Preschool children have, as a result of their level of cognitive and psychological development, difficulty coping with the stress of hospitalisation. Using a qualitative case study design with hermeneutic elements, this thesis examines the influence of music therapy in relation to coping strategies employed by a 4-year old traumatised boy who participated in music therapy sessions with his family. Suffering from a chronic disease, he had gone through several operations, one of which particularly provoked his anxiety. Followed by additional unpleasant procedures, this event led to the development of traumatic stress symptoms, negatively affecting the boy’s functionality in his everyday life. In order to obtain insight and knowledge of the boy’s reactions, the theoretical research focused on the field of paediatric medical traumatic stress and coping among preschool children. Knowledge of how age, coping style and cognitive development relates to the traumatised preschool child's perceptions of hospitalisation and illness is important in developing effective music therapy strategies. As such, the therapist can help children gain mastery of the unfamiliar environment related to hospitalisation.
Summarising the music therapy research from theory, it was discovered that music therapy can be relevant in multiple ways when working with hospitalised preschool children who suffer from paediatric medical traumatic stress (PMTS):
1. As environmental support in the hospital setting: The music therapist is able to facilitate a structure wherein the child’s active coping strategies are strengthened due to increased engagement, independence and the feeling of being in control.
2. As a tool for preventing anxiety, this being an important goal as anxiety is a significant predisposing factor in developing PMTS.
3. As a tool for treating PMTS: By establishing relational contact, the music therapist is able to meet the child’s need to be embraced while helping the child regain the feeling of comfort, strength, control, physical sensation and self–esteem. These goals are meaningful because it is common for the child to develop regressive behaviour along with feelings of extreme helplessness due to the traumatic event.
A hermeneutic process of analysis with four steps is used to examine the clinical practice with the boy mentioned above. One goal of the music therapy sessions was to develop the boy’s coping strategies in order to give him a feeling of control by counterbalancing the internal and external chaos that he was experiencing because of the traumatic event.
According to author’s assessment, the following factors were conducive to the boy’s coping strategies:
- The relation between the music therapist and the patient: Importance of trust, positive interactions and successful interventional experiences.
- The family’s participation: This was found relevant in respect to his psycho-social and cognitive level of development; moving between comfort zones and new surroundings.
- Music therapy and structure: The therapy contributed support and predictability in chaotic surroundings such as the hospital environment.
- The music: As a “hidden companion”, the music was able to support and enhance emotional processing while facilitating both engagement and pleasure.
- The interventions: music and play therapy, song writing and guided imagery using music and scripts are all interventions significant for behavioural reframing and diversion of coping strategies. According to trauma theory, some of the interventions influence the fight-or-flight responses which can cause the release of excess energy linked to traumatic experiences. Likewise, play therapy can be an important element in working with traumatised children because exposure can lead to new solutions and contribute to the trauma treatment.
Music therapy was found conducive to the boy’s coping strategies in both a behavioural and an interpersonal perspective.