Sunday, July 11, 2010

Therapy in the Psychiatric Hospital: Music for the Mind, Body and Soul

One of my readers recently asked me a great question. She is a music therapy graduate student working in a psychotherapy setting and would like to know some activities she can do for group activities. I have not written much about the psychiatric setting, although I did complete my internship at a psychiatric hospital and currently do some activity therapy at an in-patient facility. I think that my reader has reached out for ideas because in-patient psychiatric patients can often be a challenging population. Here are some of the things I consider as I develop group activities for clients in an in-patient setting:

1. Although there are many written examples of music therapy case studies with individuals with mental illness, group activities are often described as task analysis and not in narrative format. This makes it important to search out the research literature and try to transfer and apply the findings to practice. This leads to what is termed "evidence-based practice." My first idea is to look at some of the new research by Dr. Michael J. Silverman at the University of Minnesota. The latest issue of Music Therapy Perspectives, for example, published an article by Dr. Silverman that listed therapeutic goals and music therapy interventions by coordinating them with the medical goals and treatment objectives. Dr. Silverman has many other published articles and research papers about using music therapy with this population.

2. Another resource I go to is the edited book by Robert Unkefer and Michael Thaut: Music Therapy in the Treatment of Adults With Mental Disorders: Theoretical Bases and Clinical Interventions. In the back of this book there is a taxonomy of psychological symptoms with corresponding music therapy interventions. I sometimes look through this section to help focus my activities on a particular issue or symptom (i.e., disturbed affect and mood, psychomotor agitation).

3. Music therapy for the mind. One of the most difficult considerations for group music therapy is that the clients (also often called "consumers") have wide ranging states of cognitive ability. Consumers with dual diagnosis (drug and/or alcohol addiction plus mental disorder) and people with intellectual disabilities are often grouped with single diagnosis consumers. Medication changes and time on the unit can also affect cognitive abilities. I have found that the best approach to this problem is to be prepared with multiple activities or activities that can be implemented at different cognitive levels or utilize higher functioning clients as "peer" helpers. I do one fun activity called "Disco Nerf" where a ball is passed around while music is playing and then participants have to make up dance moves if they have the ball when the music stops. The clients who cannot dance can be chosen to be the "DJ" and are put in charge of starting and stopping the music. More advanced clients can be assigned to help their peers make up dance moves or keep the circle going if the music therapist has to leave to help the DJ. I have successfully done this activity in the admissions group as well as more stable step-down groups.

4. Music therapy for the body. Consumers at in-patient facilities often lament the fact that they are stuck inside with little or no exercise. Their diets even have to be closely watched so that weight gain does not become a problem. In some facilities there are outdoor areas or courtyards that can be utilized by clients who have permission. Almost any activity seems to be more fun and engaging when it is done outside (assuming the weather is nice, of course!). Music and movement activities are also perfect for groups in any stage of treatment or stabilization. Aerobics, work-out videos, line dancing, progressive muscle relaxation and even the Wii Fit are all good options.

5. Music therapy for the soul. Religious themes can be problematic in the psych setting for several reasons. One possible pitfall is that some hallucinations and voices associated with schizophrenia have religious overtones. Another reason is the simple fact that you may find a wide variety of religious ideas in one group. Religious differences have often been the stimulus for conflict throughout world history so it can certainly be the case in a group activity of people with mental illness! On the other hand, many clients respond positively to spiritual music and this can be a normalizing experience and a chance to share positive emotions such as hope, happiness and gratitude. I have not usually had any problems with using songs like Down By the Riverside or He's Got the Whole World In His Hands. Mood is an important component to address in overall health, especially when it is known that depressed mood can lead to greater risk of heart attack and depression. One of the easiest and most neutral ways to affect the "soul" is through teaching and practicing relaxation to counter stress and anxiety. You may still be able to use some sedative spiritual music, but the emphasis will be on the relaxation and not on the content of the music.

6. I also wanted to mention the possibility of co-treating with other therapies. In my experience, clients with mental illness enjoy doing art, dance and even drama. If you have the luxury of working with these other kinds of therapists, it is a good idea to explore combining music listening and music creating with art and drama interventions. One of my favorite things to do is having a group create a circle similar to the Hindu or Buddhist "mandala" by using themes from music selections to guide the creative process. The group can make one giant mandala on butcher paper by rotating the circle by one person for each new song or theme. Each person adds his or her own element to each section of the circle. It is nice to see a group combine for a single product and supporting each other with compliments and ideas!

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