نمونه‌های موردی درمان موسیقی برای اختلالات مصرف مواد

Individuals with substance use disorders often have dual diagnoses, that is, their substance problem is complicated by other clinical issues such as depression, physical or psychological abuse, psychosis, and so forth. Of course, individuals who abuse substances also have many resources and strengths that they can bring to bear in overcoming their dependence or abuse. Though these resources and strengths are not usually discussed in formal definitions, the case examples in this book provide myriad perspectives not only how the above substance related problems are manifested differently by each individual, both within and outside of a musical context, but also how these problems can be addressed through carefully designed music experiences. About Music Therapy (Based on Bruscia, 1993) ## Definition and Applications In music therapy, the therapist and client use music and all of its facetsphysical, emotional, mental, social, aesthetic, and spiritual-to help the client improve or maintain his or her health. In some instances, the client's needs are addressed directly through music and its intrinsic therapeutic properties; in others they are addressed through the relationships that develop between the music, client, therapist, and other participants. Music therapy is used with individuals of all ages and with a variety of conditions, including: psychiatric disorders, medical problems, physical handicaps, sensory impairments, developmental disabilities, substance abuse, communication disorders, interpersonal problems, and aging. It is also used for self-development purposes, such as: improving learning, building self-esteem, reducing stress, supporting physical exercise, and facilitating a host of other health-related activities. Given its wide applications, music therapists may be found in general hospitals, psychiatric facilities, schools, prisons, community centers, training institutes, private practices, and universities. clients who have physical or mental impairments that interfere with one or more of these basic musical potentials. Therefore care is always taken to adapt music therapy experiences to the unique musical capabilities and preferences of each client. Music therapists also screen clients who may have adverse psychological or psychophysiological reactions to participation in music. ## Four Basic Music Experiences Used in Therapy To understand how music therapy works, it is necessary to examine the unique nature of each of the four types of music experiences-listening to, recreating, improvising, and composing music. In those therapy sessions that involve listening, the client takes in and reacts to live or recorded music in the style preferred by the client. The client may respond through activities such as: relaxation or meditation, structured or free movement, perceptual tasks, free-association, story-telling, imaging, reminiscing, drawing, and so forth. Music listening experiences are used with clients who need to be activated, soothed, or further developed-either physically, emotionally, intellectually, and/or spiritually-as these are the kinds of responses that music listening elicits. In those therapy sessions that involve re-creating music, the client sings or plays pre-composed music. This may include: learning how to produce sounds, imitating musical phrases, learning how to sing, learning to read notation, participating in group sing-alongs, performing a song or piece, participating in a musical show or drama, and so forth. Re-creative experiences are most appropriate for clients who need to: develop sensorimotor skills, learn adaptive behaviors, maintain reality orientation, master different role behaviors, identify with the feelings and ideas of others, work with others cooperatively, or merely share in the joy of making music-as these are the main aspects of singing or playing pre-composed music that have therapeutic implications. In those therapy sessions that involve improvising, the client makes up his or her own music extemporaneously, singing or playing whatever arises in the moment. The client may improvise freely and spontaneously, or according to the musical or verbal guidance of the therapist. Sometimes the client is asked to improvise sound portraits of feelings, events, persons, or situations that are being explored in therapy. The client may improvise with the therapist, with other clients in a group, or alone, depending on the therapeutic objective. Improvising music is most appropriate for clients who need to develop spontaneity, creativity, freedom of expression, self-awareness, communication, and interpersonal skills-as these are the basic components of improvising. In those sessions that involve composing, the therapist helps the client to write songs, lyrics, or instrumental pieces, or to create any kind of musical product, such as music videos or audiotape programs. Usually the therapist simplifies the process by engaging the client in aspects of the task within their capability (e.g., generating a melody, or writing the lyrics of a song), and by taking responsibility for more technical aspects (e.g., harmonization, notation). Activities involving composing music are used with clients who need to learn how to make decisions and commitments, or find ways of working in an organized way toward a goal. Most often, clients create compositions representative sample of all clinical practices in music therapy for individuals with substance use disorders. The bibliography below further elaborates how individuals with substance use disorders can derive therapeutic benefits from music. Each case details the process by which therapist and client engage in music experiences that enable the client to explore and better utilize the personal resources needed to address his or her own therapeutic needs.