Music therapy in mental health for illness management and recovery

The second edition of Music Therapy in Mental Health for Illness Management and Recovery by Michael J. Silverman (2022) focuses on promoting illness management and recovery for people with mental health conditions through a cognitive behavioral, motivational, and educational model of music therapy. Silverman authored his second edition of the book to be more “reflexive and scholar-centric” (p. viii), as he provides discussion questions after each chapter in addition to ideas for possible supplementary assignments.

In the preface, Silverman addresses major key points including the purpose of the text, a statement about privilege, an explanation of editions one and two, a notice about “jargon,” the philosophical and contextual underpinnings of the text, caveats, prerequisites to reading and understanding this text, discrepancies between research and clinical practice in mental health, a discussion about musicality, and an explanation about how to use the text effectively. The introduction is written with the intention of allowing the reader to become familiar with the expert and authentic tone of the author.

In chapters one and two, Silverman provides an overview of factors that people with mental health conditions may be experiencing, etiology of mental illness, and various treatments and management techniques for mental illness. Implications for music therapy are described for illness recovery and management. While it is important to avoid absolutes, for example “music therapy always works and is effective,” (p. 32) Silverman shares evidence of positive effectiveness data that music therapy is effective for addiction treatment. Each chapter ends with a “main ideas box” to summarize the key points and includes questions for review and discussion.

Chapter three focuses specifically on the history of music therapy for adults in mental health settings. The chapter begins by introducing the complexities of the music therapy profession due to its broad scope of practice. Silverman then describes current and historical music therapy practices in mental health settings including long-term, acute care, and group music therapy. Silverman references common mental health objectives in music therapy including coping strategies, decision-making, leisure skills, problem-solving, substance use, symptom management, mental health knowledge, and community reintegration and resources.

Chapters four and five offer the reader an understanding of prevalence of substance use disorders, stages of addiction, recovery process, non-music therapy treatments, and music therapy treatments for illness management and recovery. Silverman addresses the Transtheoretical Stages of Change; precontemplation, contemplation, preparation and determination, action, and maintenance. While he mentions various forms of treatment in illness management and recovery, he highlights the importance of motivation in the recovery process. Music therapists who work towards goals of illness management and recovery emphasize autonomy and self-determination, which aligns with other traditional therapeutic approaches.

Chapters six through eight cover illness management and recovery approaches, music therapy as a therapeutic mechanism, and the importance of relationships in recovery. Trauma-informed care is the focus for mental illness management and recovery, as Silverman describes group therapy practices, facilitating group discussions, various approaches to illness management, and coping strategies. Music therapy can be an effective mechanism for change when service users and music therapists are able to effectively work together. Other considerations cited as mechanisms of change include cognitive, affective, and behavioral factors. Music therapy applications are considered at the conclusion of chapter seven. The chapter on therapeutic relationship and alliance is a new addition to the 2nd edition. Silverman references the significance of therapist adaptability, collaboration in problem-solving, and methods of developing an alliance with service users.

In chapters 9 and 10, Silverman discusses approaches and theories for music therapy in mental health settings. Wheeler’s “Continuum Model” is referenced as a foundational construct for the relationship between music and verbal processing in music therapy and mental health treatment. Silverman then takes a deep dive into transdiagnostic theory and provides a clinical example to illustrate how this theory can be applied to a music therapy treatment in mental health. Rather than focusing on the diagnoses specifically, this theory allows the music therapist to emphasize the importance of motivators, strengths, and resources.

Chapters 11 through 13 address music therapy treatment processes and interventions used in adult mental health settings. Diversity in adult mental health is the primary focus of these chapters. Silverman discusses intersectionality, cultural humility and reflexivity, the LGBTQIA + community, and those who have disabilities. Expanding on these topics, Silverman considers diversity, or lack thereof, in the music therapy education system. He positions the text as a whole from a Western lens and acknowledges the need for a more diverse perspective in the field of music therapy practice and education.

Silverman explains the process of treatment planning including in-services, referrals, assessment process, goals and objectives, monitoring progress, documentation, and discharge, in addition to providing clinical examples of and sample forms that can be utilized for teaching or professional purposes. The section closes with a model of how a music therapy session might be implemented into the treatment process. Chapter 13 includes various music therapy methods and interventions that may be effective in psychiatric populations. Some examples are verbal processing, songwriting, lyric analysis, rhythm-based interventions, group drumming, music and art, social stories, and improvisation. Silverman expands on each intervention, providing variations of facilitation, goals that may be addressed, and suggestions for specific materials and/or song selections.

The final three chapters focus on research in music therapy for mental health, the evidence-based practice (EBP) of music therapy in mental health, and the future of music therapy and mental health. While objectivist research is predominantly the focus of generalizable literature, Silverman mentions the importance of interpretivist research and the need for input from the service user. He concludes chapter 14 with a table, alphabetical by author, of objectivist music therapy studies involving adults with mental health conditions. Included in the table are the independent and dependent variables, number of participants, diagnosis, research design, and results of the study. Silverman emphasizes the significance and demand for EBP in music therapy. To support music therapists in this process, he includes a table that outlines his five steps of EBP; (1) ask the clinical questions, (2) collect the most relevant and best evidence, (3) critically appraise the evidence, (4) integrate all evidence with one’s clinical expertise, patient preferences, culture, and values in making a practice decision or change, and (5) evaluate the practice decision or change. The table describes each of these steps and provides the music therapy-specific application. Specific evidence-based treatments are also described for adults with mental health conditions and adults with substance use conditions. Silverman concludes the text with a discussion on the future of music therapy with mental health populations including models in music therapy and considerations for music therapists working with these populations.

Silverman addresses an extensive breadth and depth of material, allowing the second edition of Music Therapy in Mental Health for Illness Management to be most accessible to those who have some previous knowledge about music therapy and mental health illness management and recovery. The text is rooted in current research in both fields of psychiatry and music therapy in mental health settings while acknowledging that continued research is necessary. The music-therapy-specific interventions and resources that Silverman provides can be used as a foundational resource for students and professional clinicians perusing the mental health population.