Reflection Paper 1: Theoretical Foundations

Chelsea Gibbs

University of Kentucky

MUS 630-001: Medical Music Therapy

Olivia Yinger, PhD, MT-BC

Spring, 2023

Reflection Paper 1: Theoretical Foundations

Biopsychosocial Model of Illness

            The biopsychosocial model of illness was created by psychologist, George Engel in 1977 due to “dissatisfaction with the biomedical model of illness…” (Wade & Halligan, 2017).  The model is a more inclusive and holistic look at illness.  Contrary to some beliefs, the model it is not in opposition to the biomedical model of illness, but an extension of the model.  It has been utilized in many healthcare fields but is not used as the dominant model in medicine, particularly in acute medical and surgical fields (Wade & Halligan, 2017).  

            In the biopsychosocial model of illness, three elements of an individuals’ experiences are considered.  The biological aspect assesses the clients’ physical symptoms.  The persons’ mental health and well-being are considered in the psychological aspect of the model.  Lastly, how an individuals’ place in society and how that impacts their relationships falls under the social umbrella.  Some may argue that this model offers less concrete scientific information than the medical model (2017).

            Kaushik & Mohan’s study in India collected data on 100 depressive patients (2018).  Of those 100 patients, 50 identified as male and 50 identified as female.  All study participants were between the ages of 40-70.  The participants received music therapy once a week lasting an hour over the course of six months.  Kaushik and Mohan (2018) tested the clients both before starting treatment and after receiving treatment using three different tests.  One of those tests was the biopsychosocial assessment.  Results suggested that there was overall improvement in depression, levels of feeling lonely, sadness, self-esteem, aggression, communication, disinterest, nervousness, and socialization.  

            Depression, sadness, aggression, disinterest, and nervousness arguably have a biological basis.  The above symptoms with the addition of self-esteem fall under the psychological umbrella in the model and loneliness and socialization would fall under the social elements.  While the categorization of the symptoms are fluid, the biopsychosocial model is a holistic approach and can be used across multiple disciplines, including music therapy. 

Multicultural and Social Justice Counseling Competencies Framework           

         The Multicultural and Social Justice Counseling Competencies Framework (MSJCC), developed by Sue, Arredondo, & McDavis (1992), is a theoretical structure which establishes different types of power/privilege dynamics within the therapeutic relationship.  The framework is divided into four quadrants: privileged counselor and marginalized client, privileged counselor and privileged client, marginalized counselor and privileged client, and marginalized counselor and marginalized client (Ratts et al., 2015).  Marginalization includes numerous minority statuses including race, sexuality, disability, and race etc.  At the center of the framework is the counselor's commitment to practicing social justice.

        The social ecological model (Bronfenbrenner, 1997) is incorporated in the MSJCC.  The model is “illustrated by nesting circles that place the individual in the center surrounded by various systems” (Kilanowski, 2017).  At the center of the model is the child, or individual.  The next larger circle is the microsystem and includes the individual’s family, school, peers, religious organizations, and health services.  The mesosystem is interconnected with the exosystem and considers factors such as the child’s parents’ economic situation, government polices/agencies, media, and extended family and neighbors.  The last two, larger circles, are the macrosystem, which inspects how ideas of the child’s culture affects their beliefs, and the chronosystem, which is the larger overarching environmental changes that occur of their life (Bronfenbrenner, 1997).   

Synthesis and Implications

        While the biopsychosocial model and the social-ecological model both consider how multiple and complex outside factors impact an individual’s current state, the biopsychosocial model is more applicable in the field of medical music therapy.  In medical music therapy situations, the music therapist often only sees the patient one time.  This limits the opportunity for the music therapist to learn extensively about the client’s past and how their upbringing, relationships with family and friends, religious experiences, local and federal government policies, etc. have impacted them.  Applying the social-ecological model in a short period of time is not feasible. 

A music therapist can easily assess the biological symptoms a client is experiencing either from observation, reading monitors, or reading their medical charts.  Similarly, a music therapist can assess the individual’s psychological status either through observation or documentations in their medical records.  The client’s social roles may be more difficult to evaluate, but the music therapist can gather small pieces of information through observation, communication with the client or their family and nursing staff. 

    Given that a music therapist can access information included in the biopsychosocial model more easily than aspects comprising of the social-ecological model, the biopsychosocial model applied to medical music therapy sessions is more practical.  The music therapist can use this information to create goals and objectives to guide their practice and interventions used with their clients.  With appropriate goals comes increased likelihood of successful interventions to aid the client, which should be the primary purpose the music therapist’s presence.

References

Bronfenbrenner, U. (1977). Toward an experimental ecology of human development. American Psychologist, 32(7), 513–531. https://doi.org/10.1037//0003-066x.32.7.513

Kaushik, U., Mohan, M. (2018). Music Therapy with Depressive Patients: A Theoretical Review. Journal of Arts, Culture, Philosophy, Religion, Language and Literature, 2 (4), 245-248. 

Kilanowski, J. F. (2017). Breadth of the socio-ecological model. Journal of Agromedicine, 22(4).https://doi.org/10.1080/1059924x.2017.1358971

Ratts, M. J., Singh, A. A., Nassar-McMillan, S., Butler, S. K., & McCullough, J. R. (2015). Multicultural and Social Justice Counseling. https://www.counseling.org/docs/default-source/competencies/multicultural-and-social-justice-counseling-competencies.pdf?sfvrsn=20

Wade, D. T., & Halligan, P. W. (2017). The biopsychosocial model of illness: a model whose time has come. Clinical Rehabilitation, 31(8), 995–1004. https://doi.org/10.1177/0269215517709890