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Electronic Theses, Treatises and Dissertations The Graduate School

2009 The Effects of Music Therapy on Feelings of Hopelessness and Personal Control for Women Affected by Domestic Violence Jessica L. Rushing

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COLLEGE OF MUSIC

THE EFFECTS OF MUSIC THERAPY ON FEELINGS OF HOPELESSNESS AND

PERSONAL CONTROL FOR WOMEN AFFECTED BY DOMESTIC VIOLENCE

By

JESSICA L. RUSHING

A Thesis submitted to the College of Music in partial fulfillment of the requirements for the degree of Master of Music

Degree Awarded: Summer Semester, 2009

The members of the committee approve the thesis of Jessica L. Rushing defended on July 6, 2009.

______Jayne M. Standley Professor Directing Thesis

______Alice-Ann Darrow Committee Member

______Dianne Gregory Committee Member

Approved:

______Don Gibson, Dean, College of Music

The Graduate Studies has verified and approved the above-named committee members.

ii

I dedicate this thesis to my mother and father, who have unceasingly supported me and allowed me to follow my dreams.

iii ACKNOWLEDGEMENTS

I would first and foremost like to thank the women participating in this study. They allow me to love what I do on a daily basis and challenge me to be better. A special thanks goes to the staff at Hubbard House and Lowell Correctional Institution, especially Kay Davis, Alison, and Djuna Poole, for supporting this project and assisting in its implication. Endless thanks goes to my parents Julie Snow and Neil Rushing for supporting me in every way possible. Thank you to my grandparents who are a continuous source of inspiration. I would like to thank my Junior Thesis Advisor, Natalie Wlodarczyk, who let me ask many questions and freely gave of her time and talent to edit and help me complete this project. Special thanks to Miriam Hillmer who served as open ears as I verbally processed more minute details of the project then anyone ever needs to hear. To Jack Tyndall, who went above and beyond to assist me. My deepest and continued gratitude goes to Dr. Jayne Standley. From the moment I walked on the FSU campus her door has been open to me. Her guidance and leadership will forever inspire me both through my career and life. Thank you to the many, many teachers and mentors I have been blessed to know.

iv TABLE OF CONTENTS

LIST OF TABLES ...... vii

ABSTRACT ...... viii

CHAPTER I INTRODUCTION ...... 1

CHAPTER II REVIEW OF LITURATURE ...... 3 Domestic Violence in Correctional Facilities ...... 3 Alcohol and Drug Use ...... 4 Effects of Domestic Violence ...... 4 Control and Domestic Violence ...... 5 Perceived Control ...... 9 Creative Arts and Trauma ...... 12 Music Therapy and Domestic Violence ...... 13 Music Therapy in Correctional Settings ...... 16 Purpose ...... 17

CHAPTER III STUDY A – DOMESTIC VIOLENCE SHELTER ...... 19 Setting and Participants ...... 19 Design & Instruments ...... 20 Procedures ...... 22 Results ...... 25

CHAPTER IV STUDY B – WOMEN’S CORRECTIONAL INSTITUTION ...... 30 Setting and Participants ...... 30 Design and Instruments ...... 31 Procedures ...... 31 Results ...... 33

CHAPTER V DISCUSSION ...... 38 Considerations ...... 42 Conclusion ...... 43

APPENDIX A DEMPGRAPHIC QUESTIONNAIRE ...... 44

APPENDIX B THE HOPELESSNESS SCALE ...... 45

APPENDIX C THE HOPELESSNESS SCALE SCORING KEY...... 46

APPENDIX D PERSONAL CONTROL & EMOTIONAL STATE QUESTIONNAIRE ...... 47

APPENDIX E PERSONAL CONTROL & EMOTIONAL STATE QUESTIONNAIRE SCORING KEY ...... 48

v APPENDIX F ACTION STEPS CHECKLIST ...... 49

APPENDIX G RESPONSE TO MUSIC THERAPY QUESTIONNAIRE ...... 50

APPENDIX H RESPONSE TO MUSIC THERAPY QUESTIONNAIRE SCORING KEY ...... 51

APPENDIX I “YOU GOTTA BE” LYRICS ...... 52

APPENDIX J “YOU GOTTA BE” FILL-IN-THE-BLANK ...... 53

APPENDIX K THEMES OF EMPOWERMENT USED FOR SONGWRITING ANALYSIS ...... 54

APPENDIX L RESULTS BY PARTICIPANT FOR HS & PCESQ ...... 55

APPENDIX M RESULTS BY PARTICIPANT FOR THE ACTION STEP CHECKLIST ...... 56

APPENDIX N RESULTS BY PARTICIPANT FOR THE RESPONSE TO MUSIC THERAPY QUESTIONNAIRE ...... 58

APPENDIX O SONGS WRITTEN BY PARTICIPANT ...... 59

APPENDIX P RESULTS BY PARTICIPANT – SONGWRITING PHRASES AND THEMES ...... 67

APPENDIX Q INSTITUTIONAL REVIEW BOARD APPROVAL SITE APPROVAL, AND CONSENT FORMS ...... 71

REFERENCES ...... 76

BIOGRAPHICAL SKETCH ...... 80

vi LIST OF TABLES Table 1. Subject Demographics ...... 20

Table 2. Hopelessness Scale Mean and Standard Deviation ...... 25

Table 3. PCESQ Mean and Standard Deviation ...... 26

Table 4. Action Step Checklist Mean and Standard Deviation ...... 27

Table 5. Response to Music Therapy Mean Scores ...... 28

Table 6. Themes Found in Songwriting ...... 29

Table 7. Subject Demographics ...... 31

Table 8. Hopelessness Scale Mean and Standard Deviation ...... 33

Table 9. PCESQ Mean and Standard Deviation ...... 34

Table 10. Action Step Checklist Mean and Standard Deviation ...... 35

Table 11. Response to Music Therapy Mean Scores ...... 36

Table 12. Themes Found in Songwriting...... 37

vii ABSTRACT

The purpose of this study was to determine the effects of music therapy in a single session on feelings of hopelessness, feelings of personal control, and change in emotions for women with histories of domestic violence. This study also looked at emotional states prior to and after a music therapy session, thematic material derived from songwriting, and assessed the use of the Action Step Checklist handout in relation to problem solving and goal-setting. Women seeking shelter services (n = 12) and women residing in a state Correctional Institution (CI) (n = 8) served as participants. This research was comprised of two studies: Study A (women in the shelter) and Study B (women at the CI). The same design was utilized for both studies. Data were collected immediately prior to a music therapy session and immediately after the session for the Hopelessness Scale (HS) (Beck, Weissman, Lester, & Trexler, 1974) and the Personal Control and Emotional State Questionnaire (PCESQ). Participants filled out a demographic questionnaire prior to the group and the Response to Music Therapy after the group. An Action Step Checklist was completed once during the music therapy group and as a one-week follow-up for available participants. Participants wrote all songs used for analysis during the music therapy session. A Mann Whitney-U test (α= .05) was run for HS and PCESQ and showed no statistical significance between pre and posttest measures. All measures, with the exception of the follow-up Actions Step Checklist in study B, showed positive gains between pre and posttest, though not significant. Participants were found to have low levels of hopelessness, high levels of personal control, and displayed positive emotions. The Action Step Checklist determined that participants had completed an average of three to five out of seven steps, both at initial completion and at the one-week follow-up. Prominent themes found in song-writing analysis included self-knowledge/awareness/acceptance, strength/innate power, and courage/confidence. Response to the Music Therapy Questionnaire revealed that a single music therapy session had positive effects on motivation, comfort, personal decisions, decisions of the future, and desire to take action-steps. The strongest effect of music therapy in Study A was on desire to take action steps. The strongest effect of music therapy in Study B was on feelings of motivation. Results from this study suggest that participants were able to verbalize and recognize their own strength and courage through a single music therapy session focused on belief in personal control and problem solving.

viii CHAPTER I INTRODUCTION

Domestic violence affects an alarming amount of people on a daily basis. Though referred to in many terms with differing definitions, domestic violence, intimate partner violence, and dating violence produce detrimental effects on thousands of people annually. This paper will focus specifically on women survivors of domestic violence; however, researchers have begun and continue to study the effects of domestic violence on male victims. According to a 2005 report by the Bureau of Justice, about 60% of family violence that occurred was reported between 1998 and 2002 (Durose et al., 2005). The victim was female in 73% of the cases reported. During the 1990s, the National Institute of Justice and the Centers for Disease Control and Prevention conducted a survey to determine the national status of domestic violence against women. Results indicated that violence is more widespread and injurious to both women’s and men’s health than had been previously thought (Tjaden & Thoennes, 2000, p. iii). Tjaden and Thoennes (2000) discovered that approximately 1.9 million women are physically assaulted each year in the United States. Approximately 1.3 million US women experienced violence from an intimate partner in one year and women were significantly more likely than men to experience domestic violence. More than 1 in 5 (22.1%) of those surveyed had been physically assaulted by a current or former intimate partner. Women were also more likely to be injured during an assault, however, only an estimated one third of injured or raped women received medical treatment. In addition to experiencing violence, 7.7% of women reported being raped with forced vaginal, oral, or anal sex by a current of former intimate partner. This number equates to 3.2 for every 1000 women, not including those under the age of 18. The authors of these findings called for intimate partner violence to be recognized as a “major public health and criminal justice concern” (Tjaden & Thoennes, 2000, p. v). During 2008 in Florida, where the present study was conducted, 113,123 accounts of domestic violence were reported (Florida Department of Law Enforcement, 2008). This number does not acknowledge the many incidences of domestic violence that annually go unreported. This number also does not account for partner violence outside of the family or household. Each state has different legal implications for domestic violence. Domestic violence, under the 2008 Florida State statue title XLIII, chapter 741.28, section 2, is defined as “any assault,

1 aggravated assault, battery, aggravated battery, sexual assault, sexual battery, stalking, aggravated stalking, kidnapping, false imprisonment, or any criminal offense resulting in physical injury or death of one family or household member by another family or household member.” One hundred-eighty domestic violence cases reported in Florida in 2008 resulted in murder and 931 cases involved forcible rape, manslaughter, stalking, forms of assault, and threats. The majority of reported incidents involved either a cohabitant or spouse. Of the 113,123 reports, 67,615 arrests were made. These state and national numbers show the vast amount of domestic violence experienced by women on a regular basis. Incidences can develop beyond physical battering to sexual abuse, stalking, and even death.

2 CHAPTER II REVIEW OF LITURATURE

Feelings of self-esteem, empowerment, personal control, and self-efficacy are associated throughout literature as paramount in affecting the well-being of women who have been battered. Women’s feelings of personal control are found to be significantly compromised by experiencing abuse from a partner (Umberson, Anderson, Glick, & Shapiro, 1998). In a study highlighting a cognitive approach for treating battered women with PTSD, 94% of participants were found to no longer meet PTSD diagnostic criteria (Kubany, Hill, & Owens, 2003). In the same study, which provided work for the above principles, it was suggested that a greater emphasis could be placed on decision-making skills for women in abusive relationships. Similarly, Campbell, Rose, Kub, and Nedd, (1998) found that, “self-talk, decisions to subordinate and negotiate, were essential to many women in staying safe as they moved through the process of achieving nonviolence” (1998, p. 759). The following review of literature will illustrate the effects that domestic violence can have on women survivors. It will also serve to outline theories of hopelessness and control, concluding with an examination of the benefits of music therapy with survivors of domestic violence. Domestic Violence in Correctional Facilities According to Bureau of Justice statistics, almost half of women residing in a correctional institution report past abuse including physical or sexual abuse (Halow, 1999). Browne, Miller, and Maguim (1999) reviewed national surveys and found that 33.5 - 69% of incarcerated women reported physical abuse during their lifetime. The Bureau of Justice reported that 23 - 37% of women offenders have been physically or sexually abused prior to the age of 18. This is more than twice as high as the general population and also childhood abuse reported by male offenders (Halow, 1999). Browne et al. (1999) looked at prevalence rates for incarcerated women and found that 75% had experienced violence by an intimate partner as an adult. Acts of violence included, but were not limited to, being kicked, punched, hit with an object, choked, and threatened or assaulted with a gun or knife. Relationship to the abuser is one difference between women in the state, federal, or probation system and the general public. A parent, guardian, or other relative was more likely to have abused women in the system, were as women in the general public who experienced domestic violence had higher rates of spouse or cohabitant abuse

3 (Halow 1999; Browne, Miller, & Maguim, 1999). Browne et al., found that 70% of incarcerated women had experienced severe violence by a parent or caregiver. Adult domestic violence and intimate partner violence has been examined in some detail; however, abuse can and often does begin much earlier. In the state system, 25% of the women identified being abused as both juveniles and adults (Harlow, 1999). For female prisoners who came from foster care, the rate of prior abuse jumped to 87%. Female inmates with histories of abuse also often had histories of parental alcoholism and relatives with a history of incarceration. Childhood abuse, including physical, sexual, or other forms of abuse is shown to be a leading factor in predicting adult abuse and negative psychological outcomes (Ham-Rowbottom, Gordon, Jarvis, & Novaco, 2005; Walker 2000). Based on research statistics, experiences of domestic violence may have lifelong implications spanning from early childhood to adult women in prison with histories of abuse. Alcohol and Drug Use Alcohol and drug use or dependency is reported in high numbers for women who have been abused. Golding (1999) found that many women who had been abused also reported alcohol and drug dependency (18.5% average and 32.6% for women in shelters). Similarly, Harlow (1999) estimated that 80% of abused women in state prisons had regularly used illegal drugs and 58% reported regular drinking. Harlow (1999) found that 46% of women offenders were using illegal drugs and 33% were using alcohol when they committed their current offense. These reports point to the use of alcohol or drugs as maladaptive coping strategies for victims of abuse. Impaired judgment while under the influence of drugs and alcohol could lead to further negative consequences, such as jail or prison. Effects of Domestic Violence Research has shown the serious effects of abuse on women. Abuse yields not only physical but also life-altering psychological outcomes. Studies repeatedly find that abuse has high prevalence rates for depression and Post Traumatic Stress Disorder (PTSD) (Coker, Davis, Arias, Desai, Sanderson, Brandt et al., 2002, Golding, 1999; Halow, 1999; Ham-Rowbottom, Gordon, Jarvis, & Novaco, 2005; Johnson & Ferraro, 2000; Mechanic, Weaver, & Resick, 2008; Walker, 2000). Low self-esteem and learned helplessness are vastly observed in women survivors of domestic violence (Johnson & Ferraro, 2000; Walker, 2000). A meta-analysis done by Golding (1999) revealed that just under half of battered women suffer from depression. A

4 meta-analysis of studies involving only women in shelters saw the incidence of depression jump to 60%. Golding (1999) found that 63% of battered women met the criteria for PTSD. Severity and length of abuse was positively correlated with depression and PTSD. A suicide rate of 17.9% was found with an increase to 33.9% for women in shelters. Mechanic et al. (2008) studied the impacts of physical violence, sexual coercion, psychological abuse, and stalking in relation to symptoms of depression and PTSD. The researchers interviewed 413 severely battered and help-seeking women and found that 31% fell in the severe range for PTSD and depression. These findings showed that all forms of abuse, as listed above, were significant in predicting PTSD. Psychological abuse, including verbal abuse and stalking, were found to be predictors of PTSD and depression. Ham-Rowbottom et al. (2005) looked specifically at life constraints and psychosocial well-being of 81 domestic violence shelter graduates. Of the graduates who had post-shelter relationships, 96% reported being violence free; however, 75% of the surveyed sample had clinical levels of depression post-shelter. While depression remained an obstacle, the graduates expressed general satisfaction with life status but reported that financial struggles were a significant problem. Control and Domestic Violence Early literature on this topic focused specifically on women as victims of domestic violence; however, subsequent studies are beginning to examine partner violence across gender, socioeconomic, and cultural lines. The pursuit for power and control is one of the basic motives behind domestic violence, regardless of socioeconomic status, culture, or gender (Johnson & Ferraro, 2000; Walker, 2000). Research in this area holds a consensus that domestic violence and other forms of partner violence are a learned behavior for establishing power and control (Walker, 2000). Walker (2000) outlined partner violence as a method for establishing and maintaining power and control over one’s partner. Walker (2000) also identified the typical batterer as one who uses violence to achieve this goal. Recent studies have examined domestic violence in an attempt to better define it and make predications regarding future incidences. Johnson and Ferraro (2000) reviewed literature from the 1990s and identified four types of domestic violence that seek to establish control over their victim: couple violence, intimate terrorism, violent resistance, and mutual violent control. Couple violence is identified by patterns of control related to arguments, wanting one’s way, and physically lashing out. Intimate terrorism is characterized by establishing control over one’s

5 partner with heightened physical encounters and increased escalation. Violent resistance occurs in situations that call for self-defense and mutual violent control is defined as both persons in the relationship using violence as a mechanism for control. Control may be seen as an act to maintain homeostasis or an effort to retain control when one perceives or fears it is being lost or threatened. In addition to the elements of violence previously described, Johnson and Ferraro (2000) recognized emotional abuse as being a component in all forms of relationship violence. Theories of learned helplessness and hopelessness have been linked in an effort to explain the psychological experiences of women who have been battered or continue to be battered. After conducting extensive interviews with over four hundred battered women, Walker (2000) reported “from preliminary investigations, it was believed that women develop a cluster of psychological symptoms from living in a violent relationship that could be called ‘the Battered Woman Syndrome’” (p. ix). As violence in the relationship continues, perceived reinforcements, and lack there of, begin to change causing distortions in beliefs about the control one has and regarding positive outcomes. Walker (2000) describes a cycle of violence and how positive reinforcement, which was previously related to acts of love and contrition, can become viewed as a woman’s ability to deescalate incidences of violence, anger and tension. The “honeymoon” period of the cycle can produce such extreme decreases in negative reactions that women feel reinforced by the decrease. Women seeking therapy while still with violent partners generally are not looking to get out of the relationship but to end the violence with hopes of an unrealistic relationship reconciliation. “The Battered Woman Syndrome (BWS) includes disruption in interpersonal relationships, usually from the isolation, over possessiveness, intrusiveness and jealousy displayed by the batterer” (Walker, 2000, p. 167). Being in a violent relationship significantly reduces one’s sense of personal control. It has negative effects on one’s sense of self and well-being (Umberson, Anderson, Glick, & Shapiro, 1998). In combination with isolation, a disrupted sense of relationship stability between violence and tension, altered feelings of personal control, and high rates of depression can result in feelings of helplessness. Learned helplessness is a term often associated with a woman’s general outlook as a result of being in an abusive relationship. Peterson and Seligman (1983) described learned helplessness and victimization as they relate to partner abuse. These authors defined learned helplessness as coming from response-outcome learning during abusive episodes and ultimately resulting in low self-esteem, future response passivity, and emotional numbing. Understanding

6 the model of learned helplessness can assist in understanding numbing and passive responses to victimization. When a woman repeatedly learns that responding to an abuser is generally fruitless, the learned response-outcome is that responding yields negative results and therefore responding is not worth the effort or risk. Characteristics of learned helplessness and victimization include an uncontrollable experience of trauma, a belief in future uncontrollability with expected response-outcome independence (this refers to the belief that responses generated will be independent of outcomes), general deficits in situations and an overall belief that future responses will be futile (Peterson & Seligman, 1983). In learned helplessness motivation to respond becomes influenced by attribution of global and specific attitudes, therefore guiding future behavior (Walker, 2000). In summary, learned helplessness affects a battered woman’s belief that her actions can be effective and create positive change. Concepts from learned helplessness may parallel and support aspects of the hopelessness theory. In the hopelessness theory, if a person attributes negative events to internal (self), stable and global causes, there may be a loss of self-esteem and potential for long term deficits (Peterson & Seligman, 1983). Negative self-talk such as “I’m so dumb, I should have had the house clean before he came home” would lead towards more harmful effects. According to the hopelessness theory, if a situation is viewed as external, unstable and specific, there is less risk of hopelessness (Abramson, Metalsky, & Alloy, 1989) or learned helplessness (Peterson & Seligman, 1983). A learned response that includes feeling that it is within one’s power to create change for the better can lead to decreased feelings of helplessness and hopelessness. These feelings may then spread to other life events even after leaving the abusive relationship. The effect of this response on one’s self-esteem is repeatedly emphasized in the research literature (Peterson & Seligman, 1983). Hopelessness theory, as defined by Abramson, Metalsky, and Alloy (1989), is a subtype of depression resulting from a causal chain of events. Hopelessness depression involves having the expectation that desirable outcomes are unlikely and that there is nothing one can do to prevent undesirable outcomes from occurring. There are two factors in hopelessness as defined by Abramson et al. (1989); helplessness or attribution of control over life events, and the expectation of negative outcomes. The causal chain that leads to hopelessness may contain some type of life event (most likely negative), situational cues, or previous personality tendencies toward negative inferential styles. Symptoms of hopelessness include delayed initiation of

7 voluntary responses related to motivation, sad affect, suicide, lack of energy, apathy, psychomotor retardation, sleep disturbance, difficulty in concentration, and mood-exacerbated negative cognitions. Lowered self-esteem and dependency may also accompany these symptoms. Women who have been subjected to domestic violence may make negative inferences about cause, consequence, and self; and therefore are more likely to have negative expectations about the future. Two studies were found that investigated hopelessness in samples of women who have been in abusive relationships. Findings of these studies showed low levels of hopelessness in contrast to high levels of dysphoria (depression). In addition to other scales, both studies used Beck, Weissman, Lester, and Trexler’s (1974) hopelessness scale. The scale was designed to identify one’s feelings of negative expectations for the future. Clements & Sawhney (2000) surveyed 70 women from domestic violence agencies who had an average of eight years in an abusive relationship. The hopelessness theory was used to look at control perception, coping styles, and psychological well-being. Over half of the participants showed clinical levels of dysphoria but not hopelessness. They found that self-blame, avoidance coping, and low levels of problem-focused coping were associated with increased dysphoria. It was shown that problem- focused coping related to decreased hopelessness and dysphoria. The most recent and severe episodes of abuse were seen as uncontrollable by many women; however, high expectations for control of future events was seen as decreasing dysphoria. Higher levels of hopelessness were seen in women whose abuse began early in the relationship and who experienced violence outside of the main relationship. Decreased levels of hopelessness were associated with the belief that one could avoid negative events using problem-focused coping. The second study done by Clements, Sabourin, and Spiby (2004) evaluated a sample of 100 shelter-seeking women. Similarly, this study found moderate to severe levels of dysphoria and low self-esteem but not high levels of hopelessness. Similar coping strategies were found including self-blame, denial, behavioral disengagement, and drug use. Decreased self-esteem was shown in women who experienced pre-marital abuse and early relationship abuse. Increased dysphoria was seen in women with high-perceived control over current abuse and decreases in dysphoria and hopelessness and increased self-esteem were seen in women who expected to control future abuse. Increased levels of hopelessness were shown in cases in which the abuse started early in the relationship and also included violence outside of the main relationship. The findings of

8 these two studies show low levels of hopelessness paired with high levels of dysphoria as measured by the Beck Depression Inventory. These results are noteworthy as “it is relatively rare to find individuals with moderate to severe levels of dysphoria who do not report hopelessness” (Clements et al., 2004, p. 33). Clements et al. (2004) indicated that effective treatment could be aimed at reduction of self-blame, problem-focused coping, and perceived control. Clements et al. (2004) also discussed passive coping, concluding that “the ineffective coping strategies shown by a large portion of this sample suggest a passive approach to the abuse situation, as do the data showing low perceived control over current abuse” (p. 34). Other researchers have argued that strategies such as passivity and denial, can be used by women as a means of active problem-solving (Campbell, Rose, Kub, & Nedd, 1998). Perhaps the lack of perceived hopelessness in the previous studies relates to a misconception of active coping strategies. In a longitudinal study, Campbell, Rose, Kub, and Nedd (1998) interviewed women who reported having a “serious problem in an intimate relationship,” including physical and/or sexual abuse, threats, intimidation, financial, social and other forms of coercive control. Results showed that women engaged in various responses to abuse such as evaluating options, decision-making, and handling daily issues. Passivity and denial were consciously used as active coping strategies. Subordination, such as “keeping feelings in” or “claming up,” and negotiation were chosen responses used in efforts to move towards nonviolence and/or reduce escalation. Leaving the relationship was reported to occur as a process of identifying and evaluating turning points, negotiation with self and the abuser, and experimenting with strategies to decrease abuse, therefore improving the relationship. Examples of turning points include incidences of extreme abuse or threat of death. At the first interview, 78% of the women were currently in an abusive relationship. At the last interview 53% of the women were no longer in the abusive relationship. Women in this study were found to be strong, courageous, able to make intelligent decisions, and resourceful despite perceived passive coping strategies Perceived Control Control is a central agent when discussing domestic violence. It may represent the control that an abuser is trying to exert with the use of violence or the perceived control the victim feels they have over the abusive situation as well as their perceived ability to effectively change the situation. A survivor’s perceived control can have an effect on their feelings of

9 helplessness, hopelessness, and dysphoria (depression). Elevated self-esteem, improved psychological adjustment, and reduced anxiety and depression are among the benefits of a belief in personal control (Berrenberg, 1987). Berrenberg (1987) reports that “belief in personal control has been viewed traditionally as consisting of an internal and external locus [or component]” (p. 195). The internal locus is related to self-assessment of one’s abilities, actions, efforts, and other aspects of self. Coping strategies may also fit into this category. External elements fall outside of the individual and include powerful others, fate, or luck. Outcomes can be seen as resulting from these internal or external forces. “An individual may believe that he or she has control over outcomes to the extent that some external agent(s) can be enlisted to aid in the achievement of those outcomes” (Berrenberg, 1987, p. 196). If one believes that they have less internal control than external control it may result in decreased feelings of self-efficacy leading to passive or maladaptive coping strategies. In an abusive relationship, perceived feelings of control can go in many directions. Women report not being in control of current abuse but having generally positive expectations of future events (Clements & Sawhney, (2000). High feelings of perceived control over current abuse has been shown to relate to increased dysphoria, where as positive expectations about future abuse decreases negative feelings (Clements, Sabourni, & Spiby, 2004). Belief in internal control is thought to be more beneficial than harmful; however, it is also important to note Berrenberg’s (1987) findings that extreme belief in internal control can also be maladaptive. When internal belief is perceived at an exaggerated level it could become unrealistic and detrimental. For instance, if a woman in an abusive relationship feels that she can personally control the actions of her batterer, she may remain in the relationship with a false sense of safety while experiencing continued abuse. This idea relates back to Walker (2000) and the cycle of violence with reinforcement coming from decreased tension after an abusive episode. In a treatment setting it then would be important to provide psycho-education on identifying abuse, setting realistic goals, and problem solving to address distorted beliefs about control. Increased personal resources such as social support networks, community resources, problem-solving techniques, and overall quality of life can enhance belief in personal control and self-efficacy. Having supportive persons aid in these efforts can be significant in reducing levels of abuse and also in reducing sustained, long-term abuse. Supportive persons are especially effective when providing accessible resources in rural populations (Bosch & Bergen, 2006).

10 Bosch & Bergen (2006) interviewed 56 women in rural settings who had been in an abusive relationship for an average of 11.7 years. They identified characteristics of a supportive person as taking a non-judgmental stance in aiding women to make the best decisions for them, assisting in creating access to resources, validating experiences, and asking questions about the abuse. Characteristics of non-supportive persons included having traditional gender roles and values, minimizing abusive behavior, not taking action to end the abuse, giving discouraging advice or questioning decisions, and not asking the women what they thought was best for them. Bybee and Sullivan (2002) studied the effects of advocacy work for 278 battered women using strength- based interventions. They found that battered women working with an advocate significantly increased social support, successfully obtained community resources, increased overall quality of life, and significantly reduced the likelihood of reabuse. Bybee and Sullivan (2002) suggested that “…improvement in quality of life can influence a woman’s perception of what is possible for her to have or achieve and also expand her personal resources for protection from reabuse by a partner or ex-partner” (p. 106). Hegarty (2008) discussed a similar project that focused on validating, listening, educating and increasing self-efficacy and safety planning. This project, called Weave, adapted the psychological readiness to change model for brief intervention in the primary care setting. Their concept focused on similar ideas from the aforementioned belief in personal control, discussing internal factors such as recognizing that abuse is abuse, support systems, and self-efficacy or perceived control. In turn, external factors are “…interpersonal interactions and situational events that interact with internal factors to either facilitate or impede change” (Hegarty, 2008, p.379). Hegarty (2008) goes on to discuss that “problem-solving techniques help patients to efficiently identify problem areas, and generate and implement solutions” (p. 380). Lee, Pomeroy, and Bohamn (2007) found that perceived social support had a direct effect on problem-focused coping, support seeking, and passive coping. Supportive persons can aid women in decreasing reabuse and increasing personal resources through effective interventions, including increasing self-efficacy and problem-solving abilities. Mynors-Wallis, Gath, Day, and Baker identified problem-solving as an intervention that may serve to break down perceived external obstacles as well as being successful in treating depression (Mynors-Wallis, Gath, Day, and Baker, (2000) in Hegarty, 2008). Kubany, Hill, and Owens (2003) conducted a study implementing a cognitive trauma therapy program for battered women with PTSD. Clinical criteria for PTSD was successfully reduced for participants post

11 treatment and at a three month follow-up. This program stressed psycho-education on learned helplessness and the benefits of a solution-oriented attitude emphasizing the ability to solve problems. This program was also shown to be successful for women who immediately received treatment and women in the delayed group who waited six weeks to start treatment. These findings demonstrated that problem-solving may be a beneficial skill learned at various stages of working through abuse. Creative Arts and Trauma Creative arts are commonly used in research to facilitate change and validation for people who have experienced trauma or other life altering experiences. Booker (1999) utilized female- authored poetry with a group of Latin American battered women to validate feelings, reduce feelings of isolation and guilt, invite universality, and explore culture and societal views. In discussing group music interventions with survivors of sexual abuse, MacIntosh (2003) used drumming to promote feelings of respect and validation using turn-taking, shared leadership and respect for boundaries. MacIntosh also speaks to drumming as a means to express and keep emotions under control during a physical release. Participants reported feeling closer, safe, and empowered. “Music is a valuable form of nonverbal expression, often speaking the unspeakable. It [music] is an ideal modality for offering voice to traumatic memories which may be stored as sensations or emotions rather than narratives” (MacIntosh, 2003, p. 18). Jones (2005) used songwriting and lyric analysis with people who were chemically dependent. She found that in a single session, music therapy significantly decreased feelings of guilt, regretful/blame, and fear/distrust and significantly increased feelings of acceptance and joy/happiness/enjoyment. Validation, expression, and eliciting change in feelings are some of the goals that creative arts can address with women who have experienced domestic violence, sexual abuse, and chemical abuse. Creative arts have also been used in correctional settings. In discussing creative arts with juvenile offenders, it has been stated that “such activities [creative arts] are known to build feelings of competence and self-control, and assist to restore the youth’s belief that their efforts can make a difference in their lives” (Emerson & Shelton, 2001, p. 192). Kreuter (2007) discussed the use of poetic mantras for prisoners about to be released. Kreuter (2007) implemented a five-week program at a women’s correctional facility in which participants wrote essays and poems about their transformation and what they saw for their future. Creating

12 mantras was used to generate expression through positive self-affirmations and address anxiety in healthy ways. Kreuter (2007) discussed the use of poetry to break down negative thoughts and create new patterns using one’s personal images. Music therapists use the same principle in songwriting. Emerson and Shelton (2001) developed an eighteen-week creative arts program working with 60 female juvenile offenders to build coping skills and interrupt the intergenerational cycle of domestic violence. They describe expressive arts as “…a means for unfreezing old behaviors and creating new ones through acting out unfamiliar roles in a non- threatening environment” (p. 191). Emphasis was placed on using skills to explore participants’ roles in society and enhance social competence and emotional regulation. Creative arts interventions used included role-playing, free writing, and drawing. Creative arts continue to be used in various settings to create positive change for women affected by domestic violence and other traumatic events. Music Therapy and Domestic Violence Though limited, research suggests that music therapy can be effective with survivors of domestic violence. Positive research outcomes have included increased self-esteem (Curtis, 1996; Whipple & Lindsey, 1999; York, 2006), decreased anxiety (Hernandez-Ruiz, 2005; Teague, Hahna, & McKinney, 2006; York, 2006), decreased depression (Teague, Hahna, & McKinney, 2006), increased mood and feelings of personal control (Wilkins & Snider, 2009), and increased insight (Wallace, 1995). Music therapy has also been effective in correctional settings. Wallace (1995) worked for twelve weeks with a women’s support group at a Florida Correctional Institution. The program topics were designed to target the specific needs of women who had experienced abuse. Results revealed a substantial increase in insights gained on educational topics including effects of abuse, self-esteem, and stress management. Cassity and Theobold (1990) surveyed 80 music therapists working with survivors of domestic violence to gain knowledge about current assessments and treatments used. Findings showed that all music therapists assess for behavioral and affective goals. Behavioral goals included assertiveness, ability to confront during conflict, isolative behaviors, and cognitive distortions. Music therapists used lyric analysis, improvisation, and movement to address behavioral goals with female survivors of domestic violence. Affective goals included expression of feelings and emotions and music therapists reported using music listening and discussion, instrumental, vocal or movement improvisation, and song composition as

13 interventions. Music therapists also addressed cognitive issues, imagery, interpersonal issues, drug use, physical well-being, sensory experiences, and music behavior. Examples included addressing learned helplessness, minimizing or denying abuse, minimizing negative self-talk, relaxation, and social isolation. Other techniques implemented include, but are not limited to, drawing to music, guided imagery, music and relaxation, and client decision-making with music assistance. This review of techniques used identified the many goals that can be and are being addressed using music therapy for survivors of domestic violence (Cassity and Theobold, 1990). The ability to be in a relaxed state, to be at peace, and even sleep can be difficult for women who have learned to be in an almost constant fight or flight mode. According to Walker (2000), hyper-vigilance and anxiety symptoms are long-term effects of the Battered Women’s Syndrome. Music therapists have used music to increase relaxation and decrease anxiety (Hernandez-Ruiz, 2005; Teague, Hahna, & McKinney, 2006; York, 2006). Hernandez-Ruiz (2005) studied music therapy and its affects on anxiety and sleep for 28 abused women in shelters using an experimental-control design. Participants were assigned to either a music and progressive muscle relaxation (PMR) group or a control group using silence only. Participants met with the researcher for five consecutive 30-minute sessions. During sessions three and four, participants were instructed on how to use a 20-minute recording of their preferred music paired with a PMR script or 20 minutes of silence for the control group. Participants were instructed to use this intervention at bedtime. Findings showed decreased anxiety and significant positive effects on sleep quality for the experimental group. Hernandez-Ruiz (2005) concluded that “reductions of anxiety and improvement of sleep quality can be considered as increased personal resources, and seem feasible through the use of music therapy” (p. 140). Teague, Hahna, & McKinney (2006) also found reductions in anxiety for women in transitional housing who had experienced intimate partner violence. Teague et al. (2006) provided six weekly music therapy sessions for seven women focusing on self-esteem, self- expression, anxiety, social support, depression, and encouragement for goal setting. Interventions used included music improvising, listening, songwriting, lyric analysis, singing, and other creative arts to address these goals. Anxiety, depression, and self-esteem were assessed on a 100 point visual analogue scale prior to music therapy participation, at the conclusion of six weeks of music therapy participation, and again three weeks after music therapy participation had ended. They found that music therapy marginally decreased group

14 anxiety scores and significantly decreased depression scores from pretest to posttest with continued low scores at the three-week follow-up. No significant differences were found for self-esteem. Participant comments indicated that creative arts with music and relaxation were most effective and that group singing was least effective in addressing goals Overall, participants in the study reported music therapy participation to be a positive and helpful experience. Curtis (1996) found increased self-esteem for six participants who engaged in music therapy sessions twice a week using a feminist approach to music therapy. Each session consisted of lyric analysis for power and gender role socializations, songwriting to allow women to find their voice, and self-nurturing through relaxation and music techniques. Results were reported in a case study for six women who had been present for eight sessions. Four of the six women had marked increases in self-esteem from pre-session interview to post-session interview and one showed a moderate increase. York (2006) conducted a longitudinal music therapy study utilizing a support group format over eight months with women affected by domestic violence. This study evaluated the effectiveness of creative arts and music therapy on self-esteem and empowerment for female survivors. This two-hour weekly group focused on self-esteem and cognitive distortions including learned helplessness, body image, and depression. Interventions included vocal exercises, writing while listening to the music of female composers, therapeutic drumming/percussion interventions, music and movement, and music with a variety of creative arts including creating their own frame drums. As the group progressed, participants looked for a way to further express and transform pain. The result was an ethnographic dramatic performance called “Finding Voice,” which was comprised of script, art, and original music composed by participants from session transcriptions. Preparing and producing the performance provided participants with multiple opportunities to practice decision-making skills. Outcomes included increased self-esteem, positive interactions with family, increased risk taking, rediscovery of musical and creative impulses, decreases in anxiety, and increased assertiveness and autonomy. Women experienced positive outcomes such as returning to college, applying for scholarships, gaining employment, and no longer needing anxiety medications. Whipple and Lindsey (1990) examined the effects of group music therapy on relaxation, feelings about self, and feelings about one’s situation for fifteen battered women. Interventions

15 were varied and focused primarily on goal setting, communication, mood evaluation, and self- esteem. Participants reported benefits such as opportunities to laugh and think. One staff member also reported personal benefits gained from the music therapy experience. Whipple and Lindsey (1990) observed that group singing had immediate effects on mood elevation and increased social interaction. They found that “goal-setting appeared to be the most valuable coping skill presented, augmenting issues addressed in other individual and group therapy sessions” (p. 66). Increased self-esteem was observed during drawing and discussing past, present, and future accomplishments as well as uniqueness. Whipple and Lindsey (1990) concluded that three components are necessary for group work with domestic violence survivors: direct application to life circumstances, opportunities for peer feedback, and use of tangible objects. A current study by Wilkins and Snider (2009) looked at feelings of perceived control for women in shelters. Participants (N = 23) engaged in weekly music therapy sessions over nine weeks. A Likert scale (1-5) was reported after each session to express current feelings, feelings of relaxation, feelings of control, and expectations about music therapy. Sessions focused on self-esteem, self-image, communication, goal making, self-expression, and stress reductions. Techniques used included drum circles, song discussion, lyric analysis, songwriting, instrument play, and sing-a-longs. Results showed significant improvements in overall mood, relaxation, and feelings of control. Music Therapy in Correctional Settings Music therapists work in a variety of correctional settings such as correctional psychiatry, forensics, state psychiatric facilities and with offenders with mental illness and/or substance abuse and juvenile offenders (Codding, 2002). Only one unpublished thesis was found that focused specifically on music therapy and prisoners with backgrounds of abuse. Wallace (1995) created a twelve-week music therapy program for ten women with domestic violence backgrounds residing in a Florida Correctional Institution (CI). Group sessions were developed based on Phase Two of a domestic violence program already in place at the CI. Group topics included, but were not limited to, self-esteem, control, staying in an abusive relationship, effects of abuse, goal setting, communication, relationships, societal expectations, and stress management. Participant comments were collected prior to sessions starting, during week four, during week seven, and at the conclusion of the program. Comments were analyzed for

16 statements of group enjoyment, information learned, and insight (personal growth, self realization, group dynamics, problem solving, and personal goals). Results showed increased verbalizations of insight gained over the course of the program. Purpose The music therapy techniques used in the present study were derived from this review of literature to best address goals of decreasing feelings of hopelessness, increasing belief in self, increasing positive emotions, and transferring problem-solving skills to life situations. Whipple and Lindsey (1999) reported three components deemed necessary when working in domestic violence settings that were incorporated into the present study. These components included direct application to life circumstances, opportunities for peer feedback, and tangible objects to take with them. Many studies have used instrument improvisation or therapeutic drumming when working with domestic violence survivors (Whipple & Lindsey, 1999; Wilkins & Snider, 2009; York, 2006). Active music-making with percussion instruments was chosen to facilitate decision-making from the beginning of the group, as a form of empowerment to foster success in a task, to express or release emotions in a structured and controlled environment, and to provide an opportunity for peer feedback through group music making. Cassity and Theobold (1990) found that music therapists used instrument performance to ”…foster decision making and organizational skills…” (p. 191). Wallace (1995) found that music therapy increased personal insights gained. Effective problem-solving is dependent upon a certain level of personal insight, knowledge of the decision-making process, and the ability to organize the necessary steps to effectively solve the problem. Previous music therapy studies with women who have experienced domestic violence have all been conducted over several weeks or sessions. The present study explored the effectiveness of music therapy for survivors of domestic violence in a single session. The purpose of this study was to determine the effects of music therapy in a single session on feelings of hopelessness, feelings of personal control in relation to situation/decision making, and change in emotions related to happiness, guilt, fear, acceptance, empowerment, and anxiety. This study also examined the use of psycho-education for decision-making within a music therapy session. The null hypothesis of the present study was that there would be no significant changes in feelings of hopelessness, belief in personal control, and emotional state from pre to posttest after

17 one music therapy session. This study also explored participants’ current outlook on problem- solving as measured by steps taken on the Action Step Checklist.

18 CHAPTER III STUDY A – DOMESTIC VIOLENCE SHELTER

Setting and Participants This study was conducted at a domestic violence shelter in north Florida. The shelter is a 72-bed safe haven providing services to female and male victims of domestic violence as well as services to their children and adult dependents. Programs offered at the shelter include individual and group counseling, safety planning, victim advocacy, child services, case management, and others. Participants in this study were required to be at least 18 years of age and currently receiving services from the shelter due to experiences of domestic violence. Participants were part of a weekly, non-mandatory, domestic violence support group held at the shelter. This study was conducted as a one-time intervention in place of a weekly group meeting. There were approximately fifteen women participating at any given time in the group; however, some came late therefore did not sign consent forms and some who signed forms left early and were unable to complete posttest measures. Data were analyzed for participants (N = 12) who attended the group and completed pre and posttest measures. Domestic violence is not restricted to a certain demographic (Johnson & Farraro, 2000; Walker, 2000) and Table 1. shows the diversity present among participants in this study gathered from a demographic questionnaire (see Appendix A). Women ranged in ages from 18 - 59 years with a mean age of 36.67. African-American women comprised 58% of the group. The remaining participants were Caucasian, Hispanic, and other. English was the first language for the majority of the participants. Other primary languages were Spanish, French, and Creole. Approximately 42% of the women had high school degrees or GEDs. Some college, vocational/technical training, a bachelor’s degree, and other forms of education including associate degrees were reported in the small sample. Participants had a mean of 1.25 dependent children with numbers ranging from 0 - 4. In relation to their current abuser, 42% were separated without contact. Twenty-five percent of the women were still married to their abuser, one woman was currently in a relationship with her abuser, and one reported being separated with contact. These women spent an average of six years in their abusive relationships. A maximum of 25 years and a minimum of less then six months was reported. Almost all of the participants had been abused physically, verbally, and emotionally.

19 Seventeen percent of participants reported physical and verbal abuse without emotional abuse present. Services and programs the women were currently involved in included individual therapy/counseling, support groups, transitional housing, job training, parenting class, and transitional housing.

Table 1. Subject Demographics

r

t

t

d

r

achelor's hysical abuse othe verbal abuse verbal emotional abuse emotional sep. w/contac sep. currently with abuse currently with Sub. # Race Age Kids Dep. of # b p of abuse 3 forms All English Bilingual HS/GED Vocational/tech Some College sep. w/no contac w/no sep. abuse in years marrie S1 H 38 1 1 1 1 1 3+ 1 S2 AA/O 48 0 1 1 1 1 25 1 S3 AA 41 4 1 1 1 12 1 S4 H 39 2 1 1 1 14 1 S5 C 47 0 1 1 1+ 1 S6 AA 18 0 1 1 1 8+ 1 S7 H 27 2 1 1 1 5 1 S8 AA 59 0 1 1 1 3+ 1 1 S9 C 36 1 1 1 12 1 S10 AA 39 2 1 1 1 4 1 S11 AA 27 2 1 1 1 .5+ 1 S12 AA 21 1 1 1 1 .5- 1 1 Note: H=Hispanic, AA=African-American, C=Caucasian, O=Other, Dep.=dependent, HS=high school, Sep.=separated

Design & Instruments This study was conducted using a single session pre-posttest design with participants serving as their own control. The independent variable for this study was a single music therapy session focusing on empowerment of belief in personal control and introduction of an action step checklist geared toward problem-solving. Dependent variables included feelings of hopelessness, belief in personal control, and current emotional state. For each participant, pre- session and post-session scores were collected for the Hopelessness Scale (HS) (Beck, Weissman, Lester, & Trexler, 1974) and the Personal Control and Emotional State Questionnaire (PCESQ) developed by the researcher. Participants also completed a demographic questionnaire

20 prior to the session, Response to Music Therapy Questionnaire after the session, and the Action Step Checklist during the session and again at a follow-up one week later. The Beck Hopelessness Scale (HS) (Beck, Weissman, Lester, & Texler, 1974) (Appendix B) was designed to identify one’s feelings of negative expectancies about the future. It is a 20- item self-report measure comprising of true/false statements. Each item is scored in relation to a key indicating one point (see Appendix C for scoring key). Some items are scored as true and some as false. Scores range from 0 - 20 with larger numbers indicating higher negative expectancies for the future. The HS scale has been shown to have strong reliability with a confidence level of .93 (Beck et al., 1974). Minimal levels of hopelessness are seen at < 3, mild 4-8, moderate 9-14, and severe > 14. The Perceived Control and Emotional State Questionnaire (PCESQ) (see Appendix D for the scale and Appendix E for the scoring key) is a 1-5 Likert scale that instructs respondents to indicate their level of current feeling ranging from strongly disagree, disagree, neutral, agree, and strongly agree. PCESQ is broken into two parts; the first section (PC) seeks to assess belief in personal control using four questions taken from Berrenberg’s (1987) Belief in Personal Control Scale. Two items were used relating to feelings of internal control and two relating to feelings of external control. Items were scored such that greater numbers indicated greater belief in internal personal control. Scores for PC ranged from 4 - 20. The second part of the PCESQ, ES, evaluates current emotional states. Feelings of happiness, guilt, fear, acceptance, anxiety about the future, and empowerment to make decisions were scored in the same manner as the PC items. Higher scores indicated high positive feelings and lower scores indicated greater negative feelings. Scores range from 6 - 30. Four of the six items, happiness, guilt, fear, and acceptance, were adapted from Jones’ (2005) study that found music therapy to have significant positive effects on emotional states in a single session. The remaining two items, anxiety about the future and feelings of empowerment to make decisions, were added by the researcher to assess feelings directly related to outcomes from experiences of and treatment for domestic violence. The Action Steps Checklist (Appendix F) was developed by the researcher as a tool to aid participants in problem solving strategies and to examine participants’ current approach to problem-solving. The Action Steps Checklist outlines seven steps to be taken when evaluating personal change or goals with a free response question asking “do you feel that you are in a better place now?” The Action Steps Checklist was presented and completed by participants

21 during the actual music therapy session and at a one-week follow-up. The Action Steps Checklist was scored based on the highest number of steps completed in sequence. For example, if participant A checked that they completed steps 1, 2, 3, and 5 they would have received a score of 3 because step 4 was not completed. The Response to Music Therapy Questionnaire (Appendix G) was administered to participants at the conclusion of the session. This scale was used to evaluate participants’ perception of their music therapy experience. This scale is a five-item Likert scale structured in the same manner as the PCESQ (strongly disagree – strongly agree). A free response question of “how did today’s session related to your situation” is included on this questionnaire. Mean scores for each of the five items were collected and analyzed. (See Appendix H for scoring key). The song selection used for this study, “You Gotta Be” as recorded by Des’ree (Des’ree & Ingram, 1994), was identified by Jones (2006) as a “pro-woman” song specifically embodying the themes of strength/innate power, perseverance, courage/confidence, and growth/risk-taking. Songs written by study participants were analyzed for content themes. The songs were written in a fill-in-the-blank style. Clients were provided with a lyric sheet (Appendix I) of “You Gotta Be” in which some of original words were replaced with blanks (Appendix J). Participants were then asked to fill in the blanks with their own words. A content analysis was used to find themes of empowerment as identified by Jones (2006). Jones compiled excerpts of words from women she identified as well-known, successful, and empowered to create a description of an empowered woman. From these words Jones identified eight themes that carried the message of empowerment. Themes included 1) problem-solving, 2) self-knowledge/awareness/acceptance, 3) strength/innate power, 4) perseverance, 5) intolerance of “less than,” 6) courage/confidence, 7) growth/risk-taking, and 8) independence. An additional theme of Faith was added by the researcher due to a substantial number of lyrics written addressing faith issues in some form (for a full description of themes see Appendix K). Jones used these themes to discuss select “pro- women” songs that could be used to support female clients on their journeys. All nine themes were used in analyzing songs written by clients. Procedures This study was scheduled by facility staff to be run in place of a weekly domestic violence support group. Shelter residents were encouraged by counselors to attend this special group. The session was 90 minutes long with 30 minutes allotted for filling out questionnaires

22 and 60 minutes devoted to a music therapy session. Upon arrival at the facility the researcher explained the study and study purposes to potential participants, addressed any questions or concerns, and obtained consent. All participants signing consent forms then completed the demographic questionnaire, pre-session Hopelessness Scale, and pre-session PCSEQ. After completion of pre-session assessments, the researcher facilitated a 60-minute music therapy session. The music therapy group focused on empowerment of belief in personal control and problem-solving with discussion highlighting decisions and problems solved in relation to presented group tasks, self-reflection, lyric analysis, and feelings based on the experience. The following is an outline of the music therapy session used for this study with approximate times for each exercise. The room was set up with couches and chairs arranged in a circle. • Active music making with introductions– 15 min • Listening to “You Gotta Be” (played live) – 5 min • Lyric Analysis of “You Gotta Be” – 10 min • Fill-in-the-blank participant songwriting – 10 min • Song sharing – 10 min • Completion of the Action Step Checklist – 5 min • Closing exercise (active music making) – 5 min

The first thing introduced to the participants were group guidelines which were stated as follows: 1) you have permission to be as loud or as soft as you want to and 2) you are invited to respond to each others thoughts and ideas. Participants were asked if any other guidelines should be included, to which they responded that confidentiality within the group should be a guideline as well. The first exercise was active music-making. Active music-making has been used in previous studies with women effected by domestic in the form of therapeutic drumming or instrument improvisation (Whipple & Lindsey, 1999; Wilkins & Snider, 2009; York, 2006). A variety of percussion instruments were placed in the center of the circle. The women were asked to select an instrument they felt drawn to, to say their name, to share something about themselves, and then play how they currently felt on their chosen instrument. Participants were not told what the instruments were nor were instructions given on how to play them; however, they were told that they could ask any questions they wanted to about the instruments. Instruments included djembes, paddle drums, a tambourine, a maraca, egg shakers, gyro, slit drum, and others. After introductions, ten minutes of group playing took place in which the women were able to explore their instrument and create rhythms both as a group and individually. The group was given an opportunity to release both energy and emotions through

23 changes in dynamics using the instruments. At the conclusion of playing, the group was asked to take a deep breath and verbalize how they felt. Next, participants were asked to identify ways they had already engaged in decision- making, goal-setting or problem-solving during the group. The group focus of problem-solving and belief in self was emphasized and reinforcement was given based on the decisions they had already successfully addressed within the course of the group. The next portion of the session was structured utilizing the song “You Gotta Be” by Des’ree (Des’ree & Ingram, 1994). This portion utilized lyric analysis and songwriting. Lyric analysis and songwriting have been shown to significantly increase positive feelings and decrease negative feelings (Jones, 2005). Jones (2006) identified ‘You Gotta Be” as containing themes of strength/innate power, perseverance, courage/confidence, and growth/risk-taking. Participants were given a lyric sheet (Appendix I) for the song selection and asked to underline or circle any words/phrases that were meaningful to them as the researcher sang the song with live accompaniment. Lyric analysis of “You Gotta Be” was selected to engage the women in topics and feelings of personal strength as well as elicit a desire to challenge whatever their current obstacle may be. This was done particularly through lyrics such as “…challenge what the future holds…stand up and be counted, don’t be ashamed to cry…” and others. After processing the lyrics, participants were invited to make the song their own by filling in the blank lyric sheet (Appendix J) with strengths they have, things they would like to work on, goals, or anything else they wished. The researcher played the chords of the song softly as the women filled out their lyric sheets. Songwriting is a music therapy technique commonly used to foster expression of emotions and self-reflection (O'Callaghan, 1996), to reduce anxiety (Mayers, 1995), to increase group cohesion (Jones, 2005), to communicate ideas and feelings (Clarkson & Robey, 2000; Cordobes, 1997), and promote problem solving (Cordobes, 1997; O’Callaghan, 1996). See O'Callaghan (1996) for an in-depth paradigm of the use of songwriting with clients. Once songs were completed the women were then given the option to share their song with the group. Some chose to sing it as the researcher played, others read lyrics or had the researcher sing their lyrics. Everyone had an opportunity to share at least one line. After the songs were shared, the Action Step Check list was distributed and instructions were given for completing it. Participants were asked to identify a goal they would like to work on that week and select which step they were currently on toward completion of that goal. The

24 completed sheets were collected and participants were given a blank copy to take with them. Participants were informed that the researcher would return in one week and that they would again complete the Action Step Checklist as a follow-up measure. Participants were then asked what they would like to take with them from the session. The session concluded with a few minutes of active music-making and a one-word check-in to express how the group was feeling after the session. At the conclusion of the session, participants completed a post-session HS, a post-session PCESQ, and the Response to Music Therapy questionnaire. Lyrics composed during the session were typed and returned to participants the following week. Available participants completed the Action Step Checklist again one week after the music therapy session. Results A Mann-Whitney U was used to test differences between pre and posttest measures for HS and each section of the PCESQ (Personal Control & Emotional State). Alpha levels were set at .05 for all measures. The first research question looked at feelings of hopelessness/expectations for the future. HS pretest and posttest mean scores declined from 3.08 to 2.75. No significant difference was found for group levels of hopelessness pretest to posttest (U = 52.5, z = 1.1, p = 0.27). Though not significant, scores showed an overall decrease in feelings of hopelessness. At pretest, 75% of participants presented minimal levels of hopelessness and 25% showed mild levels. At posttest 17% reported no hopelessness, 67% had minimal levels, and 17% showed moderate levels. A pretest mean score of 3.08 shows minimal group levels of hopelessness with a decrease to a mean score of 2.75 posttest (see Table 2.).

Table 2. Hopelessness Scale Mean and Standard Deviation M SD N

Pretest 3.08 2.35 12

Posttest 2.75 3.55 12

25 A second research question looked at belief in personal control (PC) using the PCESQ. Lower scores represent higher belief in external control while higher scores show belief in internal or personal control. A minimal increase was seen between the pretest mean of 14.67 and the posttest mean, 14.92 (see Table 3.). No significant differences were found for group feelings of belief in personal control (U = 79.5, z = -0.4, p = 0.69). Pretest scores of PC ranged from 11- 18 with over 50% scoring 15 or higher. Posttest scores ranged from 11-19 with 50% of participants scoring 16 or higher. As 91.67% of participants scored above the median of 12 both pre and posttest, it is concluded that women seeking shelter services from domestic violence have a generally high belief in personal control (see Appendix L for participant scores). Current emotional state (ES) was assessed using the PCESQ. No significant difference was found from pretest to posttest (U = 77, z = -1.05, p = 0.29). Visual analysis showed an increase in positive feelings with a pretest mean of 18.55 and posttest mean of 20.45 (see Table 3.). One participant was not included in these results due to incomplete data (N = 11). Sixty- three point six percent of participants scored at or above the median (18) during pretest with a maximum score of 23 out of 30. At posttest, 81.81% of participants scored 19 or higher with a maximum score of 26. Results, though not significant, suggest an overall increase in positive feelings of happiness, acceptance, and empowerment and decrease in negative feelings of guilt, fear, and anxiety about the future (see Appendix L).

Table 3. PCESQ Mean and Standard Deviation M SD N

PC Pretest 14.67 1.83 12

PC Posttest 14.92 2.39 12

ES Pretest 18.55 3.72 11

ES Posttest 20.45 3.01 11

Responses on the Action Step Checklist found that women completed a mean of 3.67 steps out of 7 (see Table 4.). Each subsequent step is dependent upon the one preceding it being

26 completed. Some participants reported having completed steps even though they had skipped previous ones. The highest step completed in succession was used to find the mean. Roughly seventeen percent of participants received a score of zero. Thirty-three percent received a score of 7 (see Appendix M). Participants were asked to check what step they felt they were at in relation to their selected goal. Therefore, the number they reported is related to their individual goals that may have been established before or during the music therapy group. The women were asked to respond to “do you feel that you are in a better place now” at the bottom of the Action Step Checklist. From the comments received it can be concluded that most of the women generally felt good about their current situation (utilizing shelter services). Concrete examples of goals addressed using the steps were given such as being with or getting custody of children, establishing boundaries, being happy, and being confident in their decision to seek services at this facility. The Action Step Checklist was administered a second time one week following the music therapy session, however, only three of the original participants were present to complete it, therefore results were not analyzed.

Table 4. Action Step Checklist Mean and Standard Deviation M SD N

Pretest 3.67 2.81 12

Posttest 4.33 3.79 3

The Response to Music Therapy Questionnaire yielded positive results for all questions relating to the music therapy session. Of the five items, the highest mean (4.25) was found for the effect of music therapy on one’s desire to take action steps (see Table 5). Improved scores were also found for the effect of music therapy on comfort and motivation. Six participants completed a free response asking “how did today’s session relate to your situation” (Appendix N). Fifty percent of participants reported positive feelings including feeling open, enthusiastic and happy. One participant reported that the session helped her “in a good way because I feel

27 valuable, capable, strong and very positive and I [am] very happy. Thanks.” Comments pertaining to relaxation were found in 33.34% of comments with several women verbalizing an experience of release during the session. Other comments relating to the session included establishing boundaries and helping to “…keep me focused on what I have to do.” All responses were positive with the exception of one participant reporting confusion and an inability to focus. This response was also verbalized at the beginning of the group by this participant.

Table 5. Response to Music Therapy Mean Scores Question # M 1 effect on motivation 4.17 2 effect on comfort 4.33 3 effect on personal decisions 3.83 4 effect on decisions of future 3.97 5 effect on desire take action steps 4.25

Eleven songs written by participants during the group were analyzed for thematic content. Lyrics written in the first verse and chorus were broken into 116 phrases and identified as one of nine themes or as not applicable. Lyrics from the second verse were not used for analysis as the lyrics did not apply to the thematic material (see Appendix O for complete participant songs). The theme that recurred most often in the women’s songs was self- knowledge/awareness/acceptance (Table 6.). This category included peace, tolerance, acceptance and others; therefore many responses relating to being happy, smiling, and accepting various feelings were grouped into this category. Thirty-three percent of lyric phrases related to the women’s awareness, knowledge, and acceptance of self. The next highest recurring themes were strength/innate power found in 18.06% of lyric phrases and courage/confidence found in 17.2%. Expressions of faith were specifically found in the song phrase “all I know, all I know is ______will save the day.” All but one participant who completed this phrase filled in the blank with an expression of faith, for example “all I know, all I know is God will save the day.” Themes 2 and 6 were the only concepts used when participants completed the phrase “______may cause you tears, go, ahead release your ______.” Women included words such as release your fear, pain, stress, thoughts, past, and others. All themes except for 1, 7 and 9 were found in

28 completing the phrase “you gotta ______” (see Appendix P for a list of themes and phrases). Laughter, group reinforcement by clapping and verbalizations of approval, and smiling were present as the women shared what they had composed.

Table 6. Themes Found in Songwriting. (N=116 phrases) Theme # Theme Total 2 Self-knowledge/awareness/acceptance 38 3 Strength/Innate power 21 6 Courage/Confidence 20 8 Independence 11 9 Faith 9 4 Perseverance 6 5 Intolerance of "less than" 4 1 Problem-solving 3 7 Growth/Risk-taking 2 n/a not applicable 2

29 CHAPTER IV STUDY B – WOMEN’S CORRECTIONAL INSTITUTION

Setting and Participants Study B was run at a women’s state correctional institution located in central Florida. The correctional institute (CI) is a large prison that houses closed, minimum, medium, and community levels of custody and offers services for a variety of medical and psychological grades. The CI has a vast amount of programming options in academic, vocational, wellness, spiritual, substance abuse, parenting, and other areas. Participants in this study were required to be at least 18 years of age and have a self- reported history of domestic violence. Participants were identified by the facility staff as being able to benefit from this study and as having self-reported history of domestic violence. Inmates were given passes out of their regular assignments to volunteer for this study. Fourteen women participated in this study; however, five women were unable to complete all measures. One participant reported later that she had no history of domestic violence but was interested in the class, therefore her information was not used in the findings. Information collected from eight inmates was used for analysis. Demographic information gathered showed women’s ages to range from 34 to 58 averaging 43.88 years of age. Fifty percent of the women were African American, 37.5% were Caucasian, and 12.25% qualified as other. All participants’ primary language was English. The women had an average of 2.25 dependent children. Education backgrounds varied with 50% having completed high school or a GED. A bachelor’s degree or some college was completed by 37.5%. Thirty-seven point five percent had less then a high school education. An equal number of women reported being separated with contact and separated without contact with their abuser. One participant chose not to answer this question. The average length of abuse for participants was 7.19 years or more. All eight women experience physical, verbal, and emotional abuse. The inmates were involved in a variety of programming at the CI including 12 Step, AA, NA, faith programs, work, school, modality, and others. Table 7. displays demographic information on the inmates who participated.

30 Table 7. Subject Demographics

&

,

t

verbal

r ,

r r

achelor's othe sep. w/contac sep. abuse in years Sub. # Race Age Kids Dep. of # English Gramma b physical sep. w/no contact w/no sep. othe emotional HS/GED Vocational/tech Some College P1 C 53 1 1 1 1 3+ 1 P2 AA 58 4 1 1 1 1 3+ 1 P3 C 39 2 1 1 1 1 18 1 P4 O 34 2 1 6 gr. 1 10+ 1 P5 AA 37 2 1 1 1 1 .5+ 1 P6 AA 40 5 1 11 gr. 1 3+ 1 P7 AA 45 1 1 1 1 10 1 P14 C 45 1 1 1 n/a 10 1 Note: H=Hispanic, AA=African-American, C=Caucasian, O=Other, Dep.= dependent, HS=high school, Sep.=separated

Design and Instruments Participants in Study B completed the same dependent measures as participants in Study

A. The research design was the same for both studies.

Procedures Procedures for study B varied slightly from study A, however, the session structure remained the same. Inmates selected by facility staff met with the researcher at the CI visitor park. A morning session and an afternoon session were run at the CI with five women at any given time in the morning session and nine women in the afternoon session. Not all women in the sessions were used for data collection and analysis due to reasons previously mentioned. Each session was 90 minutes in length with 30 minutes allotted for filling out questionnaires and 60 minutes devoted to a music therapy session. Upon arrival the researcher explained the study and study purposes further to potential participants, addressed any questions or concerns, and obtained consent from those interested. Inmates were also given the option to return to their regular assignments. All participants who signed consent forms then completed the demographic questionnaire, pre-session Hopelessness Scale, and pre-session PCSEQ. After completion of pre-session assessments, the researcher facilitated a 60-minute music therapy session. The music therapy group focused on empowerment of belief in personal control and problem-solving with

31 discussion highlighting decisions and problems solved in relation to presented group tasks, self- reflection, lyric analysis, and feelings based on the experience. The following is an outline of the music therapy session used for this study. Women sat in a circle of chairs for the session. • Active music making with introductions – 15 min • Listening to “You Gotta Be” (played live) – 5 min • Lyric Analysis of “You Gotta Be” – 15 min • Fill-in-the-blank participant songwriting – 10 min • Song sharing – 10 min • Completion of the Action Step Checklist – 5 min

Active music making was the first exercise used. It has been used in previous studies with women affected by domestic violence in the form of therapeutic drumming or instrument improvisation (Whipple & Lindsey, 1999; Wilkins & Snider, 2009; York, 2006). A variety of percussion instruments were placed in the center of the circle. Varying from study A, these participants were first asked to create a sound using body percussion such as clapping, stomping, using their voice, or other. They were asked to select a number from one to eight and as the researcher said their number they were to make their sound. This was used as an icebreaker and as a metaphor focusing on using the resources one has even though they may be limited (being in prison) to be creative. The women were then asked to select an instrument they felt drawn to, to say their name, and then play how they currently felt on their chosen instrument. Participants were not told what the instruments were nor were instructions given on how to play them; however, they were told that they could ask any questions they wanted to about the instruments. Instruments included djembes, paddle drums, a tambourine, a maraca, egg shakers, gyro, slit drum, and others. After introductions, ten minutes of group playing were used in which the women were able to explore their instrument and create rhythms both as a group and individually. The group was given an opportunity to release energy and emotions through changes in dynamics using the instruments. At the conclusion of playing, the group was asked to take a deep breath and verbalize how they felt after the activity Next, the women were asked to identify ways they had already engaged in decision- making, goal-setting or problem-solving during the group. The group focus on problem-solving and belief in self was emphasized and reinforcement was given based on the decisions they had already successfully addressed within the course of the group.

32 The remaining portions of the session were conducted with the same procedures from Study A. The session concluded after completion of the Action Step Checklist with no ending exercise due to time constraints and a check in of what they would like to take with them from the session. Participants then completed posttest measures in the same manner as Study A. Available participants complete the Action Step Checklist again one week following the music therapy session. Results A Mann-Whitney U was used to test differences between pre and posttest measures for HS and each section of the PCESQ (Personal Control & Emotional State). Alpha levels were set at .05 for all measures. The first research question looked at feelings of hopelessness/expectations about the future. The HS pretest and posttest mean score slightly declined from 5.63 to 4.50 (see Table 8). No significant difference was found for group levels of hopelessness from pretest to posttest (U = 28, z = 0.37, p = 0.71). Though not significant, scores showed an overall decrease in feelings of hopelessness. At the pretest, 37.5% of the women presented minimal levels of hopelessness, 37.5% showed mild levels, one woman showed moderate levels, and one showed severe feelings of hopelessness. At the posttest, 50% had minimal levels, 37.5% showed mild levels and one showed moderate levels. Both pretest and posttest means fell in the mild range for feelings of hopelessness. The participant that originally presented with severe levels of hopelessness dropped 5 points pretest to posttest. She verbally reported feeling better by the end of the session but was unable to describe her thoughts in further detail. Facility staff conveyed that this participant had just come from a mental health assessment and that she was selected to participate because the staff felt she could benefit from the music therapy group.

Table 8. Hopelessness Scale Mean and Standard Deviation M SD N

Pretest 5.63 4.66 8

Posttest 4.50 3.07 8

33 A second question looked at belief in personal control (PC) using the PCESQ. Lower scores represent increased belief in external control with higher scores showing increased belief in internal or personal control. A slight increase was seen between the pretest mean of 13.5 and the posttest mean, 14 (see Table 9). No significance change was found for group feelings of belief in personal control (U = 33.5, z = -0.11, p = 0.91). Pretest scores of PC ranged from 7-18 with only one participant scoring below a 12. Posttest scores ranged from 8-19 also with only one participant scoring below a 12. Current emotional state (ES) was assessed using the PCESQ. No significant difference was found from pretest to posttest (U = 35.5, z = -0.32, p = 0.75). Of the three measures, the greatest change was seen for ES with a pretest mean of 20.25 and a posttest mean of 21.25 (see Table 9). Pretest scores ranged from 11 - 27 with posttest scores ranging from 18 - 26. Mean scores show an overall group increase for positive feelings.

Table 9. PCESQ Mean and Standard Deviation M SD N

PC Pretest 13.5 3.16 8

PC Posttest 14.00 3.38 8

ES Pretest 20.25 4.71 8

ES Posttest 21.25 2.76 8

At the pretest, the Action Step Checklist showed that participants had completed a mean of 4.13 steps out of 7 (see Table 10.). Only six of the original eight women were present to complete a follow-up Action Step Checklist. A statistical test was not run to compare pre and post Action Step Checklists due to incomplete data. A mean of 3.17 steps were completed by six women at a one-week follow-up. The highest step completed in succession was used to find the mean. At the pretest, 50% of the women reported completion of six or more steps and 37.5% women reported completing between 3-1 steps. One woman received a score of zero at pretest as well as posttest. Three women reported the same score pretest to posttest. One woman

34 progressed by five steps and two of the six women regressed by five steps. The women were asked to respond to the question “do you feel that you are in a better place now” at the bottom of the Action Step Checklist (see Appendix M). Comments varied between “yes” and “no.” During the follow-up, one participant reported that the use of the 7 steps and the act of writing it down made reaching goals easier. Concrete examples of goals addressed using the steps were given such as attitude towards others and bettering one’s self for the outside.

Table 10. Action Step Checklist Mean and Standard Deviation M SD N

Pretest 4.13 2.95 8

Posttest 3.17 3.06 6

Mean scores for the Response to Music Therapy Questionnaire showed that participants agreed that music therapy had positive effects in areas of motivation, comfort, decision making, and desire to take action steps. Of the five items, the highest mean (M = 4.75) was for the effect of music therapy on motivation (see Table 11.). Elevated scores were found for all items with none of the mean scores falling below 4.38 out of 5. Five participants responded to a free response asking “how did today’s session relate to your situation” (see Appendix N). Eighty percent of participants reported positive feelings such as feeling wonderful, great, joyful, and positive in a healthy and serene way. Forty percent of responses commented on decreased feelings of being alone. One woman particularly found music therapy to be beneficial stating, “it help me to find a release, and brought me joy that I never thought I could in prison! Thank you!”

35 Table 11. Response to Music Therapy Mean Scores Question # M 1 effect on motivation 4.75 2 effect on comfort 4.5 3 effect on personal decisions 4.38 4 effect on decisions of future 4.38 5 effect on desire take action steps 4.38

Eight songs written by participants during the group were analyzed for thematic content. Lyrics written in the first verse and chorus were broken into 88 phrases and identified either as one of nine themes or as not applicable. Lyrics from the second verse were not used for analysis as the lyrics did not apply to the thematic material (see Appendix O for complete participant songs and Appendix P for phrases and theme content). The theme that recurred most often in the women’s songs was strength/innate power (see Table 12.). Thirty point eight percent of lyric phrases related to recognition of one’s personal resources and strength within. The next closest theme was self-knowledge/awareness/acceptance found in 27.36% of lyric phrases followed by courage/confidence found in 14.82%. Faith represented 5.7%, problem-solving and intolerance for “less than” were both found in 4.56% of lyric phrases. Almost eight percent of phrases did not fit into any of the nine themes. A majority of women completing the phrase “don’t be ashamed to ______” filled in the word “cry.” While this is the original lyric it was still the participants’ choice to use it here. Participants included words such as “release your tears, fears, and pain.” All themes except for 1, 4 and 8 were found in completing the phrase “you gotta ______.” Participants freely gave each other positive verbal support as each individual shared with the group what they had written. Participants especially appreciated the opportunity to hear the researcher sing their compositions for the group based on the number of participants who made this request.

36 Table 12. Themes Found in Songwriting. (N=88 phrases) Theme # Theme Total 3 Strength/Innate power 27 2 Self-knowledge/awareness/acceptance 24 6 Courage/Confidence 13 9 Faith 5 1 Problem-solving 4 5 Intolerance of “less than” 4 7 Growth/Risk-taking 2 4 Perseverance 1 8 Independence 1 n/a not applicable 7

37 CHAPTER V DISCUSSION The purpose of this study was to determine the effects of music therapy on feelings of hopelessness, feelings of personal control, and change in emotions in a single music therapy session. This study also looked at themes found through songwriting, and problem-solving. Findings showed that no significant changes were made in a single session for feelings of hopelessness, personal control, or emotional state. However, with the exception of follow-up scores on the Action Step Checklist for Study B participants, all mean scores pre-posttest moved in a positive direction. Mean levels of hopelessness decreased for women in a shelter (Study A) and inmates in a state CI (Study B). Mean feelings of personal control increased across studies and an increase in mean positive feelings was also found. The average number of action steps women felt they had completed both during the music therapy session and at a one-week follow- up ranged between 3 - 5 out of 7. For each study, songs written by participants were analyzed for phrase content based on themes of empowerment. For Study A, the most recurring themes proved to be self-knowledge/awareness/acceptance, strength/innate power, and courage/confidence. For Study B the same three themes were dominate with strength/innate power occurring more than knowledge/awareness/acceptance. Both written comments and mean scores from the Response to Music Therapy Questionnaire showed a single music therapy session to have positive effects on motivation, levels of comfort, personal decisions, decisions about the future, and desire to take action steps. Slightly higher mean scores of the music therapy session were found for Study B. Though not statistically significant, overall results show that a single music therapy session can have a positive impact on feelings of hopelessness, personal control, emotional well-being, and motivation towards active problem-solving. Women from both the shelter and CI presented with visually observable symptoms of hopelessness including delayed initiation of voluntary responses related to motivation, sad affect, suicide, lack of energy, apathy, difficulty in concentration, and mood-exacerbated negative cognitions (Abramson, Metalsky, & Alloy, 1989). Despite these visual accounts, findings of hopelessness were congruent with previous domestic violence studies. Mean shelter scores in Study A, as well as earlier studies, were generally low (Clements, Sabourin, & Spiby, 2004; Clements & Sawhney’s, 2000). Previous studies found that despite low levels of hopelessness

38 scores, women from domestic violence agencies had high levels of dysphoria. The present study did not assess for feelings of dysphoria/depression as the research literature consistently shows it as a common issue survivors face (Golding, 1999; Ham-Rowbottom, Gordon, Jarvis, and Novaco, 2005). Inmate scores in Study B for feelings of hopelessness were slightly higher then the women in the shelter. This could be due to the fact that women seeking shelter services have already made a decision to take action. As seen in responses to the Action Step Checklist Question (Appendix M), many women at the shelter felt they were now in a better place where as many women in the CI did not necessarily feel that they were in a better place. This could explain why inmate scores, though still low, were slightly higher than the scores of women in the shelter. The most interesting results for feelings of hopelessness were found in Study B. One inmate came into the session noticeably upset to the point of needing assistance to fill out forms and scoring in the severe range of hopelessness. At the conclusion of the session, this participant verbally reported feeling better and dropped five points on the scale. Another inmate dropped seven points; however, she did not start in the severe range. Umberson, Anderson, Glick, and Shapiro (1998) found that being in a violent relationship significantly reduced one’s sense of personal control. This response was not found to be prominent in the present study; however, small subject pools and separation from abuser could factor into these findings. Feelings of personal control were assessed using the PC portion of the PCESQ. There was little change in mean scores for both Study A and Study B, though both sets of means show relatively high feelings of personal control. Clements, Sabourin, and Spidy (2004) found that perceived control over current abuse related to increased dysphoria and expectations of control over future abuse showed a decrease in hopelessness and dysphoria. Almost all women in the shelter were separated without contact from their abuser and the women in Study B were separated through incarceration. This demographic information in combination with high PC scores and low HS scores suggest that participants now felt a certain sense of control over future abuse. It may prove effective to use the complete Belief in Personal Control scale (Berrenberg, 1987), which includes a God-mediated portion, as faith was a theme found in songs written by participants. Future research with this complete scale could examine more specific attribution to feelings of control. It is suggested that the concept of belief in personal control continue to be paired with problem-solving or problem focused intervention.

39 Coping style has also been paired with effects on levels of dysphoria and hopelessness (Clements, Sabourin, & Spidy, 2004; Clements & Sawhney, 2000). The emotional state group means of participants in both studies increased in a positive direction by at least one point. Golding (1999) found that 60% of women in domestic violence shelters experienced depression. For participants in Study A, 63% scored above the median of 18 at pretest, indicating positive feelings. At the posttest, 81.81% scored 19 or higher. For women in Study B, mean increases for positive emotions were also seen. Comments on the Response to Music Therapy Questionnaire for Study A showed that 80% of participants reported positive feelings such as “I feel more open, and stress free” or I feel “in a good way because I feel valuable, capable strong and very positive and I [am] very happy.” Participants in Study B reported positive feelings such as “wonderful,” “very positie[sic] in a helathy[sic] way - serene way,” with two of eight women reporting not feeling alone. A renewed sense of support is particularly meaningful for survivors of abuse since abusers isolate their victims, causing a breakdown in social support. Social isolation can also contribute to the Battered Woman Syndrome, learned helplessness, and other detrimental psychological effects (Bosch & Bergen, 2006; Walker, 2000). Whipple and Lindsey (1999) identified goal-setting as being one of the most valuable coping skills presented during their music therapy sessions. The Action Step Checklist was developed to give participants tangible guidelines to follow when setting goals and problem- solving. During analysis, the Action Step Checklist was found to serve a slightly different purpose then originally intended. Initial intent included an assessment of progress over a week’s span, but more closely served to assess current practices of group members in personal problem- solving. It proved difficult to have all participants return for a one-week follow-up, making it illogical to assess realistic progress. Women exhibited confusion about the directions given in the original music therapy session. This necessitated having some participants fill out the form a second time with renewed meaning, therefore making it impossible to compare these forms to the originals. The seven steps presented on the Action Step Checklist were to be done in sequence with step 2 not being possible to do without completion of step 1 and so on. Many women from both studies skipped steps. One woman actually rearranged the step order showing that the only one she had not completed was step 3, “I have thought about the potential good and bad outcomes for

40 me at this time,” which she deemed step 7. At the first completion of the Action Step Checklist, women in Study A had completed a mean of 3.67 steps. Women in Study B had completed a mean of 4.13 steps. These findings show possible misinterpretation of the directions or the need to further present effective problem-solving skills. Based on goals identified by participants and the effectiveness seen with a limited number of participants, the Action Step Checklist is a tangible and simple form that can be used in teaching and assessing problem solving. It is suggested that future music therapy sessions either specifically address the handout throughout the session to promote accurate completion or introduce it over a number of sessions. The ideal intent for the Action Step Checklist was for one to identify a new goal or problem they wish to address therefore first completion for all participants would be only step one with other steps being completed in the future. During the group, women in both Study A and B successfully identified deciding to participate in the group, asking questions about how to use the instruments, selecting their own instrument, and making personal decisions about mood and attitude as successfully reaching goals and problem-solving. This falls in line with findings from Cassity and Theobold (1990), which indicated that music therapists use instrument playing to foster decision-making and organizational skills. It is advised that future use of the Action Step Checklist eliminate the free response question of “do you feel you are in a better place now” as participants related answers more to physical location then progress on goals and problem-solving. One participant’s response did relate to the intended purpose at follow up stating, “yes, because following these 7 steps and writing them down, you can reach your goals easier.” Future applications could address predetermined problems such as financial issues (Ham-Rowbottom et al., 2005). Responses to the music therapy questionnaire showed positive effects for all participants. One inmate commented, “it [the music therapy group] made me feel as though I can accomplish something in life.” Music therapy research in this area has often sought to address anxiety and relaxation (Curtis, 1996; Hernandez-Ruiz, 2005; Teague, Hahna, & McKinney, 2006; Whipple and Lindsey, 1999; Wilkins & Snider, 2009; York, 2006). The present studies did not specifically address anxiety or relaxation through music therapy techniques, yet the opportunity to release emotions and experience high levels of comfort were reported on the Response to Music Therapy Questionnaire. Two written comments and many verbal comments during group

41 sessions pointed to feelings of relaxation as a result of the intervention. Relaxation is an important skill for survivors of domestic violence to address PTDS (Golding, 1999). Songwriting in the present studies focused on empowerment of self as being capable of creating positive change. Previous music therapy studies incorporating songwriting with this population identified it as a way for women to “find their voice” (Curits, 1996; York, 2006). Analysis of participant composed songs found three of nine categories to be dominant in their writing. Self-knowledge/awareness/acceptant, strength/innate power, and courage/confidence were the three most occurring themes in both studies. These three categories support the finding from Wallace (1995) that showed that personal insight can be gained through music therapy. Women identified issues they felt were important such as striving to move forward, praying, staying focused, and others. They identified challenges, for example, their future, what “life may hold,” what is “dictated” to you, and others. Participants embraced opportunities to write down their feelings without shame or judgment, to openly share with the group what they had written, and to give positive feedback to their peers. Songwriting is a unique medium used to promote positive self-talk and feelings of empowerment. Future use of songwriting could incorporate direct aspects of the Action Step Checklist allowing participants to specifically write down goals in a self-supporting way. A few differences occurred between Study A and Study B based on location of the participants in the actual music therapy session. For example, the first exercise for Study A was the discussion of guidelines for the group. This was incorporated at the shelter to foster establishing personal boundaries. One participant reported twice on handouts that the group assisted in “establishing boundaries.” In Study B, the first exercise was body percussion and creating sound with only the resources they had available on their person. Since these women were incarcerated, every minute of their day was schedule and accounted for. This group was an opportunity for them to explore and to experience potential within themselves when limited resources were available due to the sheer fact that they were in prison. The conclusion of the groups also differed slightly due to time limitations and group needs. No structural or design changes were made between the two groups. Considerations It is important to note the small number of participants in both Study A (N = 12) and Study B (N = 8). Though most measures showed improvements as a result of a single session

42 intervention, larger subject pools may generate more significant results. Several participants had to be eliminated do to incomplete data collection. At the shelter, women were coming to the group from jobs causing some participants to arrive late after consent forms and pre-session data had already been collected. Several participants had young children they brought to the group with them who had to be cared for during the group. One woman left early to attend to a child. Though these circumstances were unavoidable, they made it difficult for some to participate or return the following week. At the CI, unforeseeable programming conflicts and scheduled appointments caused several of the women to leave groups early or to arrive late. In future studies, an individual sign-up method as opposed to general invitation to the group by facility staff might prevent such conflicts. Individual sign-up might also ensure that when participants arrive they already have a strong understanding of the purpose and expectations of the group. Conclusion Abramson, Metalsky, and Alloy (1989), who developed the hopelessness depression theory, suggested using interventions that seek to modify environments that foster hopefulness. They suggested personal behavior change for those who have negative self-assessments and identified that a goal of therapy should be to modify negative self-cognitions, therefore reducing stressfulness of situations. Women who participated in these studies were found to be hopeful not only based on high measurement scores but also through themes of self-empowerment evident in songs, and verbal and written comments. Similar to York’s (2006) observations across months of music therapy sessions, this single music therapy session showed the ability to foster autonomy and a desire to create positive change such as job searching, gaining custody of children, changing attitudes, and striving to better one’s self in preparation for release from prison. It is concluded that problem-solving strategies should continue to be examined within the music therapy field for psycho-education, empowerment, increasing self-efficacy, autonomy, and reducing negative cognitions. More in-depth investigation into belief of personal control and emotional state with larger samples sizes may prove to enhance the findings present in these studies.

43 APPENDIX A DEMPGRAPHIC QUESTIONNAIRE

1. Please circle your ethnic background:

African-American Caucasian Hispanic Other

2. What is your age? ______years

3. Number of dependent children ______

4. Please circle your primary language?

English Spanish Other ______

5. What Is the highest level of education you have completed? _____ grammar school _____ high school or GED _____ vocational/technical school _____ some college _____ bachelor’s degree _____ master’s degree _____ doctorial degree _____ other ______

6. What is your current relationship to the person who abused you? _____ currently in a relationship _____ separated with contact _____ separated with no contact _____ married _____ Other ______

7. Please check the approximant length of time you feel you have been harmed or abused. _____ less than 6 months _____ less than 1 year _____ more than 1 year _____ more than 2 years _____ more than 3 years _____ Other _____ years

8. Please circle the type of abuse you have experienced.

Physical Verbal Emotional All 3

9. Please list services or programs you are currently involved in at this facility. (ex. Trauma skills course, academic/job training, transitional housing, outreach, ect…)

44 APPENDIX B THE HOPELESSNESS SCALE

Below are 20 statements you may agree or disagree with. Please circle true or false based on how you feel at this moment. Please be open and honest with you response.

True False 1. I look forward to the future with hope and enthusiasm. True False 2. I might as well give up because I can’t make things better for myself True False 3. When things are going badly, I am helped by knowing they can’t stay that way forever. True False 4. I can’t imagine what my life would be like in 10 years. True False 5. I have enough time to accomplish the things I most want to do. True False 6. In the future, I expect to succeed in what concerns me most. True False 7. My future seems dark to me. True False 8. I expect to get more of the good things in life than the average person. True False 9. I just don’t get the breaks, and there’s no reason to believe I will in the future. True False 10. My past experiences have prepared me well for my future. True False 11. All I can see ahead of me is unpleasantness rather than pleasantness. True False 12. I don’t expect to get that I really want. True False 13. When I look ahead to the future, I expect I will be happier than I am now. True False 14. Things just won’t work out the way I want them to. True False 15. I have great faith in the future. True False 16. I never get what I want so it’s foolish to want anything. True False 17. It is very unlikely that I will get any real satisfaction in the future. True False 18. The future seems vague and uncertain to me. True False 19. I can look forward to more good times than bad times. True False 20. There’s no use in really try to get something I want because I probably won’t get it.

45 APPENDIX C THE HOPELESSNESS SCALE SCORING KEY

*Each answer corresponding with the above key received 1 point.

Below are 20 statements you may agree or disagree with. Please circle true or false based on how you feel at this moment. Please be open and honest with you response.

False* 1. I look forward to the future with hope and enthusiasm. True 2. I might as well give up because I can’t make things better for myself False 3. When things are going badly, I am helped by knowing they can’t stay that way forever. True 4. I can’t imagine what my life would be like in 10 years. False 5. I have enough time to accomplish the things I most want to do. False 6. In the future, I expect to succeed in what concerns me most. True 7. My future seems dark to me. False 8. I expect to get more of the good things in life than the average person. True 9. I just don’t get the breaks, and there’s no reason to believe I will in the future. False 10. My past experiences have prepared me well for my future. True 11. All I can see ahead of me is unpleasantness rather than pleasantness. True 12. I don’t expect to get that I really want. False 13. When I look ahead to the future, I expect I will be happier than I am now. True 14. Things just won’t work out the way I want them to. False 15. I have great faith in the future. True 16. I never get what I want so it’s foolish to want anything. True 17. It is very unlikely that I will get any real satisfaction in the future. True 18. The future seems vague and uncertain to me. False 19. I can look forward to more good times than bad times. True 20. There’s no use in really try to get something I want because I probably won’t get it.

46 APPENDIX D PERSONAL CONTROL & EMOTIONAL STATE QUESTIONNAIRE

Strongly Disagree Neutral Agree Strongly Disagree Agree ______

1. I am a victim of circumstances. † † † † †

2. What happens to me is a matter † † † † † of good or bad fortune.

3. Whenever I run up against some † † † † † obstacle, I strive even harder to overcome it and reach my goal.

4. I actively strive to make things † † † † † happen for me.

Please answer the following based on how you currently feel at this moment.

Strongly Disagree Neutral Agree Strongly Disagree Agree ______1. I feel happiness. † † † † †

2. I feel guilty. † † † † †

3. I feel fear. † † † † †

4. I feel accepted. † † † † †

5. I feel anxious about the future. † † † † †

6. I feel empowered to make † † † † † decisions about my circumstances.

47 APPENDIX E PERSONAL CONTROL & EMOTIONAL STATE QUESTIONNAIRE SCORING KEY

*Number given indicates scoring key. Each portion is scored separately.

Strongly Disagree Neutral Agree Strongly Disagree Agree ______

1. I am a victim of circumstances. 5* 4 3 2 1

2. What happens to me is a matter 5 4 3 2 1 of good or bad fortune.

3. Whenever I run up against some 1 2 3 4 5 obstacle, I strive even harder to overcome it and reach my goal.

4. I actively strive to make things 1 2 3 4 5 happen for me. Add score for 4 items together and record total Total______

Please answer the following based on how you currently feel at this moment.

Strongly Disagree Neutral Agree Strongly Disagree Agree ______1. I feel happiness. 1 2 3 4 5

2. I feel guilty. 5 4 3 2 1

3. I feel fear. 5 4 3 2 1

4. I feel accepted. 1 2 3 4 5

5. I feel anxious about the future. 5 4 3 2 1

6. I feel empowered to make 1 2 3 4 5 decisions about my circumstances. Add score for 6 items together and record total Total______

48 APPENDIX F ACTION STEPS CHECKLIST

Check when completed

1. ______I have identified a problem in my current situation I wish to change.

2. ______I have identified possible solutions.

3. ______I have thought about the potential good and bad outcomes of each solution.

4. ______I have decided which solution will have the best possible outcome for me at this time.

5. ______I have identified specific steps to take towards reaching my solution.

6. ______I have followed through with at least one action step towards my solution.

7. ______I have reevaluated where I am now.

Do you feel that you are in a better place now?

49 APPENDIX G RESPONSE TO MUSIC THERAPY QUESTIONNAIRE

Please answer the following based on your experience in the music therapy group today.

Strongly Disagree Neutral Agree Strongly Disagree Agree ______1. The music experienced in this † † † † † group helped me feel motivated

2. I felt comfortable in the music † † † † † therapy group.

3. The music therapy group † † † † † helped me feel empowered to make decisions for myself.

4. The music therapy group † † † † † helped me feel empowered to make decisions about my future.

5. The group increased my desire † † † † † to take action steps.

How did today’s session relate to your situation?

50 APPENDIX H RESPONSE TO MUSIC THERAPY QUESTIONNAIRE SCORING KEY

*Number given indicates scoring key.

Please answer the following based on your experience in the music therapy group today.

Strongly Disagree Neutral Agree Strongly Disagree Agree ______1. The music experienced in this 1* 2 3 4 5 Total______group helped me feel motivated

2. I felt comfortable in the music 1 2 3 4 5 Total______therapy group.

3. The music therapy group 1 2 3 4 5 Total______helped me feel empowered to make decisions for myself.

4. The music therapy group 1 2 3 4 5 Total______helped me feel empowered to make decisions about my future.

5. The group increased my desire 1 2 3 4 5 Total______to take action steps.

How did today’s session relate to your situation?

51 APPENDIX I “YOU GOTTA BE” LYRICS

You Gotta Be - Des'ree

Listen as your day unfolds Challenge what the future holds Try and keep your head up to the sky Lovers they may cause you tears Go ahead, release your fears Stand up and be counted, don't be ashamed to cry You gotta be,

You gotta be bad, you gotta be bold, you gotta be wiser You gotta be hard, you gotta be tough, you gotta be stronger You gotta be cool, you gotta be calm, you gotta stay together All I know, all I know, love will save the day

Herald what your mother said Read the books your father read Try to solve the puzzles in your own sweet time Some may have more cash than you Others take a different view My, oh, my, eh, eh, eh

You gotta be bad, you gotta be bold, you gotta be wiser You gotta be hard, you gotta be tough, you gotta be stronger You gotta be cool, you gotta be calm, you gotta stay together All I know, all I know, love will save the day

Time ask no questions, it goes on without you Live and you may hide if you can't stand the pace The world keeps on spinning, can't stop it if you try to The best part is danger staring you in the face

Remember, listen as your day unfolds Challenge what the future holds Try and keep your head up to the sky

Lovers they may cause you tears Go ahead, release your fears My, oh, my, eh, eh, eh

Got to be bold, got to be bad Got to be wise, not ever sad Got to be hard, not too too hard All I know is love will save the day

52 APPENDIX J “YOU GOTTA BE” FILL-IN-THE-BLANK

Fill in the blanks with what is important to you. You may cross out or change any words you want to. ______

______as your day unfolds

Challenge what ______

Try and keep your head up to the sky

______may cause you tears

Go ahead, release your ______

Stand up and be counted, don't be ashamed to ______

You gotta be,

{Refrain} You gotta ______, you gotta ______, you gotta ______

You gotta ______, you gotta ______, you gotta ______

You gotta ______, you gotta ______, you gotta ______

All I know, all I know is, ______will save the day

Herald what ______said

Read the books ______read

Try to solve the puzzles in your own sweet time

Some may have more ______than you

Others take a different view

My, oh, my, eh, eh, eh

53 APPENDIX K THEMES OF EMPOWERMENT USED FOR SONGWRITING ANALYSIS

1. Problem-solving – defined here as “facing and dealing with problems head on; making decisions; working things through”

2. Self-knowledge/awareness/acceptance - defined here as “questioning and searching for answer within; peace and tolerance; honesty with self and others; seeing complexity and ambiguity in situations that are often seen in either/or terms”

3. Strength/Innate Power – defined here as “realization that they have the resources and the strength to survive; stability; inner beauty; wholeness”

4. Perseverance – defined here as “staying the course; making strides towards achieving goals”

5. Intolerance of “less than” – defined here as “striving for the best from self and others; being willing to confront and walk away if need be”

6. Courage/Confidence - defined here as “trust in self and others; balance between vulnerability and strength; voicing concerns”

7. Growth/Risk-taking – defined here as “leap of faith which propels self forward”

8. Independence – defined here as “autonomy, speaking for one’s self without being unhealthily dependent on others; being okay with being alone; personal responsibility’s

9. Faith – defined here as “belief and trust in God as a positive force in one’s life, able to turn to God”

Taken from: Jones, 2006, pp. 339-340 with the exception of #9.

54 APPENDIX L RESULTS BY PARTICIPANT FOR HS & PCESQ

STUDY A – DOMESTIC VIOLENCE SHELTER

Subject # Pre-HS Post-HS Pre-PC Post-PC Pre-ES Post-ES S1 2 1 16 16 22 19 S2 5 1 13 12 12 20 S3 1 0 15 16 21 23 S4 2 1 16 16 22 23 S5 3 3 15 17 18 20 S6 2 3 14 14 23 26 S7 1 1 11 11 n/a n/a S8 2 2 18 17 16 19 S9 8 11 13 12 16 16 S10 3 0 16 19 22 22 S11 7 9 14 15 14 16 S12 1 1 15 14 18 21

STUDY B – WOMEN’S CORRECTIONAL INSTITUTE

Subject # Pre-HS Post-HS Pre - PC Post-PC Pre-ES Post-ES P1 4 5 14 14 21 22 P2 3 4 18 19 23 22 P3 1 1 15 16 27 26 P4 10 3 13 13 18 23 P5 5 3 15 17 22 22 P6 5 8 14 13 22 18 P7 2 2 12 12 18 18 P14 15 10 7 8 11 19

55 APPENDIX M RESULTS BY PARTICIPANT FOR THE ACTION STEP CHECKLIST

STUDY A – DOMESTIC VIOLENCE SHELTER

Pre- Post- Pre - Do you feel that you are in a Sub. # AC AC better place now? Post - Do you feel that you are in a better place now?

yes, absoluty, kids back, live independent make happy life en that S1 3 future. S2 2 0 ? yes, but I have a long way to go S3 7 yes S4 2 yes S5 5 not exactly S6 0 yes because I am in a safe place a pace. And the more important is my daughter don’t need that life because now we happy all the time. Never fear S7 7 for nothing again. Thanks. my thinking has become clearer, I am rediscovering the person that ? Inside me. I am a good person. No one can tell me who I am because I know. Yes the place where I am is peaceful and I feel safe. Looking forward to S8 3 graduating from college. yes I am starting to see a change in my living S9 7 7 yes arrangements once I exit the shelter yes I do feel like I am in a much better place now than I was when I first got here from out of state. I feel like I made the most important step by I have better options and more options to choose from coming to Florida. I feel more at peace that will help me become a better person and a person S10 1 6 here in Florida. that will succeed. I just felt like it was just a temp. stress reliver because I have many problems S11 0 to worry about yes because first of all I'm pretty sure my abuser dosent know and I feel good with my real man who is my son. And I S12 7 know God has me

56 STUDY B – WOMEN’S CORRECTIONAL INSTITUTE

Pre - Do you feel that Pre- Post- you are in a better Post - Do you feel that you are Sub # AC AC place now? in a better place now?

yes, because following these 7 steps and writing them down, you can reach your goals easier. I enjoyed this program very much. Music is great therapy. Thank you letting me P1 2 7 don’t know at this time be a part of music therapy

P2 7 7 yes yes and no P3 3 yes P4 6 no

no, I need to be at home with my kids and grand boys. I feel P5 0 0 that I've paid my debt to society yes, because I could P6 7 2 have been dead P7 7 2 no yes P14 1 1 no no

57 APPENDIX N RESULTS BY PARTICIPANT FOR THE RESPONSE TO MUSIC THERAPY QUESTIONNAIRE

STUDY A – DOMESTIC VIOLENCE SHELTER

Sub. # #1 #2 #3 #4 #5

S1 55555 S2 45445 S3 55555 S4 55555 S5 45333 S6 44222 S7 55555 S8 55555 S9 21113 S10 5 5 4 5 5 S11 3 3 3 3 4 S12 3 4 4 4 4

How did today's session relate to your situation? S1 I fill enthusiasm, make free, rilax S3 Established boundaries S4 I feel more open, and stress free! In a good way because I feel valuable, capable strong and very positive and I very happy. S7 Thanks. S9 I am confused and cannot focus S10 It helped to keep me focused on what I have to do.

STUDY B – WOMEN’S CORRECTIONAL INSTITUTE

Sub. # #1 #2 #3 #4 #5

P1 55 555 P2 55 555 P3 55 555 P4 53 444 P5 55 555 P6 44 444 P7 55 555 P14 44 222

How did today's session relate to your situation? P1 wonderful - esp. with the teacher. I'm very satisfied P2 to know I am not alone, to care about myself, to stay strong P3 made me feel not alone and very positie in a helathy way - serene way P4 It help me to find a release, and brought me joy that I never thought I could in prison! Thank you! P7 good. I feel great

58 APPENDIX O SONGS WRITTEN BY PARTICIPANT

Note: words in italics are original words written by participants

STUDY A – DOMESTIC VIOLENCE SHELTER

S2 Stay focused as your day unfolds Challenge what others say the you don’t agree with Try and keep your head up to the sky Life may cause you tears Go ahead, release your fear Stand up and be counted, don't be ashamed to fail You gotta be,

You gotta be bold, you gotta dream, you gotta be assertive You gotta be strong, you gotta be fearless, you gotta be independent You gotta focus, you gotta be happy, you gotta courageous All I know, all I know is, God will save the day

Herald what the ancestors said Read the books the Bible has Try to solve the puzzles in your own sweet time Some may have more ______than you Others take a different view My, oh, my, eh, eh, eh ______

S3 Pray as your day unfolds Challenge whatever challenge you face Try and keep your head up to the sky Problems they may cause you tears Go ahead, release your feelings Stand up and be counted, don't be ashamed to share your tears You gotta be,

You gotta be strong, you gotta be bold, you gotta be yourself You gotta be wiser, you gotta be tought, you gotta be indepenent You gotta be courageous, you gotta be loving, you gotta be cautious All I know, all I know is, God will save the day

Herald what your parents said Read the books your parents read

59 Try to solve the puzzles in your own sweet time Some may have more materialistic things than you Others take a different view My, oh, my, eh, eh, eh ______

S5 Listen as your day unfolds Challenge what is dictated Try and keep your head up to the sky Family may cause you tears Go ahead, release your stress Stand up and be counted, don't be ashamed to speak your mind You gotta be,

You gotta be independent, you gotta be self sufficient, you gotta be funny You gotta be careful, you gotta be courageous, you gotta be friendly You gotta be trusting, you gotta be candid, you gotta be fearless All I know, all I know is, God will save the day

Herald what the good word said Read the books always read Try to solve the puzzles in your own sweet time Some may have more money than you Others take a different view My, oh, my, eh, eh, eh ______

S6 Smile as your day unfolds Challenge what people say is wrong Try and keep your head up to the sky Pain may cause you tears Go ahead, release your stress Stand up and be counted, don't be ashamed to be yourself You gotta be, ______

S7 keping as your day unfolds Challenge what is bad for you Try and keep your head up to the sky Parnter may cause you tears Go ahead, release your thoughts Stand up and be counted, don't be ashamed to nothing You gotta be,

60 You gotta be strong, you gotta be happy, you gotta be valuable You gotta be capable, you gotta be feminine, you gotta cool You gotta be calm, you gotta be nice, you gotta be wiser All I know, all I know is, God will save the day

Herald what the people said (on the good way) Read the books ______read Try to solve the puzzles in your own sweet time Some may have more opportunities than you Others take a different view My, oh, my, eh, eh, eh ______

S8 Strive to move forward as your day unfolds Challenge what makes you afraid Try and keep your head up to the sky Though your experiences may cause you tears Go ahead, release your pain Stand up and be counted, don't be ashamed to be who you are You gotta be,

You gotta be loving, you gotta smile, you gotta be happy You gotta be successful, you gotta be stronger, you gotta be cautious All I know, all I know is, God will save the day ______

S9 Watch as your day unfolds Challenge what your future hold Try and keep your head up to the sky others they may cause you tears Go ahead, release your self Stand up and be counted, don't be ashamed to cry You gotta be,

You gotta be bad, you gotta be bold, you gotta be wiser You gotta be hard, you gotta tough, you gotta be smarter You gotta be stronger, you gotta be calm, you gotta stay together All I know, all I know is, love will save the day

Herald what your mother said Read the books your father read Try to solve the puzzles in your own sweet time Some may have more time than you Others take a different view My, oh, my, eh, eh, eh

61 ______

S10 Awaken as your day unfolds Challenge what you have been told Try and keep your head up to the sky Family they may cause you tears Go ahead, release your past Stand up and be counted, don't be ashamed to speak up You gotta be,

You gotta be real, you gotta be smart, you gotta be bold You gotta be true, you gotta be fun, you gotta be tall You gotta be cool, you gotta be brave, you gotta be together All I know, all I know is, God will save the day

Herald what my grandma said Read the books my mom read Try to solve the puzzles in your own sweet time Some may have more cash than you Others take a different view My, oh, my, eh, eh, eh ______

S11 Pray as your day unfolds Challenge what ______Try and keep your head up to the sky Men they may cause you tears Go ahead, release your fears Stand up and be counted, don't be ashamed to move forward You gotta be,

You gotta be smart, you gotta be happy, you gotta be stronger All I know, all I know is, the Lord will save the day

Herald what ______said Read the books mother read Try to solve the puzzles in your own sweet time Some may have more ______than you Others take a different view My, oh, my, eh, eh, eh ______

S12 Smile as your day unfolds Challenge whatever comes to part

62 Try and keep your head up to the sky situations they may cause you tears Go ahead, release your fears Stand up and be counted, don't be ashamed to cry You gotta be,

You gotta be strong, you gotta be confident, you gotta be smart You gotta feel trusting, you gotta be happy, All I know, all I know is, God will save the day

Herald what ______said Read the books your Grandma read Try to solve the puzzles in your own sweet time Some may have more pieces than you Others take a different view My, oh, my, eh, eh, eh

STUDY B – WOMEN’S CORRECTIONAL INSTITUTE

P1 Because as your day unfolds Challenge what is important Try and keep your head up to the sky Above and release your tears Go ahead, release your tears Stand up and be counted, don't be ashamed to be proud You gotta be, strong

You gotta forget you gotta forget, you gotta forget You gotta be strong, you gotta be strong, you gotta be strong All I know, all I know is, God will save the day

Herald what your father said Read the books your father and mother and children read Try to solve the puzzles in your own sweet time Some may have more time than you Others take a different view My, oh, my, eh, eh, eh ______P2 pray as your day unfolds Challenge what come Try and keep your head up to the sky life may cause you tears Go ahead, release your tears Stand up and be counted, don't be ashamed to admit(?) you wrong You gotta be,

63

You gotta be strong, you gotta be good, you gotta be right You gotta be bad, you gotta be loving, you gotta be forgiving You gotta be ready, you gotta be hard, you gotta be willing All I know, all I know is, straight(?) will save the day

Herald what God said Read the books you know will help Try to solve the puzzles in your own sweet time Some may have more experience than you Others take a different view My, oh, my, eh, eh, eh ______P3 Listen as your day unfolds Challenge what the future Try and keep your head up to the sky Lovers and life may cause you tears Go ahead, release your fears Stand up and be counted, don't be ashamed to cry You gotta be,

You gotta be bold, you gotta All I know, all I know is, love will save the day

Herald what your mother said Read the books father read Try to solve the puzzles in your own sweet time Some may have more cash than you Others take a different view My, oh, my, eh, eh, eh ______P4 listen as your day unfolds Challenge what the courts have done Try and keep your head up to the sky Prison time may cause you tears Go ahead, release your tears Stand up and be counted, don't be ashamed to cry You gotta be,

You gotta be tuff, you gotta be smarter, you gotta be faster You gotta be kinder, you gotta be stronger, you gotta be wiser You gotta smarter, you gotta be kinder, you gotta be stronger All I know, all I know is, compassion will save the day

Herald what your mother said

64 Read the books the lawyers read Try to solve the puzzles in your own sweet time Some may have more time than you Others take a different view My, oh, my, eh, eh, eh ______P5 Have faith as your day unfolds Challenge what the enemy does Try and keep your head up to the sky So called friends may cause you tears Go ahead, release your pain Stand up and be counted, don't be ashamed to cry You gotta be,

You gotta be yourself, you gotta be wiser, you gotta be courageous You gotta be kind, you gotta be swift, you gotta be a child of God You gotta be strong, you gotta be obedient, you gotta be peaceful All I know, all I know is, the Lord will save the day

Herald what the Lord said Read the books my mother read Try to solve the puzzles in your own sweet time Some may have more problems than you Others take a different view My, oh, my, eh, eh, eh ______P6 Think as your day unfolds Challenge what your life may hold Try and keep your head up to the sky Friends they may cause you tears Go ahead, release your fears Stand up and be counted, don't be ashamed to cry You gotta be,

You gotta be bold, you gotta be wiser, you gotta be stronger You gotta be cool, you gotta be calm, you gotta be tough You gotta be hard, you gotta be bad, you gotta stick together All I know, all I know is, love will save the day

Herald what my mother said Read the books my sister read Try to solve the puzzles in your own sweet time Some may have more clothes than you Others take a different view My, oh, my, eh, eh, eh

65 ______P7 Sara* as your day unfolds Challenge what you fear Try and keep your head up to the sky Let no one may you tears Go ahead, release your fears Stand up and be counted, don't be ashamed to cry You gotta be,

You gotta be strong, you gotta be strong, you gotta be tough You gotta be strong, you gotta cry, you gotta be bold You gotta be tough All I know, all I know is, strength will save the day Herald what your father said Read the books put read Try to solve the puzzles in your own sweet time Some may have more more than you Others take a different view My, oh, my, eh, eh, eh *song was written to self. The name has been changed ______

P14 Find Freedom Deep in my heart as your day unfold Challenge what really ______my life Try and keep your head up to the sky Because life may cause you tears Go ahead, release your fears Stand up and be counted, don't be ashamed to shine You gotta be,

66 APPENDIX P RESULTS BY PARTICIPANT – SONGWRITING PHRASES AND THEMES

STUDY A – DOMESTIC VIOLENCE SHELTER

Sub. Given lyric Words filled in by women Theme # # ____ as you day unfolds stay focused 4 S2 pray 9 S3 listen 2 S5 smile 2 S6 keping 4 S7 strive to move forward 4 S8 watch 2 S9 awaken 2 S10 pray 6 S11 smile 2 S12

others say the you don’t agree 8 S2 Challenge what ____ with challenges you 5 S3 is dictated 8 S5 people say is wrong 8 S6 is bad for you 5 S7 makes you afraid 6 S8 your future holds 1 S9 you have been told 8 S10 whatever comes to part 6 S12

____ may cause you tears, life, fear 6 S2 Go, ahead release your ____ problems, feelings 2 S3 family, stress 2 S5 pain, stress 2 S6 partner, thoughts 2 S7 though your experiences, pain 6 S8 others, self 2 S9 family, past 2 S10 men, fears 6 S11 situations, fears 6 S12

Don't be ashamed to ____ fail 7 S2 share your tears 2 S3 speak your mind 8 S5 be yourself 2 S6 nothing n/a S7 be who you are 2 S8 cry 2 S9 speak up 8 S10 move forward 7 S11 cry 2 S12

67 You gotta be*____ bold, dream, assertive, strong, fearless, independent, focus, 6,2,8,3,6,8,4,2,6 S2 happy, couragous strong, bold, yourself, wiser, tought, independent, 3,6,2,3,3,8,6,2,2 S3 couragous, loving, cautious independent, self sufficient, funny, careful, courageous, 8,3,2,2,6,2,6,8,6 S5 friendly, trusting, candid, fearless strong, happy, valuable, capable, feminine, cool, calm, 3,2,3,4,3,2,2,2,3 S7 nice, wiser loving, smile, happy, 2.2.2.4.3.2 S8 successful, stronger, cautious bad, bold, wiser, hard, tough, smarter, stronger, calm, stay 3,6,3,3,3,3,3,2,1 S9 together real, smart, bold, true, fun, tall, 5,3,6,5,2,n/a,2,6,1 S10 cool, brave, together smart, happy, stronger 3,2,3 S11 strong, confident, smart, feel 3,6,3,6,2 S12 trusting, happy

All I know, all I know is ____ will save the God 9 S2 day God 9 S3 God 9 S5 God 9 S7 God 9 S8 love 2 S9 God 9 S10 the Lord 9 S11 God 9 S12

Note: *the word “be” was not included on the given lyric handout but was inserted here for reading clarity as most women added it prior to their words. Each word is to be read proceeded by “you gotta be”

STUDY B – WOMEN’S CORRECTIONAL INSTITUTE

Sub. Given lyric Words filled in by women theme # # ____ as you day unfolds Because n/a P1 pray 9 P2 listen 2 P3 listen 2 P4 have faith 9 P5 think 2 P6 Sara (*name was changed) 2 P7

68 Deep in my heart 3 P14

Challenge what ____ is important 4 P1 come 1 P2 the future 1 P3 the courts have done 5 P4 the enemy does 5 P5 life may hold 1 P6 you fear 6 P7 really ______my life n/a P14

____ may cause you tears, above and release, tears 6 P1 Go, ahead release your ____ life, tears 6 P2 lovers and life, life 2 P3 Prison time, tears 6 P4 so called friends, pain 6 P5 friends they, fears 6 P6 let no one, fears 6 P7 because life, fears 6 P14

Don't be ashamed to ____ be proud 5 P1 admit(?) you wrong 7 P2 cry 2 P3 cry 2 P4 cry 2 P5 cry 2 P6 cry 2 P7 shine 8 P14

You gotta be*____ forget, forget, forget, strong, n/a,n/a, P1 strong, strong n/a,3,3,3 strong, good, right, bad, loving, 3,2,5,3,2,2,6,3,7 P2 forgiving, ready, hard, willing bold 6 P3 tuff, smarter, faster, kinder, stronger, wiser, smarter, kinder, 3,3,3,2,3,3,3,2,3 P4 stronger yourself, wiser, courageous, kind, swift, a child of God, 2,3,6,2,3,9,n/a,2 P5 obedient, peaceful bold, wiser, stronger, cool, calm, 6,3,3,2,2,3,3,3,1 P6 tough, hard, bad, stick together

strong, strong, tough, strong, cry, 3,3,3,3,2,6,3 P7 bold, tough

All I know, all I know is ____ will save the God 9 P1 day straight(?) n/a P2 love 2 P3 compassion 2 P4 the Lord 9 P5 love 2 P6

69 strength 3 P7 Note: *the word “be” was not included on the given lyric handout but was inserted here for reading clarity as most women added it prior to their words. Each word is to be read proceeded by “you gotta be”

70 APPENDIX Q INSTITUTIONAL REVIEW BOARD APPROVAL SITE APPROVAL, AND CONSENT FORMS

Office of the Vice President For Research Human Subjects Committee Tallahassee, Florida 32306-2742 (850) 644-8673 · FAX (850) 644-4392

APPROVAL MEMORANDUM

Date: 4/2/2009

To: Jessica Rushing Rushing [[email protected]]

Address: 2255A Shady Timbers Cir. Tallahassee, FL 32304 Dept.: MUSIC SCHOOL

From: Thomas L. Jacobson, Chair

Re: Use of Human Subjects in Research The Effects of Music Therapy on Feelings of Hopelessness and Personal Control for Women Effected by Domestic Violence

The application that you submitted to this office in regard to the use of human subjects in the research proposal referenced above has been reviewed by the Human Subjects Committee at its meeting on 03/18/2009. Your project was approved by the Committee.

The Human Subjects Committee has not evaluated your proposal for scientific merit, except to weigh the risk to the human participants and the aspects of the proposal related to potential risk and benefit. This approval does not replace any departmental or other approvals, which may be required.

If you submitted a proposed consent form with your application, the approved stamped consent form is attached to this approval notice. Only the stamped version of the consent form may be used in recruiting research subjects.

If the project has not been completed by 3/17/2010 you must request a renewal of approval for continuation of the project. As a courtesy, a renewal notice will be sent to you prior to your expiration date; however, it is your responsibility as the Principal Investigator to timely request renewal of your approval from the Committee.

You are advised that any change in protocol for this project must be reviewed and approved by the Committee prior to implementation of the proposed change in the protocol. A protocol change/amendment form is required to be submitted for approval by the Committee. In addition, federal regulations require that the Principal Investigator promptly report, in writing any unanticipated problems or adverse events involving risks to research subjects or others.

By copy of this memorandum, the Chair of your department and/or your major professor is reminded that he/she is responsible for being informed concerning research projects involving human subjects in the department, and should review protocols as often as needed to insure that the project is being conducted in compliance with our institution and with DHHS regulations.

This institution has an Assurance on file with the Office for Human Research Protection. The Assurance Number is IRB00000446.

Cc: Jayne Standley, Advisor [[email protected]] HSC No. 2009.2382

71 QuickTime™ and a TIFF (LZW) decompressor are needed to see this picture.

72 QuickTime™ and a TIFF (LZW) decompressor are needed to see this picture.

73 FSU Human Subjects Committee Approved on 4/02/09 Void After 3/17/10 HSC# 2009.2382

Informed Consent The Effects of Music Therapy on Feelings of Hopelessness and Personal Control for Women Effected by Domestic Violence

You are invited to be in a research study to better understand the effects of music therapy for women survivors of domestic violence. You were selected as a possible participant because the facility staff has identified you as being able to benefit from this study. We ask that you read this form and ask any questions you may have before agreeing to be in the study. This study is being conducted by Jessy Rushing, a music therapy master’s student under the supervision of Dr. Jayne Standley of The College of Music at The Florida State University. The purpose of this study is to apply music therapy techniques to the topic of decision-making and belief in yourself through the decision making process.

If you participate in the study you will be asked to take part in a music therapy group intervention that may involve music listening, songwriting, lyric analysis, improvisation, or other music exercises lead by the researcher. You will be asked to fill out several questionnaires before and after the music therapy, and have a brief follow up with the researcher one week following the group.

There are no foreseeable risks in agreeing to participate in this study. Benefits of participation may include a better understanding of yourself and increased positive feelings. Additionally, you will be providing music therapists and other professionals with valuable information about how to better provide services to women affected by domestic violence.

This study may be used for research purposes. The records of this study will be kept private and confidential to the extent permitted by law. Any report that might be published will not include any information that will make it possible to identify a subject. Research records will be stored securely and only the researcher will have access to the records. Participation in this study is voluntary. Your decision whether or not to participate will not affect your current or future relations with the University or facility you are currently receiving services from. If you decide to participants, you are free to not answer any question or withdraw at any time without affecting those relationships.

The researcher conducting this study is Jessy Rushing. You may ask any question you have now. If you have a question later, you are encouraged to contact myself at 904-704-5077, [email protected] or Dr. Jayne Standley at 850-644-4546, [email protected]. If you have any questions or concerns regarding this study and would like to talk to someone other than the researcher, you are encouraged to contact the FSU IRB at 2010 Levy Street, Research Building B, Suite 276, Tallahassee, FL 32306-2742, or 850-644-8633, or by email at [email protected].

I have read the above information. I have asked questions and have received answers. I consent to participate in the study

______Signature Date

______Signature of Investigator Date

FSU Human Subjects Committee Approved on 4/02/09 Void After 3/17/10 HSC# 2009.2382

74 FSU Human Subjects Committee Approved on 4/02/09 Void After 3/17/10 HSC# 2009.2382

Informed Consent The Effects of Music Therapy on Feelings of Hopelessness and Personal Control for Women Effected by Domestic Violence

You are invited to be in a research study to better understand the effects of music therapy for women survivors of domestic violence. You were selected as a possible participant because the facility staff has identified you as being able to benefit from this study. We ask that you read this form and ask any questions you may have before agreeing to be in the study. This study is being conducted by Jessy Rushing, a music therapy master’s student under the supervision of Dr. Jayne Standley of The College of Music at The Florida State University. The purpose of this study is to apply music therapy techniques to the topic of decision-making and belief in yourself through the decision making process.

If you participate in the study you will be asked to take part in a music therapy group intervention that may involve music listening, songwriting, lyric analysis, improvisation, or other music exercises lead by the researcher. You will be asked to fill out several questionnaires before and after the music therapy, and have a brief follow up with the researcher one week following the group.

There are no foreseeable risks in agreeing to participate in this study. Benefits of participation may include a better understanding of yourself and increased positive feelings. Additionally, you will be providing music therapists and other professionals with valuable information about how to better provide services to women affected by domestic violence.

This study may be used for research purposes. The records of this study will be kept private and confidential to the extent permitted by law. Any report that might be published will not include any information that will make it possible to identify a subject. Research records will be stored securely and only the researcher will have access to the records. Participation in this study is voluntary. Your decision whether or not to participate will not affect your release date or parole eligibility. If you decide not to participate or to stop participating, you will be returned to your regular assignment as soon as possible. If you decide to participate, you are free not to answer any question or withdraw at any time. Please help to make sure you cannot be identified by not writing your name or register number on any of the materials provided.

The researcher conducting this study is Jessy Rushing. You may ask any question you have now. If you have a question later you may contact the administration of your institution.

I have read the above information (or it has been read to me aloud). I have asked questions and received answers. I voluntarily consent to participate in the study.

______Signature Date

______Signature of Investigator Date

______To be completed if consent form was read aloud: The information in this consent form was accurately conveyed to the participant.

______Witness’ name (printed)

______Witness’ Signature Date

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80 BIOGRAPHICAL SKETCH

Jessica Rushing is a board certified music therapist. Jessica graduated with a B. M. in music therapy from Florida State University in the fall of 2007 after completion of a six-month internship at Musicworx of California. She has worked in a variety of settings as a music therapist including starting a program at a shelter for domestic violence, researching and developing protocol for medical music therapy reimbursement in the neonatal intensive care unit, leading developmental groups for parents and their toddlers 6 months to 2 years old, and facilitating groups in a treatment center for eating disorders. Jessica is an active member of the America Music Therapy Association. This paper marks the completion of a M. M. in music therapy from Florida State University (Fall, 2009).

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