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When music therapy is not always the right treatment Sarah Morgan, a music therapist at Chroma, talks about the importance of client autonomy
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usic therapy and neurologic music therapy are evidenced to provide clear benefits to speech and movement following a brain injury, but occasionally it is not the right therapeutic route for the client. I recently met a client who had referred themselves for music therapy. Suffering a traumatic brain injury over 20 years ago, the client underwent rehab including physiotherapy and speech and language therapy and was later deemed to have the capacity to live independently. During the assessment process, it was clear the client had cognitive deficits such as poor short-term memory, difficulty understanding some of what was being discussed, planning and organising and slurred speech. After some research and having exhausted other therapies, the client hoped music therapy would further improve movement and speech. During the first session, we discussed
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the damaged part of the brain that processes speech and moves towards the unaffected part of the brain that processes singing. While the engagement was high, the client clearly felt self-conscious, and the initial results were not what the client expected. This is understandable as although these exercises are effective immediately after a brain injury, the client, who was an older adult, felt the tasks were a bit childish. After discussing the sessions and arming the client with all the facts, the client chose to end therapy. Importantly, the client had the mental capacity to make that decision. The client chose to begin music therapy and stop it, demonstrating just how important it is expectations, and shared insight into for people to be empowered to make how music therapy works, timeframes their own decisions. and realistic goals. Music therapy works. We know it does, A three-way combination of Patterned Sensory Enhancement (PSE) exercises, but it is not for everybody, and part of where music supports the client’s range our role is not only to deliver it to the highest standards of therapeutic input, of movements, basic speech therapy but to know when it’s not right for that exercises with different sounds and phonemes and Melodic Intonation Ther- client. Unfortunately, in this case, it apy (MIT) to encourage singing a phrase was not right, but the client chose to as opposed to saying it was used during try it, realised it was not for them and stopped the sessions. All I could do at the sessions. Such exercises bypass that point was offer alternative recommendations and wish the client well. A client-centred approach is about establishing trust and a partnership between practitioners and clients, focusing care on the needs of the individual and ensuring that people's preferences, needs and values guide clinical decisions and sometimes that means being honest about the right support clients’ needs, even if means finishing a piece of work earlier than planned.
Music therapy works. We know it does, but it is not for everybody