PhD Thesis by Anke Coomans: Moments of resonance in musical improvisation with persons with severe dementia: An interpretative phenomenological study
Persons with severe dementia often show difficulties to express their emotions and needs in a way that is understandable for their family and/or caregivers. A person-centred approach towards persons with dementia, based on the theory of Tom Kitwood, emphasizes the importance of genuine meetings between persons with dementia and other persons to meet their psychosocial needs and preserve their identities. Research have shown how music therapy can increase social interactions with persons with dementia. However, there is a demand to articulate what actually happens in music therapy with persons with dementia. This study aims to explore how musical improvisation in music therapy with persons with severe dementia can lead to the occurrence of essential moments of meeting on a non-verbal, musical level.
In a multiple case study (n=4), data consisted of clinical notes of the music therapist and video-recordings of individual music therapy sessions. An in-depth analysis of these data led to a selection of essential moments of meeting between a person with dementia and the music therapist. This analysis was based on an interpretative phenomenological approach and involved a Clinical Research Intervision Group (CRIG). The essential moments of meeting were described by means of categories and implied musical, relational, and physical characteristics.
Findings of the study show how essential moments of meeting can be considered as Moments Of Resonance (MOR). MOR are defined as moments during which the therapist musically resonates with the person with dementia’s affective inner state. The musical affective level on which MOR occur, transcends the cognitive and functional deterioration that affects the person with dementia in most other situations.
The occurrence of MOR is situated within a broad context of musical improvisation. This study demonstrates an understanding of musical improvisation implying musical play, movements, gestures, body posture and prosody.
This study also explored specific music therapeutic interventions and attitudes. A specific therapeutic listening attitude, that was indicated as listening playing, was found to be preconditional for MOR to occur. It was inextricably linked to the use of musical improvisation with a crucial role for certain musical parameters, such as timbre, tempo, silence, and phrasing. Musical improvisation is considered as having a double role in the occurrence of MOR. First, musical improvisation allows the therapist to come into resonance with him- or herself. This has to be considered as crucial for the listening playing. Secondly, musical improvisation plays an important role in the listening playing itself. Listening playing implies that the therapist allows him- or herself to be guided by the music and to resonate affectively with the music of the person with dementia.
The findings of this study emphasize the importance of musical improvisation for the occurrence of essential moments of meeting with persons with severe dementia. A conceptualization of MOR, specific therapeutic listening attitudes, and musical improvisation, contribute to the clinical and theoretical framework of music therapy with people with severe dementia.