My homework for my Music Therapy class this week, is to write a paper about one of the chapter in our 600 pages long MT book. Looking through the the table og content I decided right away what I wanted to write about; Music Therapy in the treatment of Behavioral-emotinal disorder. I find this very interesting because it deals with the feeling of beeing abnormal from a certain point of view. After doing my reading about the topic, I now consider it more “normal” to feel “abnormal” then what most people would think. And I also think that chances may be big that YOU, in one way or the other, can relate to some of disorders/symptoms/feelings discribed in the followin paragrphs. Please take some time to read through and make your self some mental notes…:
“That person is acting so strange.” “What is wrong with her/him?” “Am I normal?” These are all thoughts that appear in most people’s mind once in a while. Either because of the way an other person is behaving, or because you feel yourself acting differently then others. We live in a society where normal is looks at equally with acceptance. However, the notion of what is considered normal and abnormal is very complex. It is reliant on culture, situation, a society’s norms as well as individuals, and thereon it varies a lot form place to place and gives a wide range of acceptable behaviors. For example; what clothes to wear in church versus on a football game. The way you applause on a symphony concert versus a rock concert. One will adjust ones attitude, language, clothing, and behavior, depending on the situation. Living in a world with different cultures, and social norms we can’t really say what is normal and not. However, when it comes to the point where behavior and emotions are considered a problematic on a personal level or inappropriate on a consistent term, it can be considered a behavioral-emotional disorder. The diagnosis is related to the frequency, duration and intensity in which the symptoms occur. Behavioral-emotional disorder can effect all people and is characterized as a disturbance in mood and thinking, perception of reality, and ability to relate to other people, thus, this is not a physical illness (although symptoms an be physical) but a mental disorder. Symptoms vary greatly, but can include fears, panic, lack of socialization, and racing heart.
The most common behavior-emotional disorders that people are being given treatments for is Schizophrenia, mood disorder, personality disorder, anxiety disorder and substance-related disorder.
Schizophrenia is a serious disorder where individual experience alteration in thinking, perception and behavior. Common symptoms individuals may experience are hallucination, delusions, movement disorder, flat affect and social withdrawal. However, the intensity and duration and how often the symptoms occurs differs. The term Schizophrenia refers to “splitting in mind”, and the disorder will always include impairment in more several areas of functioning; accordingly the illness is seen as pretty complex and as all behavioral-emotional disorder, hard to treat.
One of the important treatments for schizophrenia is antipsychotic medication. Medication only reduces, not cures, the illness, and can lead to serious side effects. On the other side, it will help people behave in more adaptive ways and reducing the intensity of the symptoms. Psychosocial therapy is also important as a treatment. Having a stable relationship to a therapist and a safe environment can help clients deal with their illness better and change their behavior pattern. Music therapy is a branch of psychosocial therapy that may be used for certain clients. It’s a way to make the client experience positive and uplifting feelings, that again may motivate them, help them structure their life, or make the reality seem more fearless. The therapist can guide and support the clients and help them deal with their everyday problems.
Mood disorder is a disturbance in mood, such as depression or extreme elation. The symptoms occur in episodes, periods where the victim experiences change from the normal functioning. During a depressive episodes for example, the individual will feel a persistent depressed mood, and may experience weight loss, changes in sleep pattern, lack of energy, feeling of worthlessness, and diminished interests in activities that would normally excite them. Mood disorder can be treated both with medication as well as Psychotherapy (talking therapy). The latter is where music therapy plays a role. By the use of music the clients can develop coping strategies, alter their maladaptive believes, as well as normalizing moods. As an example, music-making activities like playing instruments, sing or compose, require healthy interaction and on-task behavior, and can therefor be a good therapeutic tool. The type of treatment would vary depending on if the clients state. Some clients need to work through their conflicts, emotions and maladaptive patterns, whereas others still need to discover the conflicts within themselves.
Personality disorder is to be found at individuals with very extreme and inflexible personality traits, and/or a multiple personality. This person can come across either as acting in an odd or eccentric way, being very emotional and dramatic, or avoid social settings because of anxiety and fearfulness. Persons with this disease often lack of insight, and tend to blame their issues on others or complain about problems in their life without recognizing their own contribution to the problem. Clients with enduring patterns of maladaptive behavior, as in this case, may not benefit much by traditional therapeutic treatment, and therefor personality disorder can be difficult to change. However, a combination of therapy and medication is recently being used to a greater amount.
Anxiety disorder is shortly described as a normal response to when the stresses in everyday life becomes ongoing an excessive. Physical symptoms can be racing heart, chest panic or dizziness. Panic attack and avoiding behavior is also common which affect the interaction in everyday life.
Substance-related disorder is related to taking of drugs and abuse, or the side affects of medication and toxin exposure. It can lead to significant impairment of distress, which again leads to substance tolerance, withdrawal, and reduction in social and recreational activities.
As we have seen, symptoms and behaviors of clients with disorders vary a lot. Some clients are in a state where they don’t know where or who they are, some have issues doing basic self-skills, while others find it hard to organize their lives or even lack of insight. Because clients function differently in everyday life, one cannot treat everyone the same way. Dr. Barbara. R. Wheeler has proposed three levels of clinical practices in music therapy to meet the diverse needs of clients. Supportive, active-oriented music therapy promotes healthy behavior and requires active involvement and awareness of here-and now. Examples are group singing, playing musical instruments, or do musical games. Re-educative, insight-and-process-oriented music therapy also requires involvement, but has a greater emphasis on verbal reflection and processing emotions and relationships. The activities focus on problem solving, expressing feelings, and awareness and behavioral change. Also at this level the clients have insight in behavior and their own situation. Reconstructive, analytically and catharsis-oriented music therapy are used to uncover, relive or resolve subconscious conflicts that continues to hamper personal development. Music is used to elicit images and reconstruct conflict, as well as express feelings or act out relationships with significant people from the past. Clients must have a good reality orientation and motivation in order to gain personal change from this clinical approach.
Despite the big variation in behavioral patterns, music seems to be meaningful to a wide range of people and ages in different cultures. Because most everyone can find some sort of music to relate to, music is a great tool to use as treatment for clients with behavior-emotion disorder. Following the different levels of therapies described in the previous paragraph, there are specific categories of music therapy interventions that are commonly used. Certain interventions require more participation, such as playing, composing, songwriting and moving to music. This is a powerful tool to enhance self-awareness, to adapt healthy behaviors, and express oneself trough the means of music. Music for recreation, enjoyment, and relaxation is used either as a relaxation tool, to evoke images, or to fun (which to some clients can be a very important clinical goal). Other tools used are listening and responding to music, and music combined with expressive art.
In genera music is used to change maladaptive behavior, enhance feeling of worthlessness, energize, stabilize, help create structure and healthy pattern in everyday life, support through a difficult time etc. Clients with behavioral-emotion disorder are a fragile population, much because the line between normal and abnormal, and being sick and not, is hard to define. Because much of the symptoms derive from mental issues you cannot always tell from the external if a person is sick, in comparison to physical disabilities. I can personally connect to this, as a victim of eating disorder, which categorize as a behavioral-emotional disorder. Although the symptoms such as weight-loss, lack of energy, lack of socialization, changing in moods, frustration is more or less physical changes, the problem is not solved by for example eating more or force yourself to be more social, which is what an average person would tell you to do. This is a mental issue, where one would have to change the maladaptive patterns in your mind. Then again, how do you change the way mind function? It is not easy. That is why music therapy is used in such specific design ways when it comes to client with behavioral-emotional disorder. Therapist works to meet the client’s need and not only reduce symptoms, as medication would do, but to reach and gain change in the core of the problem, and thereon better their quality of life.