Music Therapy - in Psychiatry

The MUHC Psychiatry Inpatient Program  

The main goal of the Psychiatry Inpatient program is to help patients to reintegrate into the community by providing them tools to cope better with their mental health issues which will help them function better in their daily life.  

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The Psychiatry Inpatient Unit of the McGill University Health Center (MUHC) is located at the Montreal General Hospital.  The unit has 45 beds available for adults with a wide range of mental health diagnoses (75% - schizophrenia, 15% - mood disorders, 5% - anxiety disorders, 5% - detox with mental health issues). 

The program mainly consist of: 

• Finding the appropriate medication to stabilize patients. 
• Educate about mental health issues (life hygiene, social skills, medications, etc.) 
• Stimulate and provide new ways of expressions (music therapy group, occupational therapy group, etc.) 

The music therapy program main goals consist of:  

• Reduces anxiety and feelings of isolation. 
• Increase the capacity of feeling pleasure (having fun). 
• Maintain cognitive skills, increase attention and concentration, refocus on the present moment (here and now). 
• Improve social skills and self-esteem. 
• Learn new ways to express difficult emotions (offer a secure environment where patient can express his/her suffering). 
• Explore and develop our personal creativity. 
• Induce relaxation through music. 

The music therapy program is offering music-listening stations where patients have access to a wide variety of music styles and be able to enjoy (stimulate) or relax themselves at any time of the day they need to. An MP3 player/iPod bank is also available for patients. 

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Music Therapist Dany Bouchard in adult psychiatry at the MUHC

For the past 3 years I have been working at the McGill University Health Centre (MUHC) in the Department of Psychiatry. I work in several different units with both in-patients and out-patients. A portion of my work is with a choir composed of people with mental health disorders.

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The choir members are not usually musicians or people with vocal experience (from a choir or from elsewhere). All of the out-patients from the Department of Psychiatry at the MUHC are allowed participate in the choir if they so desire, however, there are certain conditions which apply. Each member must:

• Attend all weekly rehearsals (Tuesdays from 11 AM to 1 PM); all absences must be justified and 3 unjustified absences are grounds for expulsion from the choir
• Have enough concentration to follow a score and to participate for the entire rehearsal (120 minutes)
• Participate in choir concerts (between 4 and 6 per year) 
• Demonstrate respect for the other members of the choir and possess basic social skills

"Le Groupe MusiArt" isn't a traditional four-part choir because there are not enough members and their musical abilities do not allow for this at the present time. The group began by singing unison arrangements and today they typically sing two-part and rarely three-part vocal arrangements.

Of course, there is vocal work to be done with new members who have never read music and have never worked with their voices. These new members sometimes require individual work and time to catch up to the rest of the choir.

As well, sometimes there are new members who know how to play an instrument, so we try to musically integrate such members into the choir. For example, there is a member who was a professional percussionist before developing schizophrenia, so we incorporated a song where he can play the djembe instead of singing.

A typical rehearsal (120 minutes) begins with a 1-15 minute period of vocal warm-ups. Next, depending on the needs of the choir (if there is an upcoming concert or not), we rehearse the concert repertoire or we learn new material. Our reperaotire consists of many song medleys of music by the Beatles, ABBA, songs from films, traditional songs, etc.

It is my job to accompany the choir with my guitar, and sometimes I play the harmonica, the djembe or other percussion instruments. And of course, I always have our pianist and our conductor by my side.

I also work with the choir conductor to develop our repertoire and to adapt certain selections to two-part vocal arrangements, transposed into a key that best suits our choir. I take care of the technical and audio issues for choir recordings and concerts, and prepare the music folders for rehearsals and concerts. As well, there is the human aspect to manage, the various emotional and psychological dynamics that can occur with this clientele. It is here that my work as a music therapist is the most pertinent. I do not intervene directly through music as I would during a traditional music therapy session (e.g., improvisations, directed activities, etc.), but I intervene with the help of the music. Let me explain by sharing with you how the choir can benefit the patients. It can gives them the chance to:

• Feel a sense of belonging, which helps to break isolation
• Create long-lasting friendships and a sense of intimacy 
• Create contact with the community at large (through concerts and public events) 
• Have a place where they can express their joys and difficulties, as well as find useful help and support during a time of crisis 
• Build confidence and self-esteem with concrete and realistic goals set by the choir 
• Discover or use their creativity during composition workshops 
• Develop their voice and their musical capacities 
• Reconnect with their emotions and express them through the choral repertoire or in the composition workshops 
• Practice and improve their concentration 
• Establish a healthy routine and develop discipline (through daily practice at home and homework assignments)

I also direct the composition workshops. In 2006, I started a project to create our CD with the assistance of the MUHC’s Innovation Bursary. This project resulted in the first CD by "Le Groupe MusiArt," Confidences… in confidence that was released in January 2008. Presently, the choir is working on it’s second CD.

A typical composition workshop, which is done in weekly sessions of 60 to 90 minutes, begins with the patients arriving with a poem, an idea for song lyrics, a vocal or musical melody, etc. All ideas are welcome and taken into consideration. We work on a song, one text at a time, and each member of the group participates in the selection of the music and the words to be used in the lyrics--it is a very democratic process. For example, if we work on a text, all the participants will have a copy of the words to check the rhyme scheme and to maximize the overall expressiveness of the text. In doing so, they determine the most appropriate and poetic words, clarify the meaning of the text, edit the spelling and grammar, etc.

When a patient brings in a text or a poem, I ask them what style of music they would like to have with the words. It is for this reason that there are many different musical styles on the album (reggae, rock, blues, classical, folk, ballads, traditional, etc.). I will then compose the music and create a vocal melody that corresponds with the prosody of the text. The compositional work is shared by myself and our pianist. For the first CD music therapist Mélanie Auberson was employed by the choir as a pianist.

During the composition workshops, we also address all aspects of the artistic production of the CD booklet. The patients bring the photos, drawings and other useful images. The patients will then carefully select which images correspond best with each song and with the overall artistic direction of the album.

The next step is recording, which requires a great deal of organization. All recording and mixing take place in our regular rehearsal space which we adapt to meet the demands of recording. As well, I must prepare a practice CD with provisional mixing and a the basic vocal melody so that the choir members can learn the vocal melody at home before the recording sessions.

When it comes time to record their voices, I put the words in large print on the wall in front of them (behind the microphone); this way, we can avoid any memory lapses and it assures that they will project their voices towards the microphone. As well, I use wireless headphones to facilitate this process and to avoid the nuisance of multiple cords. Finally, I mix the final product and send it off to a company to be duplicated and packaged.

My work with the "Le Groupe MusiArt" allows me to exercise different aspects of the music therapy profession. This choir is an excellent example of what can be accomplished with an adult clientele who suffer from various mental health problems. The use of a choir as a therapeutic tool is a very effective option available to all music therapists, regardless of the population with which they work.

For more information or to attend a "Le Groupe MusiArt" concert or to observe a weekly rehearsal, please contact me at 514-934-1934, extension 42619.

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Music is the Medicine Foundation

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CBC MITM press coverage

Global MITM press coverage

MITM donation MUHC coverage

MUHC Today website coverage

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Music therapy Studio

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enBref March 2018 WEB (page 20-21)

Un nouveau studio pour le programme de musicothérapie

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