Alliance building in music therapy for forensic psychiatric patients with schizophrenia. An exploratory case study research design

ABSTRACT

Introduction: Forming therapeutic alliance with forensic psychiatric patients with schizophrenia is challenging, and there is a gap in knowledge about the dynamics in the initial phase of psychotherapy and how collaboration and trust is developed. Music therapy is described as a motivating approach enhancing the forensic psychiatric patient's ability to engage in a relationship. The purpose of the study was to explore and identify dynamics in the process of forming therapeutic alliance in music therapy for forensic psychiatric patients with schizophrenia.

Method: The study adopted an exploratory case study design with data from multiple perspectives providing thick descriptions. Four patients with schizophrenia from a medium secured unit at a forensic psychiatric hospital were offered weekly music therapy sessions for six months. An inductive process based on a hermeneutic phenomenological epistemology and a nine step procedure for the analysis led to a final abductive synthesis.

Results: Each of the following themes formed a continuum of dynamic interactional processes within the development of therapeutic alliance with forensic psychiatric patients with schizophrenia in music therapy and were presented as a condensed continua model; (a) Control, (b) Closeness/distance, (c) Structure, (d) Process/product, (e) Focus of attention, (f) Interaction, and (g) Verbal dialogue. A case example is provided.

Discussion: The continua model may contribute to the clarification and conceptualization of the developmental dynamics in the initial phase of psychotherapy with forensic psychiatric patients with schizophrenia, and hereby contribute to a recognition of the importance of treatment efforts specifically concerned with relational and musical competencies.

KEYWORDS:

• Forensic psychiatric patients
• schizophrenia
• music therapy
• psychotherapy
• trust
• therapeutic alliance

Disclosure statement

The authors report no conflicts of interest.

Acknowledgments

The authors gratefully acknowledge participants and staff for their willingness to contribute to this study.

Notes

¹ GAF (Global Assessment of Function, Jones et al., 1995) ranges from 1 (“Persistent danger of severely hurting self or others”) to 100 (“No symptoms”). The range between 10–40 consists of four categories that overall covers (“Some danger of hurting self or others and/or Some impairment in reality testing or communication”).

Additional information

Funding

No funding was received for this study.

Notes on contributors

Britta Frederiksen

Britta Frederiksen; PhD, Music therapist (DMTF), Department of Psychiatry in North Zealand, Capital Region, Frederikssund, Denmark. Previously clinical music therapist at the Department of Forensic Psychiatry, Region of Zealand, where she conducted music therapy at secured units. Her research and publications are mainly focused on music therapy in a psychodynamic understanding of psychiatric care.

Hanne Mette Ochsner Ridder

Hanne Mette Ridder, PhD, Music therapist (DMTF), Professor of Music Therapy and head of the Doctoral Programme in Music Therapy at the Department of Communication and Psychology, Aalborg University, Denmark. She is an approved clinical supervisor, finalizing her level III GIM training, and past president of the European Music Therapy Confederation (2010-2016). Her research and publications are mainly focused on music therapy in a psychosocial understanding of dementia care.

Liselotte Pedersen

Liselotte Pedersen, PhD, Psychologist, Associated Professor of Department of Psychology, University of Copenhagen, Denmark. She is a former Researcher at Psychiatric Research Unit and Department of Forensic Psychiatry, Region of Zealand. Now head of Department in “Dialogue against Violence”, a non-profit non-governmental organization offering psychological treatment to perpetrators of domestic violence as well as to the adult and child victims.