Role Of Music Therapy Research Articles

J05 Multi- and interdisciplinary collaboration between the music therapist and other professionals in huntington's patient care

BackgroundLiterature confirms that Music Therapy can support the physical, behavioral and social well being of those diagnosed with HD in all stages. Treatment goals include facilitation of emotional expression and...

Music’s relevance for pediatric cancer patients: a constructivist and mosaic research approach

Music is important in most children's lives. To advance efficacious pediatric supportive care, it is necessary to understand young cancer patients' thoughts about music. Concern about inviting unwell children to express opinions has resulted in scant research examining their views. "Mosaic" research examines children's experiences through investigating multiple perspectives which inform a "co-constructed meaning." This study examines pediatric cancer patients' and their parents' perspectives about music and music therapy's role in the children's lives. Children were receiving care at three hospitals with the Paediatric Integrative Cancer Service in Melbourne, Victoria, Australia. A constructivist research approach with grounded theory design was applied. Children up to 14years old with cancer and parents participated. Data included transcripts from semi-structured research interviews and observations of children's music behaviors. Qualitative inter-rater reliability was integrated. Findings were compared with music therapists' perspectives examined elsewhere. Interviews were conducted with 26 patients, median age 5.7years, and 28 parents. Data "saturation" was achieved. A substantive grounded theory emerged: Children's adverse cancer experiences are often alleviated by music usages. Broader family, social, and electronic musical interactions also promote children's resilience and "normal" development. Music therapy and associated programs often, but not always, alleviate children's distress. Positive effects may carry over into children's home lives and vicariously support families. Health professionals should consider ways to assist parents who are often using music to support children with cancer. Hospitals can promote pediatric cancer patients' resilience by providing music-based support services, including music therapy, and reducing unwanted stressful sounds.

Songs of Hope: Music Therapy's Role in the Interdisciplinary Palliative Care Team (710)

Songs of Hope: Music Therapy's Role in the Interdisciplinary Palliative Care Team (710)

Interdisciplinary Team Members' Perceptions of the Role of Music Therapy in a Pediatric Outpatient Clinic

ABSTRACT: The purpose of this study was to examine the perceptions of interdisciplinary team members regarding the role of music therapy in a pediatric clinic. Medical and psychosocial support staff were administered a survey regarding the different roles of music therapy prior to and directly following a video inservice. Results of the pretest indicated significant differences between occupational groups. Child life specialists/creative arts therapists rated the task Entertain the children and their families when they are not involved in medical procedures as less relevant than other professionals (P Every year, more than 3 million children are admitted to children's hospitals across the country for acute or chronic care (National Association of Children's Hospitals and Related Institutions, 2007). As these numbers continue to increase, many children's hospitals have searched for ways to modify traditional medical care and provide a more interdisciplinary approach in the treatment of hospitalized children. The field of music therapy has continued to expand within the arena of pediatric healthcare, contributing research to promote the inclusion of this therapy modality in psychosocial pediatric care (Standley & Whipple, 2003; Robb, 2003). Researchers have examined collaboration between music therapists and other creative arts therapists as contributing members of an interdisciplinary treatment team. Music therapy and medical play therapy have been shown to be complementary approaches toward increasing verbal behaviors in pediatric patients (Froehlich, 1984). Rode (1995) discussed the interfacing of art therapy and child life programs when working with pediatric patients, stressing the importance of addressing the psychosocial needs of the child through a c-ombination of modalities as opposed to singular approaches. Collaboration among creative arts therapists, psychologists, child life specialists, and social workers on interdisciplinary treatment teams appears to promote improved patient care. However, similarities in professional objectives and treatment modalities can result in overlapping role expectations and misconceptions about areas of responsibility and scope of authority, thus increasing the likelihood of tension among members of an interdisciplinary treatment team. Role Conflict and Ambiguity Ilgen and Hollenbeck (1991) define a role as a pattern of behaviors. Within the context of a hospital organization, this pattern of behaviors can be in relatio'n to specific job responsibilities, organizational needs, and professional skills. Katz and Kahn (1 978) theorize that when role behaviors are carried out in a conventional manner, the organization will operate smoothly and effectively. Work groups within an organization may be comprised entirely of members of the same professional field, or, as in the case of an interdisciplinary team, members of several different professional fields. The work group sends cues to individual employees regarding expected role behaviors. When these role behaviors conflict with the individual's perception of role, role ambiguity or conflict can occur (Lopopolo, 2002). Role ambiguity relates to the expectations regarding a specific role, and role conflict relates to the incompatibility of expectations facing an individual (llgen & Hollenbeck, 1991). Role ambiguity often occurs when the expected behaviors of a role are unclear, leading to role conflict, which occurs when the individual performing the job task has a different perception of the expected role than other team members. …

A Collaboration Between Music Therapy and Speech Pathology in a Paediatric Rehabilitation Setting

This article describes the importance of flexible music therapy practice when focusing on communication skills with a speech pathologist within a paediatric rehabilitation setting. A brief literature review on the combined use of music therapy and speech pathology in rehabilitation is provided. A case vignette is then used to illustrate the unique role of music therapy and the importance of changing the goals of music therapy in order to meet the patient’s needs.

An Exploratory Study of the Use of Electronic Music Technologies in Clinical Music Therapy

In line with wider health and educational services, there is a growing demand for music therapists to apply electronic music technologies in clinical practice. Despite a handful of accounts indicating the benefits these tools offer, an objective assessment of their role in music therapy and guidelines for their application in therapy are lacking. A qualitative study collected data in semi–structured individual interviews from music therapists experienced in using electronic equipment using MIDI generated sounds triggered by specialist input devices. Interview transcripts were analyzed independently by two multidisciplinary investigators using open coding procedures from Grounded Theory, with member checking to enhance credibility. The findings propose a five–step treatment model when using technologies with people with complex needs. Accurate assessment of movement, positioning of the technology, and establishing the client's awareness of cause and effect are central to meeting clinical aims. Clinical indicators include complex physical and sensory disabilities, motivational problems, and specific needs pertaining to expression of identity. Their use is contraindicated in cases where it is known the client has no awareness of cause and effect.

Child-Parent Wellbeing in a Paediatric Ward: The Role of Music Therapy in Supporting Children and Their Parents Facing the Challenge of Hospitalisation

This report, based on clinical practice on a children’s ward in New Zealand, examines the role of short-term music therapy in supporting children and their parents[1] facing the difficulties of hospitalisation. It endeavours to explore three questions. How might music therapy support hospitalised children? How can it support parents of hospitalised children? Is it important/valuable for music therapists working in a paediatric ward to involve parent(s) in music therapy sessions? Three hospitalised children (aged 11 months, 5 and 7 years), who were accompanied by a parent, participated in a single individual music therapy session. From the clinical notes, semi-structured interviews with the children’s parents and a staff member, and my own reflective journal it was indicated that music therapy supported the psychosocial needs of the paediatric patients and their parents in many ways. For the children music therapy: 1) promoted normalisation; and 2) provided emotional/psychological support. For parents, it: 1) elicited positive changes in mood; 2) reduced anxiety; and 3) supported parental learning/parenting. Furthermore, the findings suggested that the wellbeing of the parent-child relationship can be supported during music therapy. The importance of parental involvement varied for each case, and highlighted different views between therapist, staff member and parents regarding this. Factors that may determine parental involvement and the benefits of both parental presence and absence during sessions were elicited. The report suggests that music therapy has the potential positively to support paediatric wards in New Zealand to provide an environment that is responsive to the psychosocial needs of hospitalised children and their parents.

Is There a Role for Music Therapy in the Care of the Severely Mentally Ill?

The role of music therapy in psychiatric care in Australia is briefly traced from the early 1990s to the present. With the shift to community-based care, contemporary music therapy practice for the severely mentally ill is reappraised alongside the principles of the recovery model. Music therapy is a viable option within the creative arts therapies for enhancing quality of life in people with severe and enduring mental illness.

Expanding from Hospital to Home Based Care: Implications for Music Therapists Working in Palliative Care

The focus of health care within Australia is shifting. Health care programs, traditionally the domain of large hospitals, are increasingly becoming community based. As music therapists, we need to be aware that these changes are occurring and the implications that this has for our work. The purpose of this paper is to present a comparative examination of the role of music therapy with palliative care patients in contrasting settings home and hospital. The material will be drawn from the author's direct clinical experience, as well as music therapy and other health care literature. Awareness of the topics discussed will inform future research in the clinical practice of music therapists working in palliative care, as well as music therapists witnessing this change in other settings. (author abstract)

Schneck, D.J. & Berger, D.S. (2006). The Music Effect. Philadelphia: Jessica Kingsley Publishers. 272 pages. ISBN 1-84310-771-6. $29.95

Schneck, D.J. & Berger, O.S. (2006). The Music Effect. Philadelphia: Jessica Kingsley Publishers. 272 pages. ISBN 184310-771-6. $29.95. Daniel Schneck and Dorita Berger combined their considerable talents to write The Music Effect. The book discusses the reciprocal relationship between physiology and music and provides an excellent resource for clinical practitioners, students, and educators. The authors have extensive experience in their respective fields. Both are internationally known and both are accomplished musicians. A Fellow of the American Institute for Medical and Biological Engineering, Schneck provides information regarding physiology; board-certified music therapist Dorita Berger provides a clinician's insight. Together, they develop the noteworthy paradigm that music can alter behavior in a positive direction through physiological entrainment. The authors offer a new perspective on the subject, which is applicable to various music therapy models. I found the book well organized. Divided into 12 chapters, information is presented in a logical, sequential manner with smooth transitions between chapters. The authors' writing styles differ but do not detract from the work as a whole. In fact, I enjoyed the contrast. Both authors seem to be consummate teachers who are able to translate complex concepts into language that is easy to understand. Chapter 1 lays the foundation for the book. The authors discuss the importance of the survival instinct, input signals for fear, and the manner in which information is processed. They present their paradigm for behavior change in six clear points: (1) the human body acts on information received through the senses; (2) information is evaluated emotionally against a survival backdrop; (3) the need for homeostasis establishes physiological (4) persistent changes known as continuous disturbances result in functional adaptations through entrainment; (5) applying, repeating, and reinforcing sensory stimuli can change set-points; (6) elements embedded in music can be used as the stimuli for change (pp. 19-20). Chapter 2 draws parallels between the basic elements of music and physiology, from the smallest unit to the largest. The effect of sonic energy on the body is explained in the following excerpt: traveling sound energy can disturb the air, and anything else it encounters ... the body's atoms, molecules, cells, organs, tissues, and operational systems will indeed be affected by sonic vibrational energies (p. 36). Thus, the concept of altering human behavior through music is established. Chapters 3 and 4 delve into the physiology and processing of music. Chapter 3 is devoted to the physics of energy as it applies to music; chapter 4 is devoted to sensory processing and the conservation of energy in response to stress. Case studies are introduced in chapter 5. The five examples are included because the clients initially presented with the same predominant emotion of fear while having diverse diagnoses. The authors explain the physiology of fear in detail, the clients' manifestations of the emotion, and the role of music therapy in effecting positive change. The authors contend that entrainment to music can interrupt the fear cycle. Chapter 6 offers an explanation of the complex ways in which the body entrains to stimuli through its nervous system, genes, and enzymes. Acknowledging the contribution of Asian philosophy, the authors postulate that perhaps energy centers within the body can be manipulated through entrainment and thus restore internal balance (p. 135). A discussion of musical stimuli follows. Chapters 7 through 10 are devoted to the primary elements of music that influence behavior: rhythm, melody, timbre, harmony, dynamics, and form. The authors use numerous clinical examples to support the concepts presented. Chapter 7 explores the close relationship between biological rhythms and rhythm in music. …

Colonoscopy and the role of music therapy: How to go about an ideal protocol?

Colonoscopy and the role of music therapy: How to go about an ideal protocol?

A Retrospective lyrical analysis of songs written by adolescents with anorexia nervosa

AbstractSong‐writing plays a central role in music therapy with adolescents. A retrospective lyrical analysis of songs written by adolescents with anorexia nervosa was undertaken in order to identify common themes solicited through song‐writing interventions. Fifteen participants contributed 17 songs, from which 368 lyrical units were identified. A modified content analysis approach was used with each lyrical unit being categorised to one of six themes determined from the literature and clinical experience. The theme of ‘identity’ was used most frequently (28%), with the sub‐theme of ‘exploring new behaviours, positive self‐talk’ being addressed most often (12.5% of total). The dominance of the developmentally important theme of ‘identity’ may reflect the relationship between adolescents, music and identity or may be related to the way in which anorexia nervosa has been theorised to assist the adolescent in managing challenges to the emerging sense of self. Copyright © 2006 John Wiley & Sons, Ltd and Eating Disorders Association.

Errata

Unfortunately, BJMT 19(2) contained a number of errors. These are listed below. Contents (on page 37 and on outside back cover) The first main article should have been listed as: Parents, children and their therapists: A collaborative project examining Therapist-Parent Interactions in a music therapy clinic Simon Procter Music Therapy as a short-term intervention with individuals and families in a child and adolescent mental health service Claire Molyneux 1. Footnote One should have read: 1Names and some details have been changed to preserve confidentiality 2. Certain references were truncated. These should have read: Abad, V. & Edwards, J. (2004) ‘Strengthening families: a role for music therapy in contributing to family centred care’. Australian Journal of Music Therapy 15 Byng-Hall, J. (1995) ‘Creating a secure family base: some implications of attachment theory for family therapy’. Family Process 34 Oldfield, A. (2000) ‘Music therapy as a contribution to the diagnosis made by the staff team in child and family psychiatry - an initial description of a methodology that is still emerging through clinical practice’. In T. Wigram (ed.) Assessment and Evaluation in the Arts Therapies: Art Therapy Music Therapy and Dramatherapy Radlett: Harper House Publications Oldfield, A., Adams, M. & Bunce, L. (2003) ‘An investigation into short-term music therapy with mothers and young children’. British Journal of Music Therapy 17(1): 26–45 Wigram, T. (2000) ‘A model of diagnostic assessment and analysis of musical data in music therapy’. In T. Wigram (ed.) Assessment and Evaluation in the Arts Therapies: Art Therapy Music Therapy and Dramatherapy. Radlett: Harper House Publications Woodward, A. (2004) ‘Music therapy for autistic children and their families: a creative spectrum’. British Journal of Music Therapy 18(1): 8–14 Music Intervention in Oncology Settings: A Systematic Literature Review Maria Pothoulaki, Raymond Macdonald, Paul Flowers 1. The first two sentences on page 76 should read: Due to limited space, this paper does not deal with any methodological issues identified in this review. Nevertheless, important issues are highlighted in a forthcoming paper by Pothoulaki et al. 2. The sentence spanning pages 78–79 should read: This section of results focuses on the findings of the reviewed studies. Table 2 summarises the reported outcomes of music interventions across six categories as follows: reduction in anxiety, reduction in side effects of chemotherapy, physiological effects, psychological effects, behavioural improvements, and improvements in communication and expression. 3. The second sentence in the section “Communication and expression improvements” on page 80 should read: In particular, Bunt & Marston-Wyld (1995) suggested that music seemed to improve communication and a sense of “togetherness”, as indicated by “brainstorms” of participants. 4. The author details on page 81 should read: Maria Pothoulaki is a Postgraduate Research Student at the Department of Psychology, Glasgow Caledonian University Dr Raymond MacDonald and Dr Paul Flowers are Readers at the Department of Psychology, Glasgow Caledonian University The BJMT wishes to apologise to authors and readers for these inaccuracies.

Role of Music Therapy in Integrative Oncology

Music therapy is an evidence-based complementary therapy that enhances quality of life in cancer patients and their caregivers. The role of music therapy in integrative oncology encompassed care and treatment of patients and family members , ongoing collaboration with the health care team, and the provision of music therapy services that may benefit the cancer center community. Clinical work includes ongoing assessment and the implementation of specific music therapy techniques aimed at reducing challenging symptoms and enhancing overall well-being and quality of life. This article outlines music therapy methods and the role that the music therapist has in integrative oncology programs.

The role of music therapy in an interdisciplinary approach to address functional communication in complex neuro-communication disorders: A case report

Purpose. This paper presents a case report of collaborative work between speech and language therapy (SLT) and music therapy (MT) in the case of an individual presenting with complex communication difficulties and lability caused by pseudo-Parkinsonian vascular disease.Design. MT intervention was used to investigate whether participation could be enabled in a client presenting with complex problems as well as facilitate change in communication parameters which remained unresponsive to conventional SLT intervention. A single case design measured communication and well-being parameters using pre-, during and post-intervention measures. In addition, analysis of the client's musical responses was undertaken to examine changes in vocal functioning which are involved in communication.Results. Analysis of the client's performance during MT intervention revealed improvements in prosody and phonation, with positive reports of participation, reduced incidence of lability and improvements in measures of well-being.Conclusions. The results indicate the value of such collaborative working in addition to making recommendations for the modification of existing treatment protocols. The findings highlight that fatigue is a major consideration when working with people with severe and complex clinical presentations.

The overture: initiating discussion on the role of music therapy in paediatric palliative care

The overture: initiating discussion on the role of music therapy in paediatric palliative care

Re–finding the Voice – Music Therapy with a Girl who has Selective Mutism

The purpose of the article is to describe and understand the role of music therapy in working with a client who suffers from Selective Mutism (SM). Special attention is given to the definition, etiology, and treatment approaches of SM. My theoretical perspective, the importance of the musical act, and the role of the therapist in working with such clients are discussed. The case example that follows presents two years of work with Shiran, a 6 year–old girl who suffers from SM. I describe and analyze the therapeutic process and bring my insights and understandings as well as Shiran's changes throughout the process. An emphasis is put on the role of improvisation in processing unresolved issues in Shiran's life.

Finding Climax and Cadence in the Uninflected Voice

ABSTRACT: The paper provides a theoretical basis for understanding the positive effects music therapy programs have on enhancing the vocal expression and intonation of people with acquired brain injury. To date, this theme has not been described in the music therapy literature. In this paper, neurological, physiological, and emotional perspectives have been explored through research findings and theoretical standpoints. A comparison of the neurological underpinnings of melody in both song and speech are provided as a framework for understanding how song singing may contribute to rehabilitating vocal intonation. Music therapy's role in reducing physical tension and improving posture, and how this affects vocal freedom, has also been outlined. In addition, the influence of emotional disturbances on vocal freedom has been described with reference to how music therapy may indirectly affect vocal expression through the enhancement of mood. Finally, the authors present a short case vignette to provide a context for understanding the perspectives presented in the text. Introduction The voice is a multifaceted phenomenon. On one hand, it is a neurological activity responsible for controlling sound production and changes in pitch (Aronson, 1990). On the other hand, it can be viewed as the complex set of physiological operations involving the activation and relaxation of various muscles in the larynx, otherwise known as the voicebox (Newham, 1998). The voice could also be considered as revealing emotional states, the voice revealing the mood, emotional response and feelings of the speaker (Bolinger, 1986, 1989). These facets in themselves suggest that the voice is influenced by several differing factors and consequently may be negatively influenced by impairments in one or more of these. While impairments in voice production occur in people with developmental and physical disabilities, and people with psychiatric disorders, particularly affective disorders, the focus of this text will be on people with acquired brain injury. Intonation is a vital part of speech. It is one of three components of prosody-stress patterning, intonation and rhythm-and it forms the melodic aspects of verbal communication (Bolinger, 1989). Intonation performs both affective and linguistic functions (Perkins, Baran, & Candour, 1996). Linguistically, it contributes to lexical aspects, for example object and object (Bolinger, 1989), and syntax-for example, distinguishing questions from statements (Collier, 1993). With respect to affect, it is primarily an expression of how people feel about what they say (Bolinger, 1989), uncovering the overall mood of speakers even when they communicate sentences with no emotional content. When referring to the literature on intonation, the most cited component of intonation is the acoustic feature of the fundamental frequency (F^sub o^). F^sub o^ is the lowest frequency component of a complex tone, the frequency that excludes the harmonics and overtones. Relevant for music therapists and speech pathologists, it is the frequency which aligns with the pitch of the voice heard in speaking and singing (Hargrove & McGarr, 1994; Joanette, Goulet, & Hannequin, 1990). Much of the research in music therapy and speech pathology concerning the diagnosis and outcomes of therapy for impairments in intonation describe outcomes in terms of F^sub o^. Clinicians and researchers can follow the intonation contour of the voice by examining the changing fundamental frequency. While each person has their own individual pattern of intonation, studies have established that for affective intonation, several stereotypical patterns exist across cultures (Apple, Streeter, & Krauss, 1979; Davitz & Davitz, 1959; Fairbanks & Provonost, 1939; Mozziconacci & Hermes, 1997; Murray & Arnott, 1993; Scherer, 1991). These are summarised in Table 1. What is interesting in Table 1 is that these characteristic patterns are similar to those found for melodies expressing emotions in music (Hevner, 1935, 1936). …

Heart Health and Music: A Steady Beat or Irregular Rhythm?

ABSTRACT: Heart disease is the primary cause of death in the United States. Those who suffer from heart disease either die prematurely or suffer a marked decrease in quality of life. Medical practitioners in the United States have accepted music to address patient needs, including those with cardiac conditions, for over 100 years. Music therapy practices attest to the viability of music therapy for cardiovascular well being. However, a representative sampling of research in music therapy and heart health measurements reveals inconsistencies. In addition, researchers neglect to give sufficient criteria or details of the musical selections. These conditions in the research data are analogous to an irregular rhythmic pattern. A steady beat at regular intervals is necessary for a healthy heart. Just so, a more consistent steady beat of research designs and choice of music would allow more predictable results for clinical practice and thereby promote cardiovascular health. Since heart disease is currently the primary cause of mortality and morbidity in the United States, heart health or cardiovascular well being is an important concern for all of us. Music therapy has been able to expand the use of music as medicine in the last fifty years. Clinical practices attest to the viability of music therapy for cardiovascular health. Nevertheless, research in the area of music therapy and heart health measurements presents problems. Ideally this research would be like the steady beat of a healthy heart. However, the inconsistencies in research designs and unclear criteria for selecting music resemble an irregular pattern of rhythm. Importance of Cardiovascular Health The human heart is a rhythmic muscle, and when it is working correctly, it contracts with a steady beat pushing out more than 14,000 pints of blood a day (Martin, 2002). All human beings rely on the heart's regular and rhythmic pulsation. However, there are numerous heart diseases from mild arrhythmia to a deadly heart attack that prevent this necessary regularity. In fact, more people in the United States die every year from heart problems than from cancer, chronic lung disease, pneumonia, influenza, diabetes and all accidents combined (Martin, 2002). There are specific heart disease risk factors such as sedentary behavior, overeating, consuming foods high in fat and sodium, and cigarette smoking (Levi, Lucchini, Negri, & La Vecchia, 2002; Luepker, Perry et al., 1996; Vale, 2000). Health care educators have concentrated on community education with moderate results (Luepker, Rastam et al., 1996). The most effective programs have been with young adults and school-aged children (Luepker, Perry et al., 1996). Even though there is a growing awareness of the need for healthier lifestyles and the rate of mortality from heart disease has declined in the United States since the 1970's (Levi et al., 2002), cardiovascular disease still remains the leading cause of mortality and morbidity (decreased quality of life) in the United States (Luepker, Perry et al., 1996; Vale, 2000). For this reason, it is a primary health care concern. Music in Medicine Medical practitioners in the United States have turned to music to help address patient needs for over 100 years (Washco, 1933). Patients may also be amenable to music as an adjunct to medical treatment. One recent study of 246 patients who were scheduled for cardiac surgery showed that 81 % of the patients confirmed use of complementary or alternative therapies (Ai & Boiling, 2002). Music therapy, which began in the United States as a formalized profession in 1950, has continued to expand the use of music in medicine. The American Music Therapy Association (2001, January) provides a monograph, Music Therapy and Medicine, which documents several prominent physicians who endorse the role of music therapy as essential in patient rehabilitation in the medical setting. Music Therapy in Cardiovascular Well Being Over the last fifty years, music therapy has developed clinical practices based on research which attest to the viability of music therapy in areas vital for cardiovascular well being; for example, stress management, alteration of physiological measures such as heart rate and blood pressure, and positive changes in mood and emotional states. …

Service Evaluation: Music Therapy and Medicine for the Elderly

This paper describes a six-month evaluation of the music therapy service in a Medicine for the Elderly unit. It describes the unit and introduces the role of music therapy in this clinical area, with reference to relevant literature. The service evaluation is then described in detail. Four evaluation methods are presented. A user feedback questionnaire, which was designed by the writer for music therapists, is presented with results and discussion. A twelve-week music therapy group is observed and evaluated using rating scales to measure the level of patient communication and interaction within and outside the group. Two clinical vignettes are presented and, finally, qualitative observations are outlined. The paper then describes how these four methods were used to produce management recommendations for future service planning. It highlights the need for service providers to engage in consultation with service users when planning and reviewing services. It emphasises how important it is for music therapists to evaluate their services, and sets out this model in the hope that it will provide ideas and guidance for therapists wishing to do the same.