Forms of attunement during the initial stages of music therapy for patients with acute psychosis - A multicentre clinical study

ABSTRACT

The aim of this non-experimental follow-up study was to specify and quantify rhythmic attunement processes within free improvisations in the early phase of psychodynamic music therapy in order to investigate its predictive value for therapeutic change. Twenty-one in-patients diagnosed with psychosis (ICD-10F20, 23, 25) were included in the study. Participants received five sessions of individual music therapy as per usual. Improvisations were audio recorded. The initial and final improvisations were analysed with the Rhythmic Attunement Scale for Psychosis (RAS-P), which was specifically developed for the project. Clinical measures included external and self-report assessments (BPRS, Dührsen and Happach, TAS 20). Analysis of the audio recordings revealed early occurrence of rhythmic attunement on a stable and qualitatively high level. BPRS scores showed a post-treatment decline of 20%. There was no significant difference for the Dührsen and Happach and TAS 20 scores. Statistical analysis revealed that when initial rhythmic attunement occurred further into the first session, it was a predictor for the decline of psychotic symptoms. Evidence of carefully organised rhythmic attunement suggests beneficial effects on patients with psychosis through improvisational music therapy. Results are limited due to a small sample size and lack of a control comparison.

KEYWORDS:

• Individual psychodynamic music therapy
• free improvisation
• in-patients with acute psychosis
• rhythmic attunement
• multicentre clinical study
• predictor of therapeutic change

Supplemental data

Supplemental data for this article can be accesed from https://doi.org/10.1080/08098131.2018.1478879

Acknowlegdements

We thank Prof Dr Falk Leichsenring and Prof Dr Carsten Spitzer for scientific advice, and Prof Dr Jane Edwards for sensitive language editing.

Conflict of interests

No potential conflict of interest was reported by the authors.

Additional information

Notes on contributors

Susanne Metzner

Michael Dümpelmann, MD, is Psychiatrist, Psychoanalyst, and former head of a hospital department of Asklepios Clinic Tiefenbrunn, Göttingen, Germany. He is a well-recognised expert for psychotherapeutic treatment of psychosis.

Ulrich Jaeger

Ulrich Jaeger and Oliver Masuhr both hold a MSc degree in Psychology at the University of Goettingen and work as Head resp. Vice-Head at the Department of Documentation, Supervision and Further Education, Asklepios Clinic Tiefenbrunn, Goettingen, Germany.

Ulrike Olschewski

Elisabeth Gräfe achieved her MSc in Music Therapy at the Queen Mary University Edinburgh and her MA in Music Therapy Research at University of Applied Sciences Magdeburg, Germany. Ulrike Olschewski and Anne-Christin Böske are qualified Music Therapists (Diploma) and finished their MA in Interdisciplinary Therapy in Mental Health Care also at Magdeburg. All three music therapists have clinical experience of more than 5 years in psychiatric hospitals.

Elisabeth Gräfe

Susanne Metzner is Professor for Music Therapy at the University of Augsburg, Germany and has gained her clinical experience with patients with psychosis for more than 10 years.