Music Therapy with Learning Disabled Offenders

1
Music Therapy with Learning Disabled Offenders

• The role and contribution of a creative
  intervention
• Rebecca Roberts Music Therapist
• Rampton High Secure Hospital

2
Music as communication

• ..Richard makes his way to the drum kit. Other
  members silently communicate apprehension. The
  group begins to play, but immediately Richard
  starts hitting the drums very hard, his face
  wearing a look of frowning concentration as if
  hes trying to work out a difficult problem. His
  playing shows no awareness of what others are
  doing and overwhelms the group. In contrast to
  the previous session, the group, including the
  therapists, seems unable to confront the problem.
  The experience in the room is of something
  unbearable that has to be endured, a surrender to
  a force too powerful to be resisted... The
  therapists feel defeated and unable to make any
  useful contributions. After the session the
  therapists talk about how extremely incapacitated
  and battered they felt
• (Taken from Drummed Out of Mind. A Music
  Therapy Group with Forensic Patients John Glyn
  2002, in A. Davies and E. Richards eds, Music
  Therapy and Group Work Sound Company 2002)

3
What is Music Therapy?

• Music therapy provides a framework in which a
  mutual relationship is set up between client and
  therapist. The growing relationship enables
  changes to occur, both in the condition of the
  client and in the form that the therapy takesBy
  using music creatively in a clinical setting, the
  therapist seeks to establish an interaction, a
  shared musical experience leading to the pursuit
  of therapeutic goals. These goals are determined
  by the therapists understanding of the client's
  pathology and personal needs.
• (APMT leaflet A Career in Music Therapy
  2000)

4
Music Therapy Training

• 7 post-graduate courses in UK MA level
• Use of improvised music
• Different models of approach
• My approach psychodynamic/
• psychoanalytically informed
• Theories considered Attachment Theory,
  Developmental Theory, Psychoanalytic Theory,
  Group Analytic Theory, Music Therapy Theory

5
Music Therapy in 2008

• Profession established in the 1960s
• HPC registered from 1997
• Research/ Evidence Based Practice (EBP)
• Literature with LD patients mostly from a
  psychoanalytic perspective

6
The Arts Therapies Department in Rampton Hospital

• Art therapy for over 20 years
• Current department formed 6 years ago
• Dept currently includes 6 music therapists and 4
  art therapists
• Sessions delivered on wards and in the department

7
The National High Secure Learning Disability
Service for Male Patients

• 48 beds across 2 wards and 2 villas
• Co-morbid diagnoses
• Assessment Treatment Discharge
• LD New Build - 2010

8
The music therapists role within the
multi-disciplinary team (MDT)

• The jigsaw puzzle approach
• To feed back significant aspects of the therapy
  sessions to propose links between past and
  present patterns of relating
• To consider transference/ countertransference
  phenomena between patient and team members
• Unique capacity to follow the patient from ward
  to ward to keep patient at centre of the work

9
Why provide music therapy for male offenders with
a learning disability?

• Non-verbal approach less threatening
• Client-centred approach (Mansell report - 1992)
• Tendency to act out rather than think (Sloboda,
  1997) music therapy can work with that
• Potential to make links between musical and
  verbal selves to increase insight
• Potential to witness offence-paralleling
  behaviour/Symbolic use of the instruments

10
William Individual Vignette

• Man in early 50s
• MLD
• Incarcerated for over 20 years sex offender
• Attended 62 11 sessions
• Referred by MDT following refusal for transfer to
  RSU

• Aims from assessment
• Self-expression/ communication
• To acknowledge and name emotional responses
• Consider aspects of relating
• To develop reciprocal listening skills
• To develop spontaneity and creativity

11
William Musical presentation

• Rigid and methodical
• Fragmented playing
• Resistance to close contact
• Use of the gong
• Therapist's music in the background
• Playing in two halves

12
Musical Extract Session 41

• William plays
• Metallaphone, windchimes, cymbal, glockenspiel,
  pentatonic chimes, drum
• Gathered around him like a barrier
• Plays instruments in rotation mostly in a fast
  tempo
• Cymbal crashes provide some structure and
  dramatic expression
• A mixture of rising and falling scales uses the
  full range (not two halves)
• Music becomes more rapid more anxious
  expression towards the end
• Ends with a cymbal crash/ windchimes and direct
  eye contact

• Therapist Piano
• Opens with full, heavy chords offering
  stability matching intensity
• Positioned at other side of the room
• Remains fixed at piano to offer integration-
  tempo increases to reflect Williams lead
• Meet cymbal crashes with louder chords to
  acknowledge the assertive sounds
• Mostly remains in the middle range of piano a
  more secure base
• Capture the anxiety with more chromatic notes
• Watches William at end places three chords to
  cadence/ create resolution

13
William Changes and Aims

• Significant changes
• Being heard
• Links between internal and external worlds
• Developing confidence and trust in the setting
• Using music expressively
• Aims for the future of the work
• Experiencing and naming feelings
• Recognising aspects of his personality
• Gaining more insight links between past and
  present
• Reducing risk

14
Conclusions

• The Arts Therapies offer a unique intervention
  for LD patients bringing together expression
  through a creative medium and psychotherapeutic
  understanding
• Musical expression can reveal aspects of
  unconscious communication and offence-paralleling
  behaviour
• Particularly beneficial for patients who struggle
  to verbalise their feelings
• Can increase the capacity for self-reflection
  potential to reduce future levels of risk by
  encouraging thought before action
• Increases relating abilities and social skills
• Is client-centred works at patient's pace
• Can bring a crucial piece to the jigsaw puzzle
  that may be missing in a purely verbal approach

15
Professor Peter TyrerEditor of British Journal
of Psychiatry

• Music therapy..offers me as a psychiatrist
  another perspective it enables me to understand
  people to a much greater extent than before. We
  often have difficulties in reaching a verbal
  understanding partly because of the inadequacy of
  language to communicate but also because the
  people we work with often have poor language
  capacity. Music as a form of communication can
  transcend language. Thats really impressed me.
  
• Interview printed in The British Journal of Music
  Therapy, Vol 20 (2), 2006

16
Contact Details

• Rebecca Roberts
• Senior Music Therapist
• Rampton Hospital
• Nottinghamshire Healthcare NHS Trust
• rebecca.roberts_at_nottshc.nhs.uk