Songwriting and improvisation in acute psychiatry : clinical considerations

Music therapy (MT) sessions in an acute psychiatric setting with patients who are psychotic can be a challenging task due to the severity of their symptomatology. This article draws on research conducted between 2003 - 2006 in an Australian university teaching hospital (Morgan, et a!., 20 ll) which proved to be unique in Australian psychiatric practice in its methodological rigour and was only the second study published in such a setting in the international literature. The index group received MT with an emphasis on songwriting and improvisation over two weeks during their admission. A control group received relaxation therapy via a relaxation tape. In addition, both groups received standard ward care including pharmacotherapy, counselling and occupational therapy. The research demonstrated that songwriting and improvisation can be powerful tools in the reduction of both emotionally taxing and delusional thought processes as well as in improving socialisation in the early phase of an admission. However, the paranoid quality of the symptoms experienced by many of the patients translated into difficulty in engagement. The results of a case study review of the clinical applications of music therapy in this setting showed that music therapists need to consider their approach with care, especially as regards to MT technique and choice of instrument.