Five episodes of clients’ contributions to the therapeutic relationship: a qualitative study in adult mental health care

Abstract

Research on the effectiveness of psychotherapy has contributed to a contextual model that links therapeutic outcomes to a broad set of interacting factors, including the client’s involvement, the therapist’s techniques and the therapeutic relationship. The focus in this article is on the bidirectional nature of the therapeutic relationship, and more specifically on the clients’ contributions to the relationship with the music therapist. This focus is linked to current perspectives in music therapy that promote collaboration and equal relationship. The article reports on a multiple case study using video observation and research interviews with clients and their therapists, with an adapted Interpersonal Process Recall (IPR) procedure being used during the interviews. Five purposively selected episodes of clients’ contributions for the relationship were analyzed using a combination of narrative and interpretative methods. These episodes document clients’ active and reflexive commitment to the therapeutic relationship, and three interlinked commonalities are discussed: (1) the clients’ reflexivity regarding the asymmetric structure of the relationship; (2) the clients’ engagement for reciprocity in the relationship; and (3) the clients’ reflexivity related to their own needs in the relationship.

Keywords:

• clients’ reflexivity
• power relations
• therapeutic alliance
• therapeutic relationship
• user-involvement

Acknowledgements

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

Notes

¹ For a more thorough discussion of contextual models, see Rolvsjord and Stige (2013).

² Lambert’s much cited cake model attributes 40% of the outcome to extra-therapeutic factors, 30% to common factors, 15% to placebos and 15% to specific therapeutic factors (Lambert, 1992).

³ Notably, in the last revisions of the Defining Music Therapy (Bruscia, 2014), the asymmetric aspects of the helping relationship is less accentuated.

⁴ Interestingly, some of the debates have accentuated controversies between music-centered and psychotherapeutic (particularly psychodynamic) approaches (Aigen, 2014; Streeter, 1999). However, this article will not go into the complexity of the differences between musical relating and verbal relating in music therapy.

⁵ See Horvath (2000) for a discussion of the conceptualizations of the therapeutic relationship in psychological models.

⁶ With an emphasis on music as social action, DeNora (2006) proposes the concept of craft, implying “a symmetrical concern with what the client does” with the therapist’s knowledgeable actions (p. 90).

⁷ REK-vest.

⁸ Kvale and Brinkman (2009) describe a similar process of a theoretical reading of interviews (p. 235).

⁹ Composed by Hank Williams Sr.

¹⁰ Norwegian singer-songwriter.

Additional information

Notes on contributors

Randi Rolvsjord

Randi Rolvsjord is an associate professor in music therapy at the Grieg Academy – Institute 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.