MUSIC GROUP PSYCHOTHERAPY
BECKY BUTLER
ColumbusStateHospital
T HE MOST IMPORTANT CONSIDERATION
ginning a music-psychotherapy
to have a psychiatrist who is both interested
in be-
group is
in music therapy and willing to devote one or
more hours per week for the psychotherapy
sessions. The psychiatrist and music therapist
should work together as a team in setting up
the group. They should also set aside a special
time each week to discuss the progress of the
group and to discuss each others views on
certain matters concerning the group. The
psychiatrist plays the role of group leader.
This means that he is there mainly for guid­
ance and suggestions which are based on his
knowledge and experience within the field
of psychiatry. The music therapist plays the
role of cotherapist. His responsibility is to
share in the transference and to help prevent
feelings of omnipotence from developing.
The next important consideration is the
selection of patients for the group. The pa­
tients selected can determine the cohesiveness
of the group. Important questions in select­
ing patients are:
1. Are the patients going to be all of one
sex or mixed?
2. What age group are to be dealt with?
It is better if the age range of the group
is not too wide-ten years or less is
preferable.
3. What diagnoses should be included?
Are the patients going to be short-term
patients whose stay in the hospital will
not extend a year, or are the patients
going to be long-term patients who
have been and will be in the hospital
for many years? It is important to keep
in mind that patients should be capable
of insight and have the ability to co­
operate, if the group is to reach its goal.
Acute cases of catatonic, paranoid, and
undifferentiated schizophrenia with ac­
tive delusional systems, and cases of
deep-seated depression, therefore, have
to be excluded from the group. Some
schizo-affective reactions in the con­
valescent stage, “ambulatory” schizo-
JUNE, 1966
phrenics, and some forms of mild de­
pression, however, can be reached by
group psychotherapy. Schizophrenics do
not fit easily into group psychotherapy,
because their anxiety is so great and
their lack of relatedness so profound
that it is difficult for them to take part
in any group.
4. Are the patients of comparable intelli­
gence?
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5. Do the patients come from similar en­
vironments?’
Such factors as these are essential in con­
sidering the selections of patients for a group.
With such factors in mind, patients are inter­
viewed to determine those who fit the quali­
fications and would benefit from participation
in a music group. Selecting patients with dif­
ferent temperaments helps to increase the
potential of the group. If a group is begun
with all withdrawn or shy patients, it will take
the group a long time to work. The group
should be kept small, not more than ten mem­
bers and no less than seven.²
At Columbus State Hospital we have a
group of all female patients, ages 30 to 40.
The following characterizes the members of
the group:
1. Depressive reaction, either psychoneu­
rotic or gross stress reaction.
Obsessional reaction thinking.
3. Cooperative.
4. Religious preoccupation.
5. Guilt feelings.
Paranoid ideation.
7. Anxiety.
8. Suicidal preoccupation or history of
suicidal attempts.
9. Fixed delusion which fails to respond
to individual therapy.
Diagnostic categories play an important
role, but are not used as determinative fac­
tors in the selection of patients. A patient
might be schizophrenic as long as he is still
in contact with reality. The patient might
even have delusions, paranoid ideations, or
53
hallucinations, but if he can cooperate he
can be a member of the group. A patient di­
agnosed as depressive reaction, depressive
type, was accepted in our group on a trial
basis, but she did not fit well into the group,
since in the depressive state, she did not in­
teract, and in the manic state, she dominated
the whole session. The strictly depressed
type might benefit more from the group than
the manic.
The location for the group meeting is im­
portant. The area should be large enough to
accommodate the group, but it should not
be so large that it swallows up the conversa­
tion of the group. To maintain the group in­
terest during the sessions, the area should be
protected from external interruptions. Also,
the group sessions are usually taped; location
is important for this reason. The room should
have a relaxing atmosphere to help alleviate
the restrictive feelings the patients may have
on the ward.
Of great importance is the procedure used
in conducting a music-psychotherapy group
session. The first consideration is the selec­
tion of music. Songs are previously chosen
by both the music therapist and psychiatrist.
In selecting the songs, the mood and rhythm
of the music is kept in mind, and the lyrics
are carefully read and chosen to fit or have
similarity or resemblance to the psychiatric
problem of the particular patient. Using the
lyrics of the song as a basis, a patient may
interpret and verbalize freely, projecting his
own feelings into the discussion. For example,
the song “Don’t Fence Me In” can be easily
used this way. One patient may interpret the
lyrics with reference to being fenced in, in
the hospital, and yet another patient may feel
fenced in at home. Through the interpreta­
tions made by various patients, group inter­
action is allowed to take place. If a patient
interprets the lyrics to fit her delusion, the
other members of the group can then be en­
couraged to react to the interpretation. Of
course, the psychiatrist should always be on
hand; if the patient becomes uneasy, he can
change the discussion by asking another pa­
tient his feelings of a different song.
The piano seems to be the best instrument
to use, however, a guitar or autoharp might
be substituted. Usually patients are seated
in a circle, with at least two patients who
interact and verbalize well at opposite ends;
54
this helps to keep the patients in between
mentally alert so that they can follow the
exchange of ideas. A tape recorder with
multiple microphones is the ideal recording
set-up.
In the first session, the therapist and co­
therapist explain the purpose of the group
so the patients will not develop unnecessary
suspicions. After the explanation, the singing
begins. This isa good way to begin, since
singing seems to relax the tensions in the
group and seems to help the conversation
along. It is advantageous to have included
in the circle a music therapist who has a good
projecting voice and can demonstrate his
feelings in the group. He has the important
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role of adding support to the group and, in
some cases, of leading the singing. Often the
members of the group find themselves sing­
ing at the top of their lungs, even the psy­
chiatrist and music therapist.
The music therapist at the piano has the
same role. He can easily project his subjective
feelings at any particular moment. For ex­
ample, one day after I had had a hectic day
trying to prepare the summer musical project,
I was exhausted, and this feeling was quickly
transferred to the members of the group who
reacted with less enthusiasm and less inter­
action. At the close of the session, many of
them remarked, “Why did you select those
songs’? They were depressing.” The same is
true with the psychiatrist. The whole group
responds equally to the feelings projected by
both the psychiatrist and music therapist.
After singing for about half an hour, dis­
cussion begins. The prime goal is to have
the members of the group initiate the discus­
sion, thus permitting the therapists to play a
more passive role in the group. In our general
observations, we have noticed that a patient
can verbalize and project his own personality
into the discussion more easily by using the
lyrics of a song as the object of discussion.
Anxiety and uneasiness of the initial group
meeting is eliminated by preventilation
through singing. Group interaction is easier,
because the singing begins an interaction
which is later transferre d to the discussion
period. The psychiatrist and music therapist
are on an equal, rather than the “high and
mighty,” level with the patients, because they
also participate in the group. It may take a
long time to reach the prime goal of the
group, their initiation of the discussion, but
when it is achieved, the group seems to be
closer knit and to show more concern for
each other. They work to help one another
with their problems.
The future and further aims of our music­
psychotherapy group are as yet undefined.
There is still much research and experiment­
ing to be done. At least the door has been
further opened to the technique of combin­
ing music therapy and group psychotherapy.
Now, all that is needed is some willing music
therapists and psychiatrists. Some of the aims
which we will be striving for at Columbus
State Hospital are:
1. To shorten the hospitalization of the
patient by having a more intensive
music-psychotherapy group program.
2. To show that, with the close teamwork
of the music therapist and the psychi­
atrist, a greater numebr of patients will
benefit from both music therapy and
group psychotherapy.
3. To develop a more dynamic sense of
therapy in music therapy through the
direct relationship with psychiatry.
4. To awaken and develop the interest
and curiosity of psychiatrists in music­
psychotherapy groups.
We have just started an adolescent music­
psychotherapy group and hope to begin an
interpretive dance group with adolescents in
the near future.
case studies
CASE I. A 35-year-old, white, female, was
admitted on February 4, 1965, to Columbus
State Hospital, because of a mental pre­
occupation that she might hurt her children
and husband. Her trouble first started in
1962. She had previously been in Cambridge
State Hospital for one month in 1958, and
again in 1964, following a suicidal attempt.
In 1965, she was admitted to Columbus State
Hospital because of nervousness and depres­
sion together with a recurrence of homicidal
symptoms. Subjective fears surrounding her
obsessional thoughts became so fixed that
psychotherapy failed to dislodge them. At
one time she had been sent to a Family Care
JUNE, 1966
Home, with weekly therapy instituted to pre­
vent the possible homicidal risk in the family.
On the ward, various interviews with the
patient were all successful, as she related
freely though often interrupting with crying
spells. She openly expressed hostility to the
present job position of her husband whom
she accused of getting his time from her.
This feeling was clearly demonstrated on one
visit by the husband when he could give her
only a few minutes of his time. She broke
into such a temper tantrum that seclusion was
necessary.
The patient’s husband is domineering and
authoritative, giving her no choice but to
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suppress her own hostility. She has four chil­
dren, yet she cannot establish a relationship
as a mother. Due to her emotional condition,
she was advised against another pregnancy.
The patient, before attending music therapy,
had never spent a holiday at home and could
not adjust to the home setting. At the present
time, she is still attending therapy, coming
from Cambridge, a one and a half hour drive
to Columbus. She reports with joy that, for
the first time in three years, she is able to
spend her holidays with her family without
going back to the hospital. At the present
time she is working with her husband in his
office, as his secretary. Homicidal ideation
has subsided.
CASE II. A 41-year-old, white, female,
was readmitted on February 16, 1964, be­
cause of depression, suicidal thoughts, and
hearing taunting voices. She had run away
from the hospital on December 9, 1963, when
she found out that her pregnancy could not
be interrupted. She had had no prenatal care
and no medication. She had become increas­
ingly nervous, had refused to eat, and wanted
to commit suicide and destroy the baby. The
patient felt very guilty about this pregnancy
and for letting her son down by her action.
She has been in and out of hospitals four
times. All previous admissions were charac­
terized by depression, crying, suicidal at­
tempts, hallucinating about somebody con­
trolling her feelings, untidiness, unkemptness.
The patient verbalized her whole delusion
without hesitancy in the music group. She
seemed to have no fear of exposure in the
group. She admitted that she did report some
55
to her psychiatrist, but not as detailed as she student. A recent trial visit report is excel­
did in the group. In her first group meeting, lent, with no recurrence of delusions so far.
she practically consumed the whole session.
At succeeding sessions, her personal appear- REFERENCES
ance was improved; she was not as “sloppy” 1. Curt Boenheim. “The Role of Group Psycho­
or untidy with messy hair; she was neat. therapy in a Mental Hospital—Goals and
Problems Training,” Columbus State Hospital,
The patient is now on a trial visit, working 1964, pp. 14-24.
steadily, and living with her son who isa 2. Ibid.

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56 JOURNAL OF MUSIC THERAPY