Arts Therapies in the Treatment of Depression

Ania Zubala, Vicky Karkou, Ania Zubala, Vicky Karkou

• Publisher: Routledge
• Year: 2018
• Print ISBN: 9780367487843
• eBook ISBN: 9781315454399
• Edition: 1
• Topic: Psychology
• Subtopic: Mental Health in Psychology
• Index: Psychology

Arts Therapies in the Treatment of Depression is a comprehensive compilation of expert knowledge on arts therapies' potential in successfully addressing depression. The book identifiesways of addressing the condition in therapy sessions, shares experience of tools and approaches which seem to work best and guides towards a conscious and confident evidence-based practice.

Including contributions from international experts in the field of arts therapies, the book presents some of the most recent, high-profile and methodologically diverse research, whether in the form of clinical trials, surveys or case studies. The three sections of this volume correspond to particular life stages and explore major topics in arts therapies practice and the nature of depression in children, adults and in later life. Individual chapters within the three sections represent all four arts therapies disciplines. The book hopes to improve existing arts therapies practice and research, by encouraging researchers to use creativity in designing meaningful research projects and empowering practitioners to use evidence creatively for the benefit of their clients and the discipline.

Arts Therapies in the Treatment of Depression is an essential resource for arts therapies researchers, practitioners and arts therapists in training. It should also be of interest to other health researchers and health professionals, particularly those who work with clients experiencing depression and in multidisciplinary teams.

Part I

Arts therapies with children and adolescents experiencing depression

Chapter 1

Music therapy and prevention of depression in primary-aged children

Reflections on case work and assessment in a residential child and family psychiatric unit

Amelia Oldfield

Introduction

I have worked as a part-time music therapist (two days a week) in a National Health Service Unit for child and family psychiatry for nearly 30 years. In all this time, I remember only two children who have been given a diagnosis of depression as such, although many children appear to be sad or unhappy or may have specific mood disorders. These children may also have emotional problems and display disturbed behaviours. While depression in adolescents is more commonly discussed in the literature, there is less mention of depression when referring to primary-aged children. In the June 2013 NICE Evidence Update on depression in children and young people (NICE, 2013), only one of the five cited articles is about children under 12. Interestingly, this article (Weitz et al., 2012) talks about children with “multiple problems” and then goes on to describe interventions designed to treat anxiety, depression and disruptive conduct. It would appear, therefore, that young children are not seen to display symptoms of depression in the same way as adolescents or adults. Children under 12 will often be described as anxious, withdrawn or attention-seeking, but are more rarely labelled as being depressed. Nevertheless, it is important to address the symptoms that these children are showing, not only because the child needs help, but also because, if untreated, the child is at risk of acquiring a full diagnosis of depression as they move into adolescence.

In addition, most of the children at the Unit have complex needs and overlapping conditions and diagnoses, for example they may appear sad and low in mood, but also show some features of autistic spectrum disorder, some aspects of hyperactivity and some aspects of obsessional compulsive disorder, without convincingly fitting into one diagnostic category. This is one of the reasons why it has been useful to develop Music Therapy Diagnostic Assessments (MTDAs) at the Unit, which can provide the multi-disciplinary team with an additional and sometimes different perspective on children’s diagnoses. Over a period of two weekly music therapy sessions, the music therapist will observe behaviours that are symptomatic of autism, attention deficit disorder, emotional difficulties and mild learning disabilities. A simple and quick scoring sheet with cut-off points for each of the categories has been devised which is completed by the music therapist after the two diagnostic sessions (Oldfield, 2006b).

The other feature, which sets young children aside from adolescents and adults, is that they are dependent on their parents or carers and will be more strongly affected by these adults. There is evidence to suggest that one of the predictors for mental health problems in children is maternal depression (Seiner & Gelfand, 1995; Bassuk et al., 1997). The child will therefore need to be treated within the context of their family, as it is highly probable that the behaviours of the parents (or carers) influence the behaviours of the child, just as the child’s behaviours and difficulties will affect the parents. As we will see in this chapter the Unit, I will refer to works with children AND their families.

In this chapter I will also reflect on short-term music therapy work at the Unit with children with some aspects of depression. I will focus on how the MTDAs were created, how I have used the MTDAs with some of these children, and how music therapy has fitted in with the multi-disciplinary approach on the unit.

The child and family psychiatric unit

The Unit is a residential centre that aims to assess and provide short-term treatment for children (usually up to 12 years old) who are troubled by emotional and behavioural disturbance. Children are admitted with their families from Mondays to Fridays and go home at the weekend. This is the only psychiatric unit in the UK that admits families on a residential basis. Families usually stay eight weeks, but in some cases, may be admitted for longer (three to six months). The family approach at the Unit is based on the idea that in order to help the children, we need to understand and support both them and their families (Holmes et al., 2011).

Children and their families will only be admitted when other out-patient work has failed. Children will often have been excluded from several schools and nurseries, and some may have been absent from school for many months. Families often arrive at the Unit in a state of crisis where, for example, sleeping and meal-time routines are non-existent and where family life revolves around dealing with the child’s problem behaviours (Holmes et al., 2011). The parents will often have had difficult childhoods and may be affected by having been emotionally or physically abused themselves. They may also be struggling with their own mental health issues, such as depression or obsessive compulsive disorders.

Children admitted to the Unit may come with a diagnosis or receive a new diagnosis during their admission. Common diagnoses include: attention deficit disorder (with or without hyperactivity); autistic spectrum disorder; Giles de la Tourette Syndrome; eating disorders; mild developmental delay; specific language disorders; and attachment disorders. However, as indicated earlier, most of the children do not have typical symptoms of a single condition but rather aspects of several disorders which often makes it harder both to diagnose the problems and to provide help for the children and support for their families.

The staff team on the Unit is multi-disciplinary and works closely together, discussing each family in detail at a two-to-three-hour meeting at the end of each week. The team includes: psychiatrists, specialist nurses, teaching staff, a clinical psychologist, a psychotherapist, family therapists, a social worker and a music therapist. The opinions of the entire team are valued and listened to and although the consultant psychiatrist may be the person who finally decides what diagnosis should or should not be given, her decision is informed by the team. The observations made by the night nurses, for example, will be valued and considered just as much as the family therapist’s view, and the reports from the classroom and the playground. In addition, the team works closely with health visitors, as well as previous therapists and teachers who have been and continue to be involved with the children and their families while they are on the Unit.

Music therapy at the unit

I would describe my music therapy work at the Unit by saying that I have a positive, interactive approach which involves live and mostly improvised music making. Like Juliette Alvin (1975), with whom I trained at the Guildhall School of Music and Drama in 1979, I use music as a means to an end. My objectives are non-musical and will fit in with individual children and family’s Unit care plans, often being the same as those of my multi-disciplinary colleagues. Like Alvin (1975), I use my first instrument in my sessions which for me is the clarinet, and for Alvin was the cello. However, I use less performance than she did, and I have a definite positive stance, identifying and celebrating strengths in the children and the adults I work with before addressing and working on difficulties. Another characteristic of my approach is that I involve parents in my work, which is becoming more usual now, but was more uncommon ten years ago (Oldfield, 2006a, 2006b, 2016a, 2016b, 2016c). The work that I describe in this chapter is short-term, which is very different from the longer-term work which was more typical during my training.

I think the two main reasons that music therapy is effective at the Unit are that the music making is motivating for the children and they generally are keen to come into the room and play, and that I can interact with the children without having to use words. I have written in more detail elsewhere (Oldfield, 2016c) how my approach is not clearly allied to one psychological model but informed by developmental theorists, behavioural approaches and psychodynamic writers. In this same chapter (Oldfield, 2016c), I outline how there are overlaps and many parallels between Winnicott’s (1971) theories of “holding”, Bowlby’s (1988) attachment theory, Stern’s (1987) writing on “affect attunement” and my music therapy work at the Unit.

I have three different types of input at the Unit: a) I run a music therapy group; b) I do music therapy diagnostic assessments (MTDAs) for individual children at the beginning of their admission; and c) I do short-term treatment for individual children or families. During the MTDAs and sometimes during individual sessions and family sessions I include “song stories”, which is a specific technique that I have developed with a psychotherapist, Christine Franke (Oldfield & Franke, 2005). I will describe each of these types of treatment/techniques and will illustrate these different interventions by including some vignettes with children who show signs and/or symptoms of depression. I have permission from the children and the families to write about this work, but have changed names and details for the sake of anonymity.

The music therapy group

The music therapy group is an open group for all the children on the Unit. It is run at the same time every week and lasts 45 mi...

Table of contents

• Cover
• Title
• Copyright
• Contents
• List of contributors
• Introduction: Arts therapies’ response to the global crisis of depression: current research and future developments
• Part I Arts therapies with children and adolescents experiencing depression
• Part II Arts therapies with adults experiencing depression
• Part III Arts therapies with those experiencing depression in later life
• Index