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Amanda Lappin and Julie Lloyd, 2013. Book Review. Reformulation, Summer, p.50.
Forensic Music Therapy: A treatment for Men & Women in Secure Hospital Settings
This book offers double value; an interesting description of how to integrate various therapeutic models and an account of working with seriously dangerous personality disordered offenders in which attachment issues are pivotal. Edited by a CAT psychotherapist and music therapist, these therapeutic models include psychodynamic, dialectical behavioural and CAT. Approaches include both individual and group work, long term and planned time limited therapies.
All this takes place within the demands and constraints of both high secure and medium secure settings. When working at the highest level of security, musical instruments have to be passed through a hatch to where the patient is segregated for their own and other people’s safety. This book offers powerful and reflective descriptions of what working in such an environment involves. An equal amount of thinking was applied to working with staff teams including actively building close networks for the exchange of information. Writers discuss how good staff communication is not only about containing such challenging patients, but also exploring the parallel processes that would otherwise occur unnoticed. Mapping out Reciprocal Roles offered a vital and non blaming tool to help this awareness.
In looking at the role of music therapy, Stella Compton Dickenson writes, “Patients in high secure settings are frequently verbally fl uent and articulate; however they cannot link their inner feelings to their fl ow of words. Music, like words, can be treated mindfully in a dialogic exchange and yet this non-verbal form of expression is different to language because multiple events are occurring at the same time: for example, rhythm, melody and harmony.” P 172. The case studies give a fl avour of the range of approaches and techniques through which Music Therapists may engage their clients. Throughout all there are references to the importance of liaising with the MDT and how important it is to be clear about the aim of the intervention and give feedback on progress and any risk issues. Understanding the many layers of dynamics within the work, the MDT and the institution is emphasised and the insights made have relevance for Music Therapists in other work settings.
As an aside, from the case studies I (Amanda) was struck by the vivid description of the use and usefulness of the Sounding bowl and will be investigating if it would be a positive addition to my own music therapy practice.
One of the issues that some CAT readers may wonder about, is how much of the music therapy uses the structured approach and tools found in mainstream CAT. Stella Dickenson describes the protocol she developed which covers treatment stages, built on scaffolding from the therapeutic process as described in DBT, but with the relational focus from CAT. Maps, prose Reformulation and Target Problems are used to inform the dialogic aim of the music therapy. The relational focus is worked on via client (s) (both individual and group CAT) and therapist learning how to hear and respond to each other. CAT offers this music therapy relational concepts and structure in which the aim is to support patients to be more able to be in dialogue with others and with themselves.
Readers do not simply have to rely on the viewpoint of the authors; there is an audit using a semi structured interview to explore what was least and most effective in this approach. The ethically approved pilot studies showed that in the latter stages of the 12-session intervention, “the patients were able to move on to the exploration of CAT reciprocal roles in interpersonal effectiveness and recognition of their relating styles improved” SCD p 202. …The study demonstrated that a time-limited form of music therapy, delivered to a structured manual, could be integrated into the treatment pathway of this kind of overarching treatment approach.” P 203. G-CAMT was more than a structured psychodynamic approach and different from the constrained taught skills of DBT, as relational phenomena was facilitated by the interaction between participants as well as by instruments enabling creative and safe conditions.