Bearbejdning af skam i musikterapi - Et kvalitativt singlecasestudie af et musikterapiforløb med en suicidaltruet ung mand med Aspergers syndrom

Processing shame in music therapy - A qualitative single case study on a course of music therapy with a young suicidal man with Asperger's syndrome

Petersen, Thea Lind

4. semester

Musikterapi, Kandidat

2020

2020-06-02

80

Denne kandidatafhandling i musikterapi er et kvalitativt hermeneutisk-fænomenologisk enkeltsagsstudie, der undersøger, hvordan skam kommer til udtryk og kan bearbejdes i et musikterapiforløb med en ung selvmordstruet mand med Aspergers syndrom (en autismespektrumtilstand). Data bygger på musikterapeutens noter fra forløbet og transskriptioner af videooptagelser. Analysen bestod af en modificeret tematisk kodning samt en særskilt analyse af de musikalske improvisationer i sessionerne. Resultaterne viser, at patienten udtrykte skam i sin fremtoning, i det han fortalte om sig selv, og i sit klaverspil. Samlet pegede tegnene på en dybt skambaseret selvforståelse og en kronisk skamtilstand. Tidligere relationelle traumer og manglende indstemning i hans oplevelse af skam havde gjort det svært for ham at stole på andres anerkendelse og gav negative forventninger til nye, sunde relationer. Samtidig indebar hans skam et stærkt behov for accept, som fik ham til at åbne sig for musikterapeuten både verbalt og gennem musikken. I begyndelsen oplevede musikterapeuten skam i sin modoverføring (hendes egne følelsesmæssige reaktioner på patienten), ofte via projektiv identifikation (at tage patientens skam ind som sin egen). Ved verbalt, nonverbalt og musikalsk at holde og indstemme sig til hans skam, og senere blive opmærksom på sin egen skam, skabte terapeuten en ramme præget af voksende tillid, hvilket var afgørende for bearbejdningen. Mod slutningen tydede tegn i patientens fremtoning, tale og musik på, at skammen var blevet bearbejdet: skammen var der stadig, men mindre påtrængende og ofte ledsaget af stolthed og selvanerkendelse. Patienten syntes at være i gang med at omskabe sin selvforståelse til at være en, der kan indgå i en sund relation med musikterapeuten og tage imod hendes omsorg og anerkendelse. At han stadig kæmpede med fuldt ud at tage anerkendelsen ind, illustrerer, hvor vanskelig og langsom skambearbejdning kan være i terapi. Afslutningsvis dokumenterer casen muligheden for at bruge musikterapi til bearbejdning af kroniske skamtilstande.

This master’s thesis in music therapy is a qualitative hermeneutic-phenomenological single-case study exploring how shame is expressed and processed in a course of music therapy with a young suicidal man with Asperger’s syndrome (an autism spectrum condition). The data are based on the music therapist’s session notes and transcripts of video recordings. A modified thematic coding analysis was conducted, along with a dedicated analysis of the musical improvisations in the sessions. Findings show that the patient expressed shame in his appearance, in how he spoke about himself, and in his piano playing, pointing to a deeply shame-based self-understanding and a chronic state of shame. Relational traumatic experiences and misattunement to his shame had left him unable to trust others’ acknowledgment and expecting difficulties in forming new, healthy relationships. At the same time, his shame carried a need for acceptance, leading him to expose himself to the therapist verbally and through music. Early in therapy, the music therapist experienced shame in her countertransference (her own emotional responses to the patient), often through projective identification (taking in the patient’s shame as if it were her own). By holding and attuning to his shame verbally, nonverbally, and musically—and later recognizing her own shame—the therapist fostered a therapeutic environment of growing trust, which was essential for processing the shame. By the end of therapy, signs in the patient’s appearance, speech, and music suggested that shame had been processed: shame was still present but less intrusive and often accompanied by pride and self-acknowledgment. The patient appeared to be reshaping his self-understanding toward seeing himself as someone capable of a healthy relationship with the therapist and more open to receiving her care and acknowledgment. His continued struggle to fully take in her acknowledgment highlights how difficult and slow shame work can be in therapy. Overall, this case documents the feasibility of using music therapy to process chronic states of shame.

[Dette resumé er omskrevet med hjælp fra AI baseret på projektets originale resumé]

musikterapi ; skam

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