Guided Imagery and Music: A Spectrum Approach MED-GIM Adaptations of the Bonny Method for Medical Patients: Individual Sessions Theoretical Orientation Introduction The Bonny Method of Guided Imagery and Music (BMGIM): The Association for Music and Imagery (AMI) has recently approved the definition of The Bonny Method as a music-assisted integrative therapy, which facilitates explorations of consciousness that can lead to transformation and wholeness. It evolved as a Method through the research and practice of Helen L. Bonny, Ph.D. In its one-on-one application it is known as The Bonny Method of Guided Imagery and Music (AMI, 2005). Several authors have reported adaptations of the (BMGIM) since Helen Bonny first developed it in the early 1970’s. The literature describes some changes, such as duration of the music, selection of the music, and bodily position during the music listening (Blake, 1994; Gimeno, 2010; Goldberg, 1998; Picket, 1996-1997; Short, 1991; Summer, 2002; West 1998). Goldberg (1998) recommended the use of music with a narrow intervallic range to allow a very brief imagery experience without the dynamic unfolding that is characteristic of a standard session. Blake (1994) suggested a short duration of music no longer than 10 minutes with new age or classical style. She also recommended having the client in a sitting position rather than lying down on a couch, as is the case in a regular BMGIM session. Summer (2002) referred in her study to the importance of giving supportive therapy when clients need to be held to reinforce any positive feelings that might emerge during the session. In the same study she encourages the use of task-oriented induction as opposed to one induction that encourages exploration. She cites examples where the direction is to create a safe place or to provide a 1 relaxing image that holds the client in a common, positive feeling. Summer (2002) states that an induction should clearly present self-affirmation rather than a conflictual feeling. A positive image allows for increased feelings of safety and good self-esteem. MED-GIM Adaptations of the Bonny Method for Medical Patients: Individual Sessions I have developed two techniques that might be given to patients in a hospital. One is called MIR, which stands for music and imagery to induce relaxation. The second one is called MIJ, which stands for music and imagery journeys. Both adaptations fall under the umbrella of what I call MED-GIM, which stands for guided imagery and music in the medical setting. As a music therapist/ practitioner, I did this work in a hospital setting with an adult patient. The two types of interventions, MIR and MRJ, have two different purposes. The MIR technique is given to provide greater calmness to the patient about to face surgery or potentially traumatic procedures. The duration of the MIR session is around 15-20 minutes. The MIJ technique is longer, around 30 minutes, and is given when the patient needs emotional support. MIJ helps the patient to connect to internal resources of confidence, possibly unknown by the patient beforehand, through a process that is stimulated by the music. MED-GIM, like the Bonny Method, is client centered and mirrors the regular BMGIM session. Both MIR and MIJ have the same structure and include prelude, induction, music listening, and postlude. While in MIR the only purpose is to relax the mind, in MIJ the purpose is to help the client find an inner source of power. The music and the induction stages help the patient reach inside for some inner resource of relaxation, potential confidence, or self- empowerment. MIJ includes a dialog between the patient and practitioner that would require the 2 music therapist to be trained in the specialized Bonny Method. Instead, MIR can be used by all music therapists. The MIR Technique MIR is considered less complex in the continuum of the Bonny Method. During the prelude, a therapeutic rapport is developed by facilitating or encouraging a state of mind of well being or enjoyment that is known to the patient. The good experience must be remembered or conjured to create a sense of comfort for the patient. If the patient can reach that state of mind, the session will have been successful. If not, the music therapist must be able to provide a narrative to help the patient reach that point. During the prelude, the music therapist tries to draw out key images that will be related to the client’s experience of comfort. For example, if the client reports having had a good time while being with her/his cat, the image of her/him with the cat on a couch or in a comfortable room will help the patient be distracted from the stress that s/he is facing in the current moment anytime in the hospital. In the prelude, the therapist wants to collect the key knowledge of the experience to develop a script that she can use later in the next phase, induction. The music is played as the induction is given, and the therapist talks to the patient using the context that she collected from the prelude. The aim is for the patient to have a vivid experience or physical sensation of being “with the cat.” The therapist provides a brief relaxation exercise followed by a script elaborated from the patient’s story. All the senses are utilized--visual, auditory, kinesthetic, gustatory, olfactory—as well as thoughts, including feelings and emotions. All this is needed to make the imagery as vivid as possible. The therapist keeps the key words of the prelude in the mind of the patient. If the 3 patient falls asleep because of the tone of voice or the success of relaxation, it is alright, but there is no postlude. If the patient does not fall asleep, the therapist brings the patient back to the present moment or alert state by closing the imagery. Postlude is the fourth phase in which the therapist and the patient process the session that has been completed. The processing in MIR is short: the therapist helps the patient check her/his comfort afterwards to know if the session was satisfactory. After that, the experience of the session becomes an “anchor” to which the patient can return when s/he feels distress. If the music can be recorded or made available to the patient on an iPod or other device, the patient can listen to and feel a good experience again whenever s/he chooses. A negative experience must also be processed in the postlude to find one good positive image that the patient can take away. For MIR, the therapeutic intention is relative to the context or the client/patient. The intention is to encourage complete relaxation in the patient and to distract the patient from the upcoming worries. The intention is fulfilled by finding key words from a patient’s own experience of relaxation or wellbeing to be used later as an inner resource. Below is an example of an MIR induction. In this technique the music is played in the background from the beginning of the induction. Suggestions from the patient’s experience of wellbeing, gathered during the prelude: • A hike in Yosemite park to climb Half Dome • Her best friend Mary was with her • The autumn season was a perfect temperature for a hike • Beauty in the park • Light backpack, patient states what she carried • It was difficult, challenging and rewarding 4 • Huge satisfaction getting to the top • Full moon on the return to the campground • Great rest Induction (including then patient’s key words): Just allow yourself to lie back and relax for a few minutes… Take a deep breath in and exhale through your mouth… Do it again and let your body sink and soften into the bed that is supporting you… If you hear external sounds just let them pass and concentrate on your inner world… Find a comfortable position and gently close your eyes … Notice the gentle rise and fall of your stomach with each breath… Allow the breath to be in your natural rhythm, coming in through your nose and out through your mouth… And now allow the music in as we imagine together the scenery of your enchanted hike. It is early morning and you are ready to begin the adventurous hiking trip… Your boots are well tied, your backpack is light and only contains the things that you need for the hike: a light raincoat, a flashlight, a canteen of water, some nutritious granola bars, dry fruits, and fresh fruit… You are wearing your hat, sunglasses, and have your hiking sticks… You can feel the weight of the backpack… All is right, all is ready… Mary is with you and you both are very excited to begin the journey. As you start walking you can feel the support of the ground beneath you… Bring the strength of mother earth into your body… The time is early morning—dawn … Just before the sunrise… Allow the autumn colors (pink, yellow, and indigo) to gradually rise into your awareness… Feel your feet connecting to the ground… As you look down, imagine your feet 5 comfortably stepping on a sandy stone path… Notice the length of the trail before you; become enveloped in the beauty of the open horizon… Take in the stillness, and enjoy the moment. As you continue walking, you feel the sun is rising; all is filled with beauty… You are trying to concentrate on the pacing of your walk; it is a long journey ahead and you want to arrive safe to the top… As you move on, you find yourself standing in a beautiful meadow on a clear, fall morning… You notice the crunching of leaves under your feet… Take in the aroma of autumn morning air… Notice the dampness from the dew.