A new method in social psychiatry

The aim of this brief explanation of Social Music Development (SMD) is to share the cultural and professional values of Støtte- og Kontaktcentret (SKC) regarding the method we use for our music activities.

The model we're going to describe was created deliberately, openly, and inclusively by those who were, are and will be part of it. These activities have been designed for social psychiatry in order to combine psychology with music in a new and creative way. Several studies emphasize the impact of music on personal skills such as IQ, language skills, and mathematics while a minority of studies highlight the positive effect of music on social skills. We have directed our attention and curiosity to these latter skills.

While creating music activities at SKC we encountered two approaches: music therapy and music education. We have been profoundly inspired by them but it is necessary to differentiate ourselves in both cases.

 

Firstly, social psychiatry is held in a specific non-therapeutic setting that doesn’t have therapy as an explicit goal. In other words, the therapeutic process at SKC takes place implicitly.

This kind of indirect therapy is different from therapeutic  models, for example music therapy, that we could find in other social and health care facilities. However, we share with them the core etymology of the word therapy, that is: to promote change, to help, and to heal.

 

Secondly, SMD should not be confused with music school. The aim of our approach is not primarily to teach how to sing or play an instrument. Instead, the focus is placed on how to play and sing with other people, developing social skills through interaction. Music is the glue that facilitates socialisation.

 

The elements that we consider necessary to create and strengthen the foundations for solid social skills in our method are: inclusion, social attunement, communication and collaboration.

An important aspect of SMD is the dynamic process  through which social interaction is facilitated. It is crucial that participants have the opportunity to experience new tasks, situations and functions in order to develop social competencies.

The activities are structured for two settings: individual and group. The individual setting provides a transition period for those people with social difficulties to strengthen their interpersonal abilities with consequent gradual entry (after a period of 1-3 months) in group activities.

The group setting are of two types: open and closed. Both group settings offer the space for guests to create and to express themselves with others. All our users can participate in open sessions, while closed sessions require a minimum of 3 people and a maximum of 5 people who want to invest in a more structured project with set goals.

The main object of our music activities is to create and reinforce basic social skills. Several schools of thought during a variety of historical periods have been dedicated to clarifying social competencies. This is an extremely complex and arduous task, made even more difficult by the challenges that we face daily in our modern society. Even more difficult still is to create a theoretical model that is relevant and useful for social psychiatric settings. Fortunately, we have been able to draw on the work of Preben Bertelsen and his TP model. 1

The competence wheel allows us to work constructively, combining theory and practice in a balanced way during music activities.

 

Description of SMD

Inclusion

There are three important aspects of inclusion: firstly, to create a sense of community; secondly, to combat stigma; finally, to welcome everybody regardless of their music abilities.

The primary aim of inclusion is to strengthen a sense of belonging in contrast to social isolation by creating a safe environment in order to explore different model of attachment 2 for all participants. Being an active member of a group 3, influencing the decisions of the music activity and co-creating with others helps to establish boundaries between participants and has a positive impact on users self-perceptions.

Inclusion also allows us to address stigma. Psychiatric stigma poses many difficulties, including exclusion, which can reinforce the negative beliefs and stereotypes of patients themselves within the psychiatric population: the Self-Stigma 4.

Whitwell (1997) writes that creative participation in music group sessions helps to improve self-image, self-awareness, and to foster positive attitudes about oneself. 5  In our activities we overcome the barrier of psychiatric stigma and stereotypes related to it by helping individuals create bonds with other people and not act in a discriminatory manner.

Finally, the SMD´s activities are available to a broad psychiatric population, allowing everyone, with or without musical knowledge, to participate actively in our music program. For instance, songs in general are simplified in order to make them accessible to users. By restructuring songs together we ensure that everyone can take part in the activity, feel positive and experience a sense of achievement.

 

Social Attunement

Three key ideas related to social attunement are to make emotional contact, to establish relationships with other people, and to understand other people.

Every time we share space and time with other individuals we have an emotional connection. In fact, Povinelli (1993) 6 wrote that infants come into the world “prewired” by evolution with the motivation and capacity to begin establishing an immediate social relationship with their caregivers. This innate feature of human beings is vital.

To harmonize with the environment and the individuals who are part of it is a fundamental aspect of development and emotional regulation. Schutz, in his essay Making Music Together 7, defines the mutual tuning-in relationship as the essential structure of social interactions, emphasizing the spontaneous and intuitive aspect of pre-linguistic communication. During the music activity,  users can communicate without words through eye contact, listening, and body language, strengthening their connection with one another as they play music.

Playing music, like playing games, is a form of social interaction through which social skills, rules, and turn-taking are all learned and practiced in an interactive way. Playing music reinforces cultural expectations, giving people the possibility to intuitively understand one another.

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Communication

Communication is important for three main reasons: firstly, self-expression; secondly, self-perception; finally, constructive feedback.

During the musical activities we create opportunities for sharing. Self-expression allows people to distinguish and discern themselves from others. Research proves the importance of self-expression as social behaviour can affect and alter internal psychological processes. 8

We believe, as Freud did, that through self-expression one can develop a more authentic and accurate self-perception. 9 This also gives us the possibility to reflect on our own beliefs and needs, and confirm or challenge our self-concepts. 10

Constructive feedback is another vital element in SMD. By sharing with others, users give feedback to group members in a valuable and useful way. Participants also learn to hear feedback and adjust self-perceptions and self-expression accordingly. We have been inspired from the sandwich feedback approach. 11 In this simple model our participants share in a respectful way something positive and something that could be improved.

 

 

Collaboration

Collaboration is a notable aspect during the activities and contains three sub-elements:  firstly, mentalization; secondly, planning with others; finally, ZPD ( zone of proximal development ).

Cooperation requires the ability to mentalize 12 in order to have constructive interactions. In fact  mentalization allows the interaction between two different experiences of thoughts and feelings: the perspective of SELF and the perspective of OTHER. The result is that people have and experience more profound and empathic social exchanges, which makes collaboration possible.

The music session is planned through the involvement of all members. As mentioned before, these semi-structured activities are co-created by the participants through suggestions and feedback. Planning is the core aspect of collaboration as all members give input in order to play  or sing during the music activity.

Social workers have a role as facilitator during delicate moments of collaboration. This can be done directly or indirectly, in order to meet each participant´s ZPD (Zone of Proximal Development) 13. In other words, the difference between what a person can do alone and what the same person can do in collaboration with more able others.

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Conclusion

The aim of these music activities is to create a space for young people where they can express themselves, engage in social activities, and apply the skills they learn (or improve) for reintegration into society.

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Users have been present at music activities 1057 times during 2014, showing an increase of 76% over the year 2013 . Our goal for the year 2015 is to increase the participation of different users up to 30 people per month to achieve approximately 1200 attendees per year.

In addition, we have a number of projects such as individual sessions, group activities, social compositions, recording sessions and concerts. We are continually expanding with the view of meeting all participants´ requests, ideas and needs.

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At SKC, we strongly believe that music can be a powerful catalyst for social interactions.  When a music session or concert is finished, we see the fulfilment of our goals in tangible ways with the joy and satisfaction of those who have been part of it.

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The intentional use of the pronoun we is part of an empowering process 14, in which we feel ourselves to be co-creators of the activities. This is essential in order to grow on both personal and social levels. The constancy of users shows us how important this value is combined with a Feedback Culture 15 in which all comments from everyone become precious instruments for the purpose of change and improvement.

In order to promote the feedback culture, we have created a special form (see page 6) that will allow us to talk after each session with the users about the elements previously described, and collect this information together.

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Our idea has been to create new kinds of music activities for social psychiatry, emphasizing the social aspect of music. We intend to share a cultural space filled each day with curiosity, passion, willingness, and authenticity.

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    In this way, we can influence who we can become.

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Acknowledgment:

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I would like to thank all the users and colleagues at SKC ung who supported me and have spent so much of their time sharing with me about this project.

A special thanks to Karin Rue, former supervisor, for her trust in giving me the opportunity to start the project and for her numerous ideas and invaluable advice.

A heartfelt thanks to Steffen Holsøe for his help and cooperation during the various music activities.

 

 

References

1. Bertelsen, Preben. Tilværelsespsykologi - et godt nok greb om tilværelsen. Frydenlund, 2013.

2. Inge Bretherton."The origin of attachment theory: John Bowlby and Mary Ainsworth", Developmental Psychology (1992), 28, 759-779.

3. McMillan, D. Sense of Community: A Definition and Theory. Journal of Community Psychology. Volume 14, January 1986.

4. Corrigan PW. Self-stigma and the “why try” effect: impact on life goals and evidence- based practices.  World Psychiatry 2009;8:75-81.

5. Whitwell, D. (1997). Music learning through performance: Austin: Texas Music Educators Association.

6. Fred R.Volkmar, Rhea Paul, Ami Klin, Donald Cohen, Hand book of autism and pervasive developmental disorders. New Jersey, 2005.

7. Schutz A. Making Music Together. A study on social relationships. In: Schutz A. Collected papers. Vol II, Den Haag: M. Nijhoff 1964.

8. Heejung S.K.,  "Express Yourself": Culture and the Effect of Self-Expression on Choice. Journal of Personality and Social Psychology, Vol 92(1), Jan 2007, 1-11.

9. Breuer, J., & Freud, S. (1957). Studies on hysteria (J. Strachey, Trans.). New York: Basic Books. (Original work published 1895).

10. Constantine Sedikides, Steven J. Spencer. The Self. Psychology Press, Sep 22, 2011.

11. Peter Cantillon, Joan Sargeant, “Giving feedback in clinical settings”. BMJ volume 337, 29 November 2008.

12. Allen, Fonagy, & Bateman. Mentalizing in Clinical Practice. Washington, DC: American Psychiatric Pub, 2008.

13. Vygotsky, Lev. “Interaction between Learning and Development.” In Mind in Society: The Development of Higher Psychological Processes, edited by M. Cole, V. John-Steiner, S. Scribner, and E. Souberman. Cambridge, Mass.: Harvard University Press, [1935]

14. Zimmerman, M. A. (2000b) Empowerment Theory: Psychological, Organizational and Community levels of  analysis. In Jullian Rappaport and Edward Seidman (Eds.) Handbook of Community Psychology (pp. 43-59). New York: Kluwer Academic/Plenum Publishers.

15. Miller, S. D., & Bargmann, S. (2011). Feedback-Informed Treatment (FIT): Improving the Treatment of Male Clients One Man at a Time.  In Ashfield, J (Ed.), “Doing psychotherapy with men: Practicing ethical psychotherapy and counselling with men.” Australian Institute of Male Health and Studies, and Amazon.

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