The Development of Therapeutic Alliance in Music Therapy with Forensic Psychiatric Patients with Schizophrenia – an Exploratory Case Study Research Design
by Britta Vinkler Frederiksen
This PhD thesis investigates how music therapy can support the development of a therapeutic alliance in the initial phase of psycotherapy with forensic psychiatric patients.
A prerequisite for success in the treatment of psychiatric patients in general is a good therapeutic alliance characterized by trust and cooperation. To develop therapeutic alliance with forensic psychiatric patients though is an extremely challenging task because of these patient´s severe mental illness and a behaviors sometimes characterized by hostility, lack of ability to regulate arousal and aggression, in addition a lack of recognition of own illness and need for treatment. The fact that these patients are sentenced to treatment complicate the development of a good therapeutic alliance. In this PhD thesis, Britta Vinkler Frederiksen investigates how music therapy can contribute to the development of therapeutic alliance in the initial phase of a psychotherapy by supporting the patient`s ability and motivation to engage in social relationship and cooperate with the treatment. Among others, offering an alternative language where the patients may express anger and aggressiveness in a situation where it is socially acceptable.
Based in a case study including four forensic psychiatric patients with schizophrenia the thesis describe the process of developing the continua model, which describe dynamic micro processes in the interaction and relationship between the music therapist and forensic psychiatric patients with schizophrenia, toward a strengthening of the therapeutic alliance. The potential of music therapy is emphasized in order to engage the forensic psychiatric patient with schizophrenia in musical and non-verbal interaction and, through regulation and synchronization directly in the musical activity, to establish the first contact and support the alliance building process.
The continua model may support the structuring of actual observable interactions, non-verbal reactions and clinical reflections and, thus, help detect non-verbal dynamics, implicit knowledge and suggest interventions. Besides music therapists it may be relevant to other psychotherapists working with forensic psychiatric patients, and contribute to recognize the importance of treatment efforts in the initial phase with these patients.