ABSTRACT

Introduction: Forming therapeutic alliance with forensic psychiatric patients with schizophrenia is challenging, and there is a gap in knowledge about the dynamics in the initial phase of psychotherapy and how collaboration and trust is developed. Music therapy is described as a motivating approach enhancing the forensic psychiatric patient's ability to engage in a relationship. The purpose of the study was to explore and identify dynamics in the process of forming therapeutic alliance in music therapy for forensic psychiatric patients with schizophrenia.

Method: The study adopted an exploratory case study design with data from multiple perspectives providing thick descriptions. Four patients with schizophrenia from a medium secured unit at a forensic psychiatric hospital were offered weekly music therapy sessions for six months. An inductive process based on a hermeneutic phenomenological epistemology and a nine step procedure for the analysis led to a final abductive synthesis.

Results: Each of the following themes formed a continuum of dynamic interactional processes within the development of therapeutic alliance with forensic psychiatric patients with schizophrenia in music therapy and were presented as a condensed continua model; (a) Control, (b) Closeness/distance, (c) Structure, (d) Process/product, (e) Focus of attention, (f) Interaction, and (g) Verbal dialogue. A case example is provided.

Discussion: The continua model may contribute to the clarification and conceptualization of the developmental dynamics in the initial phase of psychotherapy with forensic psychiatric patients with schizophrenia, and hereby contribute to a recognition of the importance of treatment efforts specifically concerned with relational and musical competencies.

抽象的

简介：与法医精神分裂症患者建立治疗联盟具有挑战性，并且在心理治疗初始阶段的动力学知识以及如何建立协作与信任方面存在知识空白。音乐疗法被描述为一种增强法医精神病患者与人建立关系的能力的激励方法。该研究的目的是探索和确定法医精神分裂症患者的音乐治疗中形成治疗联盟的过程中的动态。

方法：本研究采用探索性案例研究设计，并从多个角度提供了详尽的描述数据。每周从法医精神病医院的一个中等安全部门中为四名精神分裂症患者提供音乐治疗，为期六个月。基于解释现象学认识论的归纳过程和用于分析的九步程序导致了最终的归纳合成。

结果：以下每个主题在音乐疗法中与法医精神分裂症精神病患者的治疗联盟发展过程中，形成了动态相互作用过程的连续体，并被提炼为简化的连续体模型；（a）控制，（b）亲密/距离，（c）结构，（d）过程/产品，（e）关注焦点，（f）互动，以及（g）口头对话。提供了一个案例示例。

讨论：连续性模型可能有助于对法医精神分裂症患者进行心理治疗的初期阶段发展动态的澄清和概念化，从而有助于认识到特别涉及关系和音乐能力的治疗工作的重要性。