Supportive Music and Imagery Method
By Sumi Paik-Maier
Development of the Music and Imagery Method
Since Helen Bonny created the Guided Imagery and Music method in the early 1970s, Guided Imagery and Music (GIM) has been developed and adapted for various clientele and clinical settings by many Bonny Method practitioners. (Summer, 1981, 1985, 1990, 2010; Vaux, 1993; Goldberg, 1994; Blake, 1994; Blake & Bishop, 1994; Clarkson, 1995; Moe, 2000; Booth 2005-2006; Frohne-Hagemann, 2010; Wärja, 2010).
Summer (Summer & Chong, 2006; Summer, 2010) identified "a flexible continuum of clinical practice" (Summer, 2010, p. 2) that encompasses the Bonny Method and its adaptations: supportive, re-educative, and reconstructive levels (from Wheeler, 1983; Wolberg, 1977) of Music and Imagery. The Bonny Method is a long term, exploratory, reconstructive approach whereas the supportive and re-educative levels have a short-term, directive approach.
Summer (2010) explains "all levels [...]have the same ultimate goal as derived from Bonnys (2002) foundation goals for GIM: transcendence.[...] the supportive level addresses the development of positive internal resources, the re-educative level directly addresses the clients' specific symptoms, and the reconstructive level goes to the root of the resources and symptoms within the unconscious (Summer, 2002, p. 2-3).
Supportive Music and Imagery (SMI)
The Supportive Music and Imagery Method
The Supportive Music and Imagery method works with one's positive resources rather than one's issues and problems. The positive resource can be anything that a client has/had, whatever has a positive influence on a client. Any experience that a person feels good about and nourished from can be used as a positive resource. It can be as simple as a favorite coffee break one can rest and enjoy, or a warm hug from one's mother. The focus is not on the external reality, the activity, thing and/or a person, but it is on the internal quality that one feels from these. Not the coffee break itself but the quality of the private, enjoyable moment during which one feels in touch with oneself. Not the hug itself, nor the mother, but the warmth, love one feels from the hug of one's mother. However small it may be, by focusing and deepening the inner quality of these positive resources and positive imagery, it enhances one's ego.
Supportive Music and Imagery is effective as a short - term therapy and can be applied independently or in conjunction with re-educative / reconstructive music and imagery therapy.
The Structure of Supportive Music and Imagery
Supportive Music and Imagery is highly structured and much more contained than a GIM session. It uses a single positive image and a single piece of pre-recorded music. Both are selected by the therapist and client together for the session. This method progresses as follows:
Prelude:
The overall/general information of the client is gathered briefly. Any influence from the previous session is reviewed. Then the therapist gently guides to explore any positive experiences the client has had.
Transition:
Among the above positive experiences, the client is asked to choose the one that is most meaningful to him/her. Then the selected image is filled out and elaborated upon.
Among a few music selections the client chooses music that matches the quality of his/her positive imagery.
Induction: A Bridge to Music
Using the client's description of the imagery, the therapist helps the client to focus on the experience/feeling of the imagery before the music starts. The client may or may not close his/her eyes while sitting. The induction is short, only to help the client to focus on the chosen imagery, which is different from the Bonny Method induction that is to condition the client to the altered state of mind.
Music/Imagery
The music used in Supportive Music and Imagery is simple and containing. It uses simple musical elements and a clear structure to contain the imagery. Because of this, pieces of non-classical music are often used in this approach.
Shortly after the music starts, the client is asked to open his/her eyes and express his/her imagery, often using a creative arts medium, while listening to the same music repeatedly.
Postlude
The experience of the music/imagery is explored and internalized. The focus is on the inner qualities of the imagery not on a description of what the imagery is. The therapist helps the client to feel deeply and experience the positive imagery rather than to focus on a cognitive analysis of the imagery.
The client is encouraged to explore and enjoy the positive experience using supportive music at home.
Background of the Study
Here I would like to introduce Supportive Imagery and Music by illustrating a few SMI case examples conducted by graduates and trainees from the Music & Imagery Training at Ewha Womans University in Seoul, South Korea (collaborative training with Anna Maria College; USA). The focus here is not a deep analysis of the cases but to demonstrate the process and outcome of the supportive level of music and imagery practice.
Even though most of the trainees are trained music therapists, they have rarely received any type of individual psychotherapy, including music therapy. Thus their understanding of the dynamics of psychotherapy was limited. Supportive Music and Imagery is structured, simple and relatively easy compared to the Bonny Method and it is designed as a short-term therapy in our training module. When I started giving supervision in Korea, I felt that this approach was the perfect entry level of therapy for both GIM trainees and for the Korean clientele who rarely have experience in any type of psychotherapy or music therapy. I saw the merit of Supportive Music and Imagery merely as an entry training tool/method. However, as I started supervising sessions in this model, I was surprised by the effect of the work. Regardless of the inexperienced trainee therapists and inexperienced clients with little insights, most of the clients made small but significant changes within six sessions.
Case Illustration
Case 1: Hana (Not real name) This case was conducted by therapist JungEun Suk.
Hana was in her mid 30s and married with one child aged 10. She had been in a very difficult situation. Her husband had a serious degenerative disease. Her child had been suffering from an anxiety disorder, which had been treated by JungEun at a clinic the previous year. Hana had been defensive during that period and had hardly taken any advice given by JungEun. She was known to be controlling of her child and to be demanding and argumentative with staff members in the clinic.
After Hana talked about her childhood in which she had to make considerable sacrifices for her family and about her husband's illness in the previous session, she complained that talking about her difficulties did not help her at all. She couldn't see the point of focusing on her problems as they wouldn't go away anyway. The therapist was very accepting of Hana and allowed her to talk about what she wanted to talk about her favorite activity, cooking. Hana was a very proud homemaker indeed; and she showed off how she prepares special meals each day. The chosen positive imagery was the happy moment while cooking. While repeatedly listening to Schumann's Fünf Stücke Im Volkston, Langsam, a simple cello and piano piece with a gentle comforting melody, she drew herself happily cooking in the sun - drenched kitchen, singing. With empathic warm support by the therapist, Hana felt very confident about herself in the drawing and she realized she truly feels happy while she cooks for her family.
Cooking is mere work or duty for many housewives. But for Hana, cooking represented her, her strength. As I explained to her therapist Suk, Hana was like a Chief Executive Officer (CEO) of her home and her feeling of accomplishment was compatible to a CEO who would feel proud of her successful achievement. The focus was not on the activity of cooking but on the feeling that comes from cooking: a sense of satisfaction and joy. Cooking provided a sense of self-worth, achievement and pride for Hana. Difficulties she was facing in her life made Hana guarded and controlling. As the therapist validated her strength and by supported her to fully engage in her joy, Hana was able to relax and was truly able to enjoy herself.
Since this session, Hana has become more satisfied with her life in general and feelings of joy were becoming more prevalent. She has become less guarded and less controlling of her son.
In this example, Hana was truly able to accept and enjoy herself through the Supportive Music and Imagery process and the validating, acknowledging, supporting approach of the therapist. This then led her to accept and enjoy others around her. Her son was no longer a dutiful burden for her but became a source of joy. She was able to find happiness in her life more readily.
Case 2: Su (not real name). This case was conducted by therapist Kyungpoon Ha
Su is single in her early 20s and has had conflicts with her parents for a long time. Due to their marital problems, her parents had abandoned and neglected her since her mid teens. Su has lived alone, away from her parents, for a long time and has had to make a living for herself early on while she is studying in college. She has felt very emotionally beaten down by her parents for their inconsistent treatment. After rare moments when she felt her parents being tender and loving to her, she later felt betrayed by their subsequent cold attitude and their conditional affection.
Su had worked intensely on her conflicts and emotional difficulties in previous re-educative sessions. And in the supervision, I discussed with her therapist that Su may soon need a break as she had been very weak physically and emotionally. If the situation was right, the possibility of applying Supportive Music and Imagery should be considered.
At this session, Su felt she had been betrayed again by her parents; and she was too exhausted from her emotional struggle with her parents. She told her therapist, "No matter how much I drink and eat, I still feel very thirsty and hungry. I am exhausted. I just want to rest and get support from someone but there is no one. I don't even have energy to ask for help."
The therapist acknowledged her condition and chose a simple and containing piece of music, Melodie de Nuit No. 4 by Steve Barakatt, for her imagery work. The therapist then asked Su to feel the support from the music. Su listened to the music intently while she cried. She drew a girl standing on a giant hand facing a forest. Su said she felt better and refreshed after the work. With the climax of the music, Su explained that she felt as if someone was blowing gently toward her saying "go, try, try to be free." She had an image of flying freely over the forest, feeling fresh and free. She felt the hand that held her in her drawing was strong and very reliable. Su wished that her parents' support and help her the way the hand supports her in her drawing. Instead of focusing on what she lacks in her life, her parents' love, the therapist led Su to connect this feeling of freshness and freedom from the image of the hand to her daily life, such as her joy of baking and restful moments in her home. She then realized that she needs to nourish herself more by taking a break, going to picnics in mountains, and other pleasurable activities.
In this session, Su was too exhausted to work on her problems and issues. From a recent meeting with her parents, Su was much wounded and her physical and psychological energy was very low. In her previous sessions, she had worked intensely on her issues and she needed a place to rest to ease her breath and regain her strength to work on her issues in later sessions.
At the beginning of this session, Su couldn't find any positive elements in her life. Thus she was asked to find a positive resource from the music. Music became the positive resource (imagery) for her. The simplicity of the music was able to contain her and the gentle dynamic was able to embrace and support her beaten energy. The music was steady with consistent downbeat and tempo. The melody was gentle and short enough to follow. The structure of the music was simple and clear to provide a safe boundary. There was no surprise, and the music was predictable and steady. The consistency and nurturing she so longed for from her parents could be experienced in the music. She could let go of holding onto her parents for unrequited love, at least during this session. Music acted like surrogate parents for her.
Case 3: Nori (not real name) This case was conducted by therapist Kyungpoon Ha.
Background
In this case, I will briefly present six sessions of Supportive Music and Imagery conducted with one of my trainees, Nori. I will illustrate how the session actually proceeded according to the Supportive Music and Imagery structure (Session 2, 3, 4 & 5) and I will demonstrate how the case progressed overall. To provide various views, I asked Nori and her therapist if they wanted to contribute their reflections on this case for this writing. As a result, I am adding the reflections by the therapist and Nori.
About the Client
Nori was single in her early 30s. She had enrolled in the Supportive Music and Imagery training and this case was a part of the required therapy sessions in the training. Nori experienced six Supportive Music Therapy sessions prior to this about a year ago with the same therapist, Ha. She worked diligently and enthusiastically for her first six sessions. Nori experienced a brief group therapy among people in similar fields, which overlapped with the beginning of the Supportive Music and Imagery sessions.
Nori was a music therapist who recently graduated from her master's level education. She had been very busy as she held many small therapy jobs. But slowly her scattered schedule had become more organized and was settling down.
Nori had high standards for herself and was self-conscious of others. She had been feeling exhausted from complex emotions from dealing with people close to her, "spending too much energy." Nori had a very inquisitive mind and was known for always looking for self-cultivating opportunities.
Therapy Process
(Below note is extracted from session reports by Kyungpoon Ha and my feedback)
Session 1
At her first session, Nori was very expectant, enthusiastic yet nervous about "finding myself."
The session was focused on this positive imagery of her being expectant, excited of starting something new. She drew while listening to music.
Nori felt a sense of freedom and refreshed after working on this.
The therapist asked Nori to listen to music that would provide such regenerative energy.
Session 2
Prelude:
Nori started dating recently and difficulties with her boyfriend made her start to notice certain patterns of her relationship with others.
She always had been patient and had been in a role of a carer for her friends. She felt others often took her for granted and did not respect her enough. She recognized that pattern again in her new relationship with her boyfriend and it bothered her greatly.
Transition/Chosen positive imagery:
When asked to choose a positive experience to work on, Nori chose the moment when she felt acknowledged and accepted by her group therapy members listening to her with warmth and full support.
Induction:
The therapist led Nori to fully engage in the feeling of being accepted and supported by the group to prepare for music and imagery work.Music/Imagery (MI):
While listening to Bizet's Intermezzo from Carmen repeatedly, Nori drew a girl, herself, walking barefoot on the forest mountain.
Postlude:
Nori felt free and comfortable from the Music and Imagery work. The picture contains things she loves: feeling the soil with her bare feet, fresh air in nature, trees (symbolizing her friends). The girl is happy and enjoys being with all her surroundings in this space. The girl is Nori herself and Nori felt affectionate toward her.
In this session, by focusing on the positive experience of being heard and acknowledged by her peers, Nori acknowledged her inner self and heard what she desired.
Session 3
Prelude:
Since session 2, Nori had felt much better and easy even though the external situation had not changed. Nori had reflected upon the girl in Session 2, putting her drawing on her desk for over 2 weeks. Nori felt the positive image helped her with emotional strength, which led her to be more accepting with people around her and comfortable with her inner conflicts, which still existed. Nori felt the girl (in the drawing) was getting mature.
Transition/Chosen positive imagery:
The deep appreciation of music and nature Nori felt from her recent excursion.
Induction:
Nori was reminded of the experience on the small island she had visited recently: fresh breeze, the suns reflection on the green leaves, and the feeling of being deeply engaged with nature.
Music/Imagery:
The music: Daniel Kobialka, The water is wide from Going Home Again, played several times while Nori drew.
Postlude:
Nori felt great after the work, especially about the center of the drawing.
Nori had been looking for this place for long and she found it in herself. This was a safe and peaceful place to meet a girl who lived happily and freely. Nori roamed around with bare feet freely, shouting out, being playful, enjoying the fresh air, and yet was able to rest in this place.
She felt gentle, lovable, free and confident in this place.
Nori started feeling stronger by reflecting on the girl from session 2 and introjecting the positive experience of the girl: being free with herself, playful and happy. She felt more true to this girl and the wounds she had had were now fading.
Session 4
Prelude:
Nori had been content and feeling peaceful by actively integrating the imagery and music from session 3.
She had listened to a variety of music and reflected on the imagery from session 3. It helped Nori to be calm and relaxed in dealing with conflicts in her daily life. Nori also started praying regularly to reflect on her inner struggles towards her boyfriend.
In contrast to being calm, she was very tired and not well physically.
Transition/Chosen positive imagery:
"Feeling lively, full, confident and a mature 'me' while working with my child client at work."
Music/Imagery:
Music: Daniel Kobialka, Wild Mountain Thyme from Going Home Again. It was played several times while Nori drew.
Postlude:
Nori was tired and wanted to rest as she was listening to the music. After listening to it several times, Nori had this imagery: a boy plays with soil. Nori felt "great" after drawing this and loved the boy and the soil.
The boy is content and brave playing in a vast field alone, not needing his mom, nor worrying about anything.
Ha let Nori feel the soil as fully as possible when listening to the music again.
Ha supported Nori continuing to listen to music in her daily life.
Nori acquired a sense of containment and self-assuredness from actively integrating the free spirit of the girl and from the use of supportive music in her daily life. This led her "feeling lively, full, confident and a mature 'me'" and the toddler boy, her confident autonomous self, appeared.
Session 5
Prelude :
Nori went walking barefoot in the mountains with a group of people. She tried to use the Supportive Music and Imagery method at home: listening to music and drawing at home. She drew a person who is brave and walks alone in wild nature. She imagined an eagle that is "courageous and doesn't give up." Nori still has conflicts with her boyfriend. But she showed great insight by saying: "The child in me is angry as its needs are not met. Instead of nourishing the child in me, I keep demanding it from my boyfriend."
Transition/Chosen imagery:
Nori felt very satisfied from the SMI sessions as she rediscovered her inner strength. Nori feeling full and ready like the high tide of the ocean in the evening with sunset.
Music/Imagery:
Music: Shaina Noll, Peace Be With You from Songs for the Inner Child
Postlude:
Nori enjoyed playing freely with the clay pack. It reminded her of her experience on the mountain. Nori had the greatest fun when she remembered the girl from session 3 and made a playground for her. The playground was a special place that one could come in invited over the low fence. Nori reflected on her inner child who was isolated and got angry as she didnt know how to express her desire to be with and to communicate with others. Nori was a little anxious if the space would be safe enough yet she wished to be with someone in this space.
Nori's sense of confidence has been heightened. She is cautious yet is ready to lower her defenses (fence of playground) to welcome people selectively in her playground. She now is in charge of regulating, defending her psychological space.
Session 6
The overall process of the therapy was reviewed. Being at the last session, Nori expressed how she felt and how the experience from the Supportive Music and Imagery has affected her. Nori felt confident, acceptant and expectant of her future whatever it may be. These feelings of hers were well expressed through the eyes of the boy in her drawing.
Her confident self now is in action for the future.
Summary of the Case:
Nori was under emotional stress around the time she started this therapy. She was exhausted from being overly conscious of and sensitive to people close to her.
Rather than focusing on external stressors, Nori was able to discover and explore her healthy inner child by redirecting her focus to herself and her positive resources. Both girl and boy represented her unspoiled inner self, totally at ease in unspoiled nature: soil, forest, and the open wild field.
The positive images she experienced in the Supportive Music and Imagery sessions were full of nurturing that her inner child needed. In contrast to her hypersensitivities with people and her surroundings, the girl and the toddler boy were free and confident - enjoying themselves without worrying about any external aspects at all. By fully feeling how much fun it was to be free, engaging in what she loved, experiencing a fully self-absorbed confident me, Nori was nourished and discovered her healthy inner self. The girl was interactive by being more in tune with her surroundings and the boy was totally self-contained and absorbed in enjoying himself. By having them both come back throughout the sessions, a healthy psychological balance emerged. The girl became the focal importance, claiming the ownership of her space (inviting others to HER space, the playground) while the self-absorbed happy boy became aware of the other (butterfly).
By reflecting on her inner self, she understood the source of her emotional strain from her relationships with others. She realized that her longing for respect and nurturing from her boyfriend (or any close relations) was the longing of her inner child who needed to get respect and nurturing from Nori, herself.
Toward the end of this case, I remember how Nori changed from being timid and overly polite to becoming more confident of herself, becoming more lively and more able to express her needs.
Conclusion
I introduced cases of clients with different backgrounds and situations. In each of these Supportive Music and Imagery cases, the client discovered how to work with his/her positive resources.
The fully empathic attitude of the therapist and the supportive approach of the method allowed Hana to become less guarded and to come to appreciate herself and her family. Supportive music became an adopted guardian, a source of nurturance for Su. Positive imagery allowed Nori to rediscover a healthy child in herself. All felt safe and comfortable within the contained Supportive Music and Imagery structure. Each of them was able to internalize the positive qualities of their positive resources and utilize them to enhance their inner strength.
The power of Supportive Music and Imagery work comes from deepening the feeling and experience of the positive imagery rather than from intellectual analysis -- by focusing on internal experience rather than external matters. No matter how small a positive resource one may have or one may feel, Supportive Music and Imagery supports the client to recognize and value his/her positive resource and eventually to appreciate one's healthy self.
Responses from Clients
My Experience as a Client of Supportive Music and Imagery Therapy
By Music Therapist Nori
It had been a great experience for me to take Supportive Music and Imagery therapy. It was meaningful and had positive impact on my life. I would like to tell you what it meant for me as a client in Supportive Music and Imagery therapy.
First, I found that I have strength to endure and get over any difficulties. It was emotionally strenuous for me to deal with the conflicts with my boyfriend back then. This work made me discover and trust my inner strength to go through that conflict instead of being emotionally overwhelmed. I could be expressive of my emotions, knowing it is safe to do so, and I was able to act decisively towards my boyfriend.
Secondly, I enjoyed and was happy meeting my inner self through the Supportive Music and Imagery experience, especially from session 2 and 3 on. The wounds I had had no longer felt painful. Instead, I realized those wounds were a part of the process of finding myself and becoming healthy. I realized what was very precious to me. It had been such a long journey to reach where I was.
Third, I used to get easily withdrawn and had a lack of self-confidence when I started this therapy. As I experienced my inner positive imageries, I began to unfold my crumpled (creased) mind, found my strength and became confident. The confidence from acknowledging and accepting my strength, the joy of meeting positive images, the natural and carefree attitude of the barefoot girl and the solid boy that I experienced in my sessions, all influenced me to live with more confidence. Those images offered me a strength that never gets discouraged, nor gives up but perseveres. As I played safely with the boy and girl in my sessions, I was able to make a safe playground with a low fence to allow people to come in (session 5). At the same time I could choose what I wanted without being too concerned about others and I could laugh out loudly and brightly "HaHaHa."
Reflection as a Therapist: Use of Music in Self-reflected Music and Imagery
By Kyungpoon Ha
Overall, I had a great "Aha" experience in two aspects from this case: First, it led me to an awesome experience of getting in touch with my thoughts, feelings, and emotions through music. The other, I truly learned how to conduct the Supportive Music and Imagery therapy as a music therapist. This experience and learning were the result of my self-reflected Music and Imagery work while dealing with Nori's case and being provoked by many questions and feedback from supervision.
I have a tendency to follow external conditions and situations and I respond to them very quickly and directly. Meanwhile I tend to be rigid and not able to relax internally. I always have been preoccupied with accomplishing a product fast and I am satisfied only when I can see and touch the product. Most of the time, I never question my activities, such as, "Is this what I truly want or not?" "Must I do this now?"
As I conducted Supportive Music and Imagery therapy, I realized that these characteristics/tendency cause problems. First of all, I had a sense of burden that I must do something for my client yet I wasn't too sure how music would help the client. Thus, instead of being open, I often was intrusive and overly analytical aiming at a certain direction I wanted to drive. Or to be supportive as a therapist, I felt I needed to hear
I was quite annoyed by written feedback from my supervisor in which she constantly asked many questions such as "Why do you think so?", "What made it uncomfortable for you?", "How do you feel about it?", "Why...?" My supervisor always asked me to feel and have reflection work with music before and after each session.
I carried on doing Music and Imagery reflection work on my own according to the instruction given by my supervisor. I started with checking my current feeling and emotions and chose music that reflected it and listened. Sometimes I drew as well. Whenever I needed to, I tried the method and I found that there are many different feelings in music depending on how I use it. The experience was different between simply listening to my favorite music and listening to music while reflecting on my feelings / emotions. Often, during self-reflective Supportive Music and Imagery work, I experienced the positive energy from the vitality of the music. I found myself being content and relaxed in music. And that led me to allow myself room to relax and to be confident about myself. From this positive experience, I discovered my changed self and I began to trust music.
Three and four days before each session, I thought of Nori while reading the previous session report and my supervisor's feedback. Then I worked on Music and Imagery self-reflection to "clear up myself." The day before the session, I selected the musical pieces while reflecting on Nori. The trust I gained toward music made it easier for me to do this process. After the session was over, I had enough time to reflect while writing the session report, thinking of Nori, the session and my previous supervision notes.
After repeating this process, I made an awesome discovery about myself and that influenced Nori as well, I believe. Acquiring the ability to be content and relaxed through music and imagery work allowed me to be confident with and trust myself. My comfort and trust in music allowed me to trust Nori -- trusting that she would have benefits from music effected how I conducted the sessions. She had a positive experience in rediscovering herself by loving herself and providing herself with new energy through Supportive Music and Imagery work.
I gained self-confidence and trust in myself through self-reflected Music and Imagery work. The comfort and composure I felt in music made me trust music and my way of using music to support Nori as a music therapist. I also came to trust Nori. I learnt that I do not have to do something for her but trust her to find her inner resource herself. I learned that the client gains positive experience when I am open and trust myself, music, and my client.
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