Can you give us an overview of your doctoral research in music therapy?

Most of my music therapy work and research was in one of the UK’s national high-secure hospitals.

It was very interesting to work in what at that time was a flagship hospital delivering comprehensive treatments. The hospital treated over 400 patients who had no access to the community and were seriously mentally ill. When I was appointed in 2001, I recruited a team of Music and Art Therapists and within ten years the department’s work reached out across all the wards.

The patients frequently had great humility and I learnt a lot from them and from the consultants and psychologists. It is very rare for people who have severe mental illnesses, such as schizophrenia, to do something violent, but if this occurs, they are psychiatrically assessed. If their offence is deemed to have occurred because of the impact of illness on their mind and behaviours, they are sentenced to a secure hospital for an indefinite period on the grounds of ‘diminished responsibility due to mental ill health’.

It is a challenge to think empathically and with compassion about what is happening in the minds of such people. They may respond differently to how we normally expect, because they are experiencing frightening phenomena that are unreal. This is a very different situation to that of a premeditated offence for which a fixed term prison sentence is applied.

Forensic music therapy can contribute in formulating how and why wrongdoing occurred. Such patients have almost always suffered neglect and abuse as children, which does not excuse, but may help to explain their behaviour. The overall multi-disciplinary treatment can take many years, yet we are expected as National Health Service (NHS) employees to provide interventions that are proved to be effective.

I experienced an incredible light bulb moment with one of my patients when he finally understood how he had been tricked by the psychotic experiences that he had been having at the time he committed a serious offence. He was so shocked and saddened by his truly horrendous mistake in having done so much harm, then he wanted to try to make amends.

I take a holistic and creatively expressive approach, whilst working within the boundaries of the medical profession. This was my calling: daring to tune in through jointly created musical improvisation with patients who have been violent, and helping them to connect and relate to others. This must be done safely and sensitively within the clinical setting. Secure hospitals at their best (prior to financial cuts) certainly were and can be very safe places because they are, as they say, highly secure.

Rather than working as a sole practitioner, my team and I were gradually accepted as part of the multi-disciplinary team. This was very exciting as we are all expected to contribute to helping patients change for the better, so that they may lead a more normal life without being a danger to themselves or others. This is called the recovery model, it can take a very long time for an offender patient to understand why they committed an offence and to respond differently. It is both an inner and an outer journey of personal growth and discovery.

'We discovered that people who engaged in Cognitive Analytic Music Therapy became less withdrawn and they improved in how they related to others by firstly connecting through live music making within the therapy groups.'

Can you tell us more about your music therapy research?

The research followed an ethically approved process that is set out by the medical research council and the development process took several years. I developed a form of music therapy called Cognitive Analytic Music Therapy (CAMT). It is based within tried and tested psychological models of how people relate to each other and to themselves.

When I was studying for my MSc at Guy’s and St Thomas Hospital, I really liked the sound of Cognitive Analytic Psychotherapy (CAT). I realised a lot of the underlying principles were the same as for music therapy, so over several years I worked out how to integrate the two. It is about creating a dialogue, and the creative part is the non-verbal musical dialogue between patient and therapist. The music needs to fit the perceived feelings in the room especially for those who find talking and trusting so difficult. In all, the research and development took over 15 years, including pilot projects working in small groups of five patients.

These patients have complex mental health conditions. For example, suffering with both schizophrenia and psychopathic symptoms or depression, and more and more frequently with a diagnosis of post-traumatic stress disorder. There are different schools of thought and models within music therapy, so we develop different forms of music therapy to suit different client groups. The study that I was guided to develop (and which thanks to the many collaborations that were necessary to see it through to publication) is currently the only one of its kind.

We compared patients who received standard treatment with patients who additionally received CAMT. We measured changes in both groups and discovered that people who engaged in CAMT became less withdrawn and they improved in how they related to others by firstly connecting through live music making within the therapy groups. We completed follow-up measurements two months after the end of the research period to see if the treatment effect had sustained. These showed that those receiving CAMT had developed their ability on the ward to be more sociable and less intrusive. Most excitingly none of those who engaged in CAMT have re-offended or been re-admitted. Quite a few men that we worked with had not engaged in any other sort of therapy and most of them had no musical experience. Most joyous for me to witness was a neurological change that occurred by improvising together, after which the patients were able to think clearly.

You have also worked as a successful professional musician. Tell us more about that side of your career.

I started working as a freelance musician after leaving the Academy and built up a good portfolio. I loved being an all-rounder, but it can be challenging as a freelancer learning to fit into a woodwind section when the orchestra members are already established as a group. I have found orchestral work an incredibly rewarding way to learn how we tune in and connect to others, all with the same aim, in re-creating music together.

I initially specialised in contemporary music, with the Rambert Dance Company and for ‘Lontano’, an avant-garde music group that was formed by Odaline de la Martinez when we were both studying at the Academy. Then I decided that I wanted to play more melodic tunes, though my contemporary experience stood me in good stead for work with the BBC Symphony Orchestra. So, I auditioned with the aim of moving into doing session music, firstly working with the BBC Radio Orchestra. I went back to having oboe lessons and learnt all the styles and nuances required for orchestral and opera repertoire, which led to work with the big symphony orchestras including the Royal Opera House orchestra.

From 1986 I had a ten-year partnership with composer/ arranger Paul Hart. I am incredibly proud of our legacy of original music to the oboe repertoire. We recorded a lot of music for BBC Radio 2, and we have published the Star Pieces volume 1 that were on the Associated Board of the Royal Schools of Music (ABRSM) examination boards for several years. Our CD, Love's Lore: 16 British Folk Songs for Oboe and strings, is now being streamed on all the major platforms.

Although I continued to play concerts alongside my clinical career for a while I had to be completely committed to the task of completing a research doctorate, plus having had hand injuries I don’t want to play any more concerts though I still teach and provide workshops.

'The rigorous, high-flying musical training that I received at the Academy is unique. I will never forget how exciting it was to open the letter of acceptance, and to read that I had been awarded a place.'

What does your work as a professional musician bring to your clinical work, and vice versa?

The rigorous, high-flying musical training that I received at the Academy is unique. I will never forget how exciting it was to open the letter of acceptance, and to read that I had been awarded a place. It was thanks to the North Yorkshire County grants that I was able to attend.

Training in music therapy was a process of mid-life transformation which involved humility and starting again as a mature student. My work as a professional performer has brought so much to my clinical work. Being a music therapist, I had to confront my inner fears and know myself well enough to step back, as this is not about ‘performing’. The client must be able to feel a sense of ownership of the music that we create together. I then found that I could sit much more calmly in the second oboe position of the New Queen's Hall Orchestra. I had fulfilled any aspirations to play Principal. The composer Nigel Osborne once said to me, ‘Stella leaves no stone unturned in how to interpret my music’ and I feel the same about working out how music therapy can help each individual person to change with an ability to safely lead a more normal life. I had to learn how to control my anxieties and channel them effectively and I wanted to give back to others.

Letting go of those unrelenting standards about perfection has enabled me to understand the richness of relating to other humans as well as to have the musical and personal resources that have helped the most stigmatised group of mental health patients. This would not have been possible without that Academy experience and the many challenges and resilience needed, including to overcome several serious health issues and injuries.

In music therapy I rediscovered the joy of spontaneous ‘play’. This helped me to let go of the notes on the musical page. I found that having memorised over the years orchestral repertoire motifs and little snippets, for example the slow movement of Mozart's Oboe Concerto and quartet, were particularly useful as a starting point, because Mozart expresses so subtly and concisely many different feelings. Maybe my artistic background has helped me not to over-label or medicalise; I approach patients with an open mind, since the music profession can contain and accepts all sorts of eccentric and different types of people who can be innovative and work together.

Do you have any advice for performers who would like mental health support?

Yes, of course. If you are struggling with negative thoughts or feel that you are losing direction, please don’t wait. There is a lot of help available these days, check out Help Musicians UK (HMUK) and the British Association of Performing Arts Medicine (BAPAM), where there is a list of therapists. BAPAM can both direct and assess people, or you can look at their ‘find a therapist’ profiles and approach therapists directly. It is all entirely confidential, and this first brave step can help you to realise your potential.

Keep learning, keep being curious and keep being creative, we all have a different pace of development – your time will come in a way that feels right and comfortable if you have faith and self-belief and if you receive kindness. Never let anyone humiliate you – that is old fashioned and not how we learn in the twenty-first century.