Dissertation - World Federation of Music Therapy

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Table 2. 1 Literature on BMGIM and GMI with medical populations Population Author Method (no. of sessions) HIV/AIDS Bruscia BMGIM 1991 (11) ANKYLOSING SPONDILITIS RHEUMA- TOID ARTHRITIS CARDIAC CARE ESSENTIAL HYPER- TENSION FIBRO- MYALGIA PHYSICALLY DISABLED ELDERLY Bruscia 1992, 1994 Merritt 1993 Jacobi 2001 Grocke 2002 Short 1999 McDonal d 1990 Bjellånes 1998 Short 1992 Summer 1981 PARALYSIS Moffitt 1991 BRAIN DAMAGES FIBROID TUMORS Goldberg 1988 BMGIM (individual, 10+) BMGIM (?) BMGIM (10) BMGIM (100+) BMGIM (6) BMGIM (6) ”Adapted GIM” = GMI? ”Adapted GIM” = GMI (21) n Design Outcome areas 1 Case study Enhanced coping Confronting death 20 Multiple case study Helping imagery: Being in Limbo, Releasing feelings. Finding love. Emotional healing. Embracing life and death 1 Case study Release of memories and emotions. Bodily 27 Clinical outcome, Pre-post-follow- up equilibrium and healing Decrease in psychological distress and pain. Improvements in physical measures 1 Case study Release of memories and expression of emotions. 6 Narrative analysis 30 Randomized control trial 12 Quasiexperimental 4- 6 effect study Descriptive report GMI 15 Descriptive report BMGIM + Active improvisation and verbal Gestalt Adapted BMGIM Freedom of symptoms Additional meaning about the recovery exp. Significant decline in systolic and mean diastolic blood pressure Improved consciousness of health and Quality of Life Increased social interaction, addressing psychosocial needs Increased self-awareness and self-esteem 1 Case study Enhanced self-concept Expression of emotions 1 Case study Engagement Psychotherapeutic issues addressed Moe 1995 GMI ? Case study Improved memory? Pickett 1987 BMGIM? 2 Case studies Coming to terms with life and death? Table 2.1 shows that samples are generally small, that there are no controlled studies of the effect of BMGIM or GMI on medical conditions, and that there are very few experimental studies. Results indicate that BMGIM can be used to address a wide range of psychosocial needs of patients in medical care, both physiological and psychological. However, the evidence of the therapeutic outcome is almost 18
exclusively anecdotal and based on descriptive, retrospective case studies. There is a lack of well-designed studies using fixed as well as flexible designs. In an overview of the literature on BMGIM in the treatment of individuals with chronic illness Burns (2002) addresses how BMGIM may influence immune and endocrine functions as well as emotional distress related to chronic illness. Research by McKinney and colleagues demonstrated that hormone levels, including cortisol and beta-endorphin, and depression decreased in healthy adults as a result of six BMGIM sessions (McKinney et al 1995, 1997a). Changes in cortisol were correlated significantly with changes in mood, to the point that positive mood change predicted cortisol decrease. Other studies (see McKInney 2002) indicated that BMGIM or GMI sessions may bring about significant positive changes in both mood (anxiety, depression, anger, fatigue, and confusion) and quality of life (as determined by the patient’s perspective). BMGIM may be used as a psychosocial intervention in different stages of the chronic illness disease trajectory: diagnosis, treatment, survivorship, and palliative care. In the diagnosis stage BMGIM may serve as a psycho-emotional support, giving the patient an opportunity to share his or her personal story, to ventilate emotional tension and distress, and to address physical pain (Logan 1998). In the treatment phase BMGIM can be used to manage both treatment- and disease-related symptoms through the experience of healing imagery. In the survivorship (or rehabilitation) stage BMGIM may support the patient in managing fears related to recurrence, stress connected with fatigue and pain, and problems with adjustment to a life on new conditions (for details in cancer care, see section 2.4.3). Pain and fear of pain are problems of the patient in palliative care that can be addressed through modified GIM. BMGIM in the classic format is rarely appropriate with individuals at the end of life; however, modified BMGIM (relaxation plus guided or non-guided imagery to selected classical music) may help patients to transcend physical limitations in order to facilitate life reviews or spiritual exploration (see also section 2.4.4). Table 2.2 gives an overview of empirical studies on the effects of BMGIM and GMI interventions on psychological and/or physiological variables. The list includes studies with fixed design (experimental and controlled studies) as well as case studies. 19
Page 1: THE BONNY METHOD OF GUIDED IMAGERY
Page 4 and 5: Ph.D. student’ with me the last t
Page 6 and 7: vi 4. METHODOLOGY..................
Page 8 and 9: viii
Page 10 and 11: TABLE 8. 4 EVENT STRUCTURE ANALYSIS
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Page 18 and 19: As you will see there are many comm
Page 20 and 21: The participants in this study use
Page 22 and 23: Music in medicine The terminology o
Page 24 and 25: Music in medicine vs. Music therapy
Page 26 and 27: more likely a reaction to a cancer
Page 28 and 29: melanoma Boesen (2002) reviewed the
Page 30 and 31: test showed that there was less ten
Page 32 and 33: More general overviews of how music
Page 36 and 37: Populations include non-clinical/he
Page 38 and 39: McKinney 1990 University students M
Page 40 and 41: Table 2.2 shows that most of the st
Page 42 and 43: Facilitating peak experience Provin
Page 44 and 45: express and work on their experienc
Page 46 and 47: 2) locus of control (inner mastery
Page 48 and 49: in contrast to Burns’ study, the
Page 50 and 51: In Denmark two music therapists hav
Page 53 and 54: 3 Theoretical background 3.1 Introd
Page 55 and 56: metaphor influenced each other in o
Page 57 and 58: is closely related to the body and
Page 59 and 60: structures or patterns that “allo
Page 61 and 62: explaining a phenomenon with other
Page 63 and 64: Ricoeur agrees with Ernst Cassirer
Page 65 and 66: “It appears as though certain fun
Page 67 and 68: daily life myths and fairy tales ma
Page 69 and 70: extent that it is organized after t
Page 71 and 72: Table 3. 4 Three moments of mimesis
Page 73 and 74: Thus, symbols and metaphors are the
Page 75 and 76: 4. Psychotherapy as humane care - r
Page 77 and 78: I suggest the following working def
Page 79 and 80: The scale of Klein et al. was not u
Page 81 and 82: In a psychological perspective meta
Page 83 and 84: 3.5 Narratives in psychotherapy In
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second category (analogous to ‘in
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“There currently exist no consens
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Table 3. 7 Mimesis 1-3 in narrative
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3.6.1 Music as analogy A paper by D
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Smeijsters has coined the double co
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Table 3. 8 Musical elements interpr
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function through its pre-existent s
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end, motion and rest, tension and r
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Lakoff and Johnson’s cognitive th
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crying, or symbolized as falling ch
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our analyses. For it is only by ope
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Based on his study Jungaberle formu
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and ending on dominant a - a new ro
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cross is inevitable, and the music
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is the instrumental Ground from Blo
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therapists. Open and attentive list
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closely related to basic human self
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less elegant dance. My dance is a b
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describes him or herself as ‘feel
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asket and then lie down, tell about
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Holocaust Shadow (Schulberg 1999),
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Craftsmen are working The foundatio
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series of actions and transformatio
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References to examples in the BMGIM
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“Sublime music tells in its own w
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4. Methodology Following on from ch
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trained in Aalborg is still indigen
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3) The study has its starting point
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material or intentional phenomenon,
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can also be applied in multiple met
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Table 4. 1 Basic information on the
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• The preliminary conversation (a
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One week before project start all p
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Participants score each item on a 4
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c) Audio recordings (mini-disc) of
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• Specification (1. Sensitizing c
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The imagery of the six participants
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5. Results of the quantitative inve
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The mean score of the group in depr
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Table 5. 2 Effect sizes measured at
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Figure 5. 5 QLQ-C30: Mean scores of
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These results are variable, and onl
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Statistical analysis of QLQ-C30 res
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Figure 5. 9 SOC Mean scores from th
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Figure 5. 11 SOC: Pre-test, post-te
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Results - inferential statistics an
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The results support hypothesis ten.
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generalised further, was evidently
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6. Results from the qualitative inv
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Potential of GIM in other phases of
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coding, where the categories are in
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PIJØ: It has been very hard for me
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how should it be, should there be m
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changing. Participants described ho
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IMPROVED UNDERSTANDING OF SELF (NEW
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elated subcategories. Using specifi
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D. In a few sessions the therapists
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B1 Metaphorical investigations of t
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imaging. This becomes even clearer
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odily or meditative states. In cont
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7. Two case studies. A mimetic anal
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The two cases will be presented sep
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In fig. 7.1 the therapist has given
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the healing process and was a contr
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say: ’We don’t want it to work
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Level 3 Configuration is the core o
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Trials and Tasks Observes a grey ar
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pre-test level at follow-up, while
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She knew that her own scores had no
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In fig. 7.3 the therapist has given
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eflections on the predominance of e
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and I might as well accept it. Roge
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childish, playful.” From an initi
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solution through a message, and in
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Figure 7. 4 INLAs QLQ-C30 scores, i
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• the courage to confront dangers
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e observed, also in this axis, that
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’story line’ and writes a story
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Table 7. 7 A grounded theory model
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episodes dominated by (inner) body
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8. Analysis of music and imagery Th
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8.1.1 Qualitative music research In
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This means that: Description is nev
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methods intended for analysis of (p
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following preparations: 1. Informat
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An Eclectic Approach to the analysi
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was used to investigate potential c
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Figure 8. 2 The dynamic profile of
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there was dialogue between solo ins
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were used partially (in 35 sessions
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Following the guidelines of HMA the
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Figure 8. 4 Intensity Profile of Br
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Figure 8. 5 The digitized waveform
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for assessment. In this project the
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score it is possible to see exactly
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B2 (46-51) V/E Ot B3 (52-55) E Ot V
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C2 (91-100) R R V/S V/E C3 (100-106
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The analysis of the unfolding image
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she only reports verbally that she
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• The complete narrative, based o
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an experience further before finish
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Figure 8. 6 Intensity profile - Bac
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This profile - or map of the’ inn
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Table 8. 4 Event structure analysis
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A5+t (14-16) B1+t (17-21) R S S R V
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B5 (37-39) B6 (39-41) answered tona
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V and irritated, not R wanting to s
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ANHO: The client still has difficul
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For the five of the six participant
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• Analysis of the image potential
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Text and music with accompaniment w
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section of music that visually illu
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intensity increasing feature is the
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A1 (1-10) R/V E S/E B1 (11-21) R/V
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B1 Mein Jesu A1 (1-6) V R E R S V A
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B B3 (after music) E E S side? (tea
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Jesu evoked images related to death
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String Quartet as the most challeng
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Figure 8. 12 Distribution of the th
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Table 8. 7 A grounded theory model
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the imagery: the client reacts with
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9. Discussion “..Where the mind i
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possible to show a decrease in both
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9.1.3 The role of music and imagery
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specific therapeutic influence in t
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or measurable influence on the part
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As these findings are not consisten
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adiotherapy treatment. These commen
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this study (the only exception bein
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and why they are comprehensible and
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was that core images did emerge and
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actually no alternative to “will
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9.2.3.3 The proposed grounded theor
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This leads to the critical question
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The proposed grounded theories cove
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eautiful room with candles, flowers
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eventual climaxes and peak points c
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The three categories illustrated in
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scores are influenced by my negativ
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9.4 The development of new theoreti
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9.4.2 Heuristic music analysis as c
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client’s playing in improvisation
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Anxiety and anger are very importan
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Bonny found that the musical elemen
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support and explain how BMGIM can b
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9.6 Directions for future research
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comparative analysis including a nu
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music listening has been substantia
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What elements are there that descri
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1) Can ten BMGIM sessions improve t
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After every session questionnaires
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The analyses of metaphors and image
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not be sufficient to saturate a sub
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hvordan BMGIM kan have en positiv v
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individuelle BMGIM-sessioner, som r
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C30-scores viste stigninger i genne
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• Heuristisk Musikanalyse (Brusci
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som velegnet til psykosociale under
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REFERENCES (2002). Appendix B: Musi
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Ansdell, G. (2001). Musicology: mis
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Bonde, L. O. (2002). Introduction t
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Bonny, H. L. and L. K. Marids (2001
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Clark, M. (1998). The Bonny Method
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Ferguson, D. N. (1960). Music as Me
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Hilliard, R. E. (2002). The effects
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Keiser, L. H. (1986). Conscious Lis
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Mahns, W. (1998). Symbolbildungen i
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Munro, S. (1993). "Music therapy in
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Robbins, C. and C. Robbins (1991).
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Short, A. E. (1997). "Jungian arche
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Tüpker, R. (1988). Ich singe was i
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Zachariae, B. (1997). "Forestilling
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LIST OF APPENDICES LIST OF APPENDIC
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Appendix 4.1 Data on six participan
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ESMA: 65 years old, married, three
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Appendix 4.2 Patientinformation (in
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Appendix 4.3 The HADS questionnaire
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Spørgs - mål nr. Vælg ét svar f
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Appendix 4.4 The EORTC QLQ-C30 ques
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427
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Fig. 5.14 ESMAs QLQ profile 120 100
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Fig. 5.18 WIFUs QLQ profile 120 100
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Appendix 6.2 Illustration of the de
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435
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henføre dem entydigt til noget som
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Ja. Hvert eneste gang har det være
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Det er meget rigtigt. Jeg har jo ik
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omgangshøjde endnu. Det er 2-3 år
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Ham ville jeg godt hilsen velkommen
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them out. Questionnaires like these
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it is the music! No, it is not only
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Maybe it influences me so strongly
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the music should be different. (…
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[Are there other images that you…
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Ja det tror jeg. Hvor er det lige j
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drømme jo også - de kommer også
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De hører fuldt ud sammen. Hvis man
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[The questionnaires indicate that y
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guess it has been working in the su
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them, many stairs and things like t
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Appendix 6.4.3 Interview med ESMA 9
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været mere eller mindre på afstan
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skørt, for det er virkelig svært
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den der kæmpeindsats, som jeg har
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emærker at de er der - de skal bek
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jeg ville nødig undvære musikken
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[Folkene bag spørgeskemaerne hævd
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Nej desværre ikke. Altså sådan m
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Nej ikke nødtvungent! ... Men det
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Ja, og jeg føler, at jeg ’fylder
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Der er lissom om jeg er på den and
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meget, og også at give fred; men o
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sådan det er. (Jeg sider og prøve
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[Men hver anden uge er meget passen
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andet sted at jeg har haft meget ti
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f.eks. ’Du er blevet meget mere a
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Og så får jeg lyst til at lave no
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der har arbejdet med de her ting? H
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Berlioz: 4 X PIJØ: #3,2 7 1 L’en
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Marcello: Oboe Concertor, 2nd movem
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WIFU #2 1 ANHO #1 1 4 NURTURING 2-5
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Appendix 8.2.1a. Session notes PIJ
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#5 9.12. Disc OK Bekymring for frem
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#7 14.1 Disc: kun de første 10’
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egge to. Ah! Ingen kamp, så. Sving
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#3 13.11, Disc OK #4 26/11 Disc OK
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#6 3.1.03 Disc OK #7 14.1 Has felt
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#9 20.02. Disc OK #10 5.3. Disc OK
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Appendix 8.2.2a Session notes INLA
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#5 3.1.03 Disc OK #6 15.1. Disc OK
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#8 24.02. Disc OK #9 17.03 Til US b
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Appendix 8.2.2b Session notes INLA
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#5 3.1.03 Disc OK #6 15.1. Review o
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#8 24.02. Disc OK Control examinati
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FOCUS: Finding a way out... a door.
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#3 13.11. Disc OK #4 21.11 Disc: ku
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#7 19.12. Dis OK #8 30.1. Ingen opt
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Appendix 8.2.4 Session notes ANHO (
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Disc OK #6 7.1.03 Ingen optagels e
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# 10 31.03 Disc OK hul igennem. For
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OK #4 3.12 Disc OK #5 19.12. Disc O
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Disc OK #10 17.03. Disc OK Andre ha
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#3 19.11 Disc OK #4 28.11. Disc OK
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Disc OK #9 11.3. Disc OK Lang snak
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557
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Appendix 7.4 MINI-WORKSHOP - RESEAR
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Appendix 8.5 Brahms Score + Imagery
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• The movement is basically suppo
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Appendix 8.7 Bach: Komm süsser Tod
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Appendix 8.9 Analysis of selected m
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Element Brahms: Violin concerto - s
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Appendix 9.1 Types of clinical rele
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Appendix 9.2 Grocke’s Categories
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2. The relevance of the listening s
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directing the will” (p. 5). A who
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Reviewing the sub-questions, the wo
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Works Vol. IV, p. 7. The so-called
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ased on communication theory or cul
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In this study, I have used the thir
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24. The framework for the qualitati
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English translation of the intervie
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Dissertation - World Federation of Music Therapy

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