B A C K G R O U N D
Description of the condition
Schizophrenia is a serious mental disorder with considerable impact on individuals and their families. It may take a life-long
course, although full recovery is also observed in a proportion of
cases. Symptoms of schizophrenia are usually classified as ’positive’ (where something is added, such as hallucinations or paranoid ideation; also classified as schizophrenia type I) and ’negative’
(where something is missing, such as the ability to express oneself
emotionally or to form satisfying relationships with others; also
classified as schizophrenia type II). The aspects of schizophrenia
that are linked to losing and regaining creativity, emotional expressiveness, social relationships, and motivation may be important in
relation to music therapy (Gold 2009).
Description of the intervention
Music therapy is generally defined as “a systematic process ofintervention wherein the therapist helps the client to promote health,
usingmusicexperiencesandthe relationshipsthatdevelopthrough
them as dynamic forces of change” (Bruscia 1998). It is often perceived as a psychotherapeutic method in the sense that it addresses
intra- and interpsychic, as well as social processes by using musical
interaction as a means of communication, expression, and transformation. The aim of the therapy is to help people with serious
mental disorders to develop relationships and to address issues they
may not be able to using words alone.
Recognition of music therapy as a profession (with its own academic and clinical training courses) was first introduced in North
and South America in the 1940s. The first European countries
(Austria and England) followed in 1958, and soon after that many
other countries followed (Maranto 1993). It is now a state-registered profession in some countries (Austria, UK). A survey based
in Germany showed that music therapy was used in 37% of all
psychiatric and psychosomatic clinics (Andritzky 1996).
Music therapy models practised today are most commonly based
on psychoanalytic, humanistic, cognitive behavioural or developmental theory (Gold 2009; Wigram 2002). Generally, behavioural
models are more prevalent in the USA, whereas psychodynamic
and humanistic models dominate in Europe. However, the competing theoretical models in music therapy and their applications
do not necessarily form distinct categories, but rather prototypical
positions in a varied but coherent field.
Other than by their theoretical orientation, approaches in music
therapy may also be described by their modality (’active’ versus
’receptive’), their level of structure, and the focus on the music
itself versus on verbal processing of the music experiences. The
active modality includes all activities where clients are invited to
play or sing. This includes a variety of activities ranging from free
improvisation to reproducing songs. Receptive techniques, on the
other hand, refer to clients listening to music; this may be played
by the therapist for the client, or recorded music may be selected by
either therapist or client. Although some models of music therapy
rely exclusively on one mode of musical interaction, most models
use a mixture of both.
Secondly, the level of predefined structuring may vary. Some therapists may impose a greater degree of structure than others, either
by using more structured forms of music-making or by selecting
activities before the sessions, as opposed to developing these in dialogue with the client. The level of structuring may depend on the
client’s needs but may also vary between music therapy models.
For example, it has been observed that there are considerable differences between American and European approaches in the level
of structuring (Wigram 2002). A recent review concluded that extreme positions were rarely observed and most studies used some
structure as well as some flexibility (Gold 2009). A third relevant
distinction concerns the focus of attention. Some music therapists
and music therapy models may focus more on the processes occurring within the music itself, whereas others have a greater focus
on the verbal reflection of the client’s issues brought forth by these
musical processes (Gold 2009).
In summary, music therapy for people with serious mental disorders often relies on a mixture of active and receptive techniques,
even though musical improvisation and verbalisation of the musical interaction are often central. Music therapists working in clinical practice with this population usually have extensive training,
and many show a strong psychotherapeutic orientation in their
work. Music therapy with patients in mental health care is usually
provided either in an individual or a small group setting and is
often continued over an extended period of time (Wigram 1999).
How the intervention might work
Music therapy is often justified by a proposed need for a medium
for communication and expr