Music therapy in psychiatry

Abstract

Music has long been recognised to hold therapeutic benefits for mental distress. The notion of music being able to soothe or console can be traced back as far as ancient biblical and Greek texts. However, the formal use of music therapy within psychiatric health contexts has only developed over the last century, in line with developments in psychiatric services and varying degrees of music therapy professionalisation. There are many ways in which music can be applied to help support and address both symptoms and their wider secondary impacts upon people living with mental illness. A common misconception is that the therapeutic action lies solely within the music itself-as though the music acts as a drug, to be prescribed at a certain dose. Whilst musical elements can offer therapeutic benefits (for example, a slow tempo, predictable melody and harmonic congruence may be calming), there are many wider implications of music therapy than this alone. Music therapy is commonly defined as 'a systematic process of intervention wherein the therapist helps the client to promote health, using music experiences and the relationships that develop through them as dynamic forces of change'. An emphasis is placed, not only upon the therapeutic potentials of the music, but also upon the relationships that are built and developed through musical and verbal dialogue and interplay. This combination of music and a therapeutic relationship increases the potential for the use of music, within a therapeutic context, to address and support arousal regulation, exploration of different ways of relating and opportunities to widen and develop social groups. There are international differences regarding the level of training and professionalisation of music therapists. Most commonly, training is at post-graduate Master's level. Whilst many countries have professional associations, within Europe, only a handful of countries (Austria, Latvia, the United Kingdom) hold statutory regulation. This chapter will provide an overview of the clinical practice of music therapy in psychiatry, alongside a review of the current evidence base. To contextualise this, we will begin with a brief historic account of its development in mental health settings and an overview of underpinning theories. The chapter then considers existing techniques and evidence across both specific conditions and settings and concludes with a discussion of future possible directions.