Experiences of Single-Session Improvisational Group Music Therapy: Therapist and Patient Reflections from Inpatient Psychiatry

Lesley University DigitalCommons@Lesley Expressive Therapies Dissertations Graduate School of Arts and Social Sciences (GSASS) Spring 5-17-2019 Experiences of Single-Session Improvisational Group Music Therapy: Therapist and Patient Reflections from Inpatient Psychiatry Yu-Ying Chen ychen12@lesley.edu Follow this and additional works at: https://digitalcommons.lesley.edu/expressive_dissertations Part of the Art Therapy Commons, and the Psychiatric and Mental Health Commons Recommended Citation Chen, Yu-Ying, "Experiences of Single-Session Improvisational Group Music Therapy: Therapist and Patient Reflections from Inpatient Psychiatry" (2019) Expressive Therapies Dissertations 83 https://digitalcommons.lesley.edu/expressive_dissertations/83 This Dissertation is brought to you for free and open access by the Graduate School of Arts and Social Sciences (GSASS) at DigitalCommons@Lesley It has been accepted for inclusion in Expressive Therapies Dissertations by an authorized administrator of DigitalCommons@Lesley For more information, please contact digitalcommons@lesley.edu Experiences of Single-Session Improvisational Group Music Therapy: Therapist and Patient Reflections from Inpatient Psychiatry A DISSERTATION (submitted by) Yu-Ying Chen In partial fulfillment of the requirements For the degree of Doctor of Philosophy LESLEY UNVIVERSITY May 17, 2019 STATEMENT BY AUTHOR This dissertation has been submitted in partial fulfillment of requirements for an advanced degree at Lesley University and is deposited in the University Library to be made available to borrowers under rules of the Library Brief quotations from this dissertation are allowed without special permission, provided that accurate acknowledgment of sources is made Requests for permission for extended quotation from or reproduction of this manuscript in whole or in part may be granted by the head of the major department or the Dean of the Graduate College when in his or her judgment the proposed use of the material is in the interests of scholarship In all other instances, however, permission must be obtained from the author SIGNED: _ ACKNOWLEDGEMENTS I would like to express my deepest appreciation to all those who provided me with the possibility to complete this journey I give my special gratitude to my chair and academic advisor, Dr Mitchell Kossak, who is always available and willing to assist me in many ways and guides me to explore new perspectives with his inspiring ideas and knowledge, understanding, and support I would also like to thank my internal committee member Dr Michele Forinash for her support, encouragement, and guidance and my external committee member Dr Kana Okazaki-Sakaue for her time and invaluable suggestions Furthermore, I would like to acknowledge Dr Robyn Cruz for her guidance, ideas, and support in the early phase of this journey I also appreciate the guidance given by professors Dr Molly Haaga, Dr Craig Haen, Dr Shaun McNiff, Dr Nisha Sajnani, Dr Raquel Stephenson, and Dr Rebecca Zarate, who taught me and have shown me all the possibilities in this profession A special thanks goes to my cohort, as we created and learned together, stimulating and expanding my viewpoints on and understandings of many issues in expressive therapies Many thanks go to Shuna Luk, my supervisor at work, for her assistance and encouragement, making this journey possible I must also thank my sister, my cousin, and friends who have stood with me and helped me I appreciate all the participants and coresearchers in my studies; without their contribution, the phenomenon of this single-session improvisational group music therapy in inpatient psychiatric care could not have been explored I am grateful to my mother, who passed away during this journey, who always shared her love for and belief in me I am also grateful to my father for his reassurance Last but not least, I have to thank my wife and best friend, Shaoling, for the love, kindness, understanding, and support she has shown during the five years it has taken me to finalize this journey TABLE OF CONTENTS LIST OF TABLES LIST OF FIGURES …………………………………………………………………… ABSTRACT 10 INTRODUCTION 11 Music Therapy in Inpatient Psychiatric Care ………………………………… 11 The Influence of Current Trend of Inpatient Psychiatric Care ………………… 13 The Findings of Preliminary Research ………………………………………….14 The Need of Current Research ………………………………………………….16 Research Guiding Question …………………………………………………… 17 LITERATURE REVIEW .18 Music Therapy in Adult Inpatient Psychiatric Treatment ……………………….18 Recent Development of Inpatient Psychiatric Treatment ……………….20 Standards of Clinical Practice for the Music Therapist Working in Mental Health …………………………………………………………21 Concepts and Studies of Single-Session Therapy……………………………… 24 Development, Studies, and Reports of Single-Session Therapy…………24 Concepts and Studies of Group Therapy ……………………………………… 28 Concepts of Group Therapy …………………………………………… 29 Yalom’s Therapeutic Factors …………………………………………… 31 Group Therapy in Inpatient Psychiatry ………………………………… 32 The Application of Creative Arts Therapy Groups in Inpatient Psychiatric Care ………………………………………………………… 35 Single-Session Group Therapy ………………………………………… 37 Single-Session Music Therapy Groups ………………………………… 38 Single-Session Music Therapy Groups in Inpatient Psychiatry ………… 40 Music Therapy Improvisation …………………………………………………… 41 Definition of Music Therapy Improvisation …………………………… 41 Brief History of Music Therapy Improvisation ………………………… 44 Studies of Music Therapy Improvisation …………………………………46 Conclusion ……………………………………………………………………… 54 METHOD 55 Participants ……………………………………………………………………… 55 Data Collection ………………………………………………………………… 58 Introduction – Greetings, Check-Ins, and Ground Rules …………………58 Warm-up Musical Improvisation ………………………………………….59 Feedback and Discussion ………………………………………………….59 Second Round of Musical Improvisation ………………………………… 59 Second Round of Feedback and Discussion ……………………………… 60 Third Round of Musical Improvisation …………………………………….60 Feedback, Discussion and Conclusion …………………………………… 60 Data Analysis ……………………………………………………………………….61 Stage I (Narrative) ………………………………………………………… 62 Stage II (Music Improvisation) …………………………………………… 62 Stage III (Composite Review) ……………………………………………….63 Data Storage and Confidentiality ……………………………………………63 Trustworthiness ………………………………………………………………………63 The Stance of the Researcher …………………………………………………………64 RESULTS 66 Participants and Overview of Group Process 66 The Process and Results of Data Analysis ………………………………………… 70 Theme I: The Therapist’s Experience of Work in Inpatient Psychiatric Care …… 72 Chaos/Instability …………………………………………………………… 73 Uncertainty of Role ……………………………………………………… 74 Rapid Turnover of Patients ………………………………………………… 75 Burnout/Work Overload …………………………………………………… 76 Adaption/Balance ………………………………………………………… 77 Single Session …………………………………………………………… 78 Theme II: The Patient’s Experience of Hospitalization in Inpatient Psychiatry ……80 Treatment/Care …………………………………………………………… 81 Group Programs …………………………………………………………… 82 Interaction with Peers ……………………………………………………… 82 Stigma ……………………………………………………………………… 83 Isolation/Constraint ………………………………………………………… 83 Medication Management …………………………………………………….84 Discharge …………………………………………………………………… 85 Single Session …………………………………………………………… 85 Theme III: Participants’ Experiences of Group Musical Improvisation in a Single Session………………………………………………………… 86 Here and Now/Present ……………………………………………………… 87 Rhythm ……………………………………………………………………… 87 Use of the Guitar/Chords …………………………………………………… 89 Use of Voices/Vocalization ………………………………………………… 90 Musical Interaction ………………………………………………………… 93 Reflection …………………………………………………………………… 94 Culture/Family Value ……………………………………………………… 95 Anger ……………………………………………………………………… 95 Sadness …………………………………………………………………… 97 Calm ………………………………………………………………………… 98 Bodily Sensation …………………………………………………………… 99 Sense of Belonging/Togetherness ………………………………………… 100 Safe Place/Space …………………………………………………………… 103 Theme IV: Participants’ Challenges in Single-session Improvisation ………………105 Anxiety …………………………………………………………………… 105 Resistance …………………………………………………………………… 106 Uncertainty ………………………………………………………………… 107 Tiredness/Exhaustion …………………………………………………………108 Cacophony ………………………………………………………………… 108 Theme V: Therapeutic Components in Single-session Group Improvisational Music Therapy……………………………………………………………………… 109 Change ……………………………………………………………………….110 Catharsis …………………………………………………………………… 111 Relaxation ……………………………………………………………………113 Validating …………………………………………………………………….113 Attention/Focus ………………………………………………………………115 Coping/Restore/Self-care …………………………………………………….116 Summary …………………………………………………………………………… 118 DISCUSSION 120 The Significance of Single-Session Therapy …………………………………………121 Therapists’ Professional Experiences and Patients’ Experiences of Hospitalization …125 Structure of Musical Improvisation ……………………………………………………129 The Response through Music in Single-Session Group Improvisational Music Therapy……………………………………………………………………………… 133 Therapeutic Elements ………………………………………………………………….138 Integral Thinking in Music Therapy ………………………………………………… 142 Limitations …………………………………………………………………………… 145 Conclusion …………………………………………………………………………… 146 APPENDIX A: Music Excerpts of Significant Moments …………………………………….148 APPENDIX B: Research Informed Consent ………………………………………………….150 REFERENCES 153 LIST OF TABLES TABLE 1, Demographic Information of Participants TABLE 2, Themes and Keywords LIST OF FIGURES Figure 1, Instruments ...1 Experiences of Single-Session Improvisational Group Music Therapy: Therapist and Patient Reflections from Inpatient Psychiatry A DISSERTATION (submitted by)... (a) the therapist? ??s experience of work in inpatient psychiatric care, (b) the patient? ??s experience of hospitalization in inpatient psychiatry, (c) participants’ experiences of group musical improvisation... therapists’ and patients’ experiences and feedback in order to draw a composite picture of single-session improvisational group music therapy as a reflection on music therapy practice in inpatient psychiatry