Music Therapy
1996, Vol. 14, No. 1, 61-83
Becoming Friends with Your Mother:
Techniques of qualitative research illustrated
with examples from the short-term treatment
of a girl with enuresis
DR. HENK SMEIJSTERS &HANS STORM
MUSIC THERAPY TRAINING PROGRAM
HOGESCHOOL, NETHERLANDS
The purpose of this article is twofold. The main aim is to de­
scribe the qualitative research method developed at the Music
Therapy Laboratory, Hogeschool Nijmegen, The Netherlands.
Transcripts from self-reports, live and taped observation reports,
interviews and team discussions were used as the ground data
for analysis. Using qualitative research techniques such as mem­
ber checking, analytical memos, categorization, developing mul­
tiple perspectives, peer debriefing, and triangulation,
the trust­
worthiness of analysis has been ensured.
The second aim is to demonstrate these qualitative research
techniques through the case of a little girl of seven who was
referred to music therapy because of enuresis. It is shown that
behind her behavior was hidden a severe communication
prob­
lem between the child and her mother. The relationship between
the mother and the daughter improved remarkably after partici­
pation in music therapy.
Introduction
The method used at the Music Therapy Laboratory, Hogeschool
Nijmegen, (The Netherlands), “developed by the author since 1989,” is
an example of ‘action’ research because the research process enhances
the outcome of treatment. Although the word ‘laboratory’ is used, the
course of treatment is in no way disturbed by research artificialities. The
research influences treatment by means of the feedback from the
researcher’s analysis and the research team discussions. This type of
research will be described with illustrations taken from the short-term
treatment of a little girl and her mother.
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Smeijsters and Storm
First some information about the client will be given. Then the research
techniques that were used will be described: member checking, analytical
memos, repeated analysis, categorization, developing diagnostic themes,
developing multiple perspectives, peer debriefing, and triangulation.
Each research technique will be illustrated with examples from the case.
In addition the outcomes of this research - playforms, guidelines, and
arguments about the role of music -will be taken from the case.
This article is an abstract of the research report. The amount of data
makes it impossible to give a full picture of all research details.
The Clients / Research Participants
Helen, a girl of seven, had first been referred to an out-patient
department for verbal psychotherapy and family therapy because she
had started wetting herself (wetting her trousers) again after being toilet
trained several years before. At the assessment, her mother said that she
thought wetting her trousers was a way of trying to get extra attention,
or a result of insecurity at school. From Helen’s birth, the mother-child
relationship had been disturbed in several ways. The child cried (for
several weeks) and the mother could not stand this crying.
At the verbal intake the mother described how she as a baby and child
lacked a holding relationship with her own mother. She said that she
never had experienced any affection. As a result, it was difficult for her
to fulfil her parental role. She tried to direct Helen’s behavior verbally
but was not very successful. At the same time she showed little affection
towards her daughter and was not supportive. Since the child avoided
eye contact, the mother at times was isolated. During a discussion she
moved into the background, and was unable to express herself. Her
communication style lacked creativity and initiative. Other family mem­
bers included the father and Edith, the three-year-old sister.
Referral and Indications
The Music Therapy Laboratory has made an agreement with an
institute for out-patient verbal psychotherapy and family therapy, from
which clients can be referred to the Music Therapy Laboratory. At the
end of the musical intake of five sessions the music therapist thought
music therapy was indicated because it would give the insecure child
the opportunity
to act freely, to experiment and express her feelings
without pressure to achieve. In the music therapist’s opinion the mother
showed easy access to musical activities, and could therefore become
part of the child’s process in music therapy.
Becoming Friends with Your Mother
63
The Research Team
The research team was made up of three people: the music therapist
(Storm), the researcher (Smeijsters), and an observer (in the beginning
Juchter, later on Van der Werf). After each session, the music therapist
wrote a self-report, the researcher made an observation report of the
audiovisual tape, and the observer made an observation report during
therapy from behind the one-way screen.* These reports were written
independently,
without preestablished
categories because they were
meant to give “open” descriptions of experiences. According to Smaling,
“open-mindedness”
(receptivity) is “. the ability or capacity of the
mind for receiving impressions,
to undo (your) listening and also
experiencing in general from some culturally learned habits.” (1995).
The descriptions made by the music therapist in his self-report often
contained his objectives, his observations and personal feelings about
progress in music therapy. The observer behind the one way screen gave
an impression about what (s)he felt was actually happening, without
knowing the music therapist’s intentions. By means of repeated obser­
vation of the audiovisual tape the researcher made a detailed recon­
struction of all verbal, nonverbal and musical events during the session.
In all reports cognitive arguments, emotional experiences and musical
analyses were part of the description.
The Transcript
& Member Checking
After each session the researcher made a transcript of these three
reports. Transcripts of about 10 sessions were handed to the mother who
could check whether she felt that the transcripts reflected her own
experiences. This so-called memberchecking--checking the data, themes,
interpretations, and conclusions with the very people we are studying
(Lincoln & Guba, 1985; Ely et al, 1995)-in therapy is not just checking
the credibility of the research findings but becomes part of treatment.
Therefore it is the task of the music therapist to discuss with the research
team the contribution of this member checking to the therapy process,
and also to introduce and discuss it with the clients during the session.
In this case, member checking the transcripts gave insight to the mother
and helped her to reflect her way of communicating.
Discussing the
transcript during the session was impossible in this case because of the
*In other cases clients themselves make a self-report, too. In this case the
interviews of the music therapist with the mother and sometimes the father
fulfilled this purpose.
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Smeijsters and Storm
children who were present. Therefore the music therapist made home
calls and home visits. Music therapy sessions took place at the Music
Therapy Laboratory.
Categories, Analytical
& Repeated Analysis
Memos, Circular
Iterative
Feedback
In the session transcript the three reports were kept intact as three
distinct paragraphs. While making the transcript of each report the
researcher marked those words which he thought could be of impor­
tance. In qualitative research a category, according to Strauss &Corbin, is
defied as a classification of concepts, developed by comparing con­
cepts with each other and grouping them together because they appear
to contain a similar phenomenon (1990). In this research the data were
analyzed under categories and subcategories such as:
l
l
l
l
Diagnostic musical aspects: Individual
(e.g. endurance, variation,
initiative, tension), relational (e.g. cooperation, leading-following)
Treatment: Indication, goals, objectives, playforms, techniques, and
therapeutic attitude
Experiences: The client’s and music therapist’s personal experiences
during musical activity
Progress: Experienced effects, side-effects, treatment disturbances and
treatment catalysts. Side-effects are unintended positive or negative
effects of treatment as experienced by the research team. Treatment
disturbances are counterproductive
factors from outside treatment.
Treatment catalysts are factors from outside that stimulate treatment.
Some of these categories have been developed during previous
research, whereas others have been generated during the research
process (Smeijsters & Van den Hurk, 1993, 1994; Smeijsters &Van den
Berk, 1995).
Guided by the marked words and these categories, after each session
the researcher wrote several analyticaI memos (Ely et al, 1995). In these
analytical memos some of the marked words were combined into diag­
nostic themes. Other marked words led to questions about the music
therapist’s objectives, his playforms, his techniques, the linkage be­
tween diagnosis and treatment and the music therapist’s therapeutic
attitude. Analytical memos were also used to interpret the personal
experiences of the client during musical activity, and to propose alterna­
tive suggestions to the music therapist about how to proceed.
Analytical memos are a means of stimulating the music therapist’s
reflections. The music therapist and observer comment on the memos
Becoming Friends with Your Mother
65
and thus they check the researcher’s data processing, categories,
themes, interpretations,
and conclusions.
Because this process of
feedback is circular and is repeated many times, it is called circular
iterative feedback.
Though the transcripts of the reports contain only surface descrip­
tions, analytical memos give interpretations and conclusions on a deeper
level. As they are tentative and will often be changed when therapy
proceeds, the analytical memos are excluded from member checking
with the clients during therapy.
Repeatedanalysis refers to the researcher regularly comparing old with
new data and checking his previous hypotheses. The researcher checks
whether the old data corroborated with his latest interpretations,
whether previous interpretations need to be changed or whether previ­
ous interpretations
could be used for old data. New data need new
interpretations.
Diagnostic Themes, Diagnostic Local Theory
&Process First Phase (session 6-16)
After several sessions, by combining similar marked diagnostic
words, the diagnostic hypotheses from the analytical memos, and some
categories, the researcher develops diagnostic themes. A theme is defined
as a “statement of meaning that runs through all or most of the pertinent
data” (Ely et al, 1991,page 150).At the Music Therapy Laboratory these
diagnostic themes are called focus points. Contrary to themes as used by
Ely et al they are not written from the client’s point of view. In the first
phase of treatment in Helen’s cake one of the focus points was called
‘insecurity’:
Focus Point: After Session 5
“The child was referred to music therapy because at school she wet her
trousers. The mother, when interviewed by the music therapist, told him
that she thinks the child is insecure. When during therapy the music
therapist explains a play form to Helen she often reacts by saying ‘I do not
understand.’ She stops musical activity and changes musical activity
quickly. At other times she lies down with her body on the drum, slaps her
hands on the piano, and grasps sticks from her mother. There is little
musical development, nor variation, nor initiative in Helen’s musical
activity. Often she imitates initiatives of the music therapist or the mother.”
This focus point was a result of the verbal intake and musical intake
of 5 sessions. The concept of ‘insecurity’ had been choosen from the
interview.
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Smeijsters and Storm
Treatment goals that developed as a result of the music therapist’s
suggestions, the researcher’s treatment hypotheses in the analytical
memos, and discussions in the research team were: ‘experiencing joy’;
‘prolonging musical activity’; stimulating initiative’; and ‘stimulating
creativity.’
First a short description of the process in the first phase which lasted
from session 6 to 16 will be given, followed by an example of an
analytical memo which prepared a change of focus point. While describ­
ing the first phase it is not the intention to give an overview of all
sessions as in a conventional case study. The second phase is much more
important for progress, therefore I’ll describe those events from the first
phase especially from sessions 13, 15 and 16-these were crucial and led
to a shift of focus and the beginning of the second phase.
When, in the 13th session, for practical reasons, her mother brought
Helen’s three-year-old sister, Edith, to music therapy, Helen tried to
instruct her younger sister. Again she herself asked several times “What
shall I do ?,” showed no initiative of her own, and followed her sister’s
and her mother’s musical ideas. Thus, Helen’s behavior showed am­
bivalence: directive, but also copying. When her mother hit the cymbals,
Helen reacted immediately to this by hitting the cymbals too. When her
mother rubbed her sticks on the drum, Helen did also. When later on, in
session 13, the music therapist invited the mother to play ‘the sea’ and
Helen together with Edith ‘the boat’ which is moved by the sea-a
symbolic musical playform of leading and following-Helen
reacted by
saying “Oh, no !”
Shortly afterward, in the same session, Helen and her mother were
invited to play musically together two trees that moved in the wind,
played by the music therapist and Edith. Helen did not want to cooper­
ate with her mother at all. When there was an accidental musical
interplay, Helen said to her mother: “You make me confused.”
In session 15 the child was clearly having fun. She dared to play very
loud, and explored several musical possibilities (imitating the music
therapist’s rhythms and sounds on several drums, temple blocks, chimes,
cymbals). However, she also violated musical and personal boundaries:
disrupting and stopping musical activity whenever she wanted, grasping
her mother’s drum sticks, sitting on her mother’s lap because she did not
want to exchange chairs with her in the musical playform. Session 15
resulted in fighting for sticks. During moments when Helen was not co­
operating, the mother tried verbally to instruct the child on how to
behave, but was not able to influence her child. While Helen tried to direct
musical activity, her mother withdrew musically into the background.
The child concentrated fully on the music therapist. There was no inter-
Becoming Friends with Your Mother
67
play between the mother and the child, and a clear lack of affective
relationship.
The lack of empathy between mother and child was illus­
trated strikingly
when Helen cried during session 16 because of the
punishment
her father had given her for wetting herself.
Over time, the words marked in the transcripts
and the comments in
the analytical memos gave rise to another focus point. The focus point of
‘security’ was used as a sensitizing conceptas termed by Glaser & Strauss
(1967). Guiding
the selection of words in forthcoming
transcripts,
the
process of marking words in the transcripts
and writing memos was as
‘open’ as possible and gave way to a new focus point.
Here is one analytical
memo written after session 16:
MEMO
After Session 16
“Mother is unable to show verbal and nonverbal empathy when the child
cries. If she would be more active at times when the child needs emotional
support she could restore a little bit of the influence she is longing for.
Instead of being empathic she gives only directives, claiming power the
child is not willing to accept.
The music therapist can advise the mother that she should try:
1) To be more creative during musical improvisation.
2) Not to withdraw
musically but gain some musical ‘personality,’
‘being there.’
3) To reduce the frequency of directives and to support the child by
verbal and musical empathy.
Until now there has been a ‘battle of power that the mother is unable to
win. Only by means of by-passing this battle are changes possible.”
This memo-and
other similar
Focus Point: Disturbed
memos-led
Relationship
to a change
of focus:
with Mother After Session 16
“The child plays very loudly, whereas the mother withdraws. Helen in­
structs her younger sister Edith how to play the instruments, and takes her
mother’s role. Her mother tries to instruct Helen but fails. Helen answers
her mother’s attempts by saying “You make me confused.” There is no
musical interplay, and bad eye contact between Helen and her mother.
When Helen cries during the session, telling that because of wetting her
trousers her father had hit her, her mother is unable to react with empathy.
There seems to be a conflict of power, illustrated by Helen saying “Oh, no”
when she is invited to play musically the ‘boat’ which is moved by the ‘sea’
(played by her mother). She also refuses to play together with her mother
the ‘trees’ who are moved by the ‘wind’ (played by the music therapist and
Edith). Helen does not want to exchange chairs with her mother and stops
her mother from playing by grasping her sticks.”
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Smeijsters and Storm
This focus point became the central focus of sessions 17 to 24. Com­
paring
the first and the second focus points, grasping
the sticks is
interpreted
differently.
By integrating
the first and second focus point
with additional
information
from the intake interview,
a diagnostic local
theory is developed
about one particular
case.
Diagnostic
Local Theory
“In the interview her mother said that as a child she had never experi­
enced affection herself. It can be hypothesized
that perhaps she is unable
to give affection. This might have led to a lack of basic trust in her child,
Helen, who became insecure. Wetting her trousers again after a second
child, Edith, was born and when she began to attend school, corroborated
the hypothesis that Helen was an insecure child. Helen tried to overcom­
pensate for this insecurity by taking over her mother’s parental role, and
thus crossing generation boundaries, not following her directions, fight­
ing with her about power, and forcing her mother to withdraw.
The
interaction between Helen and her mother became circular because when
mother withdrew, Helen tried to exercise more power, which resulted in
her mother’s withdrawing
even more.”
This diagnostic
local theory was meant to organize all the different
parts of information
into a “credible”
picture. Before describing
the
progress in sessions 17-24 (second phase), the concept of triangulation
will be introduced,
which is used to guide the second phase by means of
theory.
Triangulation
Because diagnosis and goals shifted from an individual
to a relational
focus, the researcher decided to explore theories of family therapy that
might be helpful when describing
interactions.
According
to Lincoln and Guba, the use of different personal sources
(the clients, the music therapist,
the researcher, the observer, the verbal
psychotherapist
and family therapist),
the use of different data collecting
techniques (self-reports,
observation
reports, discussions,
and inter­
views), as well as the exploration
of several theoretical models in this
research design are part of triangulation (1985).
The researcher began a literature
study research and came up with
several theoretical
perspectives
such as systemic family therapy (Bowen,
1965), strategic family therapy (Haley, 1987), and structural family therapy
(Minuchin,
1974; Aponte & Van Deusden,
1981). The researcher also
investigated
recent publications
on music therapy and family therapy
that might be helpful (Decuir, 1991; Hibben 1992; Oldfield,
1993; Miller,
Becoming Friends with Your Mother
69
1994). These music therapists together offer a set of rationales for music
therapy. Miller (1994) gives a summary of the perspectives in systemic,
strategic and structural family therapy. He describes six musical inter­
ventions that can be linked to one of these types of family therapy:
1) playing your own improvisation
(Self-differentiation:
systemic);
2) doing a solo improvisation
(Taking the “I”: position: systemic);
3) playing a musical duet (Congruent communication: strategic);
4) using musical echoing (Repairing communication:
strategic);
5) parents directing the musical activity (Establishing boundaries:
structural);
6) parents providing a basic rhythm on which the child may impro­
vise (Restructuring
relationships: structural).
Because structural family therapy focuses on conflicts, hierarchy,
alliances, coalitions and generation boundaries, it was concluded that
these theoretical concepts could contribute most to the understanding of
Helen’s relationship with her mother.
Therefore concepts from structural family therapy were used to con­
ceptualize the data. The musical playforms were called enactments ar­
ranged by the music therapist, showing spontaneous behaviors that
reflected the interaction process. As suggested by structural family
therapy there existed a theory the mother had adopted to explain her
daughter’s behaviour (“Trying to get attention”).
There was circularity because withdrawing by the mother increased
Helen’s dominant behaviour and vice versa. There was a problem of
hierarchy because Helen took over her mother’s parental role when in­
structing Edith. Generation boundaries between Helen and her mother
had faded. Helen not obeying her mother’s verbal instructions, and not
accepting her mother’s leading role in music showed the conflict of power.
In structural family therapy an alliance is a cooperation where people
need to fulfill a task together. Acoalition is defined as a cooperation with
someone else “to fight the enemy.” There were alliances between Helen
and the music therapist but no alliances and coalitions between Helen
and her mother.
Progress Second Phase (session 17-24)
Through interaction within the research team the following goals
were developed: “restoring
the relationship,”
“strenghtening
her
mother’s role,” " repairing generation boundaries.” In the previous phase
it had been difficult to use musical playforms where the child had to
follow her mother, this “leading and following”
could be seen as an
objective that had to be prepared first. Therefore, the music therapist
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Smeijsters and Storm
invented musical playforms where the mother and the child had to form
an alliance or a coalition. In the latter the music therapist volunteered as
the “enemy.”
In order to stimulate Helen and her mother to cooperate, session 17
started with a musical playform titled “Space ship.” First all participants
(Helen, Edith, her mother and the music therapist) collected instru­
ments to build a space ship. Helen again was directing the process. Then
her mother, directed by the music therapist was assigned to be the pilot
taking off to Mars. Mars had been choosen because Helen had told the
music therapist that little men from Mars ordered her to be disobedient
and naughty However, Helen did not join the musical playform, and
after landing on Mars she called: “No, this isn’t Mars.” Again this
seemed to be an expression of the conflict of power between Helen and
her mother. Helen took off a second time to go to Mars when her mother
made a crescendo, by playing very loud, taking over completely. After
landing on Mars, nobody knew what to do, and her mother intuitively
suggested singing. This suddenly stopped the conflict. Helen, Edith and
her mother were singing a song together.
Alliances
Singing together became a regular part of music therapy. These songs
were accompanied with instruments. When they sang a song called
“Toddle Men,” the music therapist played the song on his guitar, Helen
played on a wooden drum and the mother on a split drum. The child
played the meter and the mother played the rhythm of the song. In the
“Crocodile Song” the mother and the child musically came closer to
each other when they played the rhythm together. At that time they were
able to do the same thing musically, without quarrelling.
Coalitions
The first coalition occurred when the music therapist instructed
Helen and the mother to sing “Toddle Men” together, and he made an
attempt to sing the song in canon. After he failed, the three of them could
not help laughing. Sometime later, the therapist introduced a musical
playform where he started with a rhythmic motif that should be an­
swered by a rhythmic three-tone motif played by the mother and the
child synchronously. Because of the three-tone motif, it was called the
Boom-Boom-Boom playform (adopted from Van de Poel, 1994).
The playform looked like a musical exercise, but in essence it was a
playform to bring the mother and the child together. Because the music
Becoming Friends with Your Mother
71
therapist made a lot af variations, this playform was very funny and
there was a lot of laughter. He tried to confuse the mother and the child,
who had to be very attentive to the music therapist’s tricks. They could
succeed and oppose his challenges only when they formed a coalition.
The mother and the child looked and listened carefully to each other.
The mother directed their playing together by her facial expressions and
they succeeded in reacting in synchrony. In the musical process, a
closeness developed.
Another aspect of this playform was its continuity
Following the
gestalt law of “good continuation,”
there were no random stops; there
was predictability and logic. This synchronized the musical movements
of the mother and the child.
Conflicts
Conflicts at that time were not as heavy as before. When playing the
space ship, Helen-who
played the engine on splitdrums-said:
“When the engine isn’t ready you can’t start,” or “Wait, I first have to
finish lunch.” Helen wanted attention, but it was part of the playform.
By saying “no,” in answering questions of the music therapist (music
therapist: “Shall we make a training flight first?“, Helen: “No”) Helen
could express her rebelliousness in a less destructive way. As the music
therapist offered her choices, she could influence the event without
obstructing the musical activity. She could express her discontent in
music and at the same time be part of the musical activity. Starting
from session 20, Helen spontaneously used the gong to say “no.” The
music therapist incorporated these breaks as part of the session, and
after a short rest he brought her back to musical activity without
deviating from his intended session structure. Sometimes he used a
pragmatic paradox when asking Helen to start the engine, inviting her
to direct the musical activity. Because Helen reacted by saying “no"­
although she had always tried to direct the musical activity-she
now
forced herself not to do and to leave the leading role to someone else.
The behavior of Helen after the 20th session showed remarkable
changes: she had eye contact with her mother, she accepted mother’s
leading role in the Boom-Boom-Boom playform, she interrupted the
musical play less, and she complied with directives. When later on the
music therapist and the mother played together, the boundary between
generations was reinstalled because Helen joined Edith in her musical
activity.
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Smeijsters and Storm
Mother’s
Behavior
During his counselling visits at home the music therapist invited the
mother to become his co-therapist. Mother’s behavior changed com­
pletely. She took part in communication,
installed the musical instru­
ments, initiated actions (“landing of the space ship,” introducing the
song of the “crocodile”), and spontaneously started singing and play­
ing. In the discussion the mother was less corrective and more empathic.
The mother followed Helen’s lead in seeking body contact, softly hitting
her with a drum stick on the head. The mother gradually became very
sensitive to the music therapist’s musical activity, and was able to
support Helen musically as well. The music therapist advised her to
make use of paradoxical intentions, which turned out to be very success­
ful: when, at home before going to school, Helen did not want to go to
the lavatory, and her mother reacted by saying, “I don’t mind,” Helen
decided to go because, as she stated, “I will have no time at school.”
A Second Change of Focus
The first shift of focus from insecurity to the conflict of power had been
followed by another shift of focus. One day before the 19th music
therapy session at the institute for out-patient verbal psychotherapy and
family therapy, there had been an intake for the whole family. Because
the mother sometimes felt misunderstood
by her husband and was
convinced that she needed more support from him, the parental rela­
tionship came into focus. It was agreed that family therapy would start
at the out-patient institute and, at the same time, music therapy would
concentrate on the generational boundaries. Further, it had been agreed
that the music therapist would reduce his interviews at home. Instead of
once a week, music therapy sessions at the Music Therapy Laboratory
were now scheduled once every two weeks.
Between session 20 and 21 there was a stop of six weeks in music
therapy because of holidays and other activities at home that made the
appointments difficult. After six weeks, the improvement of the rela­
tionship between Helen and her mother was still there, but Helen once
again had started wetting herself.
Edith now came to music therapy regularly, and the music therapist
tried to let her take part in the Boom-Boom-Boom playform. He pre­
arranged with the mother that she would concentrate on Edith. During
these sessions the mother tried to synchronize Edith’s musical behavior.
Edith was playful, not able to concentrate, wanting attention, and she
did not stop playing when it was someone else’s turn. This behavior is
Becoming Friends with Your Mother
73
normal for a child Edith’s age. Sometimes Helen imitated Edith’s behav­
ior. Since the relationship with her mother had been improved, there
was no longer a conflict of power and a need to act as an adult.
In session 22 there was a quarrel about Helen’s enuresis. Helen re­
peated many times: “You can talk with anybody about anything you like,
but I won’t say anything about it,” and finally started to cry. The music
therapist, after challenging her, felt pity for her, and softly rubbed her
back. He reported that he almost cried himself. Helen’s sorrow must have
been very deep. The music therapist was permitted to comfort her, but
Helen avoided being comforted by her mother and Edith. What was she
hiding? Why didn’t she want to be comforted by her family members?
In the same session when the music therapist again played on his
guitar, Helen imagined thunder and said she was scared about this. She
also said that she now wanted to be comforted by her mother. The music
therapist arranged a musical playform. First her mother taught Helen
how to play the lightning on the vibraphone. She instructed her how to
make a fast melodic line in the high octaves that, in sound, resembled a
flash of lightning.
When they played together, Helen was the lightning,
the music
therapist and the mother were the thunder on the kettledrums, and
Edith played the wind on the piano. Helen and her mother also played
together a rhythmic playform on the vibraphone during which they
laughed together, and the session ended by Helen and her mother
synchronizing
their musical activity with Edith’s, supporting and talk­
ing to each other.
It was astonishing that a session which started with quarrelling
ended so harmoniously.
The musical enactment made it possible to
handle fear, and again increased the co-operation between Helen and
her mother. There had even been a start of a constructive interaction
between Edith, Helen and her mother.
Nevertheless, in his self-report after this 23rd session, the music
therapist felt as if he had reached a dead end. As a result, a discussion in
the research team took place.
Multiple
perspectives
There have been discussions within the research team concentrating
on the diagnostic themes, objectives, playforms, techniques, the thera­
peutic attitude, progress, possibilities, and personal feelings. Circular
feedback by means of the exchange of papers and discussions in the
research team gave rise to “multiple perspectives.” In this dialectical
interaction, the music therapist, the observer, and the researcher played
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Smeijsters and Storm
the devil’s advocate for each other. However, using such a group does
not mean searching for some sort of unanimous “truth.” This would
lead to reductionism.
As a researcher, one should respect the multiplic­
ity of perspectives
and use them to corroborate
and to adjust his own
interpretations,
or to present them as other perspectives.
During these
discussions there is also an opportunity
for catharsis. The transcript
the discussion after session 23 is given below:
Multiple
Perspectives-After
of
Session 23
“Because the music therapist felt insecure about progress, a special meeting
was arranged. The researcher and observer stimulated the music therapist
to explore his feelings. The music therapist expressed disappointment
be­
cause Helen had started wetting herself again, because it was difficult to let
Helen’s younger sister Edith share the musical playform, because the musi­
cal interplay was difficult to direct, and because the mother had little space
to express herself musically. The music therapist forgot what, in the opinion
of the researcher and observer had been gained up till now: a significant
improvement of the relationship between Helen and her mother. The music
therapist probably became a little confused by the frequent presence of
young Edith, which gradually changed the course of music therapy. Now
that the focus of therapy changed to Edith, the whole family came into sight,
and the co-operation had to be extended to three persons.”
qualitative research, including heuristic and dialogical phenomenology
and naturalistic inquiry (see Tesch, 1992). Just as in supervision, the
perspective of the other members of the research team can help to
reframe, stimulate and develop new ideas about treatment. Bruscia
notes that although this team discussion resembles supervision, it is not
the same because of the research techniques and research focus, which is
meant to fulfil the criteria of a systematic gathering of data relevant to a
community of researchers (1995).
Peer Debriefing
Peer debriefing, according to Lincoln & Guba, or peer checking, means:
inquiring biases, testing working hypotheses, by asking independent
observers to check the descriptions and give meaning to the data (1985).
At the Music Therapy Laboratory, peer debriefing is used when
experts outside the laboratory are asked to check and challange the data.
Sometimes professionals from another area are invited. Smeijsters & van
den Berk describe the participation
of neurologists in the case of the
client with musicogenic epilepsy (1995). In the case of Helen, the verbal
Becoming Friends with Your Mother
75
psychotherapist and family therapist at the out-patient institute regu­
larly received a copy of the complete research report. They were asked to
challenge the data and to communicate their opinions to the music
therapist with whom they met several times. Although these persons
were not completely independent, they did not take part in the music
therapy treatment and were not members of the research team. The
music therapist made reports from these discussions that were inte­
grated into the transcript.
Termination
(Session 24)
In session 24 the whole family was invited: the mother and father,
Helen and Edith.
When the music therapist proposed a musical coalition between the
father and the mother against the music therapist and the children, it
was very difficult for the father and the mother to synchronize their
musical activity. Starting and finishing, musical tempo, rhythm and
dynamics were different and neither of the parents had nonverbal cues
to develop musical cooperation. In the music therapy enactment, a
lack of agreement could be observed very clearly. A coalition between
the father and the mother against the children seemed to be impos­
sible. During the session, the mother moved to the background as she
had done during the conflict of power with Helen. To stop this, the
music therapist introduced a musical playform where the mother had
the leading part on the vibraphone. The music therapist, the father,
Helen, and Edith had to support her. His intention failed completely.
The father and Edith started playing on the piano in a close duet and
did not listen to the mother’s music at all. It became painfully obvious
that the father did not listen to the mother at all and that he sought a
coalition with Edith and not with his wife. The distance was symbol­
ized by the father and Edith sitting with their backs to the mother; the
mother tried to play nice-sounding
tonal motifs while the father and
Edith explored atonal sounds.
This music therapy session had shown the disturbed interaction of
the parents. It was hypothesized that the musical alliances and coali­
tions that had been very successful with Helen and her mother could be
used to harmonize the situation between the mother and the father as
well. In spite of this, there were several reasons why treatment stopped.
First, because of his professional activities, it was almost impossible
for the father to attend music therapy sessions regularly. Second, both
parents became dissatisfied with the changes in family therapy at the
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out-patient institute and the changes in music therapy as a result of
this-e.g.,
the music therapist reduced the number of home inter­
views. Third, the music therapist at that time was very busy and
sometimes had to change appointments. The cumulative effect of these
three problems led to the decision of the parents to stop both family
therapy and music therapy.
During a follow-up contact, the mother told the music therapist that
during holidays, when the relationship between the father and the
mother improved, Helen’s enuresis had disappeared completely, but
after some time when the problems between the parents resumed, the
enuresis reappeared. Although it may be that because of holidays from
school, Helen’s insecurity decreased, the problems of the child could
have been caused by the problems between the parents. The mother
supported this idea by saying that “I think Helen feels the problems
between me and my husband”. Perhaps here lies the meaning of Helen’s
words and her crying in session 22. Did she feel very deeply the misun­
derstanding between both parents? Was she hiding it, not daring to
mention it openly?
What is the outcome of this type of research? There are three issues:
the musical playforms, guide lines and hypotheses about the role of music.
1) Musical
Playforms
With the help of the concepts alliance and coalition, musical playforms
were developed to reach the therapeutic goals. Examples of alliances
and coalitions which have been introduced by the music therapist and
described before will be summarized:
Alliances
Singing together became a regular part of therapy These songs were accom­
panied by instruments. The music therapist accompanied the song on his
guitar. The child played on a wooden drum and the mother on a split drum.
There were two special forms of alliance between the mother and the child:
a) the child beating time and the mother playing the rhythm of the song;
b) the mother and the child playing the same rhythm together.
The mother and the child were able to do the same thing musically, without
quarrelling and fighting.
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I
77
Coalitions
There were two kinds of coalition between the mother and child:
a) A coalition occurred when the music therapist instructed the child
and the mother to sing a song together while he attempted to sing in
canon.
b) The music therapist introduced a musical playform; he started with
a non-specified rhythmic motif that had to be answered by a rhyth­
mic three-tone motif played by the child and the mother synchro­
nously.
In (a) the child and the mother started singing together and formed a
strong musical coalition against the music therapist who sang in canon but
was not able to stand the strong vocal opposition of the mother and child.
In (b) the music therapist tried to confuse the mother and the child by
making a lot of dynamic and rhythmic variations during his musical intro­
duction. The mother and the child had to be very attentive to each other in
order to start in time and play synchronously after the music therapist had
finished his introduction. They could succeed in opposing his challenges
only when they looked and listened carefully to each other. The mother, by
her facial expression, took the leading part and directed their timing.
In both coalitions between the mother and the child a process of interde­
pendency and being close unfolded. There was fun during this stage, with a
lot of laughter, and a relaxed atmosphere.
2) Guidelines
Guide lines are rules of thumb generated from this particular
which are transferable
and researchers might
case,
to other cases and from which other therapists
benefit. Some of the guide lines are listed below:
Guidelines
1) When there is a conflict of power, “leading and following”
should be
preceded by a parallel activity like singing and by musical “alliances”
and “coalitions.”
2) Meter and rhythm offer important possibilities for exploring contact at
different levels: playing rhythmical variations on a basic meter, playing
“off-beat,” playing a meter or rhythm synchronously.
3) Saying “no” can become incorporated in the musical playform by offer­
ing choices of musical instruments, offering alternative sequences of the
musical activity, and by offering an instrument to make a pause. Para­
doxical intentions as procedural technique can be of help.
4) Boundaries between generations can become reestablished
when the
parents take over the music therapist’s role, and the children are invited
to form a coalition against the parents.
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5) Preventing the child from taking over the parental role can be done by
the music therapist giving the one child much musical attention while
the mother gives musical attention to the other child.
6) The music therapist should act as a model for the parents, and demon­
strate how to make musical contact.
7) Children who are constantly overruled can be invited to take the leading
role or play a prestigious instrument.
3) Hypotheses
about the Role of Music
A third issue is the hypothesis about the role of music in the case of
Helen. The musical analysis used during the research process differed
from traditional musical analysis. According to Smeijsters, it was sup­
posed that in musical expression and interactions specif ic and nonspecific
analogies of psychic and social processes can be heard (1993, 1995, 1996a).
For instance: The mother’s lack of influence was expressed by her
playing pitchless and soft music. This is called a specific analogy because
it is directly expressed in musical parameters. By grasping her mother’s
sticks and instructing her sister Edith how to play, the child expressed
her rebelliousness in a non-specific way. When she interfered dynami­
cally with her mother’s musical activity, she expressed her resistance in
a specific musical way.
Musical playforms and singing were described as analogies of im­
proved communication processes. As singing together is not an exchange
but doing the same thing together, it is an easy way of co-operating. It
requires exact timing and intonation, forcing the singers to attend to the
one another. The canon used by the music therapist, and the “Boom­
boom-boom playform” were described as an analogous means to put
Helen and her mother in a coalition against the music therapist.
When discussing the research report, the mother, in music therapy
interactions, immediately recognized similarities with the interaction
processes at home. She said: “In music therapy it is less heavy, more
playful.” Thus the mother not only corroborated the analogy between
music therapy processes and interaction processes at home, she felt also
that in music therapy there is distance from normal life. Both ingredi­
ents-similarity
and divergence in musical sound-are
main character­
istics of the concept of analogy, and are central to music therapy.
Replicating
the Chain of Evidence
According to Yin, all data, categories, themes, interpretations
and
conclusions are registered in the research report, making it possible for a
second independent researcher to replicate the chain of evidence (1989).
Becoming Friends with Your Mother
79
This research report includes:
1) Transcripts of all self-reports by the music therapist and the mother,
and observation reports of the observer; transcripts of the discus­
sions within the research team; transcripts from interviews the music
therapist had with the mother at home; transcripts from the peer
debriefings with the verbal therapist and family therapist.
2) Categoriesthat guided data analysis by the researcher.
3) The researcher’s analytical memosand feedback from the music thera­
pist and observer.
4) The focus points: themes generated by the researcher from marked
words in the transcripts, and validated by the other members of the
research team. Themes were taken from a couple of sessions, describ­
ing and conceptualizing diagnostic aspects.
5) Generatedhypotheses-about indications, goals and objectives, play­
forms and techniques of music therapy-established
by the mem­
bers of the research team.
6) Localtheoriesconstructed as a result of the researcher’s content analy­
sis of the whole set of sessions.
7) Generatedhypothesesabout progress, side-effects, treatment distur­
bances, treatment catalysts and disturbances by the members of the
research team.
8) Guidelines, suggested by the researcher and validated by the other
members of the research team. Guidelines are rules of thumb that
may be used in similar cases.
9) Generatedhypothesesabout the role of music, established by the re­
searcher.
Discussion
From the section on team discussion it can be shown that reflecting
the process of music therapy leads to multiple perspectives of interpre­
tation. In this case, from one point of view, music therapy sessions have
been successful because the relationship between Helen and her mother
improved, and Helen’s enuresis had diminished up to the 20th session.
However, there was less time to let Edith take part in musical activities
and to make an alliance or coalition between the parents. From a
psychodynamic
perspective, the termination of music therapy by the
parents when their relationship came into focus might be interpreted as
resistance; from a research perspective it was interpreted as a distir­
bance in the therapeutic process.
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One point that has been mentioned when using member checks is
whether it is productive during the therapy process to hand over the
research report. In the case of the client with musicogenic epilepsy
mentioned by Smeijsters & van den Berk (1995), the client herself was
convinced that by reading the memos she would be more able to
influence the process, because there was more “openness.” However,
she sometimes felt misunderstood
when in her opinion the tentative
hypothesis inadequately expressed how she felt. In the case of Helen, it
was decided not to give the memos to the parents. They received the
transcripts of the music therapist’s self-report, the researcher’s and the
observer’s observations. Also the personal phrases in the self-reports of
the music therapist were left out. The parents, who refused family
treatment at the out-patient institute, should not at the same time be
confronted with the music therapist’s insecurity.
The concept of analogy, according to Smeijsters -which
has been
used as a theoretical perspective for describing the music-differs
from
other concepts like metaphor, symbol, or replica (1996a). When, for in­
stance, a camel is described as “the ship of the desert,” this is plausible
because, like a ship sailing across the expanse of sea, the camel takes
travellers through an expanse of desert. The camel has the same function
as the ship, but in its structure and characteristics it in no way resembles
a ship. In an analogy, in contrast, two phenomena share the same
characteristics. Several characteristics of psychic processes can be ex­
pressed in musical phenomena because in essence they are musical
themselves. For instance, “depression” can be characterized by slow
tempo and soft dynamics, anorexia by a lack of rhythmic balance. The
client experiences and expresses him/herself
in music because the
characteristics of music enable the “re-sounding”
of those experiences.
This is true as well for life events and interactions in the client’s life.
In symbolization,
says Aigen, there is a dualism between symbol
and thing (1995a). A symbol can refer to something without resem­
bling it. This again differs from analogy because an analogy has
characteristics of the thing it refers to; in analogy there is no dualism
between symbol and thing. For instance, the color red is a symbol for
socialism, whereas the color itself has no characteristics of socialism.
This is different in analogy. A shy person might express his personality
by means of soft dynamics. Aigen puts forward that in music therapy
there is a “direct” expression and not a “representation
by an abstract
symbol system” (1995). Ansdell (1995) uses the concept of “intrinsic
interpretation”
to describe how the music therapist makes a musical
response within his playing with the client, rather than translating
music into another medium.
Becoming Friends with Your Mother
81
Although we agree with these concepts, we believe that these “di­
rect” expressions and “intrinsic interpretations”
cannot be described by
means of musical analysis exclusively. They need to be “interpreted,”
to
be linked with psychological “meaning.” Our perspective is to listen to
the psychic and social processes which sound “through” the music, not
listening to the music from a perspective of traditional musical analysis.
Hesse (1967 quoted by Aigen 1995b) defines two types of “models”: a
replica having a physical and formal relationship, and an analogue having
only a formal relationship. For instance, a ship on your desk can be a
replica of a real ship. It is physically exactly the same, but smaller. An
analogue in Hess's description has no physical but a formal relation­
ship. For instance “resonating ideas” cannot “resonate” physically like
sound frequencies. Comparing these concepts to the researcher’s con­
cept of analogy it may be concluded that this concept is no replica.
Because psychic processes are expressed in another medium (music),
there is no exact physical relationship. On the other hand it is no
analogue in Hesse’s sense, because his concept of analogue is very close
to the concept of metaphor. My concept of analogy is between the replica
and the metaphor. It is not a physical copy-like
the ship on your desk­
but it is more than just a formal relationship.
Final Comments
According to Tesch, this type of research has aspects of phenomenol­
ogy and hermeneutics (1990). Marked words in the transcripts delineate
“meaning units,” which are clustered together in themes (focus points).
Considering each meaning unit of the text in relationship to the whole,
transforming
it within the theme and giving meaning to it from the
whole, is a hermeneutic component within this research.
As has been shown in the previous paragraphs the method is based
also on the principles of “naturalistic inquiry” (Lincoln & Guba, 1985),
and “grounded theory” (Glaser & Strauss, 1967).
Conclusion
The case of Helen and her family illustrated techniques on a multi­
tude of therapeutic levels. The research guidelines, instrumental
in
directing the outcomes of this case, can be applied in other situations as
well. Importantly, the family relationships improved through participa­
tion in the music therapy process.
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Smeijsters and Storm
Publications.
Miller, E. B, (1994). Musical intervention
in family therapy. Music therapy,
12(2), 39-57.
Minuchin, S. (1974). Families and family therapy. Cambridge: Harvard Univer-
Becoming Friends with Your Mother
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(eds). Qualitative approaches to music therapy research: Understanding processes
and dialogues from the first international symposium. Phoenixville: Barcelona
Publishers.
Smeijsters, H. (1996d). Qualitative single-case research in practice: A necessary,
reliable and valid alternative for music therapy research. In: M. Langenberg,
J. Frommer & K. Aigen feds). Qualitative approaches to music therapy research:
Understanding processes and dialogues from ‘the first international symposium.
Phoenixville: Barcelona Publishers.
Smeijsters, H. & P. van den Berk (1995). Music therapy with a client suffering
from musicogenic epilepsy. A naturalistic qualitative single-case research.
The Arts in Psychotherapy, 22(3), 249-263.
Smeijsters, H. & J. van den Hurk (1993). Research in practice in the music
therapeutic treatment of a client with symptoms of anorexia nervosa. In: M.
Heal&T. Wigram (eds). Music therapy in health and education. London: Jessica
Kingsley Publishers.
Smeijsters, H. & J. van den Hurk (1994). Praxisorientierte
Forschung in der
Musiktherapie
(Naturalistic research in music therapy). Musiktherapeutische
Umschau, 15(l), 25-42.
Strauss. A. &I. Cabin (1990). Basics of qualitative research. Newbury Park: Sage
Publications
Tesch, R. (1990). Qualitative research. Analysis types & Software tools. New York:
The Falmer Press.
Yin. R.K. (1989). Case study research. Design and methods. Newbury Park: Sage
Publications.
Henk Smeijsters, Ph.D. is the Director of the Creative Arts Therapy
Training
Programs at the Hogeschool
Limburg,
Sittard (Netherlands).
During this research study he has been director of Research at the Music
Therapy
Laboratory
of the Hogeschool
of Arnhem
and Nijmegen.
He
has been the Chair of the International
Scientific Committee
of the 8th
World Congress of Music Therapy in Hamburg
(1996).
Hans Storm is a music therapist at the Music Therapy Laboratory,
and
a lecturer in the Music Therapy Training Program of the Hogeschool
of
Arnhem and Nijmegen.
Special thanks to Thomas Juchter and Ria Van der Werf who participated as
observers. Both are graduates from the Music Therapy Training Program of the
Hogeschool ofArnhem and Nijmegen. This research was funded by the Dutch Music
Therapy Fund of the DUMA Association, and the Hogeschool of Arnhem and Nijmegen.