Alliance building in music therapy for forensic psychiatric patients with schizophrenia. An exploratory case study research design

Introduction: Forming therapeutic alliance with forensic psychiatric patients with schizophrenia is challenging, and there is a gap in knowledge about the dynamics in the initial phase of psychotherapy and how collaboration and trust is developed. Music therapy is described as a motivating approach enhancing the forensic psychiatric patient's ability to engage in a relationship. The purpose of the study was to explore and identify dynamics in the process of forming therapeutic alliance in music therapy for forensic psychiatric patients with schizophrenia. Method: The study adopted an exploratory case study design with data from multiple perspectives providing thick descriptions. Four patients with schizophrenia from a medium secured unit at a forensic psychiatric hospital were offered weekly music therapy sessions for six months. An inductive process based on a hermeneutic phenomenological epistemology and a nine step procedure for the analysis led to a final abductive synthesis. Results: Each of the following themes formed a continuum of dynamic interactional processes within the development of therapeutic alliance with forensic psychiatric patients with schizophrenia in music therapy and were presented as a condensed continua model; (a) Control, (b) Closeness/distance, (c) Structure, (d) Process/product, (e) Focus of attention, (f) Interaction, and (g) Verbal dialogue. A case example is provided. Discussion: The continua model may contribute to the clarification and conceptualization of the developmental dynamics in the initial phase of psychotherapy with forensic psychiatric patients with schizophrenia, and hereby contribute to a recognition of the importance of treatment efforts specifically concerned with relational and musical competencies.