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About who begins? (VA28, VA32, VA41, VA42, VA43)
This sub-theme relates exclusively to the Active Music Therapy component of the intervention and has to do with client responses when invited to initiate, lead or make choices within music making. The data indicate that in earlier sessions clients seemed hesitant to start or lead. Examples from the data include – “no start please” (A4 1c), “please start” (A17 1c), “eish can you please play one more” (D6 2x), “can you please start” (D8 3c), “rather you sing” (F15 1k), “why must I start?” (F3 6a), “you can start” (L15 1a), “I will follow you today” (R8 3a), “you can go all the time. I’ll follow you” (R14 4a). This hesitancy to take musical initiative may be due to various reasons, including the novelty of music therapy sessions, being unfamiliar with playing music, feelings of uncertainty or low confidence levels. These references to the data were from sessions 1-4.
As the music therapy sessions progressed this pattern changed. Clients began to either exercise more initiative by seeking clarification or by directing the therapist during musical tasks. Examples where clients sought clarity include: – client asks whether she can play “anything” (A3 2d, E18 8d), “we follow each other?” (A3 3d), “Must I give a rhythm?” (F3 4a), “so I must reply when you finish” (R17 1b), “wat moet ek doen? – what must I do?” (T14 3b).
The data also illustrate instances where clients exercised choice and initiative during music making.
Examples from the data refer to clients” selecting which instrument the therapist should play, how the music should proceed and on one occasion correcting the therapist when she did not mirror the client’s rhythm correctly: – “you play the piano” (A11 1c), “will you play the guitar?”) D16 3d), “you must start and I will follow you” (F3 6b), selects piano for therapist (S11 7d), during a mirroring exercise the therapist did not mirror the client’s rhythm accurately – the client said “not exactly” (D6 2q) and demonstrated the rhythm to the therapist for a second time.
Whilst this sub theme did not apply to all clients, it illustrates musical and personal uncertainties and inertia with regard to musical initiative and action.
Resisting doing (VA16, VA54) (VR150)
This sub theme demonstrates a few instances where clients indicated resistance within active music making. In the case of Client R this referred to sessions 1 and 2 “it’s not my thing but let’s go on”, “I don’t like this (vocal)”, “don’t feel like changing nothing”, “I don’t feel like playing, I don’t have the power” (R15 1d, 1i, R3 2b, R20 2m, R224l). In referring to her diagnosis and admission to hospital Client R stated “don’t want to listen to anybody” (R20 2m), Client S, in session 1, indicated that she did not enjoy the drum (S4 1g) and then lost interest saying that she would enjoy something else (S4 1h). In session 4 she was called out of the session to the doctor. Upon her return she did not want to continue due to feelings of irritation.
Whilst the data indicate resistance to aspects of musical participation, this may also indicate clients’
agency through the articulation of preference, choice and feelings.
Stuck (VA48, VA49, VA70, VA71) (VR32, VR116, VR128, VR129, VR177)
With reference to music making clients expressed feeling stuck, unable to shift or change aspects of musical expression: “I’m stuck” (P8 7l), “I feel blocked. I don’t know” (P8 7t), “You know what, today it’s like I can’t”, “No I can’t use, how can I say, I change from one” (A83p,3q), “I’ve always got only that one, ek net daardie een in my kop wat ek altyd spee – I’ve only got that one in my head that I always play”.
With reference to verbal expression: “I don’t know how to express it, I can’t express it (B19 1o). This sub-theme also reflects experiences of feeling stuck at a more personal level. The data refer to varied responses, some linked directly to the experience of clients, while others are projective responses as clients engaged with symbolic material elicited through music-centred techniques: “so dark can’t rise up” (A21 3e), “n gat en dis swart – a hole and it’s black” (H26 8b), “donker gat – dark hole” (H26 8c), “this one wouldn’t know how to get from there to there” (B19 1ad), “Vasgesluit. Ek voel vasgekeur. Ek weet nie watter kant toe nie – Locked up. I feel trapped – I don’t know which way to go” (S21 3k,l,m).
Referring to a clay image of a disabled man: “Hy voel vasgekeur, hy wil uit sy situasie uitkom. Hy voel asof hy nerens kan heen gaan nie , niemand hom wil he nie – he feels trapped, he wants to get out of his situation. He feels as if there is nowhere for him to go. Nobody wants him” (S22 4 d,e,g),”alone, isolated, disconnected, anxious, tense (F26 8f) and “Very frustrated. I’m in a situation I can’t come out of. It’s very hard” (R2 2d,e).
These utterances of feeling stuck within music making, verbal expression and related to personal
circumstances affect clients’ capacity to do, to take action, to change. The feeling state or circumstances may be experienced as overwhelming and as outweighing inner personal resources necessary to effect change. This is discussed in greater detail in 3.4.
Failing, also in self-confidence (VA29, VA44, VA69) (VR55, VR72, VR73, VR187, VR189, VR190) With regard to personal circumstances as well as varied aspects of the music therapy sessions, clients indicated feelings of inadequacy and low self-confidence, hesitancy and reticence to try, difficulty accessing ideas or understanding instructions and feelings of failure and defeat. Examples from the data include: “I have two right legs” (A12 1a), expresses lack of ability to draw (A19 1c), “no, not my voice”, agrees reluctantly to voice work, after an improvisation on the piano which highlighted his musicality he said “I can’t play” (F8 5p), “Nice. But I need more confidence” and in session 6 referred to feeling shy.
(F15 5p, F12 6h), “ek sal nie se ek is talentvol nie; ek het nie ’n mooi stem nie – I would not say I am talented, I don’t have a good voice (H20 2g, H15 2a), “I’m not good at drums” (R3 5e) and “ek is te skaam, ek is nie baie goed – I am too shy, I’m not very good” (T15 1f, T3 2l). Many clients when asked for musical ideas responded with “I don’t know what/how” (H20 2g, B11 1f, D3 1n, D6 2f D6 2w, D15 2b, D8 3z,D14 3k, D16 3c, D15 4c, D8 5e, E11, M5 2c, N14 2i, N16 7a, N18 8c, O4 1a, P10 3f, P117i, Q8 1f, R3 5b, S5 3a, T6 2c), “don’t know what kind of a story” (M235a), “I don’t understand, what can I write?, what can I draw?” (N23 5c, d; N24 6b).
Client J referred to the perception of others with regard to her voice “they laugh at me, say I’m talking not singing, they say I don’t have a beautiful voice. They say I’m just talking” (J15 1k, 2h).
Chapter 1: Introduction
1.1. Introduction
1.2. The patient groups
1.2.1. Major depressive disorder
1.2.2. Schizophrenia-spectrum psychotic disorders
1.3. Music therapy studies in depression
1.4. Music therapy studies in schizophrenia
1.5. Theoretical underpinnings of music therapy as interventi
1.5.1. Active Music Therapy
1.5.1.1. Creative Music Therapy
1.5.1.1.1. Musical interaction
1.5.1.1.2. Play, primary creativity and improvisation
1.5.1.1.3. Listening
1.5.1.1.4. Music as non-verbal expression
1.5.2. Behavioural Music Therapy (BMT)
1.5.2.1. Organising role of music
1.5.3. Analytically Orientated Music Therapy (AOM) – The Priestly Model
1.5.4. Functions of the music
1.6. Receptive Music Therapy
1.6.1. Guided Imagery and Music – The Bonny Method (BMGIM)
1.6.2. Adapted Receptive Music Therapy techniques
1.7. Communicative means supportive to music therapy
1.7.1. Words and verbal interaction in music and music therapy
1.7.2. Symbolic material
1.8. Conclusion
Chapter 2: Research methodology
2.1. Aims and objectives
2.2. Nature of the qualitative affordances
2.2.1. Musical qualities
2.2.2. Verbal expression
2.3. Ontology, Epistemology, Paradigm and Design
2.4. Population and sampling
2.4.1. The inclusion criteria were
2.4.2. The exclusion criteria were
2.5. Interventional procedures
2.6. Post therapy in-depth interview
2.6.1. Post therapy interview processing and (“ield”) notes
2.7. Data preparation and analysis
2.7.1. Data sources
2.7.2. Data analysis procedure: Data source A
2.8. Trustworthiness
2.9. Ethical considerations
2.10. Presenting the findings
2.11. Conclusion
Chapter 3: Verbal affordances
3.1. Introduction
3.2. Theme 1 – Not to feel
3.2.1. Indifference
3.2.2. Not feeling
3.2.3. Suppression of the unbearable
3.2.4. The issue of feeling and facing emotions
3.2.5. Comparative findings – Theme 1 (Not to feel)
3.3. Theme 2 – To do or not to do
3.3.1. About who begins?
3.3.2. Resisting doing
3.3.3. Stuck
3.3.4. Failing, also in self-confidence
3.3.5. Willingness to venture
3.3.6. The making of a decision
3.3.7. Comparative findings – Theme 2 (To do or not to do)
3.4. Theme 3 – Grappling with the desired future
3.4.1. Ending it through suicide
3.4.2. Doubt and scepticism about the future
3.4.3. An impasse, with unwanted dependency
3.4.4. Escaping from the realities of life to some ideal situation
3.4.5. Envisaging a desired future
3.4.6. Aspiring towards financial and occupational independence
3.4.7. Comparative findings – Theme 3 (Grappling with a desired future)
3.5. Theme 4 – Hurt and fear of undesirable unknown
3.5.1. Disabling impact of trauma
3.5.2. Ominous anticipation of the unknown
3.5.3. Fear of hurt and the unknown
3.5.4. Comparative findings – Theme 4 (Hurt and fear of unsirable unknown)
3.6. Theme – Sadness, brokenness and futility
3.6.1. Telling about sadness
3.6.2. Brokenness
3.6.3. Hardship and struggle
3.6.4. Feelings of futility
3.6.5. Comparative findings – Theme 5 (Sadness, brokenness and futility)
3.7. Theme 6 – Anger, trust and vulnerability
3.7.1. Intimate vulnerability
3.7.2. Anger at others and self
3.7.3. Difficulty in trusting other
3.7.4. Comparative findings – Theme 6 (Anger, trust and vulnerability)
3.8. Theme 7 – Desire for connection and affection of others
3.8.1. Loneliness and isolation
3.8.2. Loss of self and others
3.8.3. Need for social connection
3.8.3.1. Social support
3.8.3.2. Caring for others
3.8.3.3. Social interaction
3.8.3.4. Connection with family
3.8.4. Desire for intimacy and love
3.8.5. Comparative findings – Theme 7 (Desire for connection and affection of others)
3.9. Theme 8 – Barricaded from being here, now
3.9.1. Difficulty in being here, now in music making
3.9.2. Forgetting and remembering
3.9.3. Comparative findings – Theme 8 (Barricaded from being here, now)
3.10. Theme 9 – Tensing and un-tensing
3.10.1. References to physical bodily distress and ease
3.10.2. Tiredness
3.10.3. Telling about being stressed and tensed
3.10.3.1. Anxiety
3.10.3.2. Stress and tension
3.10.3.3. Nervousness
3.10.3.4. Calming
3.10.3.4.1. Calming through Active Music Therapy
3.10.3.4.2. Calming through Receptive Music Therapy
3.10.4. Comparative findings – Theme 9 (Tensing and un-tensing)
3.11. Theme 10 – Relating to musical expression
3.11.1. Non-acquaintance and novelty in music making
3.11.2. Reconnecting with previous musical experience
3.11.3. Personal identification with music preferences and familiarity with musical expression
3.11.4. Exercising choice in music making
3.11.5. Awareness of and discomfort with own voice in singing
3.11.6. Comparative findings – Theme 10 (Relating to musical expression)
3.12. Theme 11 – Reflections on the music and music making in the therapy
3.12.1. Spontaneous commenting on music making
3.12.2. Heightened awareness and appreciation of music
3.12.3. Recalling significant life-event memories
3.12.4. Metaphorical reflections on affordances and connections brought about by the music therapy
3.12.5. Comparative findings – Theme 11 (Reflections on the music and music making in therapy)
3.13. Theme 12 – Resilience in courage
3.13.1. Accepting circumstances and events
3.13.2. Change for the better
3.13.2.1. Reflections on change in Active Music Therapy
3.13.2.2. Reflections on change through Receptive Music Therapy
3.13.3. Strength and courage
3.13.4. Growing motivation and goal setting
3.13.5. Persisting forward
3.13.6. Attributing personal virtues
3.13.6.1. Expectations of self
3.13.6.2. New experiences of self
3.13.6.3. Specific self attributes
3.13.6.4. Feelings of significance and self-confidence
3.13.7. Comparative findings – Theme 12 (Resilience in courage)
3.14. Theme 13 – Invigoration and liberation
3.15. Post therapy semi-structured in-depth interview: Summary of emerging themes
Chapter 4: Findings – Musical Affordances
4.1. Introduction
4.2. Theme 1 – Reciprocal responding
4.3. Theme 2 – Explicit use of symbols through music
4.3.1. Comparative findings – Theme 2 (Explicit use of symbols through music
4.4. Theme 3 – Regularity
4.4.1. Rhythmic stability
4.4.2 Flow
4.4.3. Amplifications of musical tension/accent
4.4.4. Comparative findings – Theme 3 (Regularity)
4.5 Theme 4 – Disturbing and difficulty
4.6. Theme 5 – Turning points
4.7. Theme 6 – Energy bursting or lacking
4.8. Theme 7 – Bodily synchrony
4.9. Theme 8 – Intensified emotional expression
4.10. Theme 9 – Exploring new territory
4.11. Theme 10 – Resolution or arrival
4.11.1. Holding
4.11.2. Clarity
4.11.3. Resolution
4.11.4. Comparative findings – Theme 10 (Resolution or arrival)
4.12. Two kinds of findings
Chapter 5: Appraisal of the study
