Music Therapy in the Treatment of Adults With Mental Disorders
Unkefer, Robert F. & Thaut, Michael H. (Eds). (2002). Music Therapy in the Treatment of Adults with Mental Disorders — Theoretical Bases and Clinical Information. Second edition. St. Louis: MMB Music, Inc.

Reviewed by Ronit Aharoni, Beit Issie Shapiro, Raanana, Israel.

This second edition of Music therapy in the Treatment of Adults with Mental Disorders brings an updated theoretical and clinical knowledge. In comparison with the first edition, this edition is very similar in its format and chapter's content; however, it has been expanded with updated information and research knowledge mostly in the field of neurophysiology processes, psychotropic medications and cognitive model of neuropsychiatry music therapy. This second edition has been dedicated to its recently deceased first editor, Robert Unkefer.

Reading this book for the first time took me back to my music therapy studies, starting from reading Gaston's (1968) philosophical view on "Man and Music," to analyzing music as communication and aesthetic expression and experience. It was also a good reminder to Thaut's research articles, for example: "The Effect of Music on Mood State-Dependent Recall", investigating the effect of music in elevated mood, leading to an increased, positive cognitive level (Thaut & de l'Etoile, 1993)." Or another example: "The Influence of Preferred Relaxing Music on Measures of State Anxiety, Relaxation, and Physiological Responses" (Davis & Thaut, 1989), showing that music aroused and excited, rather than soothed autonomic and muscular activity. These two examples are a very small part of many other research articles, which represent a long research data base that has been condensed within the two opening chapters.

Although it has been 15 years since the first edition, it is still an excellent music therapy text book. This edited book, written by eight registered music therapists, takes the reader to a four part journey in the field of music in therapy and mental health. This journey starts from the fundamental elements of music therapy, investigating core questions within a very clear, systematic, research oriented method. After this long road, it continues to focus on music therapy in its various fields of human health, presenting music therapy programs and techniques.

Although the topics are varied, there is a line that connects them all and creates a colorful collage. The style and quality of the chapters seem very close and "cooperative" with one another. However, its variety of chapters can be sometimes too much at a time to "digest".

Part I contains five chapters that examine and explore theoretical foundation of music therapy practice. Michael H. Thaut, the editor and one of the main writers of this book, who brings some important updated material, is a leading music therapist (PhD) and a professional musician that has been extended his work in the last fifteen years to neuroscience programs and biomedical research. Thaut's science based stamp takes the reader to a very interesting field of neuropsychological and physiological processes in human function within the equivalence of music–evoked stimuli and effect/respond.

Thaut opens the first chapter with a core question on how can music stimuli evolve and influence thinking and feeling process in a meaningful and predictable way, to change abnormal behavior in desired direction. He draws his answer in five steps of theoretical and clinical applications that are illustrated within a proposed model through clinical example.

In chapter two, Thaut gives a summary of his long research data base and discusses the influence of music on physiological and motor responses in the human organism. He discusses the effect of music stimuli on motor activity and performance and learning rehabilitation, giving the reader a clear understanding of the relevance use of rhythmic stimuli to facilitate cortical movement and rehabilitation of motor function.

Although, Thaut points that not much attention has been devoted to the effects of music on motor responses I would have wished this part to be longer and more informative.

Chapters three to five, written by Kate E. Gfeller complete other aspects of music therapy foundation with relevancy parts to psychiatric population.

Gfeller is a professor of music therapy and of speech pathology and audiology. This combination gives her writing, in chapters three and five, a very balanced, clear view on music as a form of communication and aesthetic stimuli. However, the three chapters give a very short part on musical communication in the psychiatric setting, which again was a little disappointing as a reader that might have expected to read more relevant issues which specifically focused on mental health disorder.

Part II contains also five chapters and brings a summary of clinical aspects in psychiatric music therapy, presenting various frameworks, and updated information on psychotropic medications. Thaut, opens this section too, giving valuable research knowledge in the field of cognitive neuroscience. Like the opening chapter of this book, he raises again the issue of music as an affective stimuli, thus from the cognitive and behavioral mode. In the middle of the chapter he also outlined three major component of a clinical practice model for psychiatric music therapy.

Chapter nine is also an updated chapter, which gives information on psychotropic medications, their side effects and the way music therapy can assist and respond to it.

I thought that the first part was sometimes too informative. It mostly concentrated on tables with trade names and daily dosage, and brought information on various psychiatric medication and their side effects—a topic that is well documented in the literature. The part about music therapy was relatively short, summarizing music therapy responses to medication side effects. It stresses the importance of looking at side effect and taking them in account when considering specific music activity. Although it was an interesting, thought provoking part, I felt it wasn't fully covered and updated on other aspects and research related topics within music and medication.

Chapter ten deals with the role and responsibility of the music therapist in using assessment for clients' needs, presenting current assessment evaluation models. The chapter starts from global issues such as the need for assessment, presenting methods of assessment like: interviewing, observing, testing and reviewing existing information from an individual client. It continues with assessment with relevancy to the music therapist and their relation and actual use of assessment tools

Finally, the two most rewarding parts of this book (III and IV) declared the end of it's long journey in the field of music therapy.
Part III presents taxonomy of clinical music therapy programs and techniques, updated to the standard of diagnostic (DSM-IV-TR) giving both previous parts a practical view within a comprehensive treatment technique model. The taxonomy, written by six music therapists, suggests three levels of music therapy intervention based on Wheeler's work and Yalom's levels of inpatient group therapy. The three levels include: supportive-oriented music therapy, reductive-insight and process, and reconstructive-analytically and catharsis are explained wonderfully.

Part III continues with a division of various categories of intervention and well detailed technique suggestions. This part has been wisely constructed together. It brings a richness of activity within various fields like music performing, music psychotherapy, music and movement, music combined with other expressive art, recreational music and music and relaxation. Each part is beautifully and wisely explained and gives a fruitful ground to any music therapist in any level within an eclectic approach.

The last part of the book (IV) is written within tables’ format. Each table presents various diagnostic symptoms and their relevance clinical features, behaviors and needs, suggesting various music therapy techniques and programs (from the taxonomy). Although it has some "prescribed" orientation, it is an excellent resource to clinical psychiatric music therapy fieldwork.

In Summary, I think that this book is a focused, well organized and a professional music therapy resource material. It represents major fundamentals of music in therapy and can be an excellent and valuable music therapy text book not only for its use in mental disorders (although it is oriented towards this population), but it can serve as an important thought provoking material to many other population groups, as well as to music therapists at any level.

Refrences
Gaston, E. Thayer, (Ed.). (1968). Music in Therapy. New York: Macmillan.

Thaut, Michael H. & de l'Etoile, Shannon K. (1993).The Effect of Music on Mood Dependent Recall. Journal of Music Therapy, 30 (2), 70-79.

Thaut, Michael H. & Davis, Willim B.,(1989). The Influence of Preferred Relaxing Music on Measures of State Anxiety, Relaxation, and Physiological Responses. Journal of Music Therapy, 26 (4), 168-187.

Unkefer Robert F. & Thaut, Michael H. (Eds). (1995). Music Therapy in the Treatment of Adults with Mental Disorders — Theoretical Bases and Clinical Information. First edition. St. Louis: MMB Music, Inc.