was also rated by a mental health professional. Completion of the IiM was repeated after one and three months. Dimensionality, internal consistency, test–retest reliability and concurrent validity were examined. Analyses indicated two dimensions, Musical Activity and Emotional Engagement with Music (10 items) and Social Avoidance through Music (2 items). Internal consistency (Cronbach’s alpha 0.89 and 0.77), test–retest reliability (1- and 3-month intra-class correlation coefficients (ICCs) ranging from 0.61 to 0.85), and concurrent validity were demonstrated. The IiM scale fills an important gap in the tools available for music therapy assessment and outcome research in mental health.

Musical progress towards therapeutic change: A qualitative study on how to develop a focus in music therapy

By sharing and shaping a common focus through music, music therapy clients in mental health care involve themselves in a therapeutic process which is not necessarily bound to verbal language. Supplementing previous research showing that even clients with a low therapy motivation can benefit from music therapy, this study concentrates on how a therapy focus can develop in a client population that is often hard to reach by verbal approaches. Based on the assumption that our clients’ implicit ideas of favourable changes inform their way to use music, we examined how music-related activities addressed in music therapy might depict underlying processes of therapeutic changes. A qualitative content analysis was conducted utilising session logs from 23 music therapy clients. Three session logs (one each from the beginning, middle and end) were analysed for each participant using both structured and latent coding strategies. Findings suggest that music-related activities reflect the client’s responsiveness towards her/his own inner world and those of others. To the therapist, this shows a certain quality of the therapeutic encounter which can be divided into seven levels: the encounter in music therapy offers space for acceptance, provides orientation, allows contact, creates confidence, promotes expression, supports abstraction and enables transformation.

International multicentre randomised controlled trial of improvisational music therapy for children with autism spectrum disorder: TIME-A study

BACKGROUND Preliminary studies have indicated that music therapy may benefit children with autism spectrum disorders (ASD). OBJECTIVES To examine the effects of improvisational music therapy (IMT) on social affect and responsiveness of children with ASD. DESIGN International, multicentre, three-arm, single-masked randomised controlled trial, including a National Institute for Health Research (NIHR)-funded centre that recruited in London and the east of England. Randomisation was via a remote service using permuted blocks, stratified by study site. SETTING Schools and private, voluntary and state-funded health-care services. PARTICIPANTS Children aged between 4 and 7 years with a confirmed diagnosis of ASD and a parent or guardian who provided written informed consent. We excluded children with serious sensory disorder and those who had received music therapy within the past 12 months. INTERVENTIONS All parents and children received enhanced standard care (ESC), which involved three 60-minute sessions of advice and support in addition to treatment as usual. In addition, they were randomised to either one (low-frequency) or three (high-frequency) sessions of IMT per week, or to ESC alone, over 5 months in a ratio of 1 : 1 : 2. MAIN OUTCOME MEASURES The primary outcome was measured using the social affect score derived from the Autism Diagnostic Observation Schedule (ADOS) at 5 months: higher scores indicated greater impairment. Secondary outcomes included social affect at 12 months and parent-rated social responsiveness at 5 and 12 months (higher scores indicated greater impairment). RESULTS A total of 364 participants were randomised between 2011 and 2015. A total of 182 children were allocated to IMT (90 to high-frequency sessions and 92 to low-frequency sessions), and 182 were allocated to ESC alone. A total of 314 (86.3%) of the total sample were followed up at 5 months [165 (90.7%) in the intervention group and 149 (81.9%) in the control group]. Among those randomised to IMT, 171 (94.0%) received it. From baseline to 5 months, mean scores of ADOS social affect decreased from 14.1 to 13.3 in music therapy and from 13.5 to 12.4 in standard care [mean difference: music therapy vs. standard care = 0.06, 95% confidence interval (CI) -0.70 to 0.81], with no significant difference in improvement. There were also no differences in the parent-rated social responsiveness score, which decreased from 96.0 to 89.2 in the music therapy group and from 96.1 to 93.3 in the standard care group over this period (mean difference: music therapy vs. standard care = -3.32, 95% CI -7.56 to 0.91). There were seven admissions to hospital that were unrelated to the study interventions in the two IMT arms compared with 10 unrelated admissions in the ESC group. CONCLUSIONS Adding IMT to the treatment received by children with ASD did not improve social affect or parent-assessed social responsiveness. FUTURE WORK Other methods for delivering music-focused interventions for children with ASD should be explored. TRIAL REGISTRATION Current Controlled Trials ISRCTN78923965. FUNDING This project was funded by the NIHR Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 21, No. 59. See the NIHR Journals Library website for further project information.