Mixed-Methods Survey of Professional Perspectives of Music Therapy Practice in Mental Health

Abstract

The field of music therapy in the United States is undergoing a transformation that has been fueled by changes in healthcare, insurance reimbursement criteria, and requirements of evidence-based research in clinical practice. In addition, requirements within the profession as a whole are changing the landscape of education and specialization. One response to these changes is evident in the training of music therapists (MTs), as the American Music Therapy Association (AMTA) and its members consider the relative advantages of creating a Master's-Level Entry (MLE) into the profession. Healthcare delivery in the field of mental health, in particular, has been transformed, as advances made in the pharmaceutical treatment of psychiatric disorders has shifted care from the acute inpatient setting to the recovery community model. This change in treatment approach has resulted in increasingly shorter length of inpatient stays. An average length of stay of a 1987 inpatient cohort was 22.6 days (Weiden & Oltson, 1995, table 1 ), but it had fallen to 8 days in 2005 (Stranges, Levit, Stocks, & Santora, 2011) and is estimated at 7.2 days in 2015 (Centers for Disease Control and Prevention, 2015).This new treatment model is reflected in the recent music therapy literature, where short-term acute stays have resulted in a need for practices that are focused on single sessions (Carr, Odell-Miller, & Priebe, 2013; Jones, 2005; Silverman, 2014'), and address immediate areas of concern (e.g., de l'Etoile, 2002; Silverman & Rosenow, 2013,) rather than provide process or depth-oriented therapeutic experiences with a goal of insight as the outcome (Carr et al., 2013). Carr et al/s (2013) systematic review of music therapy practices in psychiatric acute care in the United States and Europe provides insight into some of the ways that music therapists have adapted to these changes. These authors found that MTs conducted a high number of sessions per week, and that the music experiences they implemented required greater therapist direction, flexibility, and predictable musical structure. This review also indicated that music therapists often found it difficult to engage patients in music therapy, especially early in their care. Because of the constant changes in group participants and functioning levels, fostering group process was often not a realistic goal. Patients in the acute unit are often in crisis; thus, goals for inpatients were focused primarily on symptom management and fostering relationships with peers and healthcare professionals in the here and now (2013). Carr et al. (2013) concluded that the current music therapy models of Guided Imagery and Music (GIM), Analytical Music Therapy (AMT), and Nordoff Robbins Music Therapy (NR) have been developed with depth-oriented care in mind and may not address the needs of acute-care patients.This interpretation may be supported by recent music therapy research literature in the acute-care setting, wherein the focus has been on single sessions that use interventions such as music games (Silverman, 2005, 2014), music games and other recreational activities (Silverman & Rosenow, 2013), music psychoeducation (Silverman, 2009, 2014), and songwriting (Jones, 2005; Silverman, 2012b; Silverman & Leonard, 2012). In contrast, in the recovery or community treatment setting, MTs use music experiences in a different way, or use other music experiences that may be more suitable for longterm treatment. This includes choirs (Bailey & Davidson, 2003; Eyre, 2011), songwriting (Vander Kooij, 2009), songwriting and recording (Grocke et al., 2014), Sound Training for Attention and Memory protocol (Ceccato, Caneva, & Lamonaca, 2006), and adapted GIM (Moe, Roesen, & Raben, 2000). Although some studies have been carried out in the community setting (e.g., Grocke, Bloch, & Castle, 2009), there is a relative lack of research and clinical literature that focuses specifically on music therapy in the community setting. …