In this age of strained healthcare resources, all therapists must be able to quickly and succinctly evidence their value.
In the neurologic strand of music therapy, this is aided by an approach in which assessments feature prominently.
In the psychodynamic branch of music therapy with children and families, however, measuring and reporting progress has long been a significant challenge.
Why is it important to assess families and more specifically, the interactions between parent and child? The most crucial reason would be to protect the children from negative parenting behaviours such as neglect or abuse.
There are also other therapeutic elements to holding an assessment. The outcome may support the parents to develop insight into their skills and emotions: affirming strengths and revealing weaknesses so that a new way of communicating between the family members can be considered.
While music therapy in relation to family and child protection issues has a lengthy history, published research and clinical literature on the topic is sparse.
The Assessment of Parent-Child Interaction (APCI) Training Manual aims to address this gap in theoretical, research and practice literature.
Co-authored by myself and its creator, Stine Jacobsen, the resource functions as an assessment tool in its own right, in determining parent-child interactions for the purposes of child protection. It also helps to shape further treatment with the family.
APCI is aimed at any family experiencing difficulties with communication, interaction or attachment behaviours; although it is best used with families with children aged five to 12.
The APCI method provides insights on nonverbal communication, mutual attunement and attachment patterns of the family and specifically the parents’ ability to respond to the emotional needs of the child.
The manual sets out how to document the effects of the APCI, understand and interpret the results and find a base of knowledge relating to attachment and family interactions / dynamics.
Crucially, the tool is user-friendly and far removed from the type of assessments common in psychiatry, for example, which can involve a very formal line of questioning.
This is fun and informal, which is ideal since lots of families are very anxious when they reach us, and are often in crisis. They might have been through numerous other assessments and are, understandably, apprehensive.
Much to the surprise of many parents, the assessment is also short, requiring only around 20 minutes of filming to monitor the family interacting with one another. This window of time actually gives you so much information to work with.
It captures a snapshot of how family members relate to each other through music and is non-directional.
At a basic level, someone playing loud might be displaying anger. But there are so many more subtle things we are looking for. One parent is playing over the top of the child or vice versa. Is that how things are conversationally at home?
Does the child listen to the parents or play over the top of them? Does mum insist on having the last word? There are so many dynamics that can manifest through making music.
The families respond really well and gradually lose their inhibitions. The first session is a practice run in which family members have an opportunity to see how things work. They often have their defences up and are a little nervous.
The second time they see us they know what’s going to happen and can relax a bit more, allowing the natural dynamics of the family to come out.
The end result is invaluable data on the problems being experienced not only between the parent and child, but within the family as a whole, and some guidance on how best to address them.
The APCI can be used as a stand alone assessment or as a systematic tool, used to monitor the progress of the family over a period time.
This ensures that any changes in the family communication patterns are seen by professionals and therapy targets re-evaluated, where appropriate. Challenges can be thought about and addressed, and successes can be celebrated.
To become a recognised and trained APCI assessor, music therapists are required to attend an official course.
But I believe the approach can inspire any therapist working with families on nonverbal communication, with or without the certification.
I would strongly urge them to consider applying some of the principles of APCI.
Rachel Swanick is a senior music therapist specialising in psychodynamic thinking around attachment, trauma and wellbeing through the arts. She works for arts therapies services provider Chroma.