Anke Coomans

Anke CoomansAnke Coomans
coomans.anke@telenet.be
 
Qualifications: Music Therapist: MA (2002, Hogeschool voor Wetenschap & Kunst, campus Lemmensinstituut, Leuven, Belgium)
 
Current Position: PhD student at the Department of Music and Music Therapy (Aalborg University) since 1st. of July 2009
Music Therapist at the UPC Sint Jozef, Kortenberg, Belgium
Assistant teacher at the master training course for Music Therapy (Hogeschool voor Wetenschap & Kunst, campus Lemmensinstituut, Leuven, Belgium)
 
Title of the PhD Study:
Music Therapy and Dementia; the value of musical improvisation for the development of a therapeutic relationship in music therapy with people suffering from dementia.
 
Supervisors:
Prof. Dr. Tony Wigram – Aalborg University, Denmark
Prof. Dr. Jos de Backer – UC Kortenberg/Hogeschool voor Wetenschap & Kunst, Lemmensinstitute
 
Introduction:
Today, a person with dementia is no longer an isolated case within our society. With a population that is getting older and older, dementia is something that gradually affects our thinking about getting older more and more. Prognoses formulated by the NIS (National Institute for Statistics, Belgium) concerning the incidence of dementia show us that by the year 2030, two percent of the Belgian population will be hit by dementia-disease. In 1990, this was only one percent. An important reason for the doubling of this number is the ‘turning grey’ of our population. However, though age is still the most important factor of risk, more and more early stage dementia is diagnosed.
Beyond all these numbers, it was two main ideas that caught my interest for doing research in this area:
First of all it was the image concerning the elderly. Years ago, elderly people were regarded as persons who deserved lots of respect and who had a lot of authority. Younger people were counting on the advice of the older generation because of their life-experience. Today this image has been changed. Beyond the fact that elder people deserve lots of respect, their image has been coloured by the idea of elderly as being helpless, as needing assistance.  Bright (1995, 1996) and Michon and Gargiulo (2003) describe how this need of assistance can
cause a period of grief but also fear for the aging one.
Another idea that drew my attention was the fact that dementia will not restrain itself to one specific group of the population. There’s no particular moment in life, from which you can conclude: ‘I escaped from dementia, it won’t get me’. Like a Damocles’ sword it’s always lurking…
Consequently, the request of research within this particular area is very high. In health care, including music therapy, the question is raised, how society can meet the needs of people suffering from dementia, on a level that is as human as possible. Many researchers in this area emphasize on the social and human opportunities music therapy can offer in the treatment of people suffering from dementia.
One of the important issues when talking about the social and human contribution of music therapy, is the fact that music therapy can increase the level of contact that can be made with persons suffering from dementia. In other words: the meeting with the other.
The research that’s proposed here will also focus on this aspect, more specific, it will focus on the meaning of musical improvisation for the therapeutic relationship in music therapy with persons with dementia.
 
Summary of Research Questions :
Main Research question:
What is the value of musical improvisation for the development of a therapeutic relationship in music therapy with people suffering from dementia?
Subquestions:
-What defines a therapeutic relationship within a music therapy context with people suffering from dementia?
-What defines the characteristics of musical improvisation in a music therapy context that contribute to that relationship with people suffering from dementia?
-What music therapeutic interventions are effective for the development of a therapeutic relationship in music therapy with people suffering from dementia?
 
Purpose
The purpose of the study is to explore the effects of individual music therapy treatment with people suffering from dementia. Focus will be laid on the therapeutic relationship within this treatment setting. The main hypothese is that music therapy, like it has been offered in this study, can promote the development of a therapeutic relationship. Benefits of this therapeutic relationship will also be explained in the study. Resonance, the phenomenon that indicates the intersubjective experience of meeting of the inner spaces of patient and therapist, will be one of the most important factors here.
 
Method
  • Design
The research will follow a qualitative multiple-case study design. The music therapist will also be the researcher.
The design is still developing, the method can slightly change during the first phase of the research-proces. All those changes will occur in function of the research-question.
  • Subjects
All subjects selected for the study will come from a population that stays at a residential unit of a psychiatric centre at a specialised ward for people with dementia. All of them will be undergoing several neuropsychological tests as soon as they will be admitted at the hospital. The assessment using the Assessment of the Quality of the Relationship (AQR - Schumacher & Calvet, see below) will also be derived from this period of testing.
The patients that are scored as having a ‘severe cognitive decline’ (following the Reisberg Scale, stage five-six-seven, see below) and that are situated on the first four levels on the AQR (Schumacher & Calvet, see below) will be selected.
From those, probably three participants will be selected for the study from those referred to music therapy.
The most important including criterion for this final selection, will be the possibility of musical improvisation to take place during the session. Patients with whom improvisation never occurs during the music therapy sessions, will be excluded.
  • Data collection
Beyond the data that will be used for the selection of the subjects, the data that will serve to answer the research question will be derived from the regular music therapy treatment sessions.
Two main data collection methods will be used: the video-recordings of all sessions and the written clinical notes of the therapist.
  • Data analysis
Analysis of the data (qualitative data: video-recordings and clinical notes of the therapist) will occur by means of a research-intervision group consisting of an external music therapist, the researcher-music therapist, a psycho-therapist/psychiatrist and a musician.
Selection of significant fragments
Important for the research are those moments at which therapist and patient are resonating with each other. One can call it moments of interpersonal contact, although the researcher prefers to use the term resonance. One of the reasons for this is the expectation that most of these moments will occur during the musical improvisation.
These moments can be very clear and obvious to select (eye-contact, physical contact,…) or audible by the synchronicity of play within the improvisation. Other selections will be made on a more intuitive way, not visible, but felt by the observer as being moments of resonance.
Categories that will be derived from the video-observations will help on this issue.
Musical analysis
Musical analyses will be made of each part of the improvisations that will be selected as being meaningful for the research. To analyse those data, there will also be made use of ‘categories’. Those categories will be derived from the musical analysis of the pilot study.
  • Measures
Probable measures that will be used are:
-The Global Deterioration Scale for Assessment of Primary Degenerative Dementia (Reisberg, Ferris, de Leon et al. 1983)
-The mini-mental state examination (MMSE) (Folstein et al. 1975)
-The Assessment of the quality of relationship (AQR) Schumacher and Calvet (Schumacher 1999).
 
Publications and presentations related to the PhD Study
Publications
  • Coomans, A. (2007). Change of therapist, change of therapy? Looking for some space and a place in a replacement. In: Nieuwsbrief BMT , extra edition
  • Coomans, A. & Schotsmans, M. (2007). Spel in de muziektherapie: een improvisatie In: Nieuwsbrief BMT , 9(18), pp. 13-18.
  • De Backer, J. & Coomans, A. (2006) Music Therapy in Belgium (Country of the month). http://www.voices.no/country/monthbelgium_february2006.html
 
Presentations
  • Het belang van de muzikale improvisatie voor de ontwikkeling van een therapeutische relatie in de muziektherapie met dementerenden – 30 september, 2009 – Nationale Studiedag Muziektherapie, UC St. Jozef, Kortenberg.
  • Mogelijkheden van muzikale improvisatie in de behandeling van personen met dementie. – 25 september, 2008 – Dag van het artistiek onderzoek, Lemmensinstituut, Leuven
  • Mentaliseren en Muziektherapie. – 16-17 September, 2008 – Vierde Vlaams Congres Geestelijke Gezondheidszorg, Antwerpen.
  • Change of therapist, change of therapy? Looking for some space and a place in a replacement. - 15-19 august, 2007 - 7th European Music Therapy Congress, Eindhoven, Nederland
  • Spel in de muziektherapie, een improvisatie. – 21-22 September, 2006 – Derde Vlaams Congres Geestelijke Gezondheidszorg, Etterbeek.
  • Spel in de muziektherapie, een improvisatie. – 25th April, 2006 – Studiedag ‘Muziektherapie in Beweging’, Tienen.
 
References:
-Bright, R. (1995). Music Therapy as a facilitator in grief counselling. In: Wigram, T., Saperston, B. & West, R. (eds.) The Art & Science of Music Therapy: A Handbook. Chur: Harwood academic publishers, pp. 309-323.
-Bright, R. (1996). Grief and Powerlessness; Helping People Regain Control of Their Lives. London: Jessica Kingsley Publishers.
-Folstein, M., Folstein, S., & McHugh, P. (1975). Mini-Mental State: a practical method for grading the cognitive state of patients for the clinician. Journal of Psychiatry Research 12, pp. 189-198.
-Michon, A. & Gargiulo, M., (2003). L’oubli dans la maladie d’Alzheimer: le vécu du patient. In : Clinique méditerranéennes, 67, pp. 25-32.
-Reisberg, B., Ferris, S.H., de Leon, M.J., Crook., T. (1983). The global deterioration scale for assessment of primary degenerative dementia. American Journal of Psychiatry, 139, pp. 1136-1139.
-Schumacher, K. (1999). Musiktherapie und Säuglingsforschung. Frankfurt am Main: Peter Lang.