Music Therapy with children exposed to domestic violence

Oxleas Music Therapy Service in partnership with Greenwich Domestic Violence and Abuse Services (Housing for Women) and CAMHS

Background

Children exposed to domestic violence are faced with a variety of challenges. These are not easy to predict in individual cases. As well as the direct psychological impact of witnessing violence they can also be affected indirectly by the problems their mother might face in the aftermath of a violent relationship. Medical diagnosis alone may not always be helpful for these children, as it may not trace problems to their underlying causes. By contrast, music therapists work in the here-and-now, accepting the child as they are and allowing space for difficult emotions to arise when the child feels ready to address them. This is called a ‘client-centred’ approach, which contrasts with the diagnostic approach that, for example, a GP might take.

For children exposed to domestic violence, music therapy may be helpful in addressing:

  • Trauma
  • Affect regulation
  • Attachment difficulties
  • Interpersonal relationships
  • Self-esteem/confidence

Good Practice

Oxleas Music Therapy Service, developed an innovative and collaborative project between a number of agencies led by Luke Annesley. It was based on 10 session blocks of individual therapy, with follow-up when required. CAMHS therapists were working alongside the service with the parent(s), following a consultation model and extending to systemic interventions when appropriate. Both were in regular communication with one another and with support workers from Greenwich Domestic Violence and Abuse Service. This close work with the families provided plenty of opportunity for useful feedback from parents and placed the child at the centre of the work. Quantitative data was questionnaire-based, and included systematic collection of SDQs from parents and, where possible, from schools.

Recent NICE Guidelines on working with domestic violence (National Institute for Health and Care Excellence 2014) support various aspects of this work. There is clear emphasis on the “wide range of ill-effects that exposure to domestic violence and abuse can have on children and young people” (4.9) and on ‘the importance of working concurrently with both the non-abusive parent or carer and child’ (4.10).

The service allowed for the provision of long term interventions when needed. The model of 10 sessions of music therapy alongside 3 parental consultations provided the starting point. During the project there were several examples of the treatment programme extending beyond this initial model. The indications from parental feedback and from the key workers and clinicians involved were that the project had a positive impact in the majority of cases. Furthermore the NICE guidelines state that “The cost [of domestic violence], in both human and economic terms, is so significant that even marginally effective interventions are cost effective” (Introduction) and that “even using conservative assumptions, it seems likely that the interventions will be cost-effective in the long term by stopping the violence and improving the mental health of all those involved” (4.24), thus providing an economic as well as a clinical rationale for the project.

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