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Destigmatizing Mental Illness: Music Therapy in the Clinical Outpatient Realm

Destigmatizing mental illness through the power of music in clinical mental health treatment therapy combined with peer support can be beneficial to achieving transformation within the current paradigm in mental health. The effects of stigma are felt most by disregarded communities who tend to be among the first to be affected by societal changes (Canen et al., 2020; Hogenaar, 2022). Destigmatizing mental illness by means of music therapy supports a collective shift in how mental health issues are addressed. Music therapy effectively reduces the stigma of mental illness by fostering inclusion and sense of belonging among clients and therapists. The goal is reducing the sole focus on mental illness and increasing the focus on music to consider the user perspective (Tuastad et al., 2022).

a music therapy session

At Elm Place clinic in Brooklyn, NY, an outpatient clinic operated by South Beach Psychiatric Center, a facility of the New York State Office of Mental Health, integrating music therapy with mental health outpatient treatment is a tradition that first started at Baltic Street OPD in the mid-1990s. The clinic merged with the Heights Hill site in April of 2022 thereby increasing the amount of access to a larger pool of clients with a range of mental health and psychosocial needs. Clients who have participated in the music therapy group and individual experiences offered at Elm place clinic have contributed much to addressing the challenge of stigma.

One such individual is a 55-year-old black American man originally from Brooklyn, New York who writes songs, plays the bass guitar in the music performance therapy group accompanying himself singing, and performs his poetry. His participation in the music therapy programs has played an integral role in his long-term psychiatric stability and in maintaining remission of the symptoms of schizophrenia that he has experienced since late adolescence. This individual’s increasing involvement with the music therapy services at the clinic, has provided him with the opportunity to reconnect with his core identity as a musician which was disrupted by mental illness and other related challenges earlier in his life. He discovered an opportunity to move away from the stigmatized label of viewing himself as a disenfranchised patient in a mental hospital to becoming a member of the community who simply needs help. This client developed into an empowered individual who possesses healthy ways to cope with challenges within the context of a life worth living. He actively supports and encourages his peers especially when they are working through difficulties, and models transformation and recovery using music therapy that he experienced as a viable therapeutic modality.

The Baltic Street Band Collective is a music performance therapy group that consists of clients who have a range of musical interests and experience and who consistently participate in rehearsing selected material and regular performances. This specialized performance therapy group has been playing in the community since the 1990s. Clients, students, peers, and therapists have all shared in the experiences of being accepted and hired in venues to perform without any reference to mental health, or request for special consideration. In 2010, the group played its first show at a well-known music venue in the East Village in Manhattan. All participants were chosen to share their artistic expression with no mention or relevance to their serious mental illness status. Therefore, the group’s accomplishments were made solely on the merit of the artistry and musical message. For example, a significant achievement was that after a couple of well-attended and positively received performances the group was offered a residency at Sidewalk Café, in Manhattan in 2014. Several key experiences from memorable performances have been captured in images, video, and audio material that clients continue to reflect upon and cherish. Furthermore, the events and media preserved remain as a testament to their experience of moving beyond stigma.

Music therapy services offered at Elm Place Clinic include performance and community drumming groups, as well as individual music psychotherapy sessions. The music therapy treatment programs are led by on-staff clinicians, qualified peers, and graduate music therapy interns. A treatment experience that begins with meeting the client where they are is integral to eliminating stigma. Meeting a client in a relatable way involves debunking the traditional clinician-client way of relating in which the clinician is perceived to have all the authority and knowledge, and the client is expected to listen to and follow the direction of the clinician (J. Layton, personal communication, December 2, 2019). In an interview with outpatient clinic peer specialist Joel Layton (2019), the music therapy program at Elm Place clinic was described as an experience that is based on showing up to the music therapy group with fellow musicians who are also clients and having staff members who are both clinicians and musicians facilitate the groups. This kind of collaboration between clients and clinical staff can bring a meaningful performance to an audience and can be transformative for clients living with mental health issues.

Within the naturally collaborative process that is music making, there is a transformative experience that occurs as both client and staff work together towards the same goal through a music-based interaction which breaks down barriers by allowing for a shared experience to take place. From a peer specialist perspective, the stigma of mental illness is removed because “we are all there as musicians” as the group works together on a project and there is no focus on diagnosis, mental health identification, and being “sick” (J. Layton, personal communication, December 2, 2019). In music, all human beings in the room are working together towards the goal of regulating and managing emotions, because all who are engaged are navigating the same unified struggle. The group members endeavor to bring out the best in one another, accessing inner potentials by working together to bring out the “best possible performance.”

The existing literature supports that music therapy is an effective service as adjunctive to traditional mental health treatment models. For example, Tseng et al. (2016) concluded that standard therapy treatment was more effective when combined with music therapy and that patients who received music therapy showed significant improvement in mood symptoms, positive symptoms, and negative symptoms compared to patients who did not receive music therapy. Also, Geretsegger et al. (2017) reviewed the effects of music therapy by adding music therapy to standard care for people with schizophrenia and schizophrenia-like disorders. The study examined treatment dosage varying from seven to forty sessions and found a positive effect on mental health for music therapy compared to standard care. Along the same vein, McCaffery and Edwards (2016) explored the utility of music therapy in the treatment of mental illness with qualitative case studies of several clients, showing that cognitions were reinforced and effectively reshaped in music therapy, while the “ability replaced disability in music therapy” (p. 137). Music therapy for many mental health patients presented a new, more empowered, and often far more forgiving view of the self that promoted cognitive awareness of ones’ self-worth that was “distinctive and positive and contrasted with the self-image outside the sessions” (McCaffery & Edwards, 2019, p. 140). In summary, research indicates that music therapy consists of a joint effort between clients and clinicians, which strengthens the therapeutic alliance by working together towards a common goal and transformative purpose. Moreover, the shared vulnerable experiences with interactive music-making involves risk taking and navigating tension and uncertainty (Wimpenny & Meadows, 2017) can be helpful to breaking down barriers, allowing for greater equity and agency. Ansdell (1995) explains that the power of music-based relationships is that they “connect two minds together in the same experience” (p. 103), reinforcing the point that the space held together between people sets the foundation for soul-making experiences and transcending labels. Songwriting allows the client’s imaginal realm to come to life because creative self-expression can lead to changes that are person-centered. There are situations where the client is directing the therapist, thereby affording them increased agency over the flow of a session. For example, in songwriting the client and therapist can envision their collective message to manifest through the music as a vehicle for a deeper kind of communication that surpasses spoken language. Thus, the effect of music psychotherapy can be destigmatizing as it allows for a more equalized form of interaction, rather than the conventional scenario where the therapist is the guide and thereby has more of a controlling influence in the therapy process.

Music therapy is a creative arts modality which focuses on the subjective experiences of clients in treatment by stimulating one’s inner emotional life and echoes the collective lived experiences which are relatable to all human beings. Jung (1933) wrote that “what is essential in a work of art is that it should rise far above the realm of personal life and speak from the spirit and heart of the poet as man to the spirit and heart of mankind” (p. 172). In service to destigmatizing mental illness, transcending the labeling of people through their illness can be redirected through reflection and raising consciousness on language, collaboration with participants, increasing solidarity through enhancing communal awareness, and promoting social justice (Tuastad et al., 2022). The overall music therapy treatment experience focuses on clients as equal participants.

Collaborating with professional music therapists and qualified peers through interactive music making allows for collective, integrative, and holistic experiences that supports ones’ individual message that reflects triumphs as well as struggles. Furthermore, clients are afforded an opportunity for personal growth that are consistent with cultural norms, and free from stigma and social ostracization. The creation of music for all involved can be deeply reflective and emphasizes healing and recovery.

Ariel Avissar, MA, MT-BC, LCAT, is a Doctoral Candidate in Clinical Psychology – Rehabilitation Counselor 2 (OMH Title) and Joel Layton, BA, CPS, is a Peer Workshop Specialist (OMH Title), at South Beach Psychiatric Center – Elm Place Clinic, Music Therapy Services.

References

Ansdell, G. (1995). Music for life: aspects of creative music therapy with adult clients. Jessica Kingsley.

Canen, N., Kendall, C., & Trebbi, F. (2021). Political parties as drivers of U.S. polarization: 1927-2018. National Bureau of Economic Research.

Geretsegger, M., Mössler, K.A., Bieleninik, L., Chen, X.J., Heldal, T.O., & Gold, C. (2017). Music therapy for people with schizophrenia and schizophrenia-like disorders. Cochrane Database of Systematic Reviews, Issue 5

Goffman, E. (1963). Stigma: Notes on the management of spoiled identity. Prentice-Hall.

Hogenaar, Timon. (2022). A societal shift, a community split: mental health challenges in a polarized society. Duquesne University.

Jung, C.G. (1933). Modern man in search of a soul. Keegan Paul, Trench, Trubner & Co.

McCaffery, J., & Edwards, J. (2016). Music therapy helped me get back doing: perspectives of music therapy participants in mental health services. Journal of Music Therapy, 53(2), 2016, 121–148

Tseng, P., Chen, Y., Lin, P., Tu, K., Wang, H., Cheng, Y., Chang, Y., Chang, C., Chung. W., &

Wu., W. (2016). Significant treatment effect of adjunct music therapy to standard treatment on the positive, negative, and mood symptoms of schizophrenic patients: a meta-analysis. BMC Psychiatry. 16:16

Tuastad, L., Johansen B., Østerholt A.L., Nielsen, I., & D.S.H., McIvor (2022): Being a person who plays in a band rather than being a person with a mental illness playing in a band: A qualitative study of stigma in the context of music therapy in mental health aftercare, Nordic Journal of Music Therapy

Wimpenny, K. & Meadows, A. (2017). Core themes in music therapy clinical improvisation: an arts-informed qualitative research synthesis. Journal of Music Therapy, 54(2), 161-195

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