The Tavistock and Portman Foundation and the University of East London An exploratory study of the processes of Supportive Music and Imagery therapy conducted in South Korea Sumi Paik-Maier A thesis submitted in partial fulfilment of the requirements of the Tavistock and Portman Foundation and the University of East London for the degree of Doctor of Philosophy October 2016 i ABSTRACT This thesis is a qualitative study of Supportive Music and Imagery (SMI) cases that I supervised in South Korea between 2007 and 2011 with the aim of exploring the SMI process and the impact of supervision on it. SMI is a brief music psychotherapy with a prescriptive structure that works with a client’s supportive resources (the supportive imagery) and uses one simple recorded piece of music, arts and verbal dialogue. The investigation applies grounded theory to analyse data, i.e. session verbatim, reports, expressive media, supervision content etc. and uses case studies to present the findings. There are two sets of cases analysed. The first consists of cases conducted by SMI trainees, the second of cases conducted by SMI graduates, both supervised by me. Through a matrix of eight grounded theory categories and the interactions between the categories: supportive imagery, difficulty, intervention, relationship, expressive media, affect, learning, change, an interaction model of the SMI process has been generated. The study finds that the process of SMI is an ego enhancing process by internalizing the client’s good object (supportive imagery) through expressive media. In SMI, the whole process of focusing and enhancing the experience of the supportive imagery can be understood as a reparative process of ‘symbol formation’ of the good part of the self. Overall changes were brought about by the way the supportive imagery was facilitated by use of expressive media and intervention; by how difficulties were taken care of, i.e. resistance was addressed and anxieties were contained; how affect was promoted and nurtured; how much insight the client gained and how much learning the therapist integrated and by the level of therapeutic/supervisory alliance (relationship). Learning from supervision and clinical skills as well as understanding the countertransference though reflexivity has a considerable impact on the SMI therapy process. Cultural differences need to be taken into account; here therapeutic relationships resembled hierarchical Korean parent-child relationships. SMI is a new method and, to date, no research on SMI has been published. This thesis contributes a critically evaluative analysis of SMI, with special attention to the role of the supervisor, and identifies directions for future research, including a potentially wider applicability of brief SMI therapy. The thesis concludes that SMI justifies further research and development. ii DECLARATION This work has not previously been submitted for any degree and is not being concurrently submitted in candidature for any degree. This thesis is the result of my own research and other sources are explicitly acknowledged. Signature…………………………. Date: 14th of October, 2016 The word count excluding abstract and references is 87,578 words. iii TABLE OF CONTENTS TABLE OF FIGURES ............................................................................................... viii Acknowledgements ......................................................................................................... x INTRODUCTION .......................................................................................................... 1 CHAPTER 1: BACKGROUND TO THE STUDY ..................................................... 7 1.1 Music and therapy ............................................................................................................ 7 1.1.1 Music ........................................................................................................................... 7 1.1.2 Music therapy .............................................................................................................. 8 1.1.3 Influence of music on people ...................................................................................... 9 1.1.4 SMI as music psychotherapy ..................................................................................... 10 1.1.5 SMI and psychotherapy, development psychology, psychoanalysis ......................... 11 1.1.6 SMI as a brief dynamic psychotherapy ..................................................................... 14 1.2 Supportive Music and Imagery Therapy ..................................................................... 16 1.2.1 The Bonny Method of Guided Imagery and Music ................................................... 16 1.2.2 Development of SMI by Lisa Summer ...................................................................... 17 1.2.3 The settings and structure of the SMI session (SMI practicum manual) ................... 20 1.3 Related Literature Review ............................................................................................. 24 1.3.1 Contribution to MI by Fran Goldberg ....................................................................... 24 1.3.2 Literature on Adapted GIM and Music and Imagery ................................................ 25 1.3.3 Literature that relates to the idea of supportive resources ......................................... 26 1.3.4 Positive psychology ................................................................................................... 27 1.4 Korea, its culture and people......................................................................................... 27 1.4.1 My relationship with Korea ....................................................................................... 28 1.4.2 A brief history of Korea ............................................................................................ 28 1.4.3 Tradition .................................................................................................................... 28 1.4.4 Group-oriented society .............................................................................................. 29 1.4.5 Contemporary family life .......................................................................................... 29 1.4.6 Support systems ......................................................................................................... 29 1.4.7 Culture and psychotherapy ........................................................................................ 30 1.5 Supervision ...................................................................................................................... 31 1.5.1 Use of reflexivity ....................................................................................................... 33 1.5.2 Roles and boundaries................................................................................................. 34 1.6 Summary ......................................................................................................................... 35 CHAPTER 2: METHODOLOGY .............................................................................. 36 2.1 Ontological view ............................................................................................................. 36 2.2 Epistemology of the study .............................................................................................. 37 2.2.1 Reflect multidimensional aspects .............................................................................. 38 2.2.2 Relational dynamics .................................................................................................. 39 2.2.3 SMI is a reflective process and a subjective experience ........................................... 41 2.2.4 Use of multi-media .................................................................................................... 41 2.3 Trustworthiness .............................................................................................................. 42 2.3.1 Credibility .................................................................................................................. 42 2.3.2 Transferability ........................................................................................................... 43 2.3.3 Dependability ............................................................................................................ 43 2.3.4 Confirmability ........................................................................................................... 43 2.3.5 Reflexivity on researcher's bias ................................................................................. 44 iv 2.4 Ethical consideration ...................................................................................................... 46 2.4.1 The dual roles and dual relationships ........................................................................ 46 2.5 Participants ..................................................................................................................... 47 2.5.1 2.5.1 Procedure for recruiting participants ................................................................ 48 2.5.2 Participants in the Trainee Group .............................................................................. 49 2.5.3 Participants in the Graduate Group ........................................................................... 49 2.6 Data and data collection ...............................................................................................