Family therapy focuses on treating individuals in the context of their family dynamics, aiming to reduce dysfunction and enhance communication. It is indicated for relationship conflicts and certain psychiatric disorders, while contraindicated in cases of family crises or unwillingness to participate. Music therapy, a specialized therapeutic approach, employs musical interactions to aid emotional expression and improve mental health outcomes, and encompasses various types, including background, contemplative, and creative music therapy.

1. FAMILY THERAPY
Introduction:
Family therapy is the branch of psychiatry which sees an individual’s psychiatric symptoms
as inseparably related to the family in which he lives. Thus the focus of treatment is not on the
individual, but the family.
Family therapy is a relatively new development that came about in the mid-twentieth century
as an adjunct to individual treatment and refers to the treatment of the family as whole.
Family therapists use a wide variety of theoretical philosophies and techniques to bring about change
in dysfunctional patterns of behaviour and interaction, some therapists may focus on the here and
now,
Several or sometimes all members of a family members take part in this treatment. Usually both
parents are involved, often together with a child, grandparents, or others members of the extended
family
Although different therapists may adhere to different theories and use a wide variety of
methods, the goals of family therapy are basically the same. These goals include the following
 To reduce dysfunctional behaviour of individual family members.
 To resolve or reduce intrafamily relationship conflicts.
 To improve family communication skills.
 To heighten awareness and sensitivity to other family members to meet their needs.
 To strengthen the family ability to cope with the major life stressors and traumatic events.
 To improve integration of the family system into the social system.
 To improve autonomy for each member.reduce distress in the member who is patient.
Indication and contraindication of family therapy
Indications:
1. Problems in the relationship within the family(erg existence of communication or generation
gap)
2. Interdependence of symptoms(e.g. the wife’s depression being contingent on the husband’s
alcohol consumption and vice versa)
3. Failure of individual therapy(may be because family tensions have not been handled)
4. Development of stress in other family members when one family member improves (e.g.
development of depression in wife following husband’s giving up drinking, leading to his
improves participation in family matters)
Contraindications:
A. Family factors
1. Family in the process of breaking up
2. Families in which tense, dysfunctional equilibrium is present.
3. Families staying apart
4. No availability of the key family member
5. Unwillingness to accept the therapy.

2. Functions of the family therapy
1. Boundary function: boundaries will maintain a distinction between individuals with the
family. Rigid boundaries prevent family members from trying out new ideas.
2. Communication function: communication within the family encourages its
members to express their feelings or emotions appropriately.
3. Supportive function: supportive function within the family give freedom to grow
and explore new roles within the family members.
4. Socialization function: socialization helps to interact, negotiate and plan adopts
coping skills within the members of the family.
5. Biological function: family is a medium where the sex relations are regulated.
6. Psychological function: love, belongingness, affection, sympathy, security,
attention, emotional satisfaction, sexual relationship, intimacy etc. will be attained
through family.
7. Educational function: mother is the first teacher and primary care giver who will
take care of the children. Child’s personality and character formation will be attained
through family.
8. Protective function: family protects the interest of the child, provides security to
cultivate healthy behavior.
9. Recreational function: family creates an atmosphere where the child’s interest can
be fulfilled. The love among family members will create positive interest in the
child.
10. Religious function: family develops religious thoughts, kind heartedness and fellow
belonging. The child learns more moral values, ethics, codes, honesty, truthfulness,
traditions and religious patterns.
11. Cultural function: family molds its members according to its culture. It transmits
ideas, folkways, mores, customs, traditions, beliefs and values from one generation
to another generation.
12. Social function:
-maintain social status and controls member’s activities.
-Promotes safety and security and lays emphasis on kinship patterns
-provides physical shelter, food, clothing which are necessary to the existence of
life.

3. TYPES OF FAMILY THERAPY:
INDIVIDUAL FAMILYTHERAPY
In individual family therapy, each family member has a single therapist. The whole family
may meet occasionally with one or two of the therapists to see how the member’s ae relating to one
another and work out specific issues that have been defined by the individual members.
CONJOINTFAMILYTHERAPY
The most common type of family therapy is the single-family group, or conjoint family
therapy. The nuclear family is seen, and the issues and problems raised by the family are the ones
addressed by the therapist. The way in which the family interacts is observed and becomes the focus
of therapy. The therapist helps the family deal more effectively with problems as they arise and are
defined.
COUPLES THERAPY
Couples are often seen by the therapist together. The couple may be experiencing difficulties
in their marriage, and in therapy, they are helped to work together to seek a resolution for their
problems. Family patterns, interaction and the communication styles, and each partner’s goals, hopes
and expectations are examined in therapy. This examination enables the couple to find a common
ground for resolving conflicts by recognizing and respecting each other’s similarities and differences.
MULTIPLE FAMILYGROUP THERAPY
In multiple family group therapy, four or five families meet weekly to confront and deal with
the problems or issues they have in common. Ability or inability to function well in the home and
community fearing of talking to or relating to others, abuse, anger,neglect, the development of social
skills, and responsibility for oneself are some of the issues on which these group focus. The multiple
family group become the support for all the families. The network also encourages each person to
reach out form new relationships outside the group.
MULTIPLE IMPACTTHERAPY
In multiple impact therapy, several therapists come together with families in a community
setting. They live together and deal with pertinent issues for each family member within the context of
the group. Multiple impact therapy is similar to multiple family group therapy except that it is more
intense and time limited. Like multiple family group therapy, it focuses on developing skills or
working together as a family and with other families.
NETWORK THERAPY
Network therapy is conducted in people’s homes. All individuals interested or invested in a
problem or crisis that particular person or persons in a family are experiencing take part. This
gathering includes family, friends, neighbours, professional groups or persons, and anyone in the
community who has an investment in the outcome of the current crisis. People who form the network
generally know each other and interact on a regular basis in each other’s lives. Thus a network may
include as many as 40 to 60 people.

4. Family therapy assessment
Boyer and Jeffrey (1984) describe six elements on which families are assessed to be either functional
or dysfunctional. The six element of assessment include:
 Communication
 Self-concept reinforcement
 Family member expectations.
 Handling differences.
 Family interactional patterns.
 Family climate
The six elements of assessment are described below:
Communication
Functional communication patterns are those in which verbal and non-verbal messages are clear,
direct, and congruent between sender and intended receiver. Family member are encouraged to
express honest feelings and opinions, and all members participate in decisions that affect the family
system. Each member is an active listener to other members of the family.
Making assumption: in this, one assumes that others will know what is meant by an action or an
expression
For e.g., a father says to his teenage son “you should have gone to market to bring some provisions
for home during my absence at home”.
Belittling feelings: this behaviour involves ignoring or minimizing another’s feelings, when they are
expressed. This encourage the individual to withhold honest feelings to avoid being hurt by the
negative response.
For e.g. elder brother scolding his sister (young one) and she is angry with him. Then the mother
consoles girl that “oh don’t be angry, he does not mean anything”.
Failing to listen: in this, one does not hear what the other individual is saying. This can mean , not
hearing the words by ‘turning out’ what is being said, or It can be selective listening, in which a
person hears only selective part of the message or interprets in a selective manner.
Communicating indirectly: it usually means that an individual does not cannot present a message to
receiver directly, so he or she seeks to communicate through a third person.
Presenting double-bind messages: in this, family-member may respond to a direct request by
another family member only to be rebuked when the request is fulfilled.
Self-concept Reinforcement
Functional families strive to reinforce and strengthen each member’s self-concept, with the positive
results being that family members feel loved and valued.in this, the manner in which children see and
value themselves is influenced most significantly by the messages they receive concerning their value
to other members of the family.

5. Family member’s expectations
Every individual have some expectations about the outcomes of the life situations they experience.
The expectations are related to and significantly influenced by earlier life experiences. Each family
member is different, with different strength’s and limitations. Each member must be valued
independently.
Handling differences
It is difficult to conceive of two or more individuals living together who agree on everything all of the
time. Serious problems in a family functioning appear when differences becomes equated with
“badness” is seen not caring. Member are willing to hear the other person’s position, respect the other
person’s right and work to modify the expectations on both sides of the issue to negotiate a workable
solution.
Family interactional patterns
All families develop recurring, predictable patterns of interactions over time. These are often thought
of as “family rules”. Interactions may have to do with communication expressing expectations and
handling differences. Family rules are functional when they are workable and constructive and
promote the needs of all family members.
Family climate
The atmosphere or climate of a family is composed of a blend of the feelings and experiences that are
the result of the family member’s verbal and non-verbal sharing and interacting. It has been suggested
that a positive family climate is founded on trust and is reflected in openness. A dysfunctional family
climate is evidenced by tensions, pain, physical disabilities, frustrations or guilt
Music Therapy
Introduction:
 Music therapy is a special type of therapy where forms of musical interactions and
communication are used alongside verbal communication.
 Systemic process of interventions wherein the therapist helps the client to promote
health, using music experiences and the relationship developing through them
 Therapies involving music therapy allow the child or adolescent to express her or
himself in these disciplines and can be effective with those who have difficulty
communicating with others.
History of music therapy:
 Using music as a healing medium dates back to ancient times which is evident in
biblical scriptures and historical writings of ancient civilizations such as Egypt, china,
India, Greece, and Rome

6.  The oldest known documentation of medical practices, the kahum papyrus, refers to
the use of incantations for healing the sick.
 Greek philosopher Pythagoras is considered the founder of music therapy in the 6th
century
 In 1800, Florence nightingale in France recognized the power of music in hospital
wards during Crimean war and used to aid in healing process for soldiers.
ADVANTAGES OF MUSIC THERAPY
 Music can help you to fight with stress find comfort, and manage pain.
 Women planning vaginal childbirth are usually encouraged to bring along music that
will help them to relax during their labour.
 It increases relaxation
 It reduces loneliness
 It enhances spiritual connection
 Helps in fight with depression and anxiety
 Facilitates emotional expressions
 Improves cognitive skills like learning, listening and attention span
 Social interaction is stimulated
 It improves communication and enhance memory.
Indications
Psychotic disorders
 Schizophrenia
 Schizoaffective disorder
 Drug induced psychosis
Mood disorders
 Major depressive disorder
 Bipolar disorder
Developmental disorders
 Autism, mental retardation
Neurological disorders
 Dementia, Parkinson’s disease

7. Types of music therapy
Background music therapy
 It is a form of therapy in which music is heard for an average of 8 to 12 hours per day
as part of a hospital routine.
 It is transmitted via audio tapes and radio
 The aim of this therapy is to create a calm environment in the hospital.
Contemplative music therapy
 It helps the patients to appreciate the significance of music and art in general
 Before music is played for patients, they are given a biography of the composer and
other details about the music.
 This can be administered in a group setting or individually.
Combined music therapy
 It is used in conjunction with other therapeutic procedures.
 Unlike background music therapy, it call for the patient to select musical
compositions that enhance musical outcome and suit the patient.
 Sometimes in this form of musical therapy, hypnosis is conducted while the subject
listens to the music.
 This form of music therapy has been used in combination with cerebral electro sleep
therapy and behaviour therapy.
Executive music therapy
 It consists of individual or group singing and playing musical instruments.
 Patients with long hospital stays are the best candidates for this form of therapy.
Executive Iatromusic therapy
 In this therapy a musician performs in children’s psychiatric units.
 This form of therapy frequently is used in managing emotionally disturbed, mentally
retarded and dyslexic children.
Creative music therapy
 In this a patient write a song, compose music, and play instruments as a form of
catharsis.
 In this repressed feelings or fears to be expressed in music and song.
Role of nurse in music therapy:
 The nurse should provide music therapy according to the age of person according to
their interests like and dislikes
 The nurse should provide music therapy to the client suffering from schizophrenia to
diminish the visual perceptual abnormalities and divert the mind of the client
 The psychiatric nurse should provide music therapy to the client who is suffering
from drug induced psychosis for diversional purpose.

8.  Nurses can provide music therapy to the client who is suffering from autism to
increase their activity with the flow of the music
 Michael gelder, paul Harrison, Philip cowen
 Shorter oxford textbook of psychiatric
 Fifth edition
 Louise rebraca shives basic coccepts of psychiatric-mental health nursing
 Wolters Kluwer publications
 Eighth edition
 BT Basavanthappa’s “textbook of essentials of mental health nursing”
Jaypee Publications,
Page No, 224, 225,226,227,228,229,230
 R Sreevani's “textbook of a guide to mental health & psychiatric nursing”
Jaypee Publications,
Page No, 147,148,153
 https://en.wikipedia.org/wiki/Music_therapy
 https://en.wikipedia.org/wiki/Family_therapy
 http://www.turkpsikiyatri.org/arsiv/music_therapy_psychiatry

9. Bibliography:
 Michael gelder, paul Harrison, Philip cowen
Shorter oxford textbook of psychiatric
Fifth edition
 Louise rebraca shives basic coccepts of psychiatric-mental health nursing
Wolters Kluwer publications
Eighth edition
 BT Basavanthappa’s “textbook of essentials of mental health nursing”
Jaypee Publications,
Page No, 224, 225,226,227,228,229,230
 R Sreevani's “textbook of a guide to mental health & psychiatric nursing”
Jaypee Publications,
Page No, 147,148,153
 https://en.wikipedia.org/wiki/Music_therapy
 https://en.wikipedia.org/wiki/Family_therapy
 http://www.turkpsikiyatri.org/arsiv/music_therapy_psychiatry