Working with Groups & Individuals in Music Therapy: Comprehensive Notes

Group Music Therapy: Purposes & Core Rationale

  • Music therapy is frequently delivered in groups for both economic and clinical reasons.

    • Economically: one therapist can treat several clients simultaneously ⇒ lower cost, greater reach.
    • Clinically: most human problems arise and are expressed in social contexts; treating them in a social (group) arena mirrors real-life challenges.
    • Groups create a safe, supportive microcosm where clients can rehearse new behaviours away from the original conflict setting.
    • Exception: family music therapy – group members are identical with the real-life problem network, intensifying ecological validity.

  • Grouping clients by chronological age (common in schools, inpatient psychiatry, nursing homes, etc.)

    • Brings together similar developmental tasks & sociocultural backgrounds.
    • Examples: adolescent units, adult units, geriatric units; older adults confronting aging & loss.

  • Grouping by level of functioning / care intensity

    • High-care vs low-care wings in facilities.
    • Spinal cord–injury vs head-injury units in rehabilitation.

  • Grouping by shared need or diagnosis

    • Emotional difficulties, communication disorders, intellectual disabilities, addictions.
    • Trend toward decreased homogeneous placement in schools ➔ inclusion / mainstreaming.

  • Maslow’s warning (1999, p. 141):

    • "Rubricizing" reduces energy but de-individualises; categories stress similarities over differences.
    • Two consequences:
    1. Labels can be damaging; use cautiously.
    2. Multi-label reality: every person fits several overlapping categories (e.g., emotionally disturbed & gifted).

Literature Addressing Group Work

  • Key monographs:
    • Ahonen-Eerikäinen (2007) – Group Analytic Music Therapy.
    • Borczon (1997) – Music Therapy: Group Vignettes.
    • Davies & Richards (2002); Davies, Richards & Barwick (2014).
    • Gardstrom (2007) – Improvisation for Groups.
    • Goodman (2007); Pavlicevic (2003).

Forming Music Therapy Groups

  • Administrative assignment → clients already together (e.g., school classroom, psych ward schedule).

    • Pros: pre-existing familiarity ⇨ safety & comfort.

  • Therapist-selected membership after assessment ⇒ grouping by shared issues, level of functioning, or interest in music.

  • Voluntary sign-up (common in adult psych & nursing homes) ⇒ intrinsic motivation.

  • Community Music Therapy (Pavlicevic & Ansdell 2004; Stige 2002; Stige & Aarø 2012; Stige et al. 2010)

    • Works within clients’ natural environments, strengthening community ties.

Short-Term vs Long-Term Treatment Settings

  • Short stays (1 – 28 days) typical in medical, rehab, mental-health due to philosophical\text{philosophical} & insurance\text{insurance} pressures.
    • Goals: crisis intervention, functional restoration, linkage to community supports.
    • Adaptations:
      • High session frequency (3-5 × week).
      • Rapid intrases­sion assessment, immediate goal-oriented methods, ongoing evaluation.
      • Therapist must acclimate swiftly to new clients with minimal background data.
    • Examples of short-term community groups: parents of children w/ special needs (Nicholson et al. 2008); disaster survivors (McFerran & Teggelove 2011); PTSD trauma groups (Borczon 1997); deinstitutionalised adults w/ ID (Stige et al. 2010).

Levels of Structure & Leadership Styles

  • Directive style

    • Therapist designs & leads specific activities ("activity therapy" – Wheeler 1983; "supportive, activities-oriented" – Unkefer & Thaut 2002).
    • Common with older adults, dementia care, skill-teaching (e.g., guitar group – Cassity 1976).
    • Pros: clarity, safety, goal focus; Cons: fosters group dependence on therapist.

  • Nondirective style

    • Therapist offers minimal guidance; group generates direction.
    • Promotes shared responsibility & autonomy.

  • Hybrid / graduated directiveness

    • Therapist modulates control across sessions or within protocol (e.g., Tamplin et al. 2016 12-session songwriting – decreasing directiveness each 4-session phase).

  • Leaderless groups (theoretical extreme) – rare; informal leaders usually emerge.

Structured-Sequence Formats (Directive▶︎Nondirective Blend)

  • Plach (1980): song → discussion/process.
  • Borczon (1997): sessions framed with Opening – Main Portion – Closing.
  • Treder-Wolff (1990): popular songs & lyric analysis in addictions; directiveness gradually relinquished to group.
  • Improvisation-centred groups (Dvorkin 1998; Gardstrom 2007) – therapist facilitates playing & verbal processing; directiveness variable.
  • Analytical Music Therapy (Priestley 1975/1994) – often less directive.

Stages of Group Development (Corey et al. 2014)

  1. Initial – trust-building, anxiety, role testing.
  2. Transition – manage resistance/conflict; leader fosters cohesion.
  3. Working – here-and-now focus; members take responsibility; confrontation accepted; high cohesion.
  4. Ending (Termination) – unfinished business resolved; future plans; goodbye rituals.
    • McGuire & Smeltekop (1994a,b) termination sequence: announcement → review/evaluation → feeling expression → future projections → goodbye.
  • Other developmental frameworks
    • Garland, Jones & Kolodny (1976) (applied by Hibben 1991 with ADHD children): Pre-affiliation → Power/Control → Intimacy.
    • James & Freed (1989) directive 5-stage model: Goal-setting → Individual/Parallel → Cooperative → Self-disclosure → Group problem-solving.

Therapeutic Factors in Groups (Yalom 1985)

  1. Instillation of hope
  2. Universality
  3. Imparting information
  4. Altruism
  5. Corrective recapitulation of primary family
  6. Development of socializing techniques
  7. Imitative behavior
  8. Interpersonal learning
  9. Group cohesiveness
  10. Catharsis
  11. Existential factors (awareness of life’s givens)

Principles for Group Planning (Plach 1980)

  1. Match activity to individual symptomatology, group needs, conceptual/physical limits.
  2. Select music congruent with cultural & age factors.
  3. Calibrate structure to group & individual functioning.
  4. Leader participation level determined by what maximises experience potential.
  5. All responses are valid.
  6. Provide immediate behavioural feedback when appropriate.
  7. Refer back to initial activity & responses as needed.
  8. Facilitate transfer of insights/skills to life outside group.

Working with Individuals: Indications & Decision-Making

  • Indications (Bruscia 1987):

    • Client too withdrawn/aggressive for group.
    • Priority on therapist–client relationship.
    • Need for privacy.
    • Medical/non-ambulatory status.
    • Preparatory step before group or supplementary parallel work.

  • Factors influencing placement

    1. Which setting best addresses goals?
    2. Suitability of interventions to 1-to-1 vs group structure.
    3. Client disposition – does individual attention enhance or inhibit?

  • Role of music often heightened in individual work due to less social chatter; therapist must adapt leadership to prevent performance pressure and ensure creativity.

  • Boundary management

    • Client ≠ friend.
    • Guard self-disclosure, gift acceptance, outside contact.
    • Guided by AMTA Code of Ethics (2014a) & Dileo (2000).

  • Pedagogical use – students may start with individual case for focus (Summer 2001 on supervision).

  • Literature rich with case examples: Aigen 1998; Bruscia 1991; Hadley 2003; Hibben 1999; Meadows 2011; plus Bruscia’s “Case Examples of …” series.

Stages of Individual Therapy

Corey & Corey (2015) Four-Stage Helping Process

  1. Identifying problems – define & clarify.

  2. Creating goals – devise new approaches.

  3. Encouraging action – plan & execute strategies.

  4. Termination – client continues change independently.

    • Example: "Sam" (back-injury patient) → pain management & songwriting protocol; uses relaxation; termination with post-discharge plan.

Bruscia (1987) Interpersonal Process

  1. Developing relationship – trust, surface exploration.
  2. Conflict resolution – deep problem exploration; unconscious material.
  3. Internalization – master & integrate insights; therapist less active.
  4. Autonomy – prepare for termination; external relationships replace therapist.

Aigen (2005a) Experiential States (non-linear)

  • Confusion → Just coping → Next best thing (sustained productive work) → Real thing (peak/transformative moments).

Stages of Musical Development (Bruscia 1987)

  • Discovery of sensorimotor schemes.
  • Sounds become symbols for inner/outer experiences.
  • Pattern repetition → need for complete expression.
  • Increasing communicativeness & control; less self-centred.
  • Musical autonomy & lifelong relationship with music.

Principles for Facilitating Individual Sessions

  1. Base on comprehensive assessment (medical, psychological, musical, social, cultural, prognosis, team goals, length of stay).
  2. Select music aligned with client preferences & background.
  3. Maintain a flexible yet goal-oriented plan; allow emergent needs.
  4. Monitor & document progress with setting-appropriate data.
  5. Evaluate & revise goals on scheduled dates.
  6. Refer to other professionals when needs exceed music therapy scope.
  7. Include client in planning, evaluation, and revision when feasible.

Student Assignments (Summarised prompts)

  • Investigate how your practicum group was formed and leadership style used; justify classification.
  • Analyse group’s developmental stage (Corey et al., Hibben, James & Freed frameworks).
  • Evaluate adherence to Plach’s guidelines; reflect on consequences.
  • Identify Yalom’s factors evident in your group.
  • For individual work: assess why client is in individual format; speculate on group suitability.
  • Map client’s progress through Bruscia’s stages and Aigen’s experiential states.