Research Rigour and Therapeutic Flexibility: Rationale for a Therapy Manual Developed for a Randomised Controlled Trial

Abstract

When doing a randomised controlled trial, concrete and observable a-priori definitions and descriptions of therapy procedures are usually considered necessary for study results to be replicable, and also to enable comparisons between different therapy approaches. However, most music therapy approaches in the field of mental health cannot be defined with a fixed therapy manual without serious danger of losing their therapeutic integrity. Manuals defining therapeutic principles which can be applied flexibly, rather than a fixed set of techniques, might be more appropriate. In this article we will present the rationale for a therapy manual developed for the purpose of a randomized controlled trial on a contextual approach to resource-oriented music therapy. The article focuses upon possible ways of dealing with the tensions and contrasts that exist between the contextual and resource-oriented perspectives and the need for pre-structured definitions to meet the standards of the rigorous quantitative research methodology.

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

“…tuning into the client's musical expression). In accordance with recommendations for psychotherapy research [32], ‘unique and essential' and ‘essential but not unique' principles were described as well as ‘acceptable but not necessary' and ‘proscribed' ones [17]. This system allowed us to describe both the similarities with (‘essential but not unique') and the differences to (‘unique and essential') other MT approaches.…”

“…In line with the goal of pragmatic trials of effectiveness [31] as well as the focus of the resource-oriented MT approach [17,18], we selected a broad range of diagnoses. Participants were inpatients, outpatients or day patients in mental health care, with a primary diagnosis of a non-organic mental disorder (F1-F6 according to ICD-10 criteria), as assessed by a psychiatrist at the study site.…”

“…The maximum number of sessions in this study was 26, and we encouraged therapists to ensure that clients received at least 18 sessions within the 3-month period when this was possible. Ten academically and clinically qualified music therapists with clinical experience in MT in psychiatry provided MT in accordance with a flexible therapy manual developed for this study [17]. Outlining 21 principles of resource-oriented MT, this manual describes general therapeutic attitudes and behaviours (e.g.…”

“…Other criteria may be more important in defining the population for whom MT is most indicated. From a resource-oriented perspective, the client's resources, strengths and potentials, more than problems and symptoms, should be emphasised, as well as collaboration and equal relationships [17,18]. Such a perspective to MT builds on a contextual understanding of therapeutic processes [19,20,21], the philosophy of empowerment [22,23] and positive psychology [24].…”

Musical improvisation and health: a review

“…Rolvsjord et al (2005) identifies improvisation as an 'essential but not unique' part of music therapy; however, not all approaches involve improvisation. It is nevertheless central to the Creative Music Therapy founded by Nordoff and Robbins and to Psychodynamic approaches, and these are the most widely discussed in the literature on improvisation and health (Trondalen and Bonde 2012).…”