This qualitative exploratory case study investigates the use of clinical improvisation through 28 individual sessions spanning one year with a woman who was at the stage of moderate/severe dementia. She was considerably limited in her speaking abilities. Long, coherent musical dialogues with reciprocity and nuanced forms of vitality contrasted with her fragmented verbal expression. Dementia and loss of language set a limit to the use of improvisations as a method. However, the results of this study points towards certain potentials: By creating an environment of trust and confidentiality it was possible to intervene non-verbally and through the implicit relationship. Dementia did not only affect the client’s language. Her behavior and attitude indicated a change in her perception of music and self through the course of the therapy.
This study is based on Daniel Stern’s psychological theories on pre-verbal subjective formations, forms of vitality and intersubjectivity, and the person-centered dementia care formulated by Kitwood. These theories are combined with communicative musicality (Trevarthen, 2012; Stige & Ridder, 2016) and are used as conceptual framework in the analysis of a purposive sampling of improvisations and the process of the music therapy. In The Oxford Handbook of Music Therapy (2016) are the contributions of Bruscia and Wigram accentuated in the chapter on improvisation. They have created a solid theoretical and methodological base for the understanding and use of clinical improvisation. The theoretical model by Ruud (1990, 1998, 2001) on the (four) levels of meaning and function (unfolded by Bonde 2009) is used to discuss and differentiate syntax and semantics in the improvisations.
The research questions asked are: Is it possible through a long, explorative period with music therapy to develop skills of free improvisation in a person who has dementia? In that case, how? And what therapeutic implications could this have? (4 sub-questions).The research method is (1) hermeneutic, i.e. it aims towards new understandings of the client, the improvisations and results/consequences of the musicking in the duo improvisations; (2) micro-analytic, regarding uncovering patterns and processes in the improvisations, (3) a semi-structured interview with the spouse, applying stimulated recall.
The empirical data derive from these sources: 1) Own observations and experiences, 2) the perspective of the spouse (analysis of the interview transcription), 3) transcriptions of musical improvisations (for analysis) and 4) the video recordings of the sessions.
Some of the significant findings of the study are that the client shedded her lifelong preference of piano playing from scores and that she overcame her resistance towards playing other instruments than the piano. During the sessions her willingness to improvise increased, and more and more often she initiated improvisations herself. The duration of the improvisations also increased considerably. The case indicates a possible connection between the duration of the first improvisation and the time elapsed since the previous session. Analysis of the interview revealed the horizon and views of the spouse regarding communication, interaction and relationship. He described how the music appeared to be both emancipating and stucturing at the same time, as well as creating an opportunity for the client to experience leading and following in the musical dialogues.
The literature review and analysis of (short as well as longer units of) the improvisations have clinical relevance to other music therapists.