Where's the science gone?

I love research. In my first year of music therapy masters I particularly fell in love with quantitative research and loved the idea of being able to conduct huge randomised controlled trials to show that music therapy is effective. In my second year, however, my love of research moved towards qualitative. So began this internal fight between numbers, logic, measurable findings - and - stories, emotion and individualised experiences of treatment. Both have a place in my world.

But - over the last few years, my experiences, conversations and reading have started me questioning the research that is thrusted into our lives whether we like it or not (yes - we are all effected by research even if we are not aware of it!).

During my music therapy life, I've been made aware by colleagues on the very experimental nature of psychiatric medications and that the trials are often funded by drug companies. At the 2012 Australian Music Therapy Association Conference in Sydney, I saw Dr Graham Martin reflect on his own experiences in challenging 'evidence-based practice' with 'practice-based evidence.' Then not long after, I came across this TED talk by Ben Goldacre: "What doctors don't know about the drugs they prescribe." For anyone passionate about mental health care, I strongly recommend you watch it.

This topic always makes me question why do we trust this research? Why is it that this poor quality research becomes the 'evidence base' of medicine and treatment? But then I also think. If I conducted a trial on music therapy and the results were negative - would I publish it? My initial thought was - of course not! Now, I feel like I would have an ethical need to do so. But I'm also aware now that other professions have studies that 'fail' - of course it's inevitable that all therapy and treatment trials will fail before they succeed. In failure there is a risk of being shunned and disconnected - so I worry that we are in a place where we try so hard to succeed, that we are missing the very point of research.

When I was at uni, we were told that scientific research should be empirical, sceptical, critical, tentative and open for the public. So my question is - where has the science gone?

The government tend to fund therapies and treatments that have a strong 'evidence-base.' Research is considered an ethical risk if an 'evidence-based' treatment was to be taken away from a participant. So what do we do? How can we prove ourselves, when the most trusted medical research has lost its scientific purpose? Do we keep trying to prove ourselves with quantitative research - and hope that they are positive and that we'll get noticed - or do we use the individualised stories of qualitative research because individuals respond differently to treatments anyway - with the chances that we don't get noticed?

For now - I'm just glad that I'm a clinician not a researcher. I will use the 'evidence base' to inform my 'practice-based' evidence in order to provide the treatment that I believe (and continue to observe) to be quality. Though I know I need to get my own knowledge out beyond the four walls of my own mind - so I will explore my research with the curious, scientific, sceptical and critical mind that research deserves.

The conformity box

As adults we so quickly fall into training babies and children to be adults. I think though that they have so much to teach us if we let them.

Conformity can begin from birth in our culture. There are many benefits. Conformity gives us rules and guidelines on how should dress, behave, speak and how not to dress, behave and speak. When it works well, conformity looks neat and tidy. So all in all conformity works right?

Maybe there is a home for it somewhere, but I haven't found it to be effective in my own existence as yet. If we don't fit into the neat tidy box of conformity (which we all experience at various points in our life if not every day!) we are considered to be weird, different, a loner, misbehaved, too quiet, too loud, mentally ill or essentially not good enough. If we do fit into the box, we spend every day putting all of our energy into keeping our place in the box. I have so many concerns on how this affects us through youth and adulthood.

I'm not gonna lie. I step into conformity myself. Sometimes I wish people would be just like me, I wish people or children would do what I tell them to and then other times I try to squeeze myself into the right type of clothes, the right groups of people and try to be the cool, calm, outgoing, in control person. These are the days I feel powerless and small no matter how successful I am at getting myself or others into that box. I believe that conformity breeds anxiety, stress, anger, depression, fear, self-hate, shame and possibly much more.

The days that I feel my best are the days that I let myself learn from the people and events in my life and surrender myself to not knowing (turns out I can't read minds or the future), creativity, play, curiosity and the gap in life. I didn't learn that from my family or my school education...I first learnt it through music, art and dance...and try to practice it in the way I play, rest and work :)

Where does conformity fit for you?

What is mental illness?

Ok mental illness is out in the media again...and now the DSM-V has psychiatrists split 3 ways about what mental illness actually is. Is this a turning point in mental health care?

I write this post with somewhat hesitance. On part, because there's a part of me that feels I need to serve  my standing in the hierarchy of mental health care and watch the 'experts' make a decision - and then my personal need to be respected by medical professionals. So I'm going to put my 'professionalism' on the line and chat about what mental illness means to me.

I can see how diagnoses came to be important as psychiatry developed in the 1900s - and I do believe that they serve a purpose to an extent. I often see how it can be helpful for people to receive a diagnosis - but I also see the other side - when it is really unhelpful...and where a diagnosis begins to define who a person is - resulting in a lesser capacity to make a recovery. Here I'd like to share why I personally do not refer to diagnosis directly - but prefer to work with the whole person.

I truly believe we are all on the spectrum of 'mental illness' or rather mental health. The book, "We are all weird" by Seth Godin - while I have not read it yet - I think will sum it up when I get around to it (see below)!

While we are all on the spectrum of mental health - at varying times we have more resilience and protective factors keeping us going...and sometimes our risk factors are holding us back from living a full life. There are some people with numbers of risk factors - but yet seem to bounce back with no troubles - then there are some with a few risk factors that have difficulty engaging with life. Then there are some with so many risk factors who have never had the opportunity to build on their resilience. What would happen if we looked at building resilience to improve a person's capacity to bounce back from adversity? Did I lose you at risk and protective factors? I can't find any good simplified links that explain the concepts - but will keep looking...or I might just have to write another blog post :)! 

Ultimately, I believe this is what the recovery model is about - and I am really excited that psychiatry is starting to take these elements into practice....and so begins a culture change in the world of mental health...

Maybe it will fit into the Press Play vision?
"A world where creativity, music, culture and collaboration are valued factors in mental health prevention and intervention."

Music therapy, medications or talking therapy?

Throughout my time practising as a music therapist, I have worked closely with the 'talking therapies.' People often wonder what added benefit there is from music therapy - especially when talking therapies, (specifically Cognitive Behavioural Therapy) and medications are the 'evidence-based' therapies at present. What do you get in music therapy that you may not get in talking therapies alone?

Holistic treatment
Often talking therapies are based at a very 'cognitive' level. This works really well for some people, but in some cases a person may not be in the right headspace to rationalise or process cognitively; and in some cases talking therapies can be a welcome opportunity to intellectualise our thinking or doing - which can impede on our capacity to make active change in our lives.

Pharmaceutical therapies, while very effective to stabilise mood and chemicals in the brain are known not to be effective without additional therapeutic support. Medications may assist to kick-start therapy, however, I work from the understanding that particular experiences produce long lasting changes in the brain and body.

Through music therapy, I work with an individual from many different angles. I am aware that many of us (including myself!) cannot work at a cognitive level until the rest of our system is more 'in sync.' Therefore, I may focus more on physical or physiological functioning, state of arousal, sensory systems, motivation, meaning and/or emotions through music based experiences to better prepare our brains for processing and understanding challenges, traumas or memories - to then move towards empowering individuals to 'press play' or 'author' their future.

Individualised treatment
I'm aware that many therapists and therapies aim to cater directly to the individual - but I'd like to share how I may be customise therapy according to who I'm working with.

• Every session in music therapy is different - while I do work from specific structures and frameworks - everyone has a different brain and body - therefore, I adapt everything according to the unique needs and dreams of every person I work with.
• I work with whatever is brought into therapy. Regardless what may have happened in a previous session, I find it really important to check in with what a person brings into the room with them - before moving on to their long term goals
• Whatever is important to you is important to me (sorry for being a little cliched!). I don't write goals for you - we work together to find out what you'd like to get out of therapy - I will make some suggestions based on your personal values, but your motivation to be in therapy and life is what will take you to those goals and your purpose.
• What music works for you? What music doesn't work for you? What does music mean to you? What is meaningful to you? We'll use music in a way that addresses your needs.
• The communities, cultures, and people we are surrounded by also play an important role in our identity. For this reason I also consider the way a person fits into the map of their communities or families and how this may need to be changed for a person to recover from their immediate challenges.

Music

We use music as a tool to make chemical changes in our brains and bodies or to establish or strengthen pathways in the brain. We use music to help us feel, connect, communicate, express ourselves, think or do. We use music as a health resource - for you to take and use in your every day life. Music is powerful. Relationships are powerful. Combine the two and you get music therapy.

So music therapy, medications or talking therapy...which one?

It depends on what works for you :)

I firmly believe (and research supports this) that the therapeutic relationship is imperative to recovery. Some people don't respond to music therapy and others will only respond to music therapy.

Regardless, each person needs to find what works for them.