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

Abstract

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 therapist's 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.

A Systematic Review of Music Therapy Practice and Outcomes with Acute Adult Psychiatric In-Patients

“…Solli & Rolvsjord [110] suggested four features of music therapy that might assist in addressing symptoms of psychosis: motivation, structure, emotional expression and social participation. Nine papers, all informed by Yalom’s model of in-patient therapy [122], proposed aims oriented towards supporting and reinforcing strengths and skills rather than longer term insight [13], [49], [76], [79], [107]-[109], [118], [119]. Mössler et al [76] linked this to Storz’s [112] ‘potential orientation’ and ‘resource orientation’ found in other short term psychotherapies.…”

“…Nine papers, all informed by Yalom’s model of in-patient therapy [122], proposed aims oriented towards supporting and reinforcing strengths and skills rather than longer term insight [13], [49], [76], [79], [107]-[109], [118], [119]. Mössler et al [76] linked this to Storz’s [112] ‘potential orientation’ and ‘resource orientation’ found in other short term psychotherapies. Similarly psychodynamic and psychoanalytically informed approaches focused upon building and strengthening defence structures [52], [65], [119], aiming at “containing action and delineating boundaries” [65] rather than opening up of emotions or deep connection with others.…”

“…Engagement of patients in therapy itself was noted as a difficult process either due to anxiety in use of the medium [29], [39], [59], [62], [65], [76], [82], [85], [90], [95], [111], lack of motivation [39], [56], [57], [66], [77], [87] or damage in previous relationships [79]. Attendance for the duration of the session could also be challenging [29], [59], [62].…”

“…Arnason [29] also suggested that some may not feel that they need therapy or may hold ambivalence towards attending as they fear missing visitors, clinical appointments or wish to return home. Patients may attend in order to ‘play the system’ to obtain early discharge [87] and it may be that the idea of making music itself may be more motivating for patients than that of psychological change [76], [108]. Cullen [39], noted resistance may take many forms including resistance to choice, personal expression, focus on the here and now, criticism, breaking the mood of the group and intellectualization.…”

“…Papers from the 1980s onwards are influenced by Yalom’s application of group psychotherapy to in-patient settings [121], [129], whilst therapists working within psychoanalytic and psychodynamic approaches have adapted their models to focus more upon the immediate interpersonal processes (influenced by the work of Daniel Stern [130], [131]) than upon interpretation of transference dynamics. In Norway, the concept of resource orientation in mental health care is also developing [13], [76], [107]-[110].…”