From “This F***ing life” to “that's better” … in four minutes: an interdisciplinary study of music therapy's “present moments” and their potential for affect modulation

Abstract

AbstractThis article presents the findings of a preliminary interdisciplinary research project instigated by a group of three music therapists, a music psychologist and a psychiatrist. The group shared a professional and academic interest in music therapy's seeming ability to help patients experiencing severe affect dysregulation as a result of psychotic states to effectively modulate affect in a creative way within a surprisingly short time-span.The study takes a qualitative-phenemenological stance designed to elicit cross-professional descriptions/interpretations of clinical events from an exemplary single case of a woman with a psychotic illness. A strategic sample of two key events in the patient's music therapy provides the data, which are explored systematically and progressively in order to attend to the real-time micro-detail of the musical-clinical process in relation to the perceived outcome of affect modulation.Combined inductive and abductive approaches are pursued in an attempt to refine perceptions and descriptions of the phenomenon of "music therapy process and affect modulation" in relation to current inter-disciplinary theory – primarily by Trevarthen, Malloch, Stern and Schore – all of whom use musical analogies to characterize the real-time therapeutic process. We ask, reciprocally, how their theories can illuminate the mechanisms of the music-therapeutic process.The aim of this phenomenological study was not to produce definitive conclusions, but to sensitize inter-professional perceptions of this area, and to develop provisional theoretical formulations that could help assemble a conceptual platform on which to develop peer discussion, and hopefully a more sophisticated empirical investigation at a further stage.Keywords: Nordoff-Robbins music therapyadult psychiatryqualitative micro-analysis"present moments""affect modulation" Notes1"Music is the art of modulating well" (St Augustine). Quoted in Levarie and Levy (Citation1983, p.185).2The music therapist works according to the Nordoff-Robbins approach (see Glossary for his stance to this).3So as not to over-complicate this text we have chosen to define key terminology (not defined in the main text) within a Glossary at the end of the article. Such terms will be indicated by an asterisk.4In this study we aimed not at an acoustic description per se, but at an intersubjective phenomenological hearing of the musical-interactive patterns of the music therapy example, as a first step of empirical attention to identifying and clarifying pertinent aspects of the phenomenon. As we will suggest later, this could pave the way for more complex explorations using quantitative designs.5Recent music therapy literature has given increasing attention to one of these musical-relational processes – the initial process of affect attunement – from both a theoretical and research perspective (e.g. Trondalen & Skarderud, Citation2007). Our research adds a further perspective to this from the specific focus on affect modulation, and at the level of musical-relational microanalysis that we attempt. On a more practical level, it has always been part of the Nordoff–Robbins approach to music therapy to train music therapists how to "tune-in" to such micro-level manifestations of musical communication and to help affective modulations to take place.6Many of these theorists go on to trace these mechanisms to a neurobiological level: Schore to unconscious right brain-right brain synchronization; Trevarthen to a brain-generated "intrinsic motive pulse" (IMP); Stern to "mirror neurons". For our purposes in this study it was less this neuropsychological explanatory level than the "surface" phenomenological descriptive level of their theory that was of interest to us at the current stage of our project.7Pam was happy to give permission for her anonymised music therapy work to be used as part of this research project (which was part of a broader project – "Qualitative Outcomes in Mental Health" - which obtained appropriate ethics approval through the Local Research Ethics Committee). Pam, however, did not want to be part of the research in terms of commenting on her own material, as reflection on a previous phase of illness could have been distressing for her.8We will use the following taxonomy for this study: excerpt is the selected part of the clinical session, heard from an audio recording; event is the dynamic behavioural-relational content of this; episodes are smaller chunks of this event; phrases are equivalent to "present moments" – the shaped properties and qualities of the episodes; moves are the micro-level of such phrases.9Mostly the group chose to simply start the tape again and continue listening. In Chunk 3, however, they wanted to wind back again and hear a transition again.10In a section entitled "The Duration of the Present Moment in Music" Stern (Citation2004, p. 45) discusses the research evidence for the duration of the "perceptual present" in music, citing Clarke's (Citation1999) review, which places this as between two–eight seconds. Stern equates this with a musical phrase.11"We need a subjective process unit that is intermediary in size, larger than a single present moment and shorter than a whole session – a process unit that lumps sequences into larger, coherent, subjective experiences that are, so to speak, the stanzas or movement of the session. […] I call these sequences "relational progressions" because they carry a sense of movement towards relational endpoints or resting places within a session" (Stern, Citation2004, p. 209).12"Narratives are the very essence of human companionship and communication. Narratives allow two persons to share a sense of passing time, and to create and share emotional envelopes that evolve through this shared time. They express innate motives for sharing emotion and experience with other persons, and for creating meaning in joint activity with others" (Malloch, Citation1999, p. 45).13That is, the point in the clinical interaction of the session where a mutually arrived at point of significance has happened. In Excerpt 2 the "crisis" which precipitated this was different from the "blow-up" of Excerpt 1. This time the time leading up to the event was one of fragmentation and frustration at not finding an adequate level of musical/intersubjective contact between client and therapist. The beginning of Excerpt 2 signals the arrival of something which precipitated appropriate change.14Named after the theatrical cabaret-performing character in Christopher Isherwood's novel, Goodbye to Berlin, and the musical and film based on it, Cabaret.15Such a transcription implies no more than another level of description in the terms of this project. It was not intended to provide information on the same level as a spectograph of the interaction (as, for example, Malloch has done), and was not intended to quantify precise timings or features of the interaction. It was (as matches the project as a whole) designed to sensitize observations and descriptions at a qualitative level.16Links could also be made, for example, with Even Ruud's (Citation2003) suggestions concerning aspects of self psychology and its concept of "affect consciousness" could help explain how music therapy (in particular a Guided Imagery & Music (GIM) approach) can help with affect regulation through cultural processes.