The challenges and opportunities related to the therapeutic use of music in psychiatry

Figures & data

Table 1. Potential negative side effects of MT arising from factors related to the music stimulus, the music therapist, the application of music, the therapeutic relationship, the client’s associations with music and ecological factors. Some of the presented information is based on [17].

	Factors	Potential negative side effects
Music stimulus	– Overwhelming vibrations, sensations, or perceptions – Overstimulating music – Overly complex music – Under-stimulation	– Distress – Musicogenic seizures – Boredom
Music therapist	– Inadequate clinical training – Practicing outside one’s scope of practice – Difficult personality traits – Improper motivations – Poor decision-making or responsiveness – Poor self-awareness – Avoidance of feedback or supervision	– Impaired psychological safety in the therapeutic space – Regression – Resistance
Application of music	– Nonadherence to treatment protocols – Poor planning – Nonresponse to a client’s negative reactions	– Distress – Impaired communication abilities
Therapeutic relationship	– Unresolved transference or countertransference – Verbal, emotional, financial, or sexual abuse – Accepting gifts – Becoming friends with a client	– Hazardous psychodynamic – Impaired therapeutic progress – Psychological trauma – Worsening of the mental health condition
Client’s associations with music	– Historic associations – Emotional associations – Knowledge about the music	– Triggering of traumatic memories – Negative emotions – Negative memories – Relapse into substance abuse – Memory of acoustic trauma
Ecological factors	– Space where the MT takes place – Cultural background and identity – Ideologies and attitudes – Violation of a taboo in the client’s culture – Incognizance of culture-related pathophysiological factors	– Non-attendance – Feeling of ostracism – Psychological harm – Reinforcement of harmful ideologies

Table 2. Challenges and action points for the therapeutic use of music in psychiatry.

Challenges	Action points
– Changed perception of music (e.g. in autism, OCD) – Music symptoms part of the psychiatric disorder (musical hallucinations, earworms) – Clients may use music in unhealthy ways – Lack of RCTs with appropriate sample size – Side effects not systematically collected – Many publications of scientific studies are difficult to understand because the MT interventions are not adequately described	– Regular history taking of healthy and unhealthy use of music – Sufficiently powered RCTs testing MT for mental health disorders – Studies to understand the biological underpinnings of the therapeutic and the potential negative side effects of MT – Standardized systematic measurement of side effects of MT – Register of MT side effects

Murakami B. The music therapy and harm model (MTHM). Conceptualizing harm within music therapy practice. ECOS. 2021;6(1):e003. doi: 10.24215/27186199e003

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