Blog no. 4
Music therapy in psychiatric hospital
Music Therapy in the mental health field is one of my most passionate area of work, it’s a very demanding, challenging yet very rewarding field. In my final year of training as a music therapist, I was placed in a local hospital with an inpatient psychiatric unit in UK. It has a dedicated department of arts therapies, with a team of art, music, drama, movement, play therapists working there full time.
Patient who are staying in the unit have a variety of diagnosis including depression, anxiety disorder, bi-polar disorder, schizophrenia, personality disorder, post-traumatic stress disorder.
My day one arriving in the hospital was a bit of shock: all the wards are locked and required access card to get in and out, everybody are required to carry an alarm in case of emergence.
One of the most memorable advice my supervisor told me was this- “Always check what you’re ‘carrying’ (metaphorically) before you enter the ward/music therapy room, and check what ‘sticks’ on your after you come out.” This piece of advice is really the golden rule of survival working in a psychiatric hospital as well as dealing with people in everyday life. What that advice actually means is that very often we walk into a situation or relationship that has specific feelings or emotions attached to it, or the people that we are working with unconsciously project some unwanted feelings or aspect of themselves onto us, it is important to identify what belong to us and what belong to the others so that we don’t end up carrying all the unwanted burdens on us.
The dynamic in a such a challenging environment is rather complex, this is a place where one can experience all the psychodynamic phenomenon in an intensive level. Including transference, countertransference as well as various defence mechanisms such as projection, acting out, regression, dissociation etc can also be observed in this setting.
So how does music therapy actually work here?
We usually have a room with musical instruments such as piano, guitar, tuned and un-tuned percussion and different kinds of drums such as djembe, tabla.
For individual therapy, patient are invited to attend the session according to their needs and schedule, it might be few times a week, or once a week.
Once the client enters the room, he or she would be invited to explore the different instruments around the room and play in whatever ways he or she prefers, while the therapist would sense the mood and feelings from the clients and start accompanying him/her according to his/her music. The therapist acts as a container for any emotions and feelings expressed, reflecting them back to the client musically.
When the music stops, the client and the therapist might engage in verbal discussion, discussing thoughts, feelings, emotions evoked from the music we played together. In later session, if the clients are able and have insights, therapist might discuss whether there are any symbolic meanings, connection and unconscious thoughts or behaviour reflected from the client’s ways of playing, choice of instruments, ways of interacting with the instruments and with the therapist.
Every musical elements and instrument could potentially act as transference trigger (Konig and Linder, 1994 p. 40), and a projective device that extend and displace one’s outer, inner, audible and feeling self (Bruscia 1987, p. 516-517). It is in the musical interaction where a client might unconsciously acts out an interactional pattern or feelings from early relationship (Priestley 1994, p.34)
Individual music therapy case:
In this psychiatric hospital I have worked with a few individual cases with depression, anxiety disorder and personality disorder. The patients usually walked into the session being very low in mood, highly anxious or very emotional.
Through many musical improvisations, I’ve seen these patients gradually coming alive, transformed by the power of music and able to freely express themselves with different musical elements. The music gradually moved from representing the patient’s current state of condition to representing who they really are and who they want to be, as well as reflecting different aspects of the patient for examples their personality, their relationship patterns, their way of life and ways of dealing with problems and conflicts. In music therapy, all of these conscious and unconscious material can be externalized and projected onto an audible, concrete form of music, musical instruments and the therapeutic relationship that could be integrated back into the patient’s consciousness and thus becoming part of oneself. I personally think verbal discussion after the musical improvisation is a crucial element in music therapy as it aids the integration process, helping the patient to further consolidate and digest all the unconscious material.
According to Jung this act of blending the unconscious and the conscious together is the Transcendent Function, it is the step to individuation. I personally believe that Jung in explaining the concept of individuation, has beautifully and expressively summed up the therapeutic value of understanding each individual’s unconscious - ‘Individuation means becoming an "in-dividual,' and, in so far as "individuality" embraces our innermost, last, and incomparable uniqueness, it also implies becoming one's own self. We could therefore translate individuation as "coming to selfhood" or "self-realization" (Jung 1971, p.121).
A very brief explanation of three key psychodynamic phenomenon:
Transference- is a phenomenon characterized by unconscious redirection of feelings from one person to another. Usually from important relationships during childhood (i.e. parents, siblings, caregiver) onto others in the present i.e. friends, teachers, colleague.
Countertransference-a therapist’s unconscious redirection of feelings from the past onto the patients.
Projection- Freudian Projection: where the negative, disowned aspects of oneself are being projected onto an objects or person.
Jungian Projection: where every aspect of the unconscious including the negative and the positive are to be manifested and projected onto an objects or person.
Reference:
Bruscia, K. E., 1987. Improvisational models of music therapy. Springfield IL: Charles C Thomas Publishers.
Konig K, Linder W., 1994. Psychoanalytic group therapy. Northvale, NJ: Jason Aronson.
Jung, C.G., 1971. The Portable Jung (No. 70). Penguin Classics.
Priestley, M. 1994. Essays on analytical music therapy. Gilsum, NH: Barcelona Publishers.