Musikterapi og demens. En filosofisk-hermeneutisk undersøgelse af indre billeddannelse i musikterapi med en blind kvinde med demens og hallucinationer

Abstract

Aim: This master thesis is based on a single case-study, aiming to explore multimodal mental imagery as it appears in individual music therapy sessions with a person suffering from dementia, more specifically how the imagery is expressed by the client during the sessions and how it is approached by the therapist. Background: During my 9th semesters internship at a nursing home, I was presented with a blind elderly woman with Lewy Body dementia who was often disturbed by vivid visual hallucinations outside the music therapy. From the 10th music therapy session, she spontaneously began to express positive imagery related to songs sung. These expressions were accompanied by a positive state of mind and had a communicative content towards the music therapist. Due to the client’s issues with hallucinations, the music therapist initially was hesitant to engage with the client’s imagery. However, gradually ways were found to explore, support and co-creative music-related imagery together with the client. This revealed the need of exploring and defining appropriate clinical approaches to working with mental imagery with people with dementia and an unstable sense of reality. Method: A philosophical-hermeneutic (Højberg, 2005; Loewy & Paulander, 2016) informed ‘reflexive thematic analysis’ (Braun & Clarke, 2021) was conducted in order to 1) explore and categorize the client’s different types of multimodal imagery expressed by the client, including nonpathological imagery, hallucinations, delusions and imagery due to agnosia. and to 2) explore and describe the music therapist’s different approaches in relation to the client’s imagery. Results/conclusion: This case-study concludes that the client’s imagery is an integrated part of her way of engaging with the music and the music therapist, and more generally it is part of her way of making sense of the world around her. Furthermore, the study defines three clinical approaches to the client’s imagery, resulting in the creation of a model of continua, illustrating the music therapist’s varying degrees of engagement with the content of the client’s different kinds of imagery. The clinical approaches are: 1) ‘The distracting approach’ in which the therapist intents to direct the shared focus of attention away from the client’s current imagery in order to create flow and movement in the interaction and to ease the mental load of the client when the expression of the imagery is associated with delusions or aphasia. 2) ‘The embracing approach’ in which the therapist shows a holding and validating attitude towards the client’s emotional expression, but without engaging with the content of her imagery. And 3) ‘the co-creating approach’ in which the therapist is actively engaging in the imagery through a co-creative imagery process together with the client, based on the therapeutic process of the client, supporting the client to unfold her creative resources. The study finds that within those playful co-creative imagery-processes supported by the music therapist, the client does have the ability to differ between imagery and reality. A prerequisite for succeeding in applying ‘the co-creating approach’ is that the music therapist is able to sensitively tune into to the client’s emotional expressions and is aware of the client’s current state of mind and current sense of reality. With reference to more general research on dementia, hallucinations and imagery, this study suggests a correlation between the hallucinations experienced by the client outside of music therapy and the nonpathological imagery taking place during the music therapy. This indicates clinical implications for applying music therapy with imagery as an active clinical intervention in order to support a person with dementia and hallucinations. It would be relevant to conduct a further exploration of the continua model of the three approaches to the client’s imagery, using it as a navigation map in clinical practice with people with dementia and an unstable sense of reality. Through further clinical processing, the model could potentially serve as an assessment tool for music therapists working in dementia care. Keywords: music therapy; dementia; Lewy Body Dementia; imagery; hallucinations; agnosia; communication; sense of reality

A master thesis from Aalborg University

Musikterapi og demens. En filosofisk-hermeneutisk undersøgelse af indre billeddannelse i musikterapi med en blind kvinde med demens og hallucinationer

[Music therapy and dementia. A philosophical-hermeneutic study of mental imagery in music therapy with a blind woman with dementia and hallucinations]