Resonance and Relationship: A Qualitative Inquiry to Music Therapy in Public Healthcare

PI: Ms. Estelle Ng
Board certified, Music Therapist, Allied Health Division, Singapore General Hospital

SPECIFIC AIMS:

This qualitative research project aims to deepen the understanding of therapeutic processes within music therapy to inform and promote integrated, patient-centered care across healthcare in Singapore. Specifically, the research aims are:
• To investigate on-the-ground interpersonal and intermusical experiences between patients and music therapists within clinical music therapy sessions in Singapore General Hospital, with a focus on understanding their contribution to therapeutic relationship and patient engagement;
• To understand the function of music as a medium within the therapeutic dyad;
• To explore the utilization of embodied resources (e.g. touch, gesture, sound) in music therapy to facilitate and/or enhance patient-centered interactions within the cultural context of Singapore.

The context-specific qualitative data and theoretical insights generated by this research will inform the development of evidence-based practice within healthcare professionals, enhancing empathetic communication and patient-centered approaches within Singapore.

BACKGROUND:

As healthcare systems modernize, there is a demand to transform healthcare from the paternalistic approach driven by biomedicine to one of patient-centered care, taking into account patients’ experiences.[1] As healthcare systems advance , there is a growing demand to shift from a top-down, biomedicine-driven model to one that prioritizes patient-centered care, significantly accounting for patients' unique experiences in achieving healthcare outcomes. Key characteristics of patient-centered care include: (1) individualized focus, advocating for the distinct needs of each patient; (2) a holistic approach such as taking on a bio-psycho-social-spiritual lens; (3) relationships characterized by mutual trust, (4) empathy; between patients and healthcare professionals and (5) engagement wherein clinicians are fully present and committed to upholding patient agency.[2]

Music Therapy as a Patient-Centered Intervention

Music therapy is an evidence-based approach involving music interventions delivered by a certified music therapist “within a therapeutic relationship” to address and promote a range of functional, rehabilitative and well-being needs.[3] Within inpatient hospitals worldwide, music therapy is shown to benefit patients by regaining communication functions [4], promoting gait [5], pain management [6], and emotional coping with grief [7]. Higher patient satisfaction scores from patients receiving music therapy were also reported as compared to standard rehabilitation therapies.[8]

Since 2005, music therapy services have been employed in public hospitals in Singapore.[9] Music therapy, by its nature, is a deeply relational practice wherein the therapist and client co-exist in a therapeutic relationship (interpersonal) and relate to each other through musical experiences .[10] This inherent collaborative and individualized approach of music therapy aligns strongly with the principles of patient-centered care, emphasizing empathy, engagement, and a holistic understanding of the patient's healthcare experience.

Gap in Current Literature

Despite music therapy being a patient-centered approach, much research has been geared towards measuring impact and outcome of music therapy interactions in healthcare settings [11, 12, 13] and research is limited in understanding these interpersonal dynamics: how patients and therapists communicate, react to one another, and behave in building a relationship.[14] A systematic review conducted on doctor-patient relationships suggests that interpersonal dynamics may potentially impact patient experience and perception of their care, and in some instances, reduce the duration of visit length, suggesting lower cost of care [15]. These interpersonal dynamics of care are the cornerstone of music therapy, which has the potential to inform practices within larger healthcare systems. Thus, there is a need for detailed evidence-based analyses on the interactions that happen within music therapy sessions, to supplement existing literature and further our understanding of the mechanisms of music therapy. 

Implications of Research and Potential for Scalability

Given that relational dynamics between healthcare providers and patients impact patient outcomes and clinical care [16,17], this proposed research has significance beyond the immediate scope of music therapy. The detailed understanding of relational dynamics within music therapy gained from this study holds considerable promise to inform clinical practice for a wider range of healthcare professionals, fostering more patient-centered approaches across the system.

A potential educational program that could emerge from this research may involve equipping healthcare professionals with knowledge and practical skills on enhancing interpersonal dynamics within clinician-patient relationship. Studies have shown that educational programs equipping healthcare professionals with practical skills on patient-centered approaches have yielded positive results in terms of better health outcomes [18,19]. By integrating novel findings from this research, particularly regarding critical interpersonal elements observed within music therapy interactions, into an educational workshop driven by hands-on experiential learning, we can provide a robust framework. Through participant-engagement and self-reflections, this framework has the potential to be adaptable for integration with other areas of clinical practice, thereby contributing to a more effective, responsive and ultimately, compassionate healthcare system.