Dissertation - World Federation of Music Therapy

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ENGLISH SUMMARY Introduction and motivation Cancer rehabilitation is an extremely important area within the health care system. After termination of medical treatment most cancer survivors have very few options for support, especially if they need psychological or psychosocial support. In Denmark the large-scale, private organization Kræftens Bekæmpelse offer support groups and verbal counselling, and all cancer survivors are – in principle – entitled to a one week stay at Dallund Castle, a rehabilitation centre open to people living with all types of cancer, and their relatives. Besides this resource, there are small-scale private organizations supporting cancer survivors in different ways. In Denmark, music therapy has not yet been integrated into psychological or psychosocial support work, and the clinical protocol in this study was the first attempt to investigate how cancer survivors might benefit from music therapy – in this case The Bonny Method of Guided Imagery and Music (BMGIM). Six volunteers, all women recruited by announcements in local oncology wards and Kræftens Bekæmpelses counselling office, participated in the study. Videnscenter for Forskning i Alternativ Behandling (ViFAB; Centre for Research and Information on Complementary Therapies in Denmark) funded the clinical part of the study. Abroad, especially in the USA, Great Britain, Australia and Germany, some studies and programs have indicated that BMGIM has a potential as a supportive psychological and psychosocial intervention with cancer survivors. The inspiration and motivation for this study was grounded in the results and reports from these studies and programs. This study is a systematic investigation of how BMGIM may influence selected variables and aspects of problems experienced by cancer survivors, as expressed in the main research question: What is the influence of ten individual BMGIM sessions on mood and quality of life in cancer survivors? In order to operationalize this question the investigation addresses the following subquestions systematically: 366
1) Can ten BMGIM sessions improve the mood of the participants? 2) Can ten BMGIM sessions improve the quality of life of the participants? 3) Can music and imagery help the participants in their rehabilitation process? 4) What is the experience of the participants of BMGIM and its effects on mood and quality of life in the rehabilitation process? 5) What is the specific nature of the imagery or image configuration of cancer survivors in BMGIM? 6) How does the imagery develop and/or is re-configured during BMGIM therapy? 7) What elements are there that describe the relationship between the music and the imagery transformations? Subquestions 1-3 are addressed in a quantitative investigation with 10 hypotheses, while subquestions 4-7 are addressed in a qualitative investigation in three parts: Part I with focus on the participants’ experience of the BMGIM therapy, Part II with focus on the imagery, Part III with focus on the interrelationship between music and imagery. Theoretical foundations A comprehensive review of the literature on music therapy in cancer care is presented, with a focus on the application of BMGIM to the discrete phases of cancer treatment (diagnosis, curative medical care, rehabilitation, palliative care) (chapter 2). The review shows that many case studies have indicated the potential of BMGIM and adaptations of the model in rehabilitation and palliative care of cancer patients and other patients living with a life-threatening disease. However only two effect studies were identified, one of which was a controlled study. A comprehensive review of the literature on metaphor and narrative in cognitive psychology, psychotherapy, musicology and music therapy is presented (chapter 3). The purpose of the review is to establish a theoretical framework and database for the qualitative investigation. The review includes a presentation of Paul Ricouer’s 367
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THE BONNY METHOD OF GUIDED IMAGERY
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Ph.D. student’ with me the last t
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vi 4. METHODOLOGY..................
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viii
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TABLE 8. 4 EVENT STRUCTURE ANALYSIS
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xii
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xiv
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xvi
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As you will see there are many comm
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The participants in this study use
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Music in medicine The terminology o
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Music in medicine vs. Music therapy
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more likely a reaction to a cancer
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melanoma Boesen (2002) reviewed the
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test showed that there was less ten
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More general overviews of how music
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Table 2. 1 Literature on BMGIM and
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Populations include non-clinical/he
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McKinney 1990 University students M
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Table 2.2 shows that most of the st
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Facilitating peak experience Provin
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express and work on their experienc
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2) locus of control (inner mastery
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in contrast to Burns’ study, the
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In Denmark two music therapists hav
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3 Theoretical background 3.1 Introd
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metaphor influenced each other in o
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is closely related to the body and
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structures or patterns that “allo
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explaining a phenomenon with other
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Ricoeur agrees with Ernst Cassirer
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“It appears as though certain fun
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daily life myths and fairy tales ma
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extent that it is organized after t
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Table 3. 4 Three moments of mimesis
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Thus, symbols and metaphors are the
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4. Psychotherapy as humane care - r
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I suggest the following working def
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The scale of Klein et al. was not u
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In a psychological perspective meta
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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
Page 331 and 332: 9.1.3 The role of music and imagery
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Page 337 and 338: As these findings are not consisten
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Page 343 and 344: and why they are comprehensible and
Page 345 and 346: was that core images did emerge and
Page 347 and 348: actually no alternative to “will
Page 349 and 350: 9.2.3.3 The proposed grounded theor
Page 351 and 352: This leads to the critical question
Page 353 and 354: The proposed grounded theories cove
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Page 357 and 358: eventual climaxes and peak points c
Page 359 and 360: The three categories illustrated in
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Page 363 and 364: 9.4 The development of new theoreti
Page 365 and 366: 9.4.2 Heuristic music analysis as c
Page 367 and 368: client’s playing in improvisation
Page 369 and 370: Anxiety and anger are very importan
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Page 375 and 376: 9.6 Directions for future research
Page 377 and 378: comparative analysis including a nu
Page 379 and 380: music listening has been substantia
Page 381: What elements are there that descri
Page 385 and 386: After every session questionnaires
Page 387 and 388: The analyses of metaphors and image
Page 389 and 390: not be sufficient to saturate a sub
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Page 393 and 394: individuelle BMGIM-sessioner, som r
Page 395 and 396: C30-scores viste stigninger i genne
Page 397 and 398: • Heuristisk Musikanalyse (Brusci
Page 399 and 400: som velegnet til psykosociale under
Page 401 and 402: REFERENCES (2002). Appendix B: Musi
Page 403 and 404: Ansdell, G. (2001). Musicology: mis
Page 405 and 406: Bonde, L. O. (2002). Introduction t
Page 407 and 408: Bonny, H. L. and L. K. Marids (2001
Page 409 and 410: Clark, M. (1998). The Bonny Method
Page 411 and 412: Ferguson, D. N. (1960). Music as Me
Page 413 and 414: Hilliard, R. E. (2002). The effects
Page 415 and 416: Keiser, L. H. (1986). Conscious Lis
Page 417 and 418: Mahns, W. (1998). Symbolbildungen i
Page 419 and 420: Munro, S. (1993). "Music therapy in
Page 421 and 422: Robbins, C. and C. Robbins (1991).
Page 423 and 424: Short, A. E. (1997). "Jungian arche
Page 425 and 426: Tüpker, R. (1988). Ich singe was i
Page 427 and 428: Zachariae, B. (1997). "Forestilling
Page 429 and 430: LIST OF APPENDICES LIST OF APPENDIC
Page 431 and 432: 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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