What clients do to make music therapy work: A qualitative multiple case study in adult mental health care

Abstract

The importance of clients’ agency and involvement in therapy has been emphasized in music therapy as well as in the broader interdisciplinary field of mental health and psychotherapy. Although the quickly growing discourse and research base of music therapy in mental health care increasingly include user perspectives, most of the existing research and literature focus on the therapists’ interventions. This article reports a qualitative multiple case study of clients’ contributions within therapeutic collaborations in the field of adult mental health care. Data were collected through semi-structured interviews with clients and therapists including an adapted procedure of interpersonal process recall (IPR). Through a thematic analysis four main categories of clients’ agency in the therapeutic process were identified taking initiatives, exerting control in sessions, commitment to the relationship and engagement across contexts. The findings documented clients’ actions as well as their intentions and reflexivity regarding such actions.

Keywords:

• agency
• common factors
• clients’ efforts
• clients’ reflexivity
• therapeutic collaboration
• user involvement

Acknowledgements

I am grateful to the four institutions participating in this project: Bjørgvin District Psychiatric Centre, Bergen, Norway; Lovisenberg Diakonale Hospital, Oslo, Norway; Skien District Psychiatric Center, Telemark Hospital Health Authority; and Nordfjord Psychiatric Centre, Nordfjordeid, Norway.

Notes

¹ The client as a common factor includes also socio-demographic variables such as gender, age and race, diagnosis and personality traits as discussed by Clarkin and Levy (2004). Although such variables are relevant to the knowledge of the client as a common factor, it is outside of the scope of this article to consider such aspects of client characteristics.

² Some protagonists for the recovery perspective seem to be more oriented towards a consumer-oriented liberalistic ideology of welfare markets.

³ Mackrill (2009) offers a critical analysis of how clients’ agency is constructed in psychotherapy research.

Additional information

Notes on contributors

Randi Rolvsjord

Randi Rolvsjord is Associate Professor in music therapy at the Grieg Academy – Department of Music, University of Bergen, Norway. She holds a PhD from Aalborg University. Her research and publications include resource-oriented perspectives on music therapy in mental health, user involvement and feminist perspectives.