Music therapists work with a wide variety of clients in diverse stages of life, in an environment which encourages and allows authenticity, openness, connection, and support. Therapeutic alliance can be defined as the collaborative and trusting relationship between a therapist and a client. It’s a key concept in many forms of therapy, not just music. A strong therapeutic alliance is considered one of the best predictors of successful treatment outcomes.
In his 2019 article, “Music Therapy and Therapeutic Alliance in Adult Mental Health: A Qualitative Investigation”, Michael J. Silverman PhD, MT-BC explores how music therapists cultivate therapeutic alliances with adult patients in mental health settings. Recognizing the established link between therapeutic alliance and positive treatment outcomes, Silverman identified a gap in understanding the specific methods that music therapists employ to build these important relationships. He used an exploratory interpretivist approach to conduct somewhat structured interviews with eight music therapists, each possessing between 1-29 years of clinical experience across numerous inpatient mental health facilities. These providers represented varied orientations and employed a range of interventions in both group and individual therapy contexts.
In this study, Silverman identified eight themes, sorted into music-related and non-music related factors that influenced the development of a therapeutic alliance. Music-related factors included the use of improvisation (spontaneous music creation), songwriting, and lyric analysis to foster connection, while non-music factors included therapist authenticity, empathy, and the establishment of trust.
The study helps us understand the complicated nature of building therapeutic alliances in music therapy, which highlights the interplay between musical engagement and interpersonal dynamics. I know from experience that creating a strong therapeutic alliance makes for many successful sessions for both the therapist and the patient. As music therapists, we have a unique advantage that can enhance therapeutic alliance, which is the fact that music itself helps to build rapport and trust. Shared music-making or lyric discussion can foster connection, reduce defensiveness, and create a space where clients feel seen, heard, and understood, all of which contribute to a strong therapeutic alliance. We can also utilize music-based interventions to target the core components of a strong therapeutic alliance, which include agreement on goals, agreement on tasks or interventions utilized, and emotional bond- a mutual trust, respect, and sense of working together as a team. Building a strong therapeutic alliance in a supportive environment of music therapy helps to optimize therapeutic results.
For more information on how music therapy and mental health, please visit www.musictherapy.org or centralohiomusictherapy.com.
Silverman, M.J. (2019). Music therapy and therapeutic alliance in adult mental health: A qualitative investigation. Journal of Music Therapy, 56(1), 90-115. https://doi.org/10.1093/jmt/thy018
Hannah C. Westfall LPMT, MT-BC
Central Ohio Music Therapy, LLC