There are no large-scale outcome studies of music therapy in secure hospital settings for people who have committed serious offences. These patients have a right to expect evidence-based multi-disciplinary treatment (Duggan et al. 2006); NICE (2010). Music therapy therefore should take a form which can be integrated into the treatment pathway. A single site implementation of a mixed-methods patient preference randomised controlled trial investigated the clinical effectiveness of a manualised music therapy model called Group Cognitive Analytic Music Therapy (G-CAMT). This context-specific, time limited intervention incorporates theories from Group Analysis (Foulkes 1964) and Cognitive Analytic Therapy (Ryle and Kerr 2003). The central research question was ‘Is G-CAMT feasible and effective for offenders in a secure multi-disciplinary treatment setting?’ The research process followed the Medical Research Council framework for developing and evaluating complex interventions (Campbell et al. 2000, 2007). Twenty patients were recruited; those expressing no preference were randomised to treatment or control arms. The two music therapists and the principal investigator were masked to their allocation status. Those in the treatment arm were allocated to one of two treatment groups of five, each run individually by one of the music therapists. Each group had sixteen ninety minute weekly sessions with followup at eight weeks. Treatment and control groups received standard care. The primary measure was the Person’s Relating to Others Questionnaire (Birtchnell and Evans 2004) Secondary measures were the Basic Empathy Scale (Jolliffe and Farrington 2006a), The Multi-Scale Dissociation Inventory (Briere, 2002) and an observational measure, the Chart of Interpersonal Reactions in Closed Living Environments (Blackburn and Glasgow, 1993). Quantitative data from these measures were examined for associations with qualitative data from semi-structured interviews administered to the music therapists and analyzed using Interpretative Phenomenological Analysis (Smith et.al. 2009) Findings from the results of the primary measure demonstrated statistically significant (Mann Whitney U: p<.05) reductions in favour of the treatment group compared to the control, in intrusive, restrictive and possessive behaviors and helpless or self-denigrating behaviours. There were improvements over time within the treatment group in the domains of sociability and hostility (Friedman Test :p<.04). The use of a manual was shown to help the music therapists manage the risk of violence without constraining their creativity. Two years after the end of the treatment 78% of treatment participants had moved to conditions of lower security over a mean period of 19 months compared with 66% of control subjects over a mean period of 25.5 months. The thesis concludes by situating G-CAMT amongst contemporary music therapy models.

Inledning: Syftet med denna studie är att få en bredare kunskap om ett outforskat område; psykodynamiska psykoterapeuters upplevelse av att arbeta med personer dömda för mord eller allvarliga våldsbrott. Frågeställning: Hur upplever psykodynamiska psykoterapeuter det är att arbeta med personer dömda för mord eller allvarliga våldsbrott? Metod: Studien bygger på den halvstrukturerade livsvärldsintervjun med fem terapeuter med erfarenhet av att bedriva psykoterapi med brottsdömda för allvarliga våldsbrott eller mord. Intervjuerna spelades in och bearbetades med tematisk analys. Resultat: Terapeuterna har svårt att känna empati och upplever också ångest och rädsla i terapierna. Terapeuterna försöker att förstå personen och brottet för att kunna arbeta för egen del men också för att kunna behandla patienten. Terapeuten uttrycker behov av stöd genom riskbedömning, utbildning och handledning för denna patienttyp. Diskussion: Terapeuternas upplevelse bekräftade det forskningen visat på; att det är stora känslomässiga påfrestningar i det terapeutiska arbetet med brottsdömda för mord och allvarliga våldsbrott. Terapeuterna hade svårt att erbjuda en empatisk förståelse och bearbetande psykoterapi. Terapeuterna efterfrågade en mer genomtänkt behandlingside för denna patientgrupp från organisationens sida och egen handledning och utbildning för att kunna genomföra det psykoterapeutiska arbetet. / Introductions: The purpose of this study is to achieve a broader knowledge of an area not researched on; psychodynamic psychotherapists experience of working with people convicted of murder or serious violent crimes. Issues: How do psychodynamic psychotherapists experience working with people convicted of murder or serious violent crimes? Method: The study is based on the semi-structured interview with five therapist’s with experience of treatment with people convicted of murder or serious violent crimes. The interviews were recorded and processed using thematic analysis. Result: The therapists have difficulty feeling empathy and they also experience anxiety and fear in the therapies. The therapists try to understand the person and the crime in order to be able to work for their own part but also to be able to treat the patient. The therapists expresses the need for support through risk assessment, training and supervision for this kind of patient. Discussion: The therapist’s experience confirmed what research shows; that there are severe emotional strains in the therapeutic work with those convicted of murder and serious violent crimes. The therapists found it difficult to offer an empathetic understanding and processing psychotherapy. The therapists wished for a more elaborate treatment idea for this patient group on the part of the organization and their own supervision and training to be able to carry out the psychotherapeutic work.