Music therapy in children's hospices: An evaluative survey of provision

This paper presents the results of a survey of the range of music therapy practice in children's hospices in the UK. Music therapists are challenged to work with children with life-limiting and life-threatening conditions during short periods of respite care over several years or at end of life. Flexibility is fundamental to working both individually and in small groups in response to the shifting needs of the children and their families. In the context of a children's hospice music therapists are called upon to work creatively with siblings and family members and members of the multidisciplinary team in addition to the children themselves. A questionnaire and focus group for music therapists working in the children's hospices provided evidence of the range of work, priorities and future plans for development. Telephone interviews with specialist staff at children's hospices where music therapists were not currently working provided evidence of how music and musical activities were perceived and utilised, with any plans for future provision for a music therapy service and some of the practical and resource issues being itemised.     

Is there a role for music therapy in the recovery approach in mental health?

The recovery approach in mental health care emphasises the importance of the service user leading a fulfilling, meaningful life beyond the limitations of illness or symptomatology. This approach to care is increasingly included as a central part of mental health policy and service provision in a number of countries including the UK and Ireland, to address the needs of people who have severe and enduring mental disorders. It is an autonomous, holistic and empowering way of working with individuals as they journey towards healing. Fundamental to this model is the relationship fostered between service users and health professionals. The recovery philosophy of care mirrors some of the core principles of music therapy, including the importance of the therapeutic relationship and the possibilities for change and growth within this. This paper explores the congruence between music therapy and the recovery approach by providing: (1) An overview of current published evidence for music therapy in mental health care. (2) A discussion of this psycho-social creative arts therapy intervention within the specialized area of recovery in psychiatry, and (3) case vignettes to illustrate the application of this philosophy in music therapy work within a recovery service.     

Creative arts groups in psychiatric care Development and evaluation of a therapeutic alternative

Creative arts and non-verbal psychotherapy methods have been introduced as an alternative or a complement to conventional verbal therapies and pharmacotherapy for patients with various psychiatric disorders. The application of a structured creative arts group program for 4 weeks was tested in 58 markedly impaired patients with different diagnoses. The program included body awareness, receptive music therapy (GIM), art therapy, occupational therapy, and verbal group therapy. Outcome of symptoms, interpersonal difficulties, and health potential were assessed with self-rating scales and internal and external evaluations. Eighty-eight per cent of the patients completed the program with significant improvements in all instruments and most subscales. The study design with a uniform treatment for a heterogeneous patient population gave useful information about indications and contraindications for subgroups of patients and for development of creative arts techniques for different patient requirements. Thus patients with an anamnesis of trauma had significantly better treatment results than those without trauma. The results indicate that creative arts therapy may be used as a treatment alternative in cases in which pharmacotherapy and conventional verbal psychotherapy have failed.     

A caregiver perspective of complementary and alternative medicine use among patients with schizophrenia and bipolar disorders

The World Health Organization estimates that about 40%–60% of patients with mental illness use Complementary and Alternative Medicine (CAM), but little is known about the types and outcomes of these CAM therapies in Ghana. This study therefore sought to describe the patterns of use and perceived outcome of CAM therapy among patients with schizophrenia and bipolar disorders in a health facility in Ghana. The qualitative study involved both clinical and family caregivers of patients with schizophrenia and bipolar disorders. Semi-structured interviews were conducted over a period of 3 months to identify the pattern of CAM use and perceived outcome from caregiver perspectives. The interviews were audio recorded, transcribed and analyzed thematically using NVivo 10. About 92% of family caregivers reported that their patients had used some form of CAM therapy. The therapies used included spiritual interventions (100%) herbal therapies (83%), dietary supplements (50%) and music therapies (6%). Both clinical and family caregivers perceived CAM therapies to be ineffective in resolving mental illness when used as an alternative to antipsychotic therapy. However when used as complementary, better outcomes were perceived. Spiritual interventions, herbal therapies, dietary supplements and music therapies were the types of CAM therapies used. Both negative and positive outcomes of CAM therapies were highlighted by caregivers. CAM use may therefore not be an alternative choice but rather complementary to mental health care.     

Australian general practice and the meeting of needs for mental health care

Background: This report, drawing on a national epidemiological survey conducted in 1997, examines the role of Australian medical general practitioners (GPs) in responding to needs for mental health care. Methods: We analysed data from the Australian National Survey of Mental Health and Wellbeing (NSMHWB). The NSMHWB employed clustered probability sampling of all Australian adults, and 10,641 participants were interviewed. The field questionnaire included modules of the Composite International Diagnostic Interview, and instruments assessing disability, service utilisation and perceived needs for care. Results: Eighty-four percent of people with a mental disorder consulted a GP in the year prior to survey, but only 29 % consulted in relation to a mental health problem. GP services were seen as more responsive to needs for medication, counselling and information than needs for social interventions and skills training. People with perceived needs for counselling were more likely to consult with other providers, either as alternative or additional consultations to those with a GP. Counselling needs were reported as less well met when people saw a GP alone than when consulting other service providers. Conclusions: Many people with mental health problems attend primary medical care practitioners without presenting these problems to their physicians. When they do present, perceived needs for medication are rated as well met, but there is substantial unmet perceived need for interventions in social and occupational domains. Perceived needs for counselling are less well met where the GP is the sole provider. To close these identified gaps calls for improvements in primary care physicians' skills and effective collaborative models with other providers. Accepted: 18 May 2001     

The role of music therapy in paediatric rehabilitation

Meeting the needs of the child in rehabilitation requires an interdisciplinary approach, whereby a variety of health care professionals are called upon to work together in planning and coordinating each patient's programme. The Registered music therapist is one of the allied health professionals who plays an integral role in this team approach. Music therapy is a recognized allied health profession, which is becoming acknowledged in the expanding world of health care as a therapy able to meet the expansive needs of the patient in rehabilitation. This article will present a literature review which advocates the role of music therapy in rehabilitation, with particular focus on the needs of the paediatric patient. Case vignettes will be used as further evidence to support the role of music therapy in this context, together with considerations for future research.     

Allied health care interventions and complementary therapies in Parkinson's disease

Allied health care and complementary therapies are used by many patients with Parkinson's disease (PD). For allied health care, supportive scientific evidence is gradually beginning to emerge, and interventions are increasingly integrated in the treatment programs for PD patients. To evaluate whether such multidisciplinary programs are justifiable, we review the literature of allied health care and complementary therapies in PD. According to the level of available evidence, we provide recommendations for clinical practice. Finally, we discuss the need for an improved organization of allied health care, and identify topics for future research to further underpin the pros and cons of allied health care and complementary therapies in PD.     

Collaboration between traditional practitioners and primary health care staff in South Africa: developing a workable partnership for community mental health services

The majority of the black African population in South Africa utilize both traditional and public sector Western systems of healing for mental health care. There is a need to develop models of collaboration that promote a workable relationship between the two healing systems. The aim of this study was to explore perceptions of service users and providers of current interactions between the two systems of care and ways in which collaboration could be improved in the provision of community mental health services. Qualitative individual and focus group interviews were conducted with key health care providers and service users in one typical rural South African health sub-district. The majority of service users held traditional explanatory models of illness and used dual systems of care, with shifting between treatment modalities reportedly causing problems with treatment adherence. Traditional healers expressed a lack of appreciation from Western health care practitioners but were open to training in Western biomedical approaches and establishing a collaborative relationship in the interests of improving patient care. Western biomedically trained practitioners were less interested in such an arrangement. Interventions to acquaint traditional practitioners with Western approaches to the treatment of mental illness, orientation of Western practitioners towards a culture-centred approach to mental health care, as well as the establishment of fora to facilitate the negotiation of respectful collaborative relationships between the two systems of healing are required at district level to promote an equitable collaboration in the interests of improved patient care.     

Emotional foundations of music as a non-pharmacological pain management tool in modern medicine

This paper reviews the use of music as an adjuvant to the control of pain, especially in medical procedures. Surgery causes stress and anxiety that exacerbates the experience of pain. Self-report of and physiological measures on post-surgical patients indicate that music therapy or music stimulation reduces the perception of pain, both alone and when part of a multimodal pain management program, and can reduce the need for pharmaceutical interventions. However, multimodal pain therapy, including non-pharmacological interventions after surgery, is still rare in medical practice. We summarize how music can enhance medical therapies and can be used as an adjuvant with other pain-management programs to increase the effectiveness of those therapies. As summarized, we currently know that musical pieces chosen by the patient are commonly, but not always, more effective than pieces chosen by another person. Further research should focus both on finding the specific indications and contra-indications of music therapy and on the biological and neurological pathways responsible for those findings (related evidence has implicated brain opioid and oxytocin mechanisms in affective changes evoked by music). In turn, these findings will allow medical investigators and practitioners to design guidelines and reliable, standardized applications for this promising method of pain management in modern medicine.     

Employing behavioral methods to improve the context of care in a public psychiatric hospital: some applications to health care management

While intervention procedures grounded in behavioral science have proven useful in the provision of direct care and in organizational management, they are seldom used effectively in many psychiatric care organizations. Behavioral practitioners often acknowledge this fact but few have applied their behavior change skills to change the behavior of the organization that is failing. This report outlines several examples of how behavioral technology was employed from an administrative perspective to encourage and strengthen needed changes in the interdisciplinary clinical care procedures of a public psychiatric hospital. The potential of these procedures for administering health care provision as well as the challenges encountered in realizing such applications are discussed.     

Economic grand rounds: A pay-for-performance program for behavioral health care practitioners

This column describes a pay-for-performance program for behavioral health care practitioners. Implemented in 1996 by a large national health insurer, the program's goals are to improve the quality of care, recognize the practitioners who provide higher-quality care, demonstrate the value of behavioral health services to purchasers, and help providers align their practices with national standards. A future goal is to provide patients with data on provider quality to improve their treatment decisions. Important considerations in measure development include application of the measure to all disciplines, feasible data collection processes for providers, creation of clinically meaningful and fair measures, and selection of measures with large baseline variability.     

Music therapists’ attitudes and actions regarding the LGBTQ community: A preliminary report

This is a preliminary report on survey research currently being conducted by a team of music therapists across the United States. The study's purpose was to explore the attitudes and actions of music therapists across the globe in regards to lesbian, gay, bisexual, transgendered, and questioning (LGBTQ) clients, coworkers, and students. The survey questions were designed to explore areas of knowledge as well as deficits in order to direct future educational offerings for music therapists and music therapy students. These results are preliminary, reflecting the first 2 months the survey was open representing a total of 409 respondents. Results indicate a need for further education and training of music therapists regarding LGBTQ issues.     

Music therapy techniques as predictors of change in mental health care

The application of music in therapy is realised through different working modalities which can be categorised into three types of techniques: production, reception, and reproduction. These techniques are commonly used in mental health settings in music therapy practice and previous research suggests that specific working modalities might be important predictors of change in music therapy. However, little is known about which ingredients specifically contribute to the outcomes of music therapy. This study aimed to investigate the application of music therapy techniques and whether they predict changes in clinical outcomes in mental health settings with individuals displaying a low therapy motivation. Participants (N = 31) were assessed before, during, and after participating in individual music therapy. Music therapy techniques were assessed for three selected therapy sessions per participant. Associations between music therapy techniques and outcomes were calculated using linear models with repeated measures. Results showed that reproduction techniques were used most intensely. In addition, relational competencies (interpersonal and social skills) amongst the participants improved when focusing on reproducing music (e.g. singing or playing familiar songs, learning musical skills). Results indicated that reproduction music therapy techniques may foster the development of relational competencies in individuals with low motivation.     

Arts therapies for young offenders in secure care—A practice-based research

This article describes the results of the first phase of a research project to develop, implement, evaluate, and improve arts therapies interventions for young offenders in secure care. By means of a naturalistic/constructivistic research methodology in combination with grounded therapy methodology, practice-based evidence has been generated. Core problems of young offenders that are connected to delinquency have been described and arts therapies interventions have been developed that can be used to change these core problems. Core problems are problems with self-image, with expressing and discharging emotions, the inability to resolve interpersonal problems and finally, negative cognitions. In co-creation with practitioners, interventions have been developed for drama therapy, music therapy, art therapy and dance-movement therapy. A treatment theory has been developed that explains the working of arts therapies by means of the first author's theory of analogy. This theory explains arts therapies by means of the equality between forms of expression in art and the core self consciousness as described by Damasio and the vitality affects within the core self as described by Stern.     

Alternative therapy use in neurologic diseases: use in brain tumor patients

BACKGROUND: The extent of alternative therapy use in brain tumor patients is unknown, but it may be frequent and seems important to those who use it. OBJECTIVE: To characterize alternative therapy use in brain tumor patients. METHODS: Prospective questionnaire-based survey of 167 brain tumor patients who attended a cancer center in Southern Alberta. Physicians completed forms describing clinical information such as disease status. RESULTS: The response rate was 91% (167/184). Twenty-four percent of patients used alternative therapies and often more than one therapy at the same time. Motivation to use these therapies was influenced by the desire for patient-focused treatment and a perceived need to take charge. Alternative therapy users were younger (p = 0.04) and more likely to be on sick or disability leave (p = 0.02), to come in for repeat visits (p = 0.05), and to have received conventional treatments (p = 0.01). Users tended to have lower quality of life with respect to physical well-being, functional well-being, and a specific brain tumor subscale. Clinical variables, such as disease status, tumor type, and Karnofsky Performance Score, were not related to alternative therapy use. Major changes in number and types of alternative therapy use occurred during the study period. No major side effects or tumor responses were seen with alternative therapies. CONCLUSIONS: Alternative therapy use in brain tumor patients is common and may reflect unmet patient needs with respect to their cancer care within the current model of health care delivery.     

Regulation, religious experience, and epilepsy: a lens on complementary therapies

Complementary and alternative medical (CAM) therapies include chiropractic, acupuncture and traditional Oriental medicine, massage therapy, and herbal remedies; mind-body therapies (such as meditative practices and visualization); and folk practices and religious healing. Of these, modalities based on spiritual healing create a number of conundrums for the clinician, including legal, regulatory, and ethical issues. Further, the historic relationship between the study of epilepsy and religious experience suggests particular, potential associations between CAM therapies (and especially spiritual healing) and care for epileptic patients. There are at least two dimensions to this exploration: first, the widespread use of spiritual healing for treatment of epilepsy; and second, the hypothesized connection between epileptic seizures and mystical states. A number of legal rules help address potential abuse of authority by health care professionals, and include: (1) medical licensure; (2) scope of practice; (3) professional discipline; (4) malpractice; and (5) fraud. This article offers a preliminary resource for clinicians interested in these topics.     

Understanding music as a temporal-aesthetic way of being: Implications for a general theory of music therapy

Music therapy is generally considered a discipline that utilizes music for promoting health, in which music is understood as a phenomenon inextricably tied to the medium of sound. Yet, alternatively, music therapy may also be considered a discipline that promotes human health both as and through music, in which music is understood as a temporal-aesthetic way of being transcending the concrete medium of sound, that manifests across all of the domains targeted in clinical music therapy goals. This explorative perspective potentially resolves certain critical dichotomies and dilemmas with which the music therapy field has had to contend, while meaningfully distinguishing music therapy's indigenous expertise and unique value from those of related health disciplines. Moreover, it carries implications for the formulation of a general theory of music therapy, applicable across a plurality of specific music therapy models, methods, and practices. Likewise, it carries implications for general theories of other expressive arts therapies, based upon understanding their respective modalities as particular ways of being, transcending concrete media.     

The use of complementary and alternative therapies to treat anxiety and depression in the United States

OBJECTIVE: This study presents data on the use of complementary and alternative therapies to treat anxiety and depression in the United States. METHOD: The data came from a nationally representative survey of 2,055 respondents (1997-1998) that obtained information on the use of 24 complementary and alternative therapies for the treatment of specific chronic conditions. RESULTS: A total of 9.4% of the respondents reported suffering from "anxiety attacks" in the past 12 months; 7.2% reported "severe depression." A total of 56.7% of those with anxiety attacks and 53.6% of those with severe depression reported using complementary and alternative therapies to treat these conditions during the past 12 months. Only 20.0% of those with anxiety attacks and 19.3% of those with severe depression visited a complementary or alternative therapist. A total of 65.9% of the respondents seen by a conventional provider for anxiety attacks and 66.7% of those seen by a conventional provider for severe depression also used complementary and alternative therapies to treat these conditions. The perceived helpfulness of these therapies in treating anxiety and depression was similar to that of conventional therapies. CONCLUSIONS: Complementary and alternative therapies are used more than conventional therapies by people with self-defined anxiety attacks and severe depression. Most patients visiting conventional mental health providers for these problems also use complementary and alternative therapies. Use of these therapies will likely increase as insurance coverage expands. Asking patients about their use could prevent adverse effects and maximize the usefulness of therapies subsequently proven to be effective.     

Staff perceptions of complementary and alternative therapy integration into a child and adolescent psychiatry program

Art, music, yoga, and dance/movement therapies have been researched individually, mostly in adults, but few studies explain the impact of integrating these therapies into the treatment of children with psychiatric illnesses. Given the financial constraints of current healthcare, as well as limitations of verbal and medical therapies, it is important to document the added value of integrating complementary therapies, including creative arts therapies, into childhood mental health and treatment. The present study looked to evaluate views of clinical professionals (n = 23) (i.e. psychiatrists, psychologists, and social workers), nurses (n = 17) and milieu staff (mental health counselors; n = 56) within the Psychiatry Department of a large children's hospital on the perceived benefits of integrating Complementary and Alternative Medicine (CAM) therapies within inpatient and day treatment programs. The majority of respondents (96% of clinicians, 100% of nurses, and 82% of milieu staff) reported that CAM positively impacted patient care. Staff indicated that sessions facilitated by masters level creative arts therapists or yoga therapists helped patients by increasing self esteem, increasing motor coordination and body control, providing relaxation, teaching coping skills, decreasing acting out behaviors, developing patient's awareness of emotions or underlying issues, and helping to broach difficult topics or issues for the first time. Milieu staff who participated in CAM groups alongside patients also received personal and professional benefits.     

Psychiatric benefits of integrative therapies in patients with cancer

Abstract

Integrative oncology uses non-pharmacological adjuncts to mainstream care to manage physical, emotional, and psychological symptoms experienced by cancer survivors. Depression, anxiety, fatigue and pain are among the common, often burdensome symptoms that can occur in clusters, deplete patient morale, interfere with treatment plans, and hamper recovery.

Patients already seek various modalities on their own to address a broad range of problems. Legitimate complementary therapies offered at major cancer institutions improve quality of life, speed recovery, and optimize patient support. They also augment the benefits of psychiatric interventions, due to their ability to increase self-awareness and improve physical and psychological conditioning. Further, these integrated therapies provide lifelong tools and develop skills that patients use well after treatment to develop self-care regimens. The active referral of patients to integrative therapies achieves three important objectives: complementary care is received from therapists experienced in working with cancer patients, visits become part of the medical record, allowing treatment teams to guide individuals in maximizing benefit, and patients are diverted from useless or harmful ‘alternatives.’

We review the reciprocal physical and psychiatric benefits of exercise, mind–body practices, massage, acupuncture, and music therapy for cancer survivors, and suggest how their use can augment mainstream psychiatric interventions.