Music Therapy
1992, Vol 11, No. 1, 65-98
Music and Imagery
with Physically Disabled Elderly Residents:
A GIM Adaption
ALISON E. SHORT
MUSIC THERAPIST, GROTTA CENTER,
WEST ORANGE, NEW JERSEY
This article outlines a music and imagery program with
physically disabled elderly residents in which the Bonny
Method of Guided Imagery and Music (GIM) was adapted to the
group setting. Selected participating residents exhibited a
wide range of physical disabilities, including those result­
ing from head trauma (stroke), sensory deficits, fractures,
and systemic problems. The average age of attendees was
83 years. The format of the weekly l-hour sessions in­
cluded extensive therapeutic discussion, a GIM-like induc­
tion, and carefully selected taped classical music that
ranged in length from approximately 4 to 12 minutes.
Based on a qualitative approach, descriptive data was
gathered and then reviewed after 21 sessions. Results indi­
cated that the elderly residents used imagery vividly and
effectively to address a broad range of past, current, and
impending future issues, including disability, bereave­
ment, sexuality, and the aging process. The effect of physi­
cal disability, especially related to the induction, did not
seem to present a major difficulty to the music and imagery
process. The group setting enhanced resident participation
and encouraged sharing and support among participants.
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66
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Considerations in Adapting GIM
to Physically Disabled Elderly Residents
The Bonny Method of Guided Imageryand Music (GIM) is an imagery
technique within the field of music therapy that integrates music
and imagery in the therapeutic process (Bonny, 1978a, 1978b,
1980; Bonny & Savary, 1973). In order to ascertain the therapeutic
viability of Guided Imagery and Music (GIM) techniques with a
group of physically disabled elderly residents, it was necessary
first to consider what adaptions needed to be made to utilize the
techniques of GIM-based imaging and processing with such a
group.
Adapting GIM to Groupwork
The GIM method is currently defined, with founder Helen
Bonny’s approval, specifically asa one-to-one method, withactive
dialogue taking place between the client and GIM therapist during
specifically programmed classical music (Association for Music
and Imagery, 1990) (see Figure 1 for a schematic summary; also
refer to Short (1991) for an in-depth outline). GIM has been
applied to many populations, with Fink (1986) finding that it
enhanced spiritual life for elderly individuals.
Since GIM is by nature and definition an individual method
(AMI, 1990), any group practice of this method must be consid­
ered an adaption.’ Originally, Helen Bonny did work with groups
as an introductory experience to the broad area of GIM (Bonny &
Savary, 1973). However, it seems that few GIM practitioners have
reported initiating ongoing therapeutic groups using music and
imagery, exceptions being Goldberg (1989) and Summer (1988).
Goldberg has adapted GIM for acute psychiatric care by continu­
ing the directiveness of the induction and talking over the music.
Summer (1988, 1981) has adapted GIM for groupwork in the
institution, with emphasis on work with substance abuse patients
and with the elderly, but with little mention of physical disability.
1Unfortunately, the definition of individual/group GIM has been confused and
unclear in the past, and hence the literature refers to GIM in many ways. The
present article follows the AM1 (1990) definition, which has been approved by
the founder of this method.
Music and Imagery with Physically Disabled Elderly Residents
67
PRE-MUSIC THERAPEUTIC DISCUSSION
l
l
therapeutic issues
physical and emotional states
Transition to Altered State of Consciousness
(ASC)
INDUCTION
l
l
l
autogenic (Schultz & Luthe, 1959)
progressive/tension-release
(Jacobson, 1942)
other (Bonny, 1978a)
Transition to Music
MUSIC
l
l
active dialogue and relationship with
imagery and music
interventions by GIM therapist
Transition to Normal Stats of Consciousness
(NSC)
POST-MUSIC THERAPEUTIC DISCUSSION
l
processing and integration of insights
and awareness
Figure 1.
Schematic summary of standard single-client GIM session.
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Short
Therapists outside of the GIM field have suggested that there may
be many approaches to using imagery in a group setting (Singer
& Pope, 1978; Ettin, 1987).
In the current study it was necessary to adapt standard one-to­
one GIM practice to a small-group setting of physically disabled
elderly residents.
Adapting to Physical Disabilities
In this study the elderly clients experienced a wide range
of physical disabilities, such as blindness, strokes, heart con­
ditions, cancer, and arthritis. It was essential to consider
whether these physical disabilities would present a barrier to
successful use of imagery. Studies of the use of imagery with
clients with severe visual impairment (Wagner-Lamp1 &
Oliver, 1988), strokes (Farah, Levine, & Calvanio, 1988;
Levine, Mani, & Calvanio, 1988), unusual heart rhythms
(Bonny, 1986) and cancer (Fiore, 1988; Simonton, MatthewsSimonton, & Creighton, 1980; Siegel, 1986) tend to suggest that
this may not be a problem. However, it was apparent that the
type, location, and the range of physical disability needed to be
taken into account within the group. The effects of the GIM
induction especially demanded careful consideration and
adaption to the combination of physical disability and the aging
process.
A GIM induction is typically a combination of a relaxation
procedure and a specific image designed to help the client change
focus from the concrete outside world to the inner awareness (an
altered state of consciousness) necessary for the effective use of
imagery. Since a feeling of calmness and security is generally
required in order for this change of focus to occur, areas of overt
conflict, such as the difficulty of moving disabled limbs, should
be avoided in the induction.
In this program a broad variety of inductions was used, pri­
marily based on autogenic principles (Schultz & Luthe, 1959), but
also incorporating modified progressive relaxation procedures
(Jacobson, 1942) with post-session feedback from residents deter­
mining adaptation and further use.
MusicandImagerywith PhysicallyDisabledElderlyResidents 69
Adapting to Psychological/Situational
Problems
In considering the goals for the current GIM program, it was
also important to consider the implications of psychological and
situational problems:
Psychological effectsof&ability
In the elderly, disability frequently causes chronic psychologi­
cal problems that are not easily resolved. Reich, Zautra, and
Guarnaccia (1989) found that disabled participants faced “con­
tinuing and chronic burdens associated with their stressful situ­
ation” (p. 64) and remained troubled psychologically. They also
noted a negative impact on self-esteem and self-concept caused
by the effects of physical disability.
In adapting GIM for use with clients experiencing the psycho­
logical effects of disability, it is important for the music therapist
to be aware of such issues and to make a commitment to enhance
group sharing and support between residents.
Bereavement
Bereavement is a serious psychological stressor for the elderly
person (Reich, Zautra, & Guarnaccia, 1989). As age increases,
losses occur more frequently and may include loss of spouse,
family, peers, and even children. The normal grieving process
may be long and uneven, and mourners may never fully resolve
their feelings of loss (Osterweis, 1985). Ambivalence toward or
dependence on the deceased may increase difficulty in coping
with bereavement. Additionally, life within a long-term care fa­
cility for the aged involves a continual awareness of death as other
residents come and go.
In the current study, although most of the clients had experi­
enced the death of their spouse many years previously, there were
indications from other therapy sessions that issues of bereave­
ment might form an important focus for the music and imagery
program. The question arose whether the effects of present or past
bereavement would appear in the music and imagery session, and
if so, whether the residents would be willing to share this with the
music therapist and with each other.
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It has been demonstrated that psychodynamic therapy can
address such factors as unresolved previous losses, defective
defensive and coping strategies, and preexisting emotional insta­
bility in order to promote resolution of grief in the elderly popu­
lation (Osterweis, 1985). It has also been clearly demonstrated that
GIM has the capacity to address grief (Short, 1993) and has poten­
tial application to the group setting. The actual manner in which
to facilitate this needed careful consideration.
Aging process
Successful adaption to the aging process requires a re-organi­
zation of the psyche. Atchley (1989) suggests that as people age,
they bring with them their individual adaptive or maladaptive
patterns of coping with problems. Muslin (1992) expands this idea
to propose the concept of the elderly self, a self that has changed to
meet and react to internal and external circumstances. He de­
scribes a cohesive elderly self as being one in which these self­
alterations have resulted inan adaptive self, without the signs and
symptoms of overreaction to the external world in the form of
self-fragmentation or loss of worth. He clearly distinguishes be­
tween adjustment (implying acceptance of inadequacy) and adap­
tion, and states that “the elderly self is, depending on the
surroundings, not only at peace with itself, but is also ajoyous self
reflecting achievements that are deemed laudatory” (p.6). Work­
ing toward this goal of the cohesive elderly self became a focus of
the music and imagery program.
Although it might be expected that imagination deteriorates
with age, Pierce and Storandt (1987), studying cognitive abilities,
state that “imaginal ability does not vary with age” and found
“little evidence of an age-related deficit in image vividness or the
ability to control images” (p. 211). Thus, aging itself was not
expected to interfere with the generation of imagery, although
other factors, such as resistance, could have a substantial impact
on the implementation of the music and imagery program.
In adapting GIM to this elderly population, the initial focusing
questions included:
l
Could resistance, a common defensive maneuver in the
elderly (Burr, 1986), be circumvented?
MusicandImagerywith PhysicallyDisabledElderlyResidents 71
. Could involvement in the decision-making process, as sug­
gested by Burr (1986), reduce the effects of possible resis­
tance to an internally directed music and imagery pro­
gram?
. Would the music and imagery program impact directly on
the client’s life and experiences, both past, present, and
the impending future?
l Would reminiscence and life review (Beadleson-Baird &
Lara, 1988) occur?
. Since individual GIM sessions were unavailable due to
time limitations, would the ongoing group setting still pro­
vide therapeutic benefits for these elderly disabled resi­
dents in their use of music and imagery?
Adapting to the Setting
A quiet and pleasant venue free from interruptions is required
for the GIM technique. With space and quietness at a premium in
a residential facility, this can be difficult to find and creative
solutions may be needed. Adaptions may include trying a room,
monitoring its suitability, and then changing as necessary. Regu­
lar sessions are required, with weekly sessions optimal in terms
of scheduling and group process. Unlike 2-hour, single-client
GIM sessions, the length of group music and imagery sessions
usually extends to only 1 hour, being limited by other program­
ming within the facility, and by the attention span and physical
stamina of the residents.
The Adapted GIM Model
Having reviewed the above issues, an adapted GIM model was
derived. Decisions regarding adaptations of GIM procedure, con­
clusions regarding the efficacy of the procedures, and the results
of the work were based on extensive qualitative observations.
Selection of Clients
This music and imagery program was originally envisaged as
a small group, with 4 to 6 clients an optimal number. Attendees
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Short
were carefully selected by the music therapist, with input from
other staff. The criteria for selection included good hearing capac­
ity, ability to be quiet and inner-focused during the induction and
the music (that is, able to inhibit conversation), reliable verbal
and/or communicative skills (but not necessarily fluent use of
language), and a perceived potential for achieving insight into self
and situation.
It was important to screenout those clients for whom GIM may
be contraindicated, such as those who may have an unstable ego
(Summer, 1992), yet to some extent it was impossible to determine
response to the imagery situation until the session was experi­
enced by the client. Therefore, it was determined that the final
evaluation for long-term attendance of the music and imagery
sessions would be based on attendance at a single session on a
trial basis.
The clients initially selected responded within an appropriate
range to the music and imagery session with the exception of three
particular clients. In these instances, either by their own decision
or by a post-session assessment of their responses to the imagery,
the music and imagery setting was deemed unsuitable. In one
case, the client had problems following instructions and remain­
ing quiet and inner-directed; another used the music and imagery
process well but for personal reasons declined further attendance;
yet another client showed evidence of an unstable ego, which
seemed to be undermined by the music and imagery experience,
and he was subsequently redirected into alternate programs
within the facility. The other selected clients continued to attend
for over two years, some of whom have been included in a
subsequent study (Short, 199213).
Description of Clients
Ages of attendees at the beginning of the study varied from 72
to 90 years, with the average age being 83. The attendees had
disabilities that included visual impairment (two clients were
legally blind); right hemiplegia, left hemiplegia with aphasia;
diabetes and heart disease; severe arthritis; post-cancer remission;
cellulitis with poor circulation to lower extremities; and paraple­
gia. All clients were wheelchair-fast due to their physical disabili-
Music and Imagery with Physically Disabled Elderly Residents
73
ties; some could walk brief distances with assistance. Although
many clients regularly took medications, these particular medica­
tions did not appear to substantially affect the music and imagery
situation.
Setting
Two different rooms were used during this program, with a
change occurring at the ninth session when the first room became
untenable due to interruptions. Both rooms used in the program
had pleasant and relaxing views. The second room was down­
stairs in a nonresidential area, necessitating an elevator ride, and
was a quiet room, free from interruptions. A double-deck portable
audiocassette player was used to play the selected audiotapes.
Attendance
Sessions were held on a weekly basis as much as possible;
occasionally sessions were canceled, however, due to external
circumstances related to scheduling within the facility. Atten­
dance at the music and imagery program averaged between 4 and
5 clients per session, with the least being 1 and the most being 6
clients per session. There was a high degree of continuity in
attendance over a long period of time; of a pool of 10 clients, 7
attended on a regular basis, with 3 additional clients attending
only 1 or 2 sessions on a trial basis. Of the 21 sessions, there were
2 where only a single client attended.
Format of Sessions
The format of the music and imagery sessions in this program
followed in essence the outline of a single-client standard GIM
design, assummarized in Figure 1,where it is considered essential
to incorporate the client’s needs and issues into choices of induc­
tion and music, and to expand and integrate this with subsequent
discussion.
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Each session began with time for general discussion and check­
ing-m with all members of the group, during which time several
themes would develop? A group decision would then initiate
progression to the induction, followed by the music and imagery
segment. Participation by group members was encouraged, thus
reducing directive leadership by the music therapist. The group
was treated primarily as a single entity, in line with group dynam­
ics (Stock & Lieberman, 1974). There were, however, times when
the group mood was “split” among members of the group, and
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Each session began with time for general discussion and check­
ing-in with all members-of the group. during which time several
this situation had to be addressed carefully (Short, 1992a). Spe­
cific taped music was carefully chosen in an effort to accommo­
date the needs and issues of all attendees, in line with the
isoprinciple (Altshuler, 1948; Short, 1992a). The noticeable adap­
tion from single-client GIM was that the clients could not dialogue
with the GIM therapist about their imagery as it was happening,
but had to wait until completion of the music. After the music,
adequate time was allotted for each person to discuss their own
imagery separately, before a general group discussion and/or an
acknowledgment of the differing experiences of those present.
Post-session follow-up by the music therapist proceeded as nec­
essary, in order to fully vent feelings or discuss images resulting
from the music and imagery experience.
Pre-music discussion
For the first several sessions (and whenever new group mem­
bers were present), the pre-music discussion involved an expla­
nation of the music and imagery process and a verbal outline of
the structure of the session. Questions were always welcomed. All
sessions began by checking-in with individual group members
about how they were feeling, from which derived general topics
and issues within the group.3 The positive effects of a group
process that encouraged residents to achieve greater depth in
2 This pre-music encouragement of group discussion differs significantly from
Summer’s (1981) approach of allowing group discussion to occur only after the
music.
Music and Imagery with Physically Disabled Elderly Residents
75
looking at topics that arose were felt by the therapist to outweigh
any possible negative effects of shared imagery about shared
topics and issues (“copying” another’s images).
Emerging topics and issues ranged from questions about the
music and imagery process (“is it hypnosis?“) to difficulties relat­
ing to communal living, personal feelings, memories, physical
problems, world issues, important events in the residence, sexu­
ality, traumatic abuse/abduction, pleasant places (home, autumn,
beach, with children), and the state of the weather and the season.
In all casescomments by clients were encouraged and accepted to
reinforce both individual experiences and the commonality of the
group. Residents were encouraged to feel that the sessionbelonged
to them and that it could address whatever their needs were.
As in standard GIM, the pre-music discussion was useful for
assessing mood and themes, with a view to the appropriate selec­
tion of an induction and music, in line with the isoprinciple
(Altshuler, 1948; Short, 1992a) and standard GIM practice. The
music therapist did not enter the session with an agenda of what
the client(s) should accomplish for that day but with a willingness
to resonate dynamically with issues and thoughts as they arose
within the group.
Induction
The preliminary part of the induction involved inviting the
clients to become physically comfortable. In contrast to standard
one-on-one GIM where clients most often recline in a prone
position, no facilities were available for these elderly clients to
transfer from wheelchairs to a more comfortable position for the
music and imagery experience. With an acknowledgment of pos­
sible difficulties, attendees were encouraged to become as com­
fortable as possible in their wheelchairs.
Making use of client material from the pre-music discussion,
the induction was devised to promote an inner focus in prepara­
tion for spontaneous imagery (imagery not directed by the music
therapist) in response to the music. Several types of inductions
were used.
Although there is a body of knowledge linking Jacobson’s
(1942) progressive relaxation (tensing and relaxing of body parts)
with pain management (Raft, Smith, & Warren, 1986), inductions
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Short
other than progressive relaxation were used initially in order to
circumvent resistance. Logically, if tension could be linked with
pain, then for clients already in pain (for example, arthritis) the
tension/tightening of a progressive relaxation induction had the
potential to work in a contrary manner to achieving the altered
state of consciousness necessary for the effective generation of
imagery. Also, most residents were unable to use certain parts of
their bodies, so heavily focused attention on moving muscles in
inoperant limbs could undermine the inner focus required for the
music and imagery process. Modified progressive relaxation tech­
niques were used in later sessions, but with careful observation
and post-session client feedback in order to check for detrimental
effects of such inductions on the imagery process.
The clients’ feedback and imagery responses indicated that the
modified physically-based inductions used were satisfactory.
Both physically-based
(modified progressive relaxation or
breathing-related) and autogenic (Schultz & Luthe, 1959) induc­
tion techniques were used successfully. Some inductions sponta­
neously combined elements from the pre-music discussion in
somewhat unusual configurations in order to address ideas and
needs of the clients.
The use of brief focusing imagery in the induction was often
more specific and less open-ended than in standard GIM practice,
in order to establish a similar departing point for all members of
the group. This was then followed by music selected to address
somewhat broader needs than in standard GIM, due to varied
needs and directions of individuals within the larger group and
the wider array of experiences that they brought to the session.
In addition to inductions determined by the music therapist,
clients were asked for spontaneous ideas of inductions (unlike
Summer, 1988), and these suggestions were often very successful.
For example, “flowers” were suggested by Sarah (Sessions 7 and
10); “ocean/beach,” by Connie (Sessions 6 and 9); and “air and
lightness,” by the group as a whole (Session 13).
Selection of music
As in standard GIM, music was selected from the broadly
“classical” repertoire, with representations from Baroque, Classi­
cal, Romantic, and Twentieth-Century styles. Choices of music
Music and Imagery with Physically Disabled Elderly Residents
77
were previewed by the music therapist and used experimentally
within the group. As in standard GIM practice, changes in non­
verbal cues-such as restlessness, facial expressions, and breath­
ing rate-affected the length and type of music used. Through
testing such music in the group, some music was found unexpect­
edly successful in promoting imagery, for example, “He shall feed
his flock” from TheMessiahby Handel; other music did not appear
to promote imagery effectively, for example, Air on a G String by
Bach.
Residents’ suggestions for music were also encouraged, with
consideration and previewing by the music therapist. Both gen­
eral and specific suggestions were encouraged. For example,
Beethoven’s “Moonlight” Piano Sonata, Opus 27, Number 2 was
used successfully (Session 18) and music from The Messiah was
also found successful (Session 14). Not all client music suggestions
were suitable; for example, a suggestion of Ravel’s Bolero in Ses­
sion 12 proved unusable in the therapist’s previewing because the
music was too long, too uncompromisingly repetitious and over­
stimulating for this group music and imagery setting.
Choice of music used over the 21 sessions related to many
factors, such as mood states, personal and group issues, and
external auditory stimuli. Of the musical selections used, most
were instrumental in nature, with vocal arrangements used only
3 times in the 21 sessions. Vocal music was used with great care,
since it has the potential to elicit strong responses from clients,
frequently causing transference reactions. There was no overall
conclusion of a particular type of music being more successful
than any other, but applicability of factors in the music to the
current process seemed to be the most important determinant for
effective use: for example, using a “rocking” rhythm with clear
melody when nurturing was required, or using a strident and
rhythmic full orchestra to match high energy.
In general, one piece of music per session was used. When two
pieces of music were used, the second piece was selected to
stylistically and musically continue or expand imagery possibili­
ties already addressed; for example, Grieg following Elgar (Ses­
sion 5), both being Nationalistic styles and somewhat reflective in
nature. In general, the second piece of music followed without a
break for discussion. Exceptions to this were in Sessions 5 and 13,
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where there was an induction for each of the two pieces of music.
However, it seemed that the second brief induction was largely
superfluous, judging by comments and responses of the clients in
these two sessions, since the effects of the induced altered state of
consciousness still remained. It also seemed that discussion could
effectively wait until after the second piece of music, with both
pieces of music treated somewhat as a single entity, as in Bonny’s
(1978b) compiled tapes. Bonny (1989) speaks of the importance of
the silence between two pieces of music, but in this music and
imagery program, this could not be specifically controlled.
Length of sessions
Clients were carefully observed by the GIM therapist while the
music played, and nonverbal cues, such as coughing, restlessness,
rapid eye movement (REM), rate of breathing, and facial expres­
sions were noted and assessed in an ongoing manner in order to
gain information about the client’s depth of experience and pos­
sible distress or tiredness. This information was also used in
assessing the need for more music or for reducing the length of
music.
Each session lasted for approximately 1 hour. Since music in
single-client GIM sessions typically extends from 30 to 45 minutes,
it was necessary to adapt the length of music for this program. It
was also determined that it was not clinically responsible to use
an entire standard GIM tape designed to reach deeply into the
psyche, since the alloted time and the group situation in this study
precluded dealing with this material adequately.
Given the physical disabilities and attention spans of the eld­
erly participants, the total timed length of music in this study
varied from 3:07 (minutes:seconds) to 11:57,and comprised either
one or two pieces of music. The average total length of music was
7:42 (see Figure 2). On the basis of nonverbal cues, it seemed to
the GIM therapist that if two pieces of music were used, clients
could tolerate the music for a longer period of time. To some
extent, Figure 2 supports this premise.
Post-music discussion
For the most part, clients had no difficulty returning to a normal
state of consciousness, and the group waited until all attendees
Music and Imagery with Physically Disabled Elderly Residents
0
2
4
6
8
10
Length of Music (minutes)
79
12
Figure 2
Total length (minutes) of music
used in 21 music and imagery sessions,
were ready to join in the post-music discussion. On a few occa­
sions, particular clients seemed to take a much longer time to
return, a temporary state apparently related to their increased
depth of experience (Bonny & Savary, 1973). Group discussion
was often extensive and made good use of the material produced
within the group setting.
Efficacy
Before analyzing the case material of this study, it is instructive
to preview the general results and the therapeutic effects of the
use of GEM-based imaging and processing techniques with the
group in this study:
14
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Ability to Image Successfully
The wide array of the group members’ physical disabilities did
not seem to be a barrier to successful use of imagery. However,
the type, location, and the range of physical disability within the
group was taken into account, especially in planning the induc­
tion. The fact that residents were required to remainseated in their
wheelchairs during the entire music and imagery session did not
appear to have detrimental effects on the induction. In general,
pain distractions or postural limitations resulting from physical
disability appeared to inhibit neither the relaxed state required for
imagery nor to distract from the spontaneous generation of im­
agery. It can be assumed that the residents were very used to their
condition(s) and circumstances.
The diverse types of imagery experienced by these elderly
physically disabled residents did not appear to differ in any
substantial manner from the music therapist’s experiences of GIM
with a general population. The types of imagery produced ex­
tended beyond abstract, concrete, or photographic visual imagery
relating to reminiscence, association, or interaction to also encom­
pass somatic or kinesthetic sensations, affective or auditory im­
agery, and transpersonal or spiritual experiences (Short, 1989).
The clients were able to image successfully with the music in a
group setting, in a manner that impacted on their life and experi­
ences.
Most of the attendees repeatedly reported experiencing an
enjoyable kinesthetic sense of freedom of movement, in contrast
to their restricted wheelchair existence. It was as if these physi­
cally restricted clients could use their imagery to give themselves
the freedom lacking in their everyday lives. Clients also connected
deeply with issues surrounding sexuality; this theme recurred in
many sessions. Group members obviously deemed it an impor­
tant topic to discuss, perhaps because this subject was not being
addressed in other therapy within the facility.
Despite physical difficulties and the effects of aging, it was
impressive that the participants in this program were able to
propose a wide selection of topics, themes, and issues, and to
address these dynamically using their own imagery with the
music.
Music and Imagery with Physically Disabled Elderly Residents
81
Effects of the Group Format
It appeared that the shared focus of the group as a collection of
individuals provided a means for these elderly disabled residents
to diffuse their anxiety about material evoked and to offer support
to each other in the music and imagery program.
Because the residents were working in a group, it was necessary
for them to recall their imagery after the music had finished in
order to talk about it with the group (unlike the single-client GIM
setting where memory recall is not required because the reporting
is ongoing during the music). The ability to remember the imagery
proved, in most cases, not to be a problem. Since short-term
memory is often thought to deteriorate with age, this was a very
interesting finding and suggests that the use of imagery is not
precluded in groupwork with the elderly.
Ability to Deal with Specific Issues
One of the concerns of this study was how to deal with the
expected problem of resistance, a common defensive maneuver
in the elderly. Following Burr’s (1986) suggestions, the program
was designed to include substantial participant involvement in
the decision-making processes. The combination of eliciting resi­
dents’ suggestions for induction and music, along with a pre­
existing client-music therapist relationship, diffused or circum­
vented any potential problems with resistance.
As to how the music and imagery program would impact on
the residents’ lives, relating to physical disabilities, grief, aging,
and integration of experiences, the results are 1argely borne out
by the following case material. Residents used the music and
imagery program to address concerns in many areas of their lives;
for example, traumatic abuse from childhood (Example 2), remi­
niscence of youth (Example 1), problems of social isolation (Ex­
amples 1 and 7), reactions to a crisis within the facility (Example
5), and impending death (Example 4).
Two issues stood out as recurrent in many sessions: sexuality
and bereavement. Clients connected deeply with issues sur­
rounding sexuality, and this theme recurred in many sessions
(Example 1). Bereavement was addressed by many of the resi­
dents, both in relation to spouse (Example l), family (Example 3),
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and on occasion with regard to deaths within the facility (Example
6); deep emotions were mostly shared individually with the music
therapist, but occasionally with the group also.
Case Material
Selected and representative excerpts from the music and im­
agery program are presented below to illustrate the efficacy of this
program. Due to descriptive and narrative considerations, the
session material is not presented in chronological order. In the
first and fifth examples, an entire session is outlined; in other
examples particular clients’ responses remain the focus.
Group Process and Attunement
In the music and imagery Session 12, the clients’ responses
changed frombeing light-hearted and externally-based to a depth
of feeling and insight. The pre-music discussion began with a
facetious and joking discussion about a particular male per­
former, with an eccentric personal and musical style, who was to
entertain later at the facility. Jokes, repartee, and suggestive com­
ments flowed easily as Vivian began to talk about a doctor she
“liked,” and there was participation by all group members. The
group mood seemed very energetic, in a positive (but not frenetic)
sense.
To harness the group’s energy and address their issues, the
induction involved imagining an “ideal person” and communi­
cating in the imagery with that person in some way via words and
music. The music used was Elgar’s Enigma Variations 8 and 9. The
music conveys a sense of being open, with room to expand, and
carries a sense of strength and support, as well as a sense of
wanting to “sing,” which is a useful characteristic in image­
communication, according to Ventre (1990).Ventre (1990) has also
noted the importance of the composer’s mindset in composing the
music and its subsequent effect on the GIM client. In the case of
Elgar’s Enigma Variations, each variation refers to people in the
composer’s life, and as Elgar himself says, Variation 9 describes
spending time with his close friend who grew “nobly eloquent”
Music and Imagery with Physically Disabled Elderly Residents
83
(Bookspan, 1973, p. 162), thus suggesting an uplifting and close
relationship. The clients in the group responded in the following
ways:
For Sarah, legally blind for 14 years, her “ideal person” was
Helen Keller, whose strength in surmounting blindness and deaf­
ness Sarah was able to feel and absorb. As a direct result of the
imagery she experienced in this music, Sarah spoke about being
blind and about the things she missed in everyday life. The group
was very supportive of her and gave her positive feedback about
how well she was coping. It was unusual for Sarah to speak so
candidly or deeply about her disability; in verbal exchanges she
often avoided addressing authentic feelings, using superficial
humor or topic changes. Sarah’s competent use of imagery to
relate to an inspirational figure, and subsequent freedom and
depth of discussion, gave clues about her competent adjustment
to visual impairment (Wagner-Lamp1 &Oliver, 1988).
For Connie, the idea of an “ideal person” transformed to an
ideal period of her life: childhood and adolescence, a time when
she remembered “feeling free and easy.” “Now,” she observed,
“life is so difficult.” It seemed important for Connie to acknow­
ledge her feelings and be acknowledged and supported by others
in the group.
For Blanche, her “ideal person” was a male employee at the
residential facility, but she “declined to give further details.” She
shared that her imagery was a fantasy and very enjoyable. How­
ever, as she left the session, Blanche broke into tears about how
much she missed her long-deceased husband, and the tears lasted
for several minutes. This was the only time the GIM therapist saw
such an emotional response by Blanche in the music and imagery
sessions. She had not spoken to the music therapist about her
husband before in any context. It seemed that her imagery of her
(male) “ideal person” triggered thoughts and feelings that she had
been accustomed to sharing with her husband and accessed an
area of incomplete grief process. It was also interesting to note that
Blanche had not had “fantasy” imagery before in the music and
imagery program (usually she had factual memories of the past);
the emergence of fantasy imagery suggested a change in her
willingness to take risks and explore new areas.
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For Gwen, a right hemiplegic client with aphasia, her “ideal
person” was a female entertainer, “Rosalind.” By gesture and
words Gwen indicated that this woman conveyed warmth from
the heart, which Gwen felt was communicated to her in the
imagery. The image was so important for Gwen that she was
strongly motivated to communicate her imagery to the rest of the
group, despite her aphasia. On only two other occasions had
Gwen experienced persons in her imagery. In her life in the
facility, she often seemed rather isolated. This imagery seemed to
help Gwen bridge the gap to communicate with other people,
both within her imagery and in the group setting.
Frieda, legally blind but with some sight remaining, said that
she had no “ideal person” in her imagery, but that she found the
music deeply soothing. Since Frieda was prone to anxiety, a
response of relaxation and apparent physical reduction of anxiety
(shown by body posture, facial expression, and breathing rate
both during and after the music) was significant for her.
For Vivian, her “ideal person” was her deceased husband, and
she recalled memories of sharing good times together with him.
She further volunteered that her jokes in the pre-music discussion
had been “just a facade”; this expression showed considerable
insight into her own behavior and personality.
As this session ended, with the GIM therapist verbally acknow­
ledging to the group the deep issues that had been raised, Vivian
responded by saying, significantly, “We’re deep people.” This
session illustrates that even a relatively short piece of music (4
minutes) may quickly bring out a wide range of very deep issues,
such as adaption to disability, bereavement, childhood memories,
social isolation, relief from anxiety, and personal insight and
awareness. This session also illustrates the breadth of responses
that can occur within a group in response to the same induction
and music.
Evocation of the Past (Experiences and Relationships)
Example 2
In Session 11, the pre-music discussion was sufficient stimulus
for a client to begin to talk about a “fresh” memory of physi­
cal/emotional trauma in childhood. As in Example 1, this illus-
Music and Imagery with Physically Disabled Elderly Residents
$5
trated the depth of material that can be quickly accessed within
the music and imagery program, even within the pre-music dis­
cussion. In fact, as clients become increasingly competent in using
imagery within a GIM framework, it is not uncommon for a great
deal of memory and image-related material to be brought to
consciousness.
At the beginning of this session, Blanche (age 86) spoke of a
memory from when she was 8 or 9 years old. The memory
involved going near the cemetery with her sister when a strange
man came out of the woods, picked her up, and tried to take her
away. She struggled and “kicked up a lot of fuss”; finally he put
her down, and she ran away from him. She said that neither she
nor her sister had ever told their parents or anyone else about this
incident. Her sister and parents were now deceased.
Blanche was deeply upset by this memory, as evidenced by her
tone of voice and facial expressions, and was unsure whether she
wanted to continue with the music and imagery session. Blanche
needed reassurance about vivid and frightening memories (which
can also occur in standard GIM). After further discussion, she
decided to stay in the session.
The imagery and memories reported seemed to indicate a
post-traumatic stress disorder. In the course of this disorder, a
person’s internal control mechanism naturally oscillates between
intrusion and denial, and should reach denial before the victim’s
capacity to cope is exceeded (Claridge, 1992). In the current ses­
sion, the therapist made a decision (based on Blanche’s extreme
emotion) that this was not the time or place to further delve into
this experience of abuse/abduction. An induction was devised to
appropriately counterbalance Blanche’s frightening experience,
with a view toward future individual work with her after the
group session.
After asking each client if they could imagine an enjoy­
able/comfortable place in childhood and gaining positive re­
sponses, the induction involved getting a good sense of this
enjoyable/comfortable place. The music was Vaughan-Williams’
Rhosymedre. This orchestral arrangement has a very soothing
cantabile cello melody, giving a sense of nurturing and security,
and the hymn-like structure of the harmony and melody also
carries a sense of comfortable predictability.
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After the music Blanche took longer than her usual time to
return to a normal state of consciousness, indicating a consider­
able depth of imagery (Bonny & Savary, 1973). Her imagery
during the music involved memories of being dressed up for the
school play in a very pretty dress with her hair done beautifully.
Her parents attended the play. She reported feeling “special,” and
she obviously enjoyed remembering this occasion. Blanche’s im­
agery suggested that she needed to feel nurtured, supported,
unique, and protected by people around her, especially after the
frightening memory of severe trauma. Her imagery compensated
for the fearful and unpredictable abusive situation by providing
feelings of being loved and a sense of order and control. This
switch of feelings is a natural and adaptive reaction under the
circumstances and follows cycles of intrusion and denial common
in resolving post-traumatic stress disorders (Horowitz, 1976;
Claridge, 1992).
In post-session follow-up Blanche exhibited denial by declining
to talk further about her traumatic memories, saying that she
preferred to forget about it. It was interesting to note that in
subsequent music and imagery sessions, Blanche imaged almost
exclusively male characters who were nurturing and supportive,
particularly her husband, father, and grandfather. Despite other
opportunities, Blanche never mentioned her traumatic incident
again; it seemed that she had dealt with as much as she could or
needed to at this point.
The results of this example sound a note of caution for guided
imagery and music work: The music therapist must be clinically
skilled in dealing with the great range of deep therapeutic issues
that may occur in using music and imagery with elderly and/or
physically disabled clients.
Example 3
In this same session (Session 11), another client experienced
completely different imagery after hearing the identical induction
and music. Vivian imaged being at the cemetery where her “loved
ones” (especially her husband and grandparents) were buried.
She said that she had never connected well with her mother.
Vivian was surprised that her feeling at the cemetery was peace,
not sadness, and that she could feel their love very deeply. Her
Music and Imagery with Physically Disabled Elderly Residents
87
voice quality and a slower pace of speech suggested that she had
connected to this experience in a deep and spiritual manner; her
apparent inner quietness after the imagery contrasted with her
usual outer volubility.
These examples demonstrate the often surprising diversity of
imagery that can result from a single induction, yet the common
thread of the music in both instances accessed somewhat similar
feelings in each client: that of being loved and supported, either
in the face of memories of abuse (Example 2) or with regard to
past losses (Example 3).
Issues of Particular Concern to Aging Clients
Example 4
Death is a matter of concern and somewhat imminent inevita­
bility for elderly clients, an “existential dilemma” (Erikson, Erik­
son, & Kivnick, 1986). In contrast to Vivian’s imagery relating to
her loved ones at the cemetery, Sarah’s imagery of death ad­
dressed mortality from her point of view, although she was in
good health, apart from residual blindness.
Session 14 began with an induction in which residents were
asked to imagine lying on a bed, feeling warmth and comfort.
Sarah had suggested music from Handel’s Messiah, and the music
therapist had selected the excerpt “He shall feed His flock” be­
cause of its strong nurturing sense in the rocking 6/8 rhythm of
the accompaniment and the two solo female voices. The rhythmic
emphases imbue the music and words with a great sense of
trustworthiness. As the music moves up an interval of a fourth,
the soprano voice holds a sense of expansion and increased per­
spective.
Sarah’s imagery was that of being at her own funeral, but she
said that she did not find it upsetting. She was hearing the voices
of friends and relatives singing around her. As Sarah observed
her funeral, she felt peaceful. During the post-music discussion,
she reported having recently told her relatives not to be sad when
she dies-that she will enjoy being still! Sarah seemed happy and
comfortable in talking about this remarkable imagery that directly
addressed the aging process and her impending mortality.
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Issues Relating to Current Circumstances and Events
The next two examples address the clients’ internal responses
and reactions to externally-based stimuli within the residential
facility: Example 5 focuses on reactions of the entire group to a
shared experience, whereas Example 6 focuses on the group’s
response to a single client’s experience.
Example 5
One hour prior to Session 17, there was a fire emergency in the
dining room where most residents were eating lunch. This small
fire was effectively dealt with by staff according to standard
procedures, but residents remained emotionally upset long after­
ward. In the pre-music discussion of the music and imagery
session, residents discussed this incident. Sarah reported “the
sound of bells in my ears” (from the fire alarm), and many group
members expressed the need for “something calming” after this
upsetting incident. Each resident was asked how they would feel
about the use of vocal music in this session, and all agreed to its
use.
Using the group’s stated needs, the induction that followed
included calm images, such as the countryside, green hills, fresh
air, and a bird. Symbols of “air” and “bird” linked easily to the
solo vocal music as selected by the GIM therapist: Villa-Lobos’
BachianasBrasilieras NO.5.The clear and penetrating female voice
in this piece extends across a pitch-range similar to the fire alarm.
Supportive guitar accompaniment provides a firm and soothing
musical stimulus to counteract the high pitch. With only a brief
silence, this music was followed by Faure’s Pavane. This work,
similar in character to the preceding Villa-Lobos, has a pizzicato
alberti-type accompaniment in the stringed instruments, with a
clear legato melody in the woodwind instruments (particularly
flute). The second section of the ternary form contains increased
tension in melody and rhythm, promoting a recognition or well­
ing up of underlying feelings before a return to the predictability
of the first section.
The responses of the four clients attending this session varied
considerably. Connie’s imagery moved to a brook bubbling and
flowing along with the sound of the voice. She then imaged a deer
Music and Imagery with Physically Disabled Elderly Residents
89
that heard gunshots in the distance and ran to the client’s (child­
hood) farm to be safe. Connie particularly noticed the fear of the
deer looking anxiously from side to side, and then felt its sense of
safety and trust as it came to her farm. This imagery was clearly
connected with archetypal material, which was addressed later in
a series of individual sessions.
In contrast, Vivian remembered the Villa-Lobos piece as a
favorite that she knew well, as she had often listened to the record
with her husband. She reported that it brought her a great sense
of peace. She said that she had admired her husband’s broad
knowledge of classical music, an appreciation which she gradu­
ally shared with him as time went by.
For Sarah, the music evoked memories of a singer, Lily Pons,
and a movie she had seen, while still sighted, called “Ecstasy.” She
described her imagery as “a woman, being in love with a man,
and a lake, and her string of pearls broke-and you can imagine
the rest!”
Gwen described her experience with the music as “lovely and
beautiful”; nonverbal cues suggested that Gwen was deeply in­
volved in gaining nurturance from the music as it played.
The varied imagery in this session clearly illustrates that clients
respond to a perceived external “crisis” by using a diversity of
coping mechanisms (Atchley, 1989). Connie was able to address
the issue of fear/safety directly using images of a gentle animal
in a vulnerable setting, while Vivian experienced a sense of peace
within her memories of a close relationship and their joint connec­
tion to the music. Sarah responded to the music with memories of
a singer and a suggestive movie, thereby successfully escaping
from the recently fearful present. Gwen used the positive qualities
of the music to nurture herself deeply and likewise to counteract
the difficulties and fears of the fire emergency. In fact, all group
members left the music and imagery session in a seemingly less
anxious state than at the commencement, as evidenced by their
relaxed facial musculature and body posture.
Example 6
Twenty-four hours prior to Session 18, Connie had seen and
heard a well-known male resident, Leo, collapse dead as she
passed his room. In recounting this incident to the music therapist,
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she had cried a great deal and placed great emphasis on having
heard the sound of the resident’s collapse. Her feelings and reac­
tions were encouraged and validated by the music therapist.
Since no other residents were able to attend this session, it was
an opportunity to specifically tailor a session to Connie’s individ­
ual needs. The brief induction involved imagining “a paradise far
away, where you’d like to be.” This induction had potential to
lead in many directions, including escape from present rumina­
tions, nurturing, gaining another perspective, reinforcing spiri­
tual beliefs, and addressing her apparent fear of death. The first
piece of music was Massenet’s “Meditation” from Thais. Like the
induction, the expressive solo violin melody with a wide tessi­
tura set against a supportive arpeggiated bass of simple harmony
in harp and strings allows for many possibilities to arise. This
piece of music could be described as having a “heavenly” sound.
A second piece followed: Marcello’s Oboe Concerto in C minor,
Adagio. This composition has a similar structure to that of the
Massenet, with a melody (in the oboe) set against a supportive
accompaniment in strings, but in this work, the timbre and lower
pitch of the oboe tend to give a more “down-to-earth” and emo­
tionally-charged sense to the music. This music often opens up
the potential to assist with the grieving process.
Connie’s imagery (which she discussed after the music, follow­
ing the format used with the group) involved being inside the
great Mormon Temple in Salt Lake City, Utah, looking at the
massive several-stories-high pipe organ. She reported that the
music was “heavenly.” She was thinking about Leo and felt
increasingly peaceful. Connie reported that she felt the tension
stored in her body since the day before begin to leave and that she
subsequently felt more relaxed. She also came to a cognitive
realization that it was better for Leo to “go suddenly.” During this
music and imagery session, Connie clearly progressed toward a
sense of resolution and being at peace with the issue of death. Her
body and facial features looked more relaxed, and she exuded a
sense of peacefulness. It seemed that she had dealt with the
immediate impact of Leo’s death on her own life circumstances.
Despite further opportunities, she did not mention this matter
again to the music therapist.
Music and Imagery with Physically Disabled Elderly Residents
91
Issues Relating to Physical Disability
Example 7
The music and imagery of Session 8 brought to focus issues
surrounding a particular client’s physical disability (right hemi­
plegia and aphasia).
In the preceding session’s post-music discussion, Gwen had
expressed by gesture and words her anger about having a severe
stroke, 25 years prior, that had left one side of her body paralyzed
and limited her to mostly one-word expressions and gestures.
Group discussion of the effects of stroke (some other group mem­
bers had also had strokes but without resultant aphasia) and ways
of coping had provided support and acknowledgment for Gwen
and admiration of her endurance.
In Session 8 Gwen responded enthusiastically to a suggested
induction of “a reflection of oneself in the water” (a particular type
of induction that often helps clients access issues of self-esteem
and self-image), and this induction was subsequently used. The
music used was Debussy’s Dances Sacredand Profane. This music
is characterized by the peaceful and playful use of harp and
strings, with a major turning point occurring in a change from
duple to triple meter approximately halfway through the dura­
tion of the music.
In the post-music discussion Gwen expressed that she found
the music peaceful and enjoyable, and that it brought her helpful
insights. The musical experience seemed to bring her to a calm
aliveness, or a “quiet-alert” state. During the post-music discus­
sion, Gwen was able to produce three or four complete sentences
in succession, in answer to questions, which was the most inter­
active and ongoing use of words (especially in sentences) that the
music therapist had heard Gwen produce in the two years since
she had been admitted to the facility. Gwen’s more typical behav­
ior was to remain isolated socially, rarely commenting about her
physical disabilities.
Gwen’s deep connection with the music during her imagery
encouraged her to share this verbally with others, in a situation
where support and encouragement could be offered by peers,
thus diminishing her frustration and isolation, and potentially
enhancing self-esteem. It also seemed that the music and imagery,
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in this case, accessed and stimulated language in a different way,
giving her use of several complete sentences. Though the music
and imagery seemed to functionally diminish her aphasia, the
interpretation or explanation of this must be reserved for research
in the future.
Discussion
Although there are some reports of ongoing GIM-adapted
music and imagery groups (Summer, 1988; Goldberg, 1989), it is
timely that the literature begin to differentiate these groups by
populations and disabilities, especially in terms of application.
This article has focused on the initial part of an ongoing music and
imagery group program that demonstratedbenefits for physically
disabled elderly residents. These elderly residents experienced a
range of physical and other difficulties, yet they used imagery
successfully, clearly supporting Pierce and Storandt (1987) who
found that the ability to image does not diminish with age.
There were several noteworthy outcomes relating to resident
participation in this program. The range of imagery produced by
residents in the music and imagery sessions did not show any
unusual characteristics compared to a standard GIM client popu­
lation; the imagery reported was often exceedingly vivid and
diverse. This imagery was used by the residents in relationship to
past, present, and impending future issues, and in addressing
disability, bereavement, and the aging process.
In this program, physical disabilities did not seem to present
major difficulties in applying the music and imagery format,
although careful consideration of physical disability in terms of
location and pain, in the planning and implementation of induc­
tions, was required. A seated, rather than reclining, position (due
to wheelchairs) did not appear to present difficulties for clients in
achieving the altered state of consciousness necessary for success­
ful use of imagery with the music.
The main two recurrent themes were grieving and issues of
sexuality. Aspects of the grieving process were apparent in the
imagery of these residents, even when the loss had occurred many
years previously. For some residents there seemed to be a certain
Music and Imagery with Physically Disabled Elderly Residents
93
degree of resolution, but for others a great deal of sadness was
still hidden just below the surface and could be easily accessed on
occasion using the music and imagery process. The recurrent
theme of sexuality appeared in both serious and humorous con­
texts, and in conjunction with both real and imaginary characters.
Unfortunately, and to the detriment of clients, the topic of sexu­
ality is still often considered taboo, with Brown (1989) being one
of the few writers addressing sexuality and aging of institution­
alized residents.
Many experiences promoted the development of the cohesive
elderly self (Muslin, 1992),prompting reactions and self-alterations
resulting from both internal and external circumstances. Individ­
ual coping strategies in the face of fear and an apparent threat to
survival were shown in the clients’ responses to a fire emergency.
Past memories, both enjoyable and traumatic, were acknow­
ledged and incorporated into the psyche. Some clients adapted to
disability by identifying with heroic and/or noteworthy figures,
and all gained support by sharing with others in the group.
Impending death was addressed in many ways by the clients, the
most remarkable being a client who produced imagery of her own
funeral with her relatives surrounding her.
Although studies have looked at imagery deficits caused by
strokes (Farah, Levine, & Calvanio, 1988), the current program
found a positive effect of the music and imagery on one aphasic
stroke patient, overcoming some effects of her aphasia and en­
hancing speech abilities. Music therapy has been used with me­
lodic intonation therapy, but there are (to the knowledge of the
author) no reports of imagery being used to enhance speech of
aphasic stroke patients.
Relating to the methodology of this study, the group setting
appeared to be appropriate for these clients in using music and
imagery. Some clients were only willing to talk about particular
issues or memories within the group. The group provided sup­
port and acknowledgment of feelings that served to enhance the
experience of clients in many instances. It was thought that most
group members could not have tolerated the intensity of individ­
ual GIM sessions. The group setting also had a diagnostic poten­
tial for determining the needs of clients on many levels, had
implications for involvement of other skilled health professionals
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(for example, social worker, pastoral counselor or psychothera­
pist), and, at times, served as a screening function for the health
care team.
A major problem with the music and imagery program was its
reliance on the client’s short-term memory, since clients could
only discuss their imagery after the music was ended, rather than
while it was happening (as would be the casein single-client GIM).
This time-delay introduced possible inaccuracies and potentially
reduced actual and interactional detail, since memory is assumed
to decrease with time, and the reported imagery of the other
members might also interfere with memory retention.
Also, unlike standard GIM, an important image could not be
approached with active dialogue between client and therapist and
addressed in the moment by skilled therapeutic intervention.
However, careful questioning by the GIM therapist in the post­
music discussion did serve to enhance and expand important
images and their implications. Goldberg (1989) approached the
memory problem in a different way, by asking clients to write
down their experiences immediately, but this was impossible in
this study due to physical disabilities (only one resident was able
to write effectively). The aspect of memory retention in relation­
ship to a music and imagery program is an area deserving of
further research.
Similarly, due to the group setting, inductions could not be
customized to prior imagery and the needs of specific clients,
unless the inductions could be adapted to encompass the entire
group of residents. Likewise, music had to be selected to achieve
the “best fit” for all attendees, and occasionally this was a prob­
lem. For example, in Session 3 Vivian had a lot of anger, but at
that point, the right music for her would have overwhelmed and
jeopardized other attendees who were just beginning to trust and
learn the music and imagery process.
As with standard GIM, the sessions produced great benefits
when it was possible to link issues with induction and music, as
seen in the case of the “ideal person” (Example 1) and the fire
emergency (Example 5).
The use of a qualitative approach had both strengths and
weaknesses in this study. In terms of note-taking, the music
therapist’s memory was subject to the normal overlooking of
Music and Imagery with Physically Disabled Elderly Residents
95
small details, but audiotaping was deemed to be an obstacle to
establishing rapport with this particular client population. In
contrast, the strengths of a qualitative approach included preserv­
ing a sense of the meaning of the experience for the client, and
flexibility in addressing situational issues as they arose, such as
the fire emergency or memories of a traumatic abusive situation
in childhood.
The benefits resulting from the music and imagery program
seemed to far outweigh the difficulties experienced. The program
provided a regular opportunity for attendees to leave noisy and
confused residents and practice relaxation in a pleasant environ­
ment. The program also provided a place where residents could
share problems, wishes, and dreams, and could gain support and
reinforcement from their peers. It also provided an opportunity
to use music and imagery to address issues and difficulties of
disability, bereavement, aging, and communal living. Clients had
an opportunity to achieve resolution and enhance their coping
mechanisms, thus promoting changes in the psyche as they ad­
dressed their elderly self (Muslin, 1992). In addition, there seemed
to be particular benefits for using music and imagery with dis­
abilities such as blindness or strokes.
It is important to remind music therapists that implementation
of a music and imagery program such as this requires consider­
able experience and training. As with standard GIM, there is a
need to recognize clients with an unstable ego, a problem that
may, unfortunately, become apparent only through an imagery
experience. Likewise, it is important to remember that even a
relatively short duration of music (3 to 12 minutes) can elicit deep
(and sometimes frightening) issues for clients very rapidly, as
shown by Sarah and her funeral imagery (Example 4), and Connie
and the deer with gunshots (Example 1). In addition to having a
thorough understanding of the implications of specific inductions
and music chosen within the context of GIM training and practice,
the music therapist must take care in the use of this powerful
method and be clinically prepared for whatever issues arise.
A diverse range of previous studies has been incorporated into
developing the rationale for using and understanding music and
imagery with elderly physically disabled clients. This study has
demonstrated that standard GIM practice can be successfully
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modified for an ongoing group music and imagery program for
these residents, addressing a wealth of issues. It is hoped that
subsequent studies will continue to address the complexity of
issues and problems found within this elderly population.
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98
Short
Alison E. Short, B.Mus., RMT (Australia), MA, CMT-BC, FAMI, was
one of the first graduates in music therapy at the University of Mel­
bourne, Australia, and completed her master’s degree in music therapy
at New York University in 1987.
In addition, she completed full training
in GIM in 1989 to become the first person from outside of the Unite d
States to become a Fellow. Since then, Alison has assisted with all levels
of GIM training at New York University and through the Australian
Music Therapy Association. In her 12years of music therapy experience,
she has worked extensively with geriatric, hospice, and psychiatric
Populations
and has recently completed training in Feil’s method of
Validation/Fantasy Therapy. Alison has been music therapist at Grotta
Center for the past 7 years and has a commitment to exploring the
breadth and depth of issues for the elderly as they affect the application
of music therapy.