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Music Psychotherapy with Refugee Survivors of Torture Interpretations of Three Clinical Case Studies

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Music Psychotherapy with Refugee Survivors of Torture Interpretations of Three Clinical Case Studies 3TUDIA-USICA 3!-)!,!..% -USIC0SYCHOTHERAPY WITH2EFUGEE 3URVIVORSOF4ORTURE ).4%202%4!4)/.3/&4(2%%#,).)#!,#!3%345$)%3 Sami Alanne Music Psychotherapy with Refugee Survivors of Torture Interpretations of Three Clinical Case Studies Helsinki 2010 Music Education Department Studia Musica 44 Reprinted 2016 Copyright © Sami Alanne 2010 Cover design and layout by Gary Barlowsky Distributed throughout the world by Ostinato Oy Tykistönkatu 7 FIN-00260 HELSINKI FINLAND Tel: +358-(0)9- 443-116 Fax: +358-(0)9- 441- 305 www.ostinato.fi ISBN 978-952-5531-87-9 (paperback) ISBN 978-952-5531-88-6 (PDF) ISSN 0788-3757 Printed in Helsinki, Finland by Picaset Oy ABSTRACT Sami Alanne. 2010. Music Psychotherapy with Refugee Survivors of Torture. Interpretations of Three Clinical Case Studies. Sibelius Academy, Studia Musica 44. Music Education Department. Doctoral dissertation, 245 pages. The clinical data for this research were derived from three music psychotherapy cases of torture victims who in 2002 to 2004 lived as either asylum seekers or refugees in Finland. The patients were all traumatized men, originating from Central Africa, South Asia, and the Middle East, who received music therapy sessions as part of their rehabilitation. Music therapy was offered weekly or bi-monthly for the duration of one to two years. Music listening techniques, such as projective listening, guided imagery, and free association were applied in a psychoanalytic frame of reference. Data included 116 automatically audio recorded and transcribed therapy sessions, totalling over 100 hours of real time data that were both qualitatively and quantitatively analyzed by the researcher. While previous studies have examined refugees and other trauma sufferers, and some articles have even discussed music therapy among torture survivors, this is one of the first empirical research studies of music therapy specifically among patients who are survivors of torture. The research thoroughly describes each of the three subjects in terms of their experiences relating to music, therapy, torture and encounters with Finland, as well as their progression through the therapy. The narrative of each case study makes frequent reference to transcribed data from the music therapy sessions to provide a naturalistic view of the patients and their experiences. Transcribed discourse and clinical notes from all 116 therapy sessions were analyzed in terms of 66 variables of the “situated person” pre-identified as significant according to both the pilot study and previous theory and research in this area. Within each session, the frequency and temporal location in which these variables appeared were systematically recorded and later factor analyzed for reformulating and reducing the dimensions of the data to achieve new meanings. From the analysis, 8 statistically significant factors emerged, suggesting explanations that, in terms of these particular variables, music therapy approaches were effective for promoting verbalization as well as regulation and expression of emotions. The subjects also completed four tests on multiple occasions: (1) Beck Depression Inventory (BDI), (2) Symptom Check List-25 (SCL-25), (3) How Do You Feel Today? questionnaire, and (4) Alanne Music Therapy Outcome Questionnaire. All four tests were administered at the start of the therapy, at the end of the therapy, and six months following the conclusion of therapy sessions (for a total of three times), and two of the tests (Alanne Music Therapy Outcome Questionnaire and How Do You Feel Today?) were also administered one additional time 6 months into the therapy sessions. Three patients in music psychotherapy and their two compared persons of torture survivors who had the best other general psychiatric treatment filled the questionnaire similarly (N=5). Their general rehabilitation was followed for a two-year period with the questionnaires. According to the data analysis from clinical discourse and tests, all three subjects responded positively and demonstrated some improvement due to their music therapy treatment, although with varying degrees of satisfaction. The therapy increased the consciousness of patients regarding their traumatic experiences, however music was perceived as related to positive imagery and pleasurable experiences, and as an aid in calming and relaxation. These findings suggest that some music psychotherapy methods may be effective in treating patients who are survivors of torture and related traumatic experiences. Keywords: music therapy, psychotherapy, psychoanalysis, factor analysis, refugees, torture survivors, traumas, asylum seekers, hermeneutic phenomenology, clinical improvisation, projective listening ACKNOWLEDGEMENTS I would like to thank my scientific supervisor, Professor Kai Karma of the Sibelius Academy Music Education Department, for his contribution originating in the planning stages of this research project. I truly appreciate his methodological experience, especially concerning factor analysis, as well as his support, viewpoints and our mutual interest in integrating qualitative and quantitative methods. Even after his retirement he was willing to comment upon and supervise my research. I also owe gratitude to Professor David G. Hebert for his supervision in refining the final structure and form of the dissertation with me. His interested comments and encouraging feedback on my research, writing and literature review in particular pushed me forward in developing my topics and further exploring them. I thank Professor Lauri Väkevä for his supervision and the philosophical point of view revealed in his editorial comments and feedback on my manuscript. I would also like to remember Professor Kimmo Lehtonen for his supervision and comments during the early clinical part of this research. I thank Professor Heidi Westerlund of the Sibelius Academy for her comments and support during many parts of my research process, which made me develop my arguments. I thank the reviewers of my dissertation, Professor Even Ruud from the University of Oslo, and Doctor of Music and music therapist Ulla Hairo-Lax, for their feedback. Thanks also go to The Centre for Torture Survivors in Finland, and especially to psychiatrist and psychotherapist Asko Rauta, for their support and collaboration, which enabled this research. I would also like to thank the ethical committee of the Helsinki Deaconess Institute and the chair, Doctor of Medicine, Irma Jousela for their comments on how to develop my research. I would also like to acknowledge the late music therapist and psychologist Petri Lehikoinen (Sibelius Academy) for his encouraging words while planning this research project, and Professors David Aldridge (Witten/Herdecke University) and Tony Wigram (Aalborg University) for allowing me to consult with them about music therapy research with torture survivors at the beginning of my research project. I also offer thanks to Professor Wigram for inviting me to present my work at the Aalborg University, Denmark and, as a visiting doctoral student, to participate in a music therapy Ph.D seminar where I was able to watch doctoral defenses during a time when they were still rare in Finland. Professor Lauri Tarkkonen (University of Helsinki) shared with me his knowledge and experience of factor analysis at some crucial stages of this research. I thank the following fellow doctoral researchers at the Sibelius Academy Music Education Department for their critical but fair comments upon my manuscript; Tuulikki Laes, Alexis Robertson, Andries Odendaal and Hanna Nikkanen. Very special thanks belong to my spouse, psychologist and psychotherapist Riikka Porra, for sharing her love, support and professional knowledge with me concerning any questions and thoughts arising from this research. While writing my dissertation I was lucky to participate in the very first long advanced special level psychotherapy (VET) music psychotherapy course in Finland at the University of Oulu, 2007–2010. I would like to thank the head of the course, Doctor of Philosophy, music therapist and psychotherapist, Kari Syvänen for encouraging and supporting the completion of my work. Inspiring seminars with training psychoanalyst (IFPS) Johannes Myyrä alongside discussions with colleagues during the course and their interest in my dissertation helped me to carry on. I would also like to mention and thank the following people for their collaboration over the years: Psychoanalyst (IFPS), psychologist and art psychotherapist Mervi Leijala-Martttila, training psychoanalyst (IPA) and psychiatrist Heikki Piha, psychoanalyst (IFPS), psychologist and training child psychotherapist Kaija Mankinen, music therapist Emma Davies, Professor Marjut Laitinen and the late academic co-ordinator Marja Liisa-Kainulainen at the Sibelius Academy, and the Master of Library and Information Science Sven-Erik Baun at the International Rehabilitation Council for Torture Victims (IRCT) in Copenhagen, Denmark. Thanks go to graphic designer Gary Barlowsky for the cover design and layout and to Angie Hämäläinen for her proof-reading and notes on my work. I would like to thank the following organizations for their support of my study and research: The Sibelius Academy, the Selim and Minna Palmgren Foundation, the Viljo and Riitta Laitinen Foundation, the Alfred Kordelin Foundation, Apollo Terapiapalvelut, The Helsinki Deaconess Institute, CIRIUS and CIMO. CONTENTS 1 INTRODUCTION 9 PART ONE – THEORETICAL AND METHODOLOGICAL GROUNDS 19 2 Approaches to Music Therapy 21 2.1 Music Therapy
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