Dissertation - World Federation of Music Therapy

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Ph.D. student’ with me the last two years. And I would like to thank former and present Ph.D. students enrolled in the unique Ph.D. program in music therapy at Aalborg University for the many stimulating discussions during the years. Last, but not least, I would like to thank my wife Ellen Thomasen. She has not only been able to cope with the frequent absence and absentmindedness of her husband. She was also the therapist in the project, and her professional handling of the simultaneous roles as clinician, co-researcher, discussion partner and wife has been simply admirable. iv
TABLE OF CONTENTS Acknowledgements.........................................................................................................................iii TABLE OF CONTENTS.....................................................................................................................V LIST OF TABLES...........................................................................................................................ix LIST OF FIGURES ........................................................................................................................xi CD-ROM Contents.......................................................................................................................xiii 1. INTRODUCTION:................................................................................................................................1 Overview of the thesis ...............................................................................................................2 Music terminology and formatting............................................................................................3 Music therapy terminology .......................................................................................................3 2. LITERATURE REVIEW Introduction ..............................................................................................................................5 2.1 Music Medicine and Music Therapy in Medical Conditions.....................................................5 Music in medicine...................................................................................................................6 Music in medicine vs. Music therapy in medical conditions (Medical music therapy)...........8 2.2 Music therapy and psycho-oncology.........................................................................................8 2.2.1 Psycho-oncology and psychosocial interventions in oncology ...............................................8 2.3 Music therapy in cancer care..................................................................................................12 2.4 BMGIM in medical care .........................................................................................................16 2.4.1 BMGIM with medical conditions other than cancer.............................................................16 2.4.2 BMGIM as adjunct to medical treatment of cancer ..............................................................24 Diagnosis/pre-treatment ........................................................................................................27 Theoretical perspectives........................................................................................................29 2.4.3 BMGIM in cancer rehabilitation...........................................................................................30 2.4.4 BMGIM in palliative care.....................................................................................................32 2.4.5 Other relevant BMGIM research ..........................................................................................34 Summary .................................................................................................................................35 3 THEORETICAL BACKGROUND...........................................................................................................37 3.1 Introduction.............................................................................................................................37 3.2 Theories of metaphor ..............................................................................................................38 3.2.1 Lakoff and Johnson’s cognitive theory.................................................................................40 3.2.2 Ricoeur’s hermeneutic theory...............................................................................................44 3.2.2.1 On hermeneutic description, analysis and interpretation...........................................45 3.2.2.2 “When changing its fantasy a human being changes its existence”...........................46 3.3 Theories of Narrative..............................................................................................................49 3.3.1 Narratives in literary theory and practice..............................................................................50 3.3.2 Ricoeur’s hermeneutic theory of mimesis.............................................................................52 3.4 Metaphors in psychotherapy...................................................................................................57 3.4.1 Imagery and metaphor ..........................................................................................................59 3.4.2 Levels of understanding. Psychotherapeutic levels of images and metaphors ......................61 3.4.3 The living metaphor as a therapeutic bridge .........................................................................64 3.5 Narratives in psychotherapy ...................................................................................................66 3.5.1 Tomkins’ Script Theory........................................................................................................68 3.5.2 McAdams' critical constructivist theory of identity ..............................................................69 3.5.3 Ricoeur’s theory of mimesis applied to psychotherapy ........................................................72 3.6 Music as analogy, metaphor and narrative ............................................................................74 3.6.1 Music as analogy ..................................................................................................................75 3.6.2 Music as metaphor in musicology ........................................................................................80 3.6.3 Music as metaphor in music therapy theory..........................................................................89 3.6.4 Three levels of music – or a metaphorical listening to four selections of baroque music .....91 3.7 Metaphor and narrative in BMGIM........................................................................................99 3.7.1 A neuropsychological framework.........................................................................................99 3.7.2 Images, metaphors and symbols in BMGIM ......................................................................101 3.7.3 The BMGIM session in a metaphorical perspective ...........................................................104 3.7.4 Three levels of metaphor in BMGIM .................................................................................107 3.7.5 Conclusions ........................................................................................................................115 v
Page 1: THE BONNY METHOD OF GUIDED IMAGERY
Page 6 and 7: vi 4. METHODOLOGY..................
Page 8 and 9: viii
Page 10 and 11: TABLE 8. 4 EVENT STRUCTURE ANALYSIS
Page 12 and 13: xii
Page 14 and 15: xiv
Page 16 and 17: xvi
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 34 and 35: Table 2. 1 Literature on BMGIM and
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
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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
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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
Page 409 and 410:
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
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
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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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