Exploring mentalization-based music therapy in an adult acute psychiatric inpatient unit: a case study

Abstract

Set within an adult acute psychiatric care unit, this case study explores the emerging approach to music therapy that blends features of mentalization-based treatment (MBT) and psychoanalytically informed music therapy. Reflexive investigation was employed using a clinical example to illustrate how ‘mentalizing’ unfolds in the process of music therapy practice. Additionally, the experience of the researcher as a trainee practitioner is considered. Literature on the subject of mentalization-based music therapy (MBMT) suggests that music can be utilised by a practitioner to regulate arousal (facilitating successful mentalization), and to validate both internal emotional states and external expression, building ‘epistemic trust’ and understanding of interpersonal processes. This can be achieved using both active and receptive interactions with music, as well as explicit verbal reflective discussion. Inductive thematic analysis of reflexive session transcripts revealed that there is significance in understanding the implications of ‘promoting agency’ within MBMT – namely, how a patient feels when in or out of control and how capacity to mentalize is gained or lost in these situations. Three other themes (being present, the value in ‘not knowing’ and epistemic trust) are revealed from the case study analysis and discussed as important aspects of both MBT and psychodynamically informed music therapy. Additionally, the importance of supervision and attention to reflection is re-confirmed as a way to aid practitioners in remaining in the ‘here and now’ when with a patient, and to gauge when the patient or practitioner is in a non-mentalizing state.