SONG AND METAPHORIC IMAGERY IN FORENSIC MUSIC THERAPY Carol Chambers Thesis submitted to the University of Nottingham for the degree of Doctor of Philosophy Submitted August 2007 Defended May 2008 Abstract The present research study grew out of my professional practice as a music therapist, and seeks to put forward a new approach to the relationship between theory, research and clinical practice – while still relating in meaningful ways to a broad range of existing work. Music therapy in the UK is a broad and expanding profession, encompassing a notably diverse range of theoretical approaches and practical applications. Such approaches and applications may use, for example, free improvisation, songwriting, or listening- and response- based techniques. And there is a range of specialised literature dealing with each of these areas, as well as a number of broader, overarching studies dealing with the overall field. Within the tradition of a model based largely on musical improvisation, which has been my own practice, the use of pre-composed songs might be regarded as unusual, perhaps even as anomalous. But I hope to show that it is in fact a useful and profoundly revealing process which is firmly rooted in an ethos of active musical participation. This thesis examines the use of songs in forensic psychiatric music therapy for women, and offers this use of song as an alternative model of musical creativity within such a context. My research project as a whole is approached from the philosophical framework of behaviourism; and the thesis is written from a ‘social constructionist’ perspective of the creation and enactment of self-identity, grounded in a belief that life and music become inextricably associated during the constructive process. As its major source of evidence, the study presents a longitudinal case study of one woman over the entire three-year course of her therapy. Her song choices are examined according to an adaptation of therapeutic narrative i analysis, framed within a chronological view of events. Music remains a central focus and presence within the study, both as a vehicle for song texts and as a therapeutic medium in its own right; and the archetype of sonata form is invoked as a structural framework for analysis and the production of meaning. Images and bi-polar constructs are abstracted from the songs and their metaphoric content interpreted in the context of known life experiences and the progress of the therapy sessions themselves. Results reveal a strong use of generative metaphoric imagery which is humanized yet also, crucially, emotionally decentred or depersonalized. This then leads to assertions of a process of ‘Music Therapy by Proxy’. There are also clear indications of the relevance of the passing of time as a dimension of the therapeutic process, resulting in a pattern which I term ‘Reverse Chronology’. The songs which were used during the course of therapy provide words, imagery and, in addition, a musical substrate or continuum which ‘carries’ the textual-and-visual components but also has its own expressive and therapeutic importance. All these elements have their place and function within the therapy as described. Song as a concept is further defined as a transformative or metamorphic process enabling the expression of deeply personal, often unheard or ‘suppressed’ voices. Emerging from this process, seven core themes are identified. These then provide the focus for a wider discussion concerning the significance of song and imagery for women in forensic therapy, and the issues which arise from them. Finally, suggestions and recommendations are made for music therapy practice and for possible new directions in future research. ii Acknowledgements I gratefully acknowledge the contribution made by many people towards the process of devising and conducting the research contained in this thesis, and in the preparation of the thesis itself. I would like to thank Professor Leslie Bunt, who first encouraged me to write about my work, thus starting me off on my journey along the path of research; and also my colleagues at Nottingham MusicSpace who discussed and reviewed my work and helped to shape my ideas. I am indebted to the members of staff who deliver training courses at The University of Nottingham’s Graduate School, for their many hours spent patiently developing my research knowledge and information technology skills. In particular I was inspired by Dr Karen Carpenter, who freely gave of her own time, and convinced me to follow my ideas about metaphors and imagery, and to write in my own style. My attendance, and presentation, at a PhD research symposium at Aalborg University in Denmark strengthened my research methodology and expanded my reviews of literature into international fields, as well as enhancing my confidence. I would like to thank Professor Tony Wigram and his team for the invitation to attend, and for their encouragement and support. iii A financial award in the form of The St Hugh’s Fellowship 2001, from the St Hugh’s Foundation, is gratefully acknowledged for it made possible my visit to Denmark and, in addition, my presentation at the World Congress of Music Therapy (Oxford, 2002). Finally, but most significantly, I feel privileged to have had Mr Philip Weller as my Supervisor. He has guided me through the process of turning raw ideas into a manageable research study with unswerving interest and support, and an astonishing attention to detail that has, at the same time, both broadened and focused my perspective. And above all, he has coped admirably with my idiosyncrasies of idea and presentation, and has assisted my ‘voice’ to shine through in the completed thesis. I would like to thank him for sharing my journey and, as is often said, for ‘singing from the same hymn book’ as me. iv Contents Introduction 1 Chapter One: Conception 14 1.1 Research and Clinical Practice in Music Therapy 14 1.2 Challenging Expectations in Forensic Music Therapy 18 1.2.1 Moira 23 1.2.2 Brenda 24 1.2.3 Angela 26 1.3 The Value of Songs and Song Words 29 1.3.1 Levels of Meaning in Song Words 32 1.4 Second Songs: A Song Process? 35 1.4.1 Angela 35 1.4.2 Brenda 36 1.4.3 Moira 37 1.5 Elusive Butterflies: a Generative Metaphor 39 1.5.1 Song Metamorphosis 40 1.5.2 Therapy Metamorphosis 41 1.5.3 Research Metamorphosis 42 Chapter Two: Eggs 45 2.1 Defining the Research Framework 45 2.1.1 Philosophical Background 46 2.1.2 Research Tradition 56 2.1.3 Statement of Research Framework 70 2.1.4 Personal Presentation 71 2.1.4.1 Research Metamorphosis 75 2.1.4.2 Words and Images 76 2.1.4.3 Problems 79 2.2 Research Focus 80 2.2.1 Selecting the Focus 80 2.2.1.1 Delimitations and Limitations 82 2.2.1.2 Definition of Terms 86 2.2.2 Research Context 87 2.3 Research Procedure 91 2.3.1 The Setting 91 2.3.2 The Case 94 2.3.3 The Researcher 96 2.3.4 Ethical Review 101 2.3.5 Data Collection and Storage 116 2.3.6 Data Analysis 118 2.4 Significance and Verification 121 Chapter Three: Caterpillar 125 3.1 Songs in Music Therapy 126 3.1.1 Songs in Forensic Psychiatry and Mental Health 126 3.1.2 Songs with Children 136 3.1.3 Songs in Palliative Care 141 3.2 Language and Emotion in Music and Psychiatry 149 3.2.1 Language Use in Psychiatry 149 3.2.2 Emotion and Music in Psychiatry 154 3.3 Narrative in Research and Therapy 161 3.3.1 Narrative Analysis 161 3.3.2 Narrative Practice in Therapy 166 3.4 Songs as a Soundtrack to Life 173 3.5 Metaphor in Therapy 182 3.5.1 Images, Archetypes, Fairy and Folk 182 3.5.2 The Metaphoric Process 187 Chapter Four: Chrysalis 197 4.1 The Timeline of Songs 200 4.1.1 Exposition 205 4.1.1.1 Songs 1-3 206 4.1.1.2 Exposition Discussion 210 4.1.2 Development 215 4.1.2.1 Songs 4-8 216 4.1.2.2 Songs 9-14 222 4.1.2.3 Songs 15-17 228 4.1.2.4 Songs 18-20 229 4.1.2.5 Development Discussion 237 4.1.3 Recapitulation 240 4.1.3.1 Songs 21-22 241 4.1.3.2 Songs 22-23 248 4.1.3.3 Songs 22, 24-25 250 4.1.3.4 Recapitulation Discussion 252 4.2 Discussion 254 Chapter Five: Butterfly 258 5.1 The Song Images 258 5.2 The Life Soundtrack 270 5.3 The Bi-polar Constructs 284 5.4 Discussion 288 Chapter Six: New Pastures 293 6.1 Theme One: Social / Relationships 310 6.2 Theme Two: Colour 320 6.3 Theme Three: Movement / Space / Weight 327 6.4 Theme Four: Time 334 6.5 Theme Five: Personal / Insight 338 6.6 Theme Six: Emotion 345 6.7 Theme Seven: Possessions / Loss / Gain 351 6.8 Summary and Discussion 355 6.8.1 Concluding Assertions 357 6.8.2 New Fields, New Pastures: Directions for Future Research 359 Appendices Appendix A1: Summarised Case Histories of 10 Women 363 Appendix A2: Initial Song Choices of 10 Women 365 Appendix B1: Letter of Assent from Secure Unit 367 Appendix B2: Letter of Assent from Research Director 368 Appendix C: Sample of Narrative Account from Session Notes 369 Bibliography 370 ***** List of Figures Figure 1: Levels of Meaning in Song Words 34 Figure 2: The Generative Metaphor of Metamorphosis 40 Figure 3: A Comparison of Levels of Language, Meaning and Emotion160 Figure 4: The Timeline of Songs 202 Figure 5: The Song Images 259 Figure 6: The Life Soundtrack 272 Figure 7: A Model of Reverse Chronology over Time 282 Figure 8: The Bi-polar Constructs 285 Figure 9: Constructs and Centres of Meaning 287 Figure 10: List of Seven Core Themes 288 Introduction As the opening narrative presented in Chapter One will serve to show, this research project in Music Therapy grew out of a long-term, sustained period of clinical practice as a professional music therapist, working in secure forensic psychiatric units with women clients.