Idea Transcript
Music T’herapy 1993, Volume 12, No. 1, 59-84
MECHTILD LANGENBERG, JORG FROMMER. AND WOLFGANG TRESS CLINICAL INSTITUTE AND CLINIC FOR PSYCHOSOMATIC MEDICINE AND PSYCHOTHERAPY OF THE HEINRICH-HEINE-UNIVERSITY, DUSSELDORF, GERMANY Qualitative research approaches appear to be promising in providing insight into interventions in music therapy that are determined by all participants’ subjectivity, intuition, and wholeness. Using the procedure of triangulation (pa tient, therapist, independent describers), this article illus trates an interactive method of analyzing music therapy that is consistent with the treatment. The starting point is the concept of the resonator function that describes all par ticipants’ capacity to perceive the elements of the improvi sation that are emotional and that characterize the patient’s relationships. Then, from the musical notations and the descriptive accounts provided by the participants, induc tive qualities and motifs are compared to the clinical case study. In this research process, methodological results from qualitative social research can be helpful. What really takes place when music therapy goes on? What is specific to music therapy? What are the conditions and factors that make music therapy effective? In order to answer these questions, methods must be developed that meet the specific requirements of clinical practice. The therapeutic processes within music ther apy are determined by highly subjective factors in the very inti mate sphere of joint music-making. Investigating such processes 59
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A Qualitative Research Approach to Analytical Music Therapy
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Methodological Basis of the Approach In an earlier book (Langenberg, 1988), analytically-oriented music therapy as a method of treatment was presented, and initial descriptions and assessments of therapeutic products-impro vised music (see Figure 1)-were developed. At present, our research group is developing these qualitative methods in order to further reveal the effect-producing elements of psychoanalyti cally-oriented music therapy. At the same time, our goal is to advance the formation of indigenous theory in the field of music therapy. Our treatment method is rooted in the psychoanalytical approach and in the idea of new music (Priestley, 1982, 1983; Eschen, 1983), that is, music created according to nontraditional principles of composition, notation, sound production, and aes thetic appreciation.
ti
Joint Product = Improvised Music Figure 1. The musical product during the process of the music therapy encounter.
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in an integral way demands that the subjective dimension be included in the research. This is the only way that research, which otherwise objectifies the process, can gain insight into the whole ness, the quality of experience, and the intuition of all participants: the client, the therapist, and the research panel.
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“Play whatevercomesto mind, determinedby whateverneeds to beexpressed.” Although making music seems to be a fleeting process, it is possible for the participants, if they are willing, to re-experience the music by listening to a recording of their own improvisation. The means by which the therapist apprehends the clinical signifi cance of the created music has been described as the “resonator function” in an earlier study (Langenberg, 1988). This is the per sonal instrument of relating and understanding by which the therapist “resonates” to the latent content of the music, which allows it to become conscious and serve as an inspiration for clinical interventions. Three aspects of the music-making process are taken into ac count in this research: the participants’ self-images as resonators themselves, their ability to participate musically, and their per ceptions of inner images. In this research model, we make use of the resonator function by constructing a panel of independent persons who are not involved in or informed about the production of the improvisa tion. They are also asked to listen to each improvisation. They write down their impressions afterward, according to instructions corresponding to those given to the music-makers: “Describe your impressionsof the improvisation asfreely us possible. Feelings, thoughts, images, stories-even appar ently unrelated-my be mentioned.” Extremely subjective aspects, influenced strongly by the per sonality of the persons writing their impressions, can certainly be
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Analytically-oriented music therapy makes use of free im provisation and free associations that come to mind before, dur ing, and after the music-making. Music is created that can be understood as a blueprint of this encounter. Patient and therapist enter a relationship within this process, and this encounter be comes audible and palpable via this music. At the outset of this method, a basic direction, similar to that used in an analytical situation where the process of free associa tion is also used, is given to the participants:
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1. The interpretation should follow from the subjective perspectives and subjective experience of the indi viduals who are being investigated (Bergold & Breuer, 1987); 2. In a systematic manner, the interpretation
should draw conclusions from a comparison of data that comes from different perspectives (triangle perspec tive) (Denzin, 1970; Flick, 1991); 3. The interpretation should take the categories accord ing to which the material will be assessed from the investigated material itself, in a discoursive and dia logue-based research process that is primarily induc tive and only gradually becomes abstract (Strauss, 1987).
Obtaining the Descriptive Accounts In applying this methodological concept to improvisational creations produced during music therapy, we chose not to employ the” group validation procedure” that we had used inpreliminary studies (Langenberg, 1988). While it has been demonstrated that a higher level of vividness and precision of the descriptions can
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found in these descriptions. However, hints of common motives are also present, leading to the thesis that these independent listeners relive the therapeutic encounter in a way similar to the music-makers, via the resonator function. In order to increase ways to describe verbally and comprehend the subjective nature of the music therapy experience, it was helpful for us to use methodological considerations from the area of qualitative social research. Social research also faces the task of subjecting relatively unstructured verbal materials to an interpre tive and comparative evaluation, e.g., in evaluating narrative biographical interviews (Schiitze, 1983). Therefore, the approach requires observation and description of the situation that is as unbiased as possible (Kardorff, 1991). The following conditions are prerequisites for interpreting the descriptions that are obtained:
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1. Five independent describers, all of whom had not been trained in music therapy, were requested indi vidually to listen to a recording of an improvisation that had evolved in a music therapy session. The evaluators received no information of any kind about the type of therapy that had been the setting for the improvisation. After listening to the tape, they were asked to provide a spontaneous description of what they heard. The instructions given were: “Des&be your impressionof the improvisation asfrankly as possible. You can report feelings, thoughts, images, mental pictures, stories-even if they seemto bechaotic.” 2. The patients in the investigation received the same instructions as the independent describers, with the exception that the patients were requested to write their descriptive accounts immediately following the music therapy session.
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be achieved in a group than in individual accounts (which may have been recorded separately from each other), it has also been demonstrated that in the group process, individual members influence each other and allow their interpretations to take prece dence. Since this is difficult to control, we decided to focus not on obtaining the most differentiated and polished descriptions of the individuals’ spontaneous impressions but rather on the central issue of whether the descriptions of the music therapy-produced improvisations demonstrated any signs of common structural characteristics. Toward that end, we asked the describers to write up their responses independently of each other and from different perspectives. This was the only way to check whether the impres sions, emotions, thoughts, and fantasies that are released through the music truly reflect what the producers of the musical product expressed. The following procedure was used to acquire the descriptive accounts (See Figure 2):
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Describers
improvisation
Patient
Musicians/Composers
Figure 2. Triangle perspective related to the different levels of description.
Analytical Assessment of the Descriptive Accounts Following the music therapy session, the accounts obtained from the three different perspectives (patient, therapist, and independent describers) were then subjected to an analytical evaluation (Mayring, 1983). Based on our preliminary investi gations mentioned above (Langenberg, 1988), we developed two general categorical dimensions, Qualities and Motifs. The term quality describes the subjective response of the listener the character of the (See Figure 3); and the term motifdescribes music (see Table 1, p. 74).
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3. The therapist’s log of the portion of the session dur ing which the improvisation actually took place was also included in our investigation. (The therapist divides her log into three parts: before-during after the improvisation.)
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Qualities Any passages in the descriptive accounts that could be per ceived as responding to the question, “What content structures have I perceived in the improvisation?” were designated Quality 1. Passages in the accounts that responded to the question, ‘What feelings, subjective values, and reflections were released by what I heard?” were designated Quality 2. Since the improvisations were not verbal material, they could be described either directly, e.g., “loud,” “arrhythmic,” or “driven,” or through metaphors and mental pictures. Describers could also express their experience in the form of stories or small episodes to further illustrate the process, shape, and structure of the music. Quality 2 summed up all the contents, pictures, and scenes evoked by the music. In contrast, the emotional experiences brought about by the music or evoked by the musical experience were designated Quality 2. These experiences were closely connected to statements that matched the values and code of ethics of the describers and included their personal reflections on what they heard. The descriptions of emotional and subjective reactions could be projected onto elements of the musical improvisation (e.g., “The music was driven and aggressive”) or they could be the reactions provoked within the listener (e.g., “The music made me increas ingly nervous and irritated”). We designated the latter case, i.e., sentences in the descriptive accounts that may be responses to the question, “What feelings, etc. did the music bring forth in me?,” Quality 2a. This quality included all the emotions, moods, values, and reflections that the describers themselves designated as their reactions to the musical experience. It was only in the patient’s written record, i.e., in the description of the improvisation produced shortly before by the patient him self or herself, that we chose not to differentiate between subjec tive expressions attributed by the patient to himself or herself and subjective expressions attributed to the patient by a third party. A differentiation between the internal or external perspective did not appear to be relevant.
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Qualify 1: “What content structures have I perceived?”
Qualify 2: “What feelings, subjective values, and reflections released by what I heard?”
were
The descriptions describe the musical experience or the feelings that are brought about by the music. Statements that tell about the describer’s personal values and code of ethics are classified here, as well. Quality 2 is a collection of feelings, values, and reflections evoked by the music. Qualify 2a: “What feelings, subjective values, and reflections the music bring forth in me?”
did
Of particular importance are the expressions the describer uses to characterize which emotions, moods, or evaluations the music evoked. Figure 3. Definition of Qualities.
Motifs The second categorical dimension of our evaluation was a summary of the descriptive account in order to distill the thematic motifs. The following steps were applied to the individual de scribers’ accounts: (a) Elimination (re-iterations of statements that appeared more than once were omitted); (b) Generalization (state ments that were implied by more inclusive statements were omit ted); (c) Selection (crucial statements were retained verbatim); (d) Tying together (statements whose content was closely connected but were dispersed throughout the account were collated and reproduced as one statement) (Mayring, 1983). In this way, we could discern a variety of motifs in each de scriber’s account. As each motif was isolated, it was further inves-
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Since the imorovisations are not verbal material, their description is not only direct. Instead, the descriptions are also metaphors; and pictures from the imagination are used as well. The improvisation brings up a shape, a complex activity in process. Some people illustrate the process character of the music by responding with stories, others with pictures and images. Quality 1 is a collection of contents, images, scenes evoked by the music.
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Further Steps in the Assessment In addition to the analytical assessment focusing on qualities and motifs, a musical analysis of the improvisation was carried out by two composers. In so doing, we drew on a descriptive form that employs an individual graphic notation of the particular improvisation to be analyzed, as is used in new music (Kar koschka, 1966). 1 Following the musical analysis, the identified motifs were then related to material that had been gathered outside the music therapy session, e.g., personal history of the patient, as well as from logs written over the course of therapy. It was then possible to look for significances of motifs appearing in the improvisation within the context of experiences that werespecific to the patient’s personality and disorder. Case Study The following case study of Ms. W. is presented to illustrate our qualitative research procedure. Listen to the music created by MS. W. during her 26th session of music therapy at apsychotherapeu tic day clinic (Audio Excerpt #3, Side A, on the tape accompanying this journal). As described above, we began our analysis of the music with an assessment of the qualities, taken from the descriptive accounts of the music from five independent describers, the patient herself, and the therapist’s log. Figures 4 and 5 show two of the five
‘Also, the reader may refer to the article in this journal by Bergstrom Nielsen, “Graphic Notation as a Tool in Describing and Analyzing Music Therapy Im provisations,” pp. 40-58.
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tigated to see if it could be found in any of the other describers’ accounts. Step by step, all the accounts were compared with respect to motifs they might have in common. In addition, each motif was noted and particular attention was paid to the Quality 2a reactions that were experienced subjectively.
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Account 1
I have to think of a child absorbed in itself sitting at a xylophone compulsively and monotonously playing a children’s song. The mother (at the piano) tries to get into contact with the child and makes it use new tones, but she fails because the child is totally cut off, closed, distanced, unable to be reached. The mother (or perhaps a teacher) gets impatient, becomes angry and expresses these feelings half-heartedly. The child doesn’t react, and the mother teacher partially lets her have her way. Against her will, for a short time, she allows herself to get involved in what the child is playing, but she doesn’t manage to do it. I sense helplessness and sadness. Quality 1
Quality2
Quality 2a
child, absorbedin itself, compulsively, monotonously, playing, mother tries to make contact, tries to get child to
use new tones, fails, child cut off, unable
to be reached.
mother,impatient, angry, expresses this half-heartedly
child no reaction, mother gives in and
gets partially involved, doesn’t manage it mother: against her will helpless, sad
Figure 4. First (of five) describer’s accounts; brief conclusion and classification of the text according to the qualities.
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describers’ accounts, Figure 6 shows the patient’s account written immediately following the improvisation, and Figure 7 shows the therapist’s log (from the improvisation portion of the session) also written immediately following the session. At the top of each figure, the entire text of the description is reproduced. At the bottom of each figure, there is a summary of key words, classified into the three qualities: Quality 1, Quality 2, and Quality 2a.
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Account 5
Quality 1 Vision: Asian dolls, awkwardly nodding their heads, wound up, movingslowly, tap, tap
Quality 2
stiff,lifeless lively melodyflattersstiff woodendoll, lively young womantries to makecontactwith the woodendoll, lures, hunts, conforms,rebels against
Quality 2a
melodygets on my nerves
distractsthe doll, diverts its attention,
mechanisminside must be unwound
unfortunately,no space left to hear or to see what temptationsand threats are outside
Figure 5. Fifth (of five) describers accounts; brief conclusion and classification of the text according to the qualities.
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Vision of Asian dolls that nod their heads awkwardly moving along as if wound up. The melody of the xylophone increasingly gets on my nerves, rains stiff and lifeless, always the same set of notes, almost the same rhythm. Besides the tap, tap, another lively melody flutters around and tries to Ratter the stiff wooden doll. I imagine a lively young woman trying to relate to the wooden doll, luring it, hunting it, conforming to its rhythm, rebelling against it, trying to divert its attention and to distract it. Unfortunately, the wooden doll has a mechanism inside that must be unwound. No space left to hear or to see what sort of temptations and threats can be outside.
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Patient’s account
Figure 6. Patient’s account; brief conclusion and classification of the text according to the qualities.
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Freedom, security, letting go, holding on, testing, an overall view, enjoying space, feeling, soaking up, internalizing, sticking up for myself, my thoughts, and my feelings, feeling myself. But which of all these wishes are right, in which form, in which dimensions? Trying out something would also mean taking the risk of making mistakes. But how can I tolerate the consequences of those mis takes? I remember that the consequences of mistakes have a particularly paralyzing effect on one’s work. And when I lose the perspective over my job and my private life, I lose the orientation in my head, I getscared and can’t think straight any more. But when I don’t try to go new ways, I can’t experience any new things and everything remains as it is, but I don’t like the way it is! It's too confining. I want out. I’m angry at myself because I can’t find the courage to get out. When I don’t feel good, when I don’t say anything, when I don’t commit myself, don’t make impressions, nothing can happen to me from outside. Maybe someone will take me into account, but maybe no one will notice me. That’s a high price to pay for “maybe.” “Maybe” reminds me of “hopefully,” and I’ve always used this word in my diaries. It’s a hope that will probably never be fulfilled if I don’t set myself into motion. But I don’t have the guts to be responsible for my ideas-for things that are important for me. It often gets messed up already just because I don’t know what I want or what is important to me, or do I? Fifteen years ago, my father said, “You are as cold as a dog’s muzzle.” I often really believe that I am cold and insensitive. Sometimes, when I’m together with nice families, I have an attack of tears, and I don’t know what’s wrong. Nothing fits together. Everything seems to be a big mess. Where do I begin to put everything in order?
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Quality 1
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Quality 2
15 years ago Dad said, “You are as cold as a dog’s muzzle! I don’t know what I want; I’m cold end insensitive. When I’m together with nice families, sometimes tears well up in my eyes
(Figure 6, continued)
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I want out, I want to feel myself, have wishes (freedom, security, trying something out. .) and stick up for them. That means taking a risk and making mistakes. Fear that the consequences (especially on the job) will paralyze ma, that I will “lose my head” and my orientation. If I don’t try something out, everything will stay the same, but I don’t like the way it is, it’s too confining. I’m angry with myself becausa I don’t have the courage to go out. If I don’t stick out, people don’t take me into consideration or don’t notice me.
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The patient begins on the bass xylophone with a very resolute small and strong form that she always repeats. First I also confine myself on the piano to a limited range of tones around a. The small form has the effect of forcing and confining me. For a while, I create alongside her my little form in this harmonious space of tones until I start to get bored and feel confined. I think about whether I can afford to move to different sound colors and worlds, whether that will mean provocation and anger, whether I can afford to do this next to her and take liberties. After a while I start to pluck the strings inside the piano, to rattle and to experiment, sharpness comes into the musicmaking, the sounds swell and beside me the patient is not bothered by this and obstinately clings to her little musical form. From the piano I jump back to the keys and repeat her theme, almost imitating it. Playfully, I go back and forth from the inside to the outside, from the strings to the keys, After a while the piano ends in this dryness that is caused by her playing, but she doesn’t manage to change anything or to produce any flowing effect.
Figure 7. Therapist’s account; brief conclusion and classification of the text according to the qualities,
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Therapist’s description taken from log written about improvisation portion of the session
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Quality 2
Quality 2a
bass xylophone resolute small and strong form, repeated, therapist piano, limited range of tones, around a harmonious space of tones small form forcing and confining boredom, feel confined, I wonder whether I can afford to move into different sound colors and worlds. provocation? anger? Should I take the liberty? plucking the strings inside the piano, rattling, experimenting sharpness comes into the music-making sounds swell, patient not bothered, small musical form remaining rigid piano jumps back to keyboard, repeat, imitating the theme imitating playfully back and forth between inside and outside, from strings to keys, end in dryness, caused by her playing, no change, no flow (Figure 7, continued)
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Quality 1
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Table 1. Overview of identified motifs within the accounts of the five independent observers, the patient herself, and the therapist’s log.
little people fairies (1) at an early stage (1)
doesn’t achieve it
‘The qualitylo which the motif corresponds is shown in parentheses.
From these descriptive accounts, we identified motifs in the improvisation and grouped them according to the qualities they corresponded with. Eleven motifs were identified (see Table 1): Child (I) Isolation (II) Rhythm (III) Maturity (IV) Impulse (V) Becoming involved/Reveling Powerlessness (VII) Fake (VIII) Anger (IX) Power/force (X) Fear (XI)
in something (VI)
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/I
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(Table 1, continued) Observer 4
2own me stairs (1)
reveling in life (1)
I
Observer 5
mechanism’ofdolls (11 real-lifeyoung woman (2)
11
Patient’s
1
Therapist’s
pi&o jumps backio the keys(1) father (1)
hunts (2)
trying Out2Mx7 out
expe,ime&g (1)
flattering,luring (2)
tsars in her eyes (2), freedom(2)
~~&$~$!$f
not noticing anything (1)
mechanismmust be unwound(1)
beautiful picture(1)
woodendoll (2) melodygets on s.o.‘snerves(2)
litad& (2) consequences paralyze,loss her no change.no How (2) head (2) insensitive (2). cold, like a dog’s muzzle Q) I am angry about myself (2)
provocation,anger w
/,(I The first seven motifs were found primarily in Quality 1, i.e., on a descriptive level that allowed objective distance, as partici pants discussed what they perceived in the music, rather than particular emotions evoked in them by the music. The other motifs had a tendency to appear in the more personal quality categories, Qualities 2 and 2a, which more personally affected the describer. Motif VIII, the “fake” motif, could be classified under both Qualities 1 and 2, but appeared to signal only traces of an emotional encounter. Motif IX, “anger,” was unequivocally re lated to Qualities 2 and 2a and thus to emotional reactions on the part of the describers. The last three motifs, “power/force” and “fear,” seemed to touch on an emotional quality most intensively
I
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1
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J=107
sound material: Aeolian (natural minor in a)
(repetition with slight variability)
In this example, two instruments are played: piano and xylophone (marimba). The piece lasts 5 min. 40 sec. In the course of the first minute, the main note of the piece, a”, becomes apparent and is maintained as the main note during the entire piece. In the first minute, as well, a more or less ostinato-like motif (xylophone) is developed around this main note. This motif certainly does not circle itself, but neither does it change enough that one can speak of a development in the musical sense. Even the insertions of the piano, which to some extent pick up on the ostinato, play around it or even disturb it, are not able to break open the motif of the xylophone. The tonic space (see above) of the xylophone is also very narrow, and the xylophone does not leave it. The sound color (choice of strokes and the manner of striking the xylophone) is also maintained more or less as an ostinato. Finally, the dynamics of the xylophone also remain constant, in the moderate range (pmf). Basically, the xylophone plays a relatively narrow range of sounds which is unchanged during the entire piece. The piano breaks into the sound world of the xylophone, then plays around it and invites it to go on “sound excursions” or “irruptions,” Such invitations go unheeded by the xylophone. Figure 8. Description of the form of Notation One (U. Anstatt).
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and did not appear in every account. This was most evident for the “anger” motif, which appeared in only one describer’s account and in the patient’s description. Following the assessment of qualities and motifs, two compos ers were asked to provide an analysis of the music created in the improvisation (see Figures 8 and 9). No emotional response was presupposed in the composers’ descriptions. The two descrip tions resulted in two different analyses that we discussed together
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‘
piano briefly , takes up ostinato
.
-
. u
T/s
.
.
2’00”
u
,I,
- -. . . - - ‘V -.d . ,~ enduing notes, singular, increasingly not fitting the scale, -
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"spoiling”
‘(-
-
C.
‘w
’ ‘b
.a. Irl
.
1. Y *
piano fakes up , oslinalo molif ~0~ (appmx. 10”)
(Figure 8, continued)
\
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..
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=_ I. _, _.. -
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Ms. W.introduces theme; then pianoMT/piano comes in
I middle section
I 1 repeated figures dialogues, almost being exact stops corrected or practiced
main theme 1
I
Ms. W.: Strong rhythmicfigures in various melodicfragments Piano reactsstrongly, oppositelyto rhythmic figures: Low, high, dissonantnotes,chords, aiming!Also melodiclines, leadingmelodicforms I
main theme 2
I
returning theme, at beginning main theme
Ms. W.: same rhythm, figural variations
tempobecoming faster, atmosphereof departure
Piano strings: additional changes in sound patterns, using dynamics on notes
Urging, melodiouslines; atmosphereof departure, parallel and oppositeinterplay I
‘complementary theme
conclusion
fermata
I
Together new form of alternating notes,conclusionlike fermata A flowing form, continuous interplay on two levels. The rhythmic structure of Ms. W. was maintained during practically the entire piece (structure of the German Christmas carol “Kling Glockchen Klingelingeling”). At the end of the main theme 2, a new melody form of finely alternating notes appears and the piece ends sud denly (fermata; contemplation). Figure 9. Description of the form of Notation Two (F. Seizingar).
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I 1 two measures
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Summary Description of Improvisation Based on the Combination of the Composers’ and Panel’s Analysis In the improvisation itself, a xylophone provides a relatively narrow spectrum of sound which remains more or lessunchanged throughout the piece. Occasionally, the piano penetrates the xy lophone’s realm of sounds, then continues to play around it, inviting the xylophone to undergo a “sound excursion” or “sound irruption.” As observed by U. Anstatt, the composer creating Figure 8, these invitations go unheeded by the xylophone. Some thing seems to have a form that cannot be disturbed. Something seems to attempt to disturb this narrow form and move it to undergo changes. An adherence to a”, the main note, even as other higher and lower notes are played, can be observed. A slight variation was perceived by the composer who created the analysis in Figure 8. Yet it could be easily overlooked, since the changes were minute. It was interesting to observe that the other composer began his analysis from outside the situation and continued to explore toward the center of the situation, posing the question, “What is absent?” In accordance with his perspective, the response was that he observed neither variations nor any development. The author of Figure 8 appeared to make his obser vations starting from the center of the situationmoving to outside it, posing the question, “What is present?” Logically, he discov ered minimal figural variations and some sort of development. From the point of view of motifs, the narrow form that practi cally refused to be influenced pointed to the “isolation” motif. It appeared to be extremely difficult for the patient to establish
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as a group. The point of controversy was whether there were minimal figural variations in the music-something like develop ment--or whether there were no variations and no development, and the music remained narrow and unchanged. This difference may be due to the fact that the composer sensing development in the music identifies with the therapist’s efforts at making contact, while the composer sensing no development may be identifying more with the patient’s resistance to these efforts at establishing contact.
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contact with others, which released a profusion of emotions in the people who allowed themselves to be touched by this music. Powerlessness, anger, force, and fear were all experienced. One senses an imbalance upon attempting to establish contact with a person who appears to have barricaded herself in a small and tightly locked room in which the monotony of movement gives only the slightest hint of animation. Letting go of this narrow form even minimally appears to evoke a threatening situation for the patient and brings about expectations of forcible intrusion. On the basis of this qualitative analysis, we then proceeded to look for relationships between what took place in the improvisa tion and what had been observed previously in treatment. The patient was a 30-year-old woman with a feeling of negative self-worth and a personality structure in which depression was constantly present. Her main symptoms were migraine attacks, and her complaints were chronic. She appeared to have only slight access to her feelings and her emerging tensions. The patient based her self-worth on strategies for achievement. She felt in creasingly under pressure both on the job and at home when she was unable to avoid making a mistake once in a while. In her musical improvisation, it is interesting to note that slight inroads in the otherwise controlled and sustained rhythmic form allowed minimal variations to arise, and the rigid rhythm was altered, adding a sense of animation. In the patient’s perspective, a “mistake” seemed to be the only possibility for her to leave the rigid form and allow herself to make emotional contact. In this improvisation the feelings released by the mistake were those of fear and insecurity. At the same time, this type of small opening allowed her to perceive another person-in this case the thera pist-who otherwise had no possibility to be noticed by her. In her childhood the patient was able to experience security, physical contact, and positive reflection only to a slight extent. In order to protect herself from emotional failure, she developed a sort of “pseudoautonomy.” She had to deny herself her desires for symbiotic relationships. In order to maintain her unstable feelings of self-worth, she needed constantly to produce positive achievements. As a result, she was constantly overwhelmed and was subjected to continuous tension (headaches).
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Table 2. identified motifs related to the patient’s account. Patient's account
Child (I) lsolation (11)
Too limited, cold, insensitive
Rhythm (Ill)
-
Maturity (IV)
Father (1)
Impulse (V)
Trying to go out (2), suddenly well up
Becoming involved/reveling in something (VI)
Tears in my eyes, freedom (2)
Powerlessness (VII)
The consequences paralyze, lose my head (2)
Fake (VIII)
Insensitive (2), as cold as a dog’s muzzle (1)
Anger (IX)
I am angry about myself (2)
Power/force (X)
Taking a risk (2)
Fear (Xl)
Fear (2)
In this treatment situation, individual music therapy was car ried out in the setting of an out-patient clinic for psychotherapy. The improvisation in this article was referred to by the therapist and patient by the theme: “Freedom and Ties.” During the course of therapy, the therapist observed that the patient became increas ingly aware of how desperately she was clinging to familiar structures in order to avoid experiencing insecurity and feelings of insufficiency. Our final step, the attempt to relate the identified motifs to the biography and personality of the patient (see Table 2) demon strated that the patient had little opportunity to be a child and even less opportunity to be a little girl who was accepted and loved for who and what she was.
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Motifs
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Outlook Our study showed interconnections among motifs identified by analyzing the accounts of the participants and observers, on the one hand, and aspects of biography, psychodynamics, and the treatment setting on the other. Our methods did not aim to secure results by verifying hypotheses deduced from assumptions, but rather to find and describe new aspects of an empirical field of study of music therapy. We attempted, by comparative analysis of empirical, herme neutic data, to help explain connections in the research material; that is, to help explain the subjective and intersubjective processes
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While the “child” motif did not appear in the patient’s account, the “maturity” motif in the person of the “father” did. The patient experienced her father as someone who was constantly demand ing and achievement-oriented, and who restricted and prevented her desire for growth. In this respect, her “playing the wrong notes,” illustrated in the “fake” motif, seemed to have developed in response to the unreasonable demands, originating in the father and later internalized by the patient. Because her superego was so rigid and punishing, she often felt that moments of spontane ous expression were “mistakes.” This produced a false, rigid expression that was manifest in the research through the “fake” motif. This meant that any spontaneous liveliness was turned to her disadvantage. The patient forbade herself to express feelings and directed her strong emotions toward herself. Between anger and powerlessness, she stagnated in the symptoms of her mi graine headaches. Change seemed possible only through the use of force. Her strategy for living was an overcontrolled behavior which increasingly drove her to isolation. In the relationship to the therapist, illustrated by the improvisation, only one motif that can be described as positive appeared: the motif of “Becoming involved/Reveling in something.” This motif suggests that an emotional relationship may continue to develop in music therapy using the possibilities of encounter and the fine tuning of the music.
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References Bergold, J.,& Breuer, F. (1987).Methodologische und methodische probleme bei der erforschung der sicht des subjekts. In J. Bergold & U. Flick, Einsickten: Zugange zur sicht dessubjektsmittels qualitativer forsckung(S.2052). Tiibingen: DGVT-Verlag. Dentin, N. K. (1970). The researchact. New York: MC Graw-Hill.
2Foran explanation of research support group, refer to the article in this journal by Kenneth Aigen, ‘The Music Therapist as Qualitative Researcher,”pp. 16-39.
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accompanying the musical improvisation. We took the subjective distortion of the individual describers into account by requiring detailed documentation and substantiation for individual inter pretations, as well as by using systematic perspective triangula tion in the research design and research support group. 2 The degree to which one can generalize from our results is limited by the fact that our study was a pilot study. We also know too little, for example, about which of our motifs are of a ubiqui tous nature and which ones express very specific traits of the individual, the diagnosis, or of the musical encounter that was researched. Finally, we cannot claim that conspicuous differences between the motifs of the improvisation are exclusively a result of the therapeutic process. As usual in psychotherapy research, it is difficult to estimate the influence of many variables, for exam ple, the change of setting from inpatient to outpatient treatment, changes in other areas of the individual’s life, and the small number of sessions examined in comparison to the full extent of therapy. Nevertheless, more cases that we have evaluated in the meantime have confirmed that we have found a valid instrument for the research of the processes in music therapy. This instrument makes possible not only the research of characteristics of music therapy treatment situations, but also the comparative analysis of the methodic orientation and personal influence of the individual therapist. It is also useful for examining the progress of individual case studies and for comparing patients with differing diagnostic classifications.
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sity Press.
Mechtild Langenberg, Dr. Phil., is a amu&psychotherapist mu&psychotherapist and a training music therapist and supervisor. She was the therapist in this casestudy case study and the researcher. Jerg Frommer, Dr. med., M.A., is a psychiatrist, psychotherapist, and psychoanalyst who works mainly as a qualitative researcher. Wolfgang Tress,. Dr. med., Dr. Phil., is Professor for Psychosomatic Medicine and Psychotherapy. He is also head of the Clinical Institute and Clinic for Psychosomatic Medicine and Psychotherapy of the Hein rich-H&e-University of Diisseldorf, Germany.
AUTHORS’ NOTE: We gratefullyacknowledgethe musicalanalysesper
formedby
Uwe Anstatt an Frank Seizinger.
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Eschen, J, T. (1983). Assoziative improvisationen. In H. H. Decker-Voigt, Hand buch der musiktherapie(S.41-43). Bremen: Eres. Flick, U. (1991).Triangulation. In U. Flick, E. Kardorff, H. Keupp, L. Rosenstiel, & S. Wolff. Handbuch qualitative social forschung(S. 432-435). Munchen: Psy chologie Verlags Union. Kardorff, E. v. (1991). Qualitative sozialforschung: Versuch einer standortbes timmung. In U. Flick, E. Kardorff, H. Keupp, L. Rosenstiel, & S. Wolff. Handbuch qualitative sozialforschung (S. 3-8). Miinchen: Psychologie Verlags Union. Karkoschka, E. (1966). DaSschriftbild der neuenmusik. Celle: Moeck. Langenberg, M. (1988). Vomhandeln zum behandeln:Darstellung besonderermerk male der musiktherapeutischenbehandlungssituntion im zusammenhangmit der freien improvisatiuon. Stuttgart: Fischer. Weinheim: Beltz. Mayring, I’. (1983). Qualitative inhaltsanalyse. Priestley, M. (1982).Musiktherapeutischeerfahrungen.Stuttgart: Fischer. Priestley, M. (1983):Analytische musiktherapie.Stuttgart : Klett-Cotta. Schiitze, F. (1983). Biographische forschung und narratives interview. Neue Praxis, 3, 283-293. Strauss, A. L. (1987).Qualitative analysis forsocialscientists.Cambridge:Univer