Music therapy is defined as a systematic process where the therapist helps the client to promote health, using musical experiences and the relationships that develop through them . It is often perceived as a psychotherapeutic method where musical interaction, in addition to verbal discussion, is used as a means of communication and expression. The aim of music therapy is to help people with mental health problems to develop relationships and to address issues they may not be able to by using words alone. Results from a Cochrane review showed that music therapy helps people with schizophrenia to improve their global state, mental state and social functioning in the short to medium term . The review suggested that there is a need for studies examining the effects of music therapy over a longer term. Furthermore, studies are needed to examine the effectiveness of music therapy in clinical practice, and to further explore the psychological 'mechanisms' through which music therapy works.
Music therapy is usually not tailored to a specific diagnosis. Rather, contents of therapy are negotiated with the patient within the process of therapy, based on a variety of individual traits. It has been suggested that factors unrelated to psychiatric diagnosis, specifically therapy motivation, be considered when specifying, prescribing, and evaluating psychotherapy . Psychotherapy may not work if patients are not motivated for it [4–6]. In music therapy, the use of music (i.e. playing or listening to music) itself can often be a motivating factor for patients who may otherwise not be motivated for psychotherapy . Therefore, a low motivation for (other) therapy can become a reason for referral of a patient to music therapy, and such factors may at times be more important than the patient's primary diagnosis. However, there is a scarcity of research addressing the effects of music therapy for patients with low therapy motivation. We found only one randomised study on music therapy for depression where the authors described that the majority of the participants had previously failed to respond to verbal psychotherapy .
The problem of low motivation may sometimes be due to a lack of insight and will often lead to poor therapy outcome. It has been described for a variety of disorders, including schizophrenia [9–12], depression and bipolar disorder [11, 13], and psychosomatic disorders [14, 15]. Music therapy is often recommended for such patients and may have something unique to offer which is worth exploring. A randomised study is needed to examine the potential of music therapy for this under-researched but clinically important population.
Resource-oriented music therapy for people with mental health problems is oriented towards the client's resources, strengths and potentials, rather than primarily on problems and conflicts, and emphasizes collaboration and equal relationships [16, 17]. Such a perspective to music therapy builds on a contextual understanding of therapeutic processes [6, 18, 19], the philosophy of empowerment [20, 21], and positive psychology . In music therapy, music may be seen as a central resource for the patient, but a resource-oriented approach will also emphasise the patient's resources in the verbal discussions taking place within the music therapy sessions . Goals of resource-oriented music therapy with people with mental health problems include, among others, the ability to feel and express emotions, to build and sustain relationships to others, and to develop interest and motivation. Therefore the goals of the therapy are closely related to what has been described as negative symptoms in mental health research [2, 23].
The objectives of this study are as follows:
1.) To determine whether resource-oriented music therapy helps psychiatric patients who have a low therapy motivation and a willingness to work with music to reduce their level of negative symptoms (primary study outcome).
2.) To determine whether the therapy helps the patients to improve in the following secondary outcomes:
(a) secondary outcomes of general relevance for the patient: general symptoms; general functioning; clinical global impressions.
(b) secondary outcomes specifically linked to the assumed mechanisms of the therapy: interest in music; motivation for change; self-efficacy; self-esteem; vitality; affect regulation; relational competence; actual social relationships.
3.) Provided that significant effects are found: To determine whether general outcomes are mediated by specific outcomes.