Article Review 1

Client Experiences in Music Therapy in the Psychiatric Inpatient Milieu

As author Scott Macdonald explains, clients who arrive at an inpatient unit often have
feelings of distress and confusion due to the unfamiliar environment. It has been found that
music can decrease symptoms of psychosis, promote relaxation, and increase social
functioning, among other things. As music therapy can work to combat or ease many of the
issues clients in inpatient units often face, the author of this study desired “to capture a
broader and more client-focused perspective on what happens during music therapy.” To do
this, Macdonald utilized a phenomenological research approach.
Macdonald found in his review of the literature that understandings of how and where
in the therapeutic process the client experienced insight brought greater awareness to the
therapist of what was happening for their clients. These insights allowed the therapist to be
more alert to both the clients’ reactions and their own reactions. Macdonald also proposes that
an enhanced understanding of client experiences could also contribute to the evidence base of
music therapy. In the closing of his review of the literature, Macdonald also stressed the
importance of quality of life for the client.
This study consisted of six participants from ages 18 to 56 who were in an adult
inpatient psychiatric unit at the time of the study. The activities within the music therapy
sessions varied and included improvisation, song-writing, relaxation, musical games, and song
re-creations. The interview techniques used with the clients were semi-structured and open
ended. The author also made attempts to keep a reflective and humanistic approach in
listening to and asking about the clients’ experiences. Macdonald found sixteen distinct patient
experiences in music therapy: “release of stress, healing balm, concentration, safe space,
shared experience, mutual desire for support, intrinsic value of music, music learning, coping
with here and now/hospitalization, motivation/hope, connection to others, self-awareness,
lessons for the future, value of listening and trust, self-expression, and negative experiences.”
The author cites Bruscia in stating that a key element of all the potential interactions in
music therapy is the client’s relationship to the music. Macdonald then goes on to explain that
music played a significant role in all sixteen of the common experiences they found, and that
“music was implicated in the awareness of emotions and the physiological states that it
induced.” He continues to further prove this point by explaining that many of the clients
pointed out how music did things to them, showed them things about themselves, and brought
them together with others during the sessions and the interview. The author also explains that
in their descriptions of their experiences in the music therapy groups, clients stated they felt
they had been given an opportunity to see themselves as capable of change “despite their
mental illness.”
This article points out how empowering music therapy can be in inpatient psych
settings. The author focuses on how music therapy affected the clients from the clients’
perspectives. The author found that music therapy can create profound effects for the clients,
and the clients generally had positive experiences that they felt benefited them in some way.
This study and the sixteen different common client experiences with music therapy it uncovers
is a wonderful piece of literature to consult. Understanding the different common experiences
a client may be having allows the therapist to be more aware of what might be happening
during a session. I really appreciated the information this article contained as well as the
author’s approach to the study. Going forward, I will keep these common client experiences in
mind as I’m working in the inpatient psych setting in hopes of better serving the clients.

Article Review 2
A Conceptual Framework for Group Processing of Lyric Analysis Interventions in Music
Therapy Mental Health Practice
Author Abbey Dvorak proposes a framework of a group lyric analysis that lies within a
cognitive-behavioral orientation in her article “A Conceptual Framework for Group Processing
of Lyric Analysis Interventions in Music Therapy Mental Health Practice.” Dvorak believes this
framework will provide structure and “assist music therapy students and young clinicians in the
beginning stages of planning, implementing, and evaluating lyric analysis interventions.” The
five levels to this framework are: foundation, reflection, group process, personal insights, and
transfer.
Dvorak defends the need for this framework by drawing from surveys. Surveys Dvorak
found stated that nearly 85% of music therapists working in mental health use lyric analysis as a
common intervention. These interventions covered many different topics and worked on
therapeutic objectives such as coping skills, emotional expression, goal setting, and positive
thinking. Additionally, she found that therapists typically select the songs for lyric analysis
based on recommendations, the lyrical content, and how well the therapist likes the song.
When employing these songs, it was found that the lyrics were considered to be the most
important component of the intervention. But it was also found that other musical elements-
such as tempo and harmony- could modify the impact and meaning of the song from the client
or group’s perspective. In spite of the amount of usage this particular intervention sees and all
the considerations that go into the intervention, there are very few studies that include the
processing questions and protocol used within the intervention.
In a model by Kees and Jacobs that Dvorak references, the group leader, (the therapist,)
is the one who facilitates and chooses the exercises. The group leader must consider factors
such as the purpose of the group, the size of the group, client needs, cognitive abilities, and
level of trust. The group leader must also consider their skills as a therapist in their questioning
ability and counseling skills. As processing is one of the most important parts of this model, the
facilitator must develop appropriate and thought-provoking questions. These questions must
be supportive of the group members’ needs, timed appropriately, and rather open-ended. The
author explains her reasons for using such a model as it “provides a clear structure for planning
and implementation to assist novice clinicians in building their verbal processing skills” and
“allows for flexibility in choosing questions based on the presenting needs and responses of the
group.”
In the five levels of framework Dvorak mentions previously in the article, foundation is
the first level. Within the “foundation” level, the music therapist presents the song to the group
and allows time for processing with open-ended questions. These questions are not meant to
be the sole activity of the group processing, as it may lead to a superficial group session. The
second level, reflection, allows time for the therapist to ask questions that may lead to the
participants reflection upon their own responses to the music. The third level, group process,
has the therapist “ask questions that draw the participants’ attention to the effect of the song
on other people in the group and the interactions among group members.” The fourth level,
personal insights, has the therapist ask questions that move onto a more personal level for the
participants. These questions ask the participants to reflect upon feelings, thoughts, and
insights produced by the song. The final level, transfer, has the therapist ask questions about
how to transfer the concepts and ideas discussed within the group to their own lives outside of
the group.
As I have done lyric analysis activities within practicum this semester, I have felt that I
could have posed better questions towards the group participants. Yet, I never could quite
figure out what I was missing. This article served as a great guide to fill in those blanks for
myself, and I will use it when planning questions for the next time I facilitate a lyric analysis
activity at my practicum site.