Music therapy, a description of process: engagement and avoidance in five people with learning disabilities.

A number of approaches exist within the field of music therapy. Some models for evaluating the efficacy of therapy have been adopted in the UK in recent years. These have measured the occurrence of specific behaviours within therapy, or compared music therapy with other interventions. There is a need to find reasonably reliable methods of describing change and the therapeutic process occurring within music therapy. This paper describes change occurring in five people with learning disabilities, in terms of their levels of engagement in therapy and in the therapeutic relationship. A method is provided to evaluate independent observers' perceptions of change in the patients over a 30-session period of therapy. A significant increase in levels of engagement over time was found. It was also found that the degree of change over time was not related to the mean level of engagement. The present authors discuss some subtle factors involved in therapeutic engagement for the five patients in the study, and stress the importance of a therapy which emphasizes the dynamics of interpersonal communication for people with limited opportunities to express thoughts and emotions.