Music therapy and dosage considerations

The question of dosage has been raised in relation to the current review of music therapy being conducted for the NDIS by Dr Stephen Duckett. Like a pill to swallow, how many doses does a person require of music therapy? I feel like saying how long is a piece of string, but…

 I have been reading Klyve et al (2023)[1] an online article which explores transdisciplinary teams, highlighting the interprofessional perspectives of music therapy. Initially I was concerned that it had little to do with my area of work with people with neurodevelopmental conditions and support workers, which was the focus of my research. I persisted – I do love reading the latest research and found some wonderful gems, even though the population was children with mental health issues in an inpatient facility in Norway, and the perspectives were of the other professionals. However, what really caught my attention was the discussion around the conundrum in relation to emotion regulation and free expression and it brought up questions for me on dosage in music therapy.

One of the children in the study ceased attendance in the music therapy program and it seemed that there was an overt requirement set by the team for emotional expression and regulation to be the goal. However, it would also appear that there was insufficient rapport developed and the child didn’t feel safe enough and thus stopped attending music therapy.  Klyve identifies “a possible contradiction between the staff’s understanding of music therapy as a place to achieve treatment goals with specific directions, and their understanding of music therapy as a place where the children can feel free”

Klyve states “[there needs to be] acknowledgement of some children’s need for more time and a better rapport with the music therapist before specifically focusing on emotions”.

So perhaps we should be talking about how long it takes to develop rapport and when is the right time to begin focus on therapeutic goals. In my own experience there have been assessment sessions with parents who had a fixed conception about what they wanted music therapy to achieve. Invariably we failed. Like Klyve’s statement above, it seemed that what music therapy could achieve for the participant was at odds, or at least felt restricted, by a predetermined goal.

 It is still a piece of string, however. For some participants rapport develops quickly and we can address goals seamlessly. For others, it can take a while to get to know each other and what we can fruitfully work on and achieve. The most meaningful goals are a product of that time of learning and rapport developing. Given that I work from a strength-based person-centred approach, working in a prescriptive manner without letting the participant contribute to the direction of therapy feels like a recipe for failure.

 So how to we know how long therapy will take? We don’t. My participants are typically complex individuals with many health concerns and developmental delays. It is often a case of two steps forward, one step back, or , one step forward, two steps back. Many have epilepsy, may be in pain, or exhausted from lack of sleep because another resident in their home shouted all night. Some don’t attend a session because of carer issues or many respond differently because of the carer they have that day. The variables are endless. One week may produce fantastic outcomes but the next, it’s an achievement for them to just be in attendance.

They are people and they are not taking a pill. But they are receiving musical interventions and interactions designed and responsive to their needs moment by moment, often necessitating the official work on goals and outcomes to be sidelined, or necessitating a realignment of goals to be more orientated better to their developing needs. As quoted in this article:

“Communicative activity through music and its effects plays a part in what conceptual content we put into music, it is the practice that decides the content of the concept of music” (Ruud, 1990, p. 220,)”

Perhaps it is just a case of the Hare and the Turtle, slow and steady wins the race. And until there is a large scale quantitative study on dosage for complex neurodivergent people who are non-speaking, we may never have the answer. But if someone needs a PhD topic, here it is, for free. Until then I will be guided by my participants, get to know them, and design and deliver my sessions in line with their needs first and foremost.

Helen

[1] Klyve, G. P., Rolvsjord, R., & Elgen, I. B. (2023). Polyphonic perspectives: A focus group study of interprofessional staff’s perceptions of music therapy at an inpatient unit for children in mental health care. International Journal of Qualitative Studies on Health and Well-Being, 18(1), 2197750. https://doi.org/10.1080/17482631.2023.2197750