An Overview of Research in the Bonny Method of Guided Imagery and Music
By Denise Grocke
From the very beginning of the development of Guided Imagery and Music (GIM) at the Baltimore Psychiatric Research Center in the 1970s, Helen Bonny was interested and involved in research. One of her first studies was a comparison of individual GIM sessions and verbal therapy in which she found that those who received GIM worked through issues more quickly than those receiving verbal therapy (cited in McKinney, 2002).
Bonny’s colleagues at the Centre included Stanislav Grof and Joan Kellogg. In the 1970s Bonny collaborated with Kellogg on a study that compared the imagery in GIM with the form and structure of mandalas drawn at the end of the GIM session (Bonny & Kellogg, 1977/2002). She also published with Walter Pahnke (Bonny & Pahnke, 1972) about altered states of consciousness, and a detailed account of using music with LSD. They associated specific selections of music with the six phases of the LSD experience. This research is particularly important because it created the basis upon which Bonny subsequently devised her music programs. Later, she conducted a study of music listening in coronary care units that followed from her own personal experience of being hospitalized documenting the healing properties that music provided to her at that time (Bonny, 1983; Bonny & Latteier, 1983).
Research in GIM has therefore been at the forefront of the development of the method. There are numerous research methods that can be utilized in studying the Bonny Method of GIM; and these are commonly grouped into quantitative methods and qualitative methods. More recently researchers have been blending these approaches into mixed methods studies, and others have explored ways of analyzing the role and function of the music as a catalyst for imagery and shifts in imagery experiences.
Three questions guide this review of research literature: 1) Why do we do research? 2) For whom do we do research? 3) What sort of research do we do?
In answer to the first question, many of the studies reviewed here are Master’s degree studies or PhD studies. This is not surprising as those who come into GIM training must already be qualified therapists bringing with them their inquiring minds. As for whom we do research for, the answer is easy: We do research for our clients in order to serve them better and to demonstrate the efficacy of GIM to professional colleagues through publications. As for what sort of research do we do, our research has been positioned within different paradigms:
- Quantitative studies, and mixed methods
- Modifications/adaptations (including groups)
- Qualitative studies, and
- Studies of music, involving music analysis
First of all, we must ask the question: How much research is there? The reader is encouraged to access the GIM data-base developed by Lars-Ole Bonde (introduced in this issue of Voices). There you will find more than 800 articles, chapters, unpublished writings, recordings and videos about the Bonny Method of Guided Imagery and Music.
In this review of research, various terms are used to refer to the individual 1.5+ hour GIM. Some researchers use the acronym GIM to refer to the individual session, whereas other researchers used the acronym BMGIM, indicating the Bonny Method of Guided Imagery and Music, a longer term introduced to delineate the Bonny Method from other forms of GIM. In this review the acronym used in the original publication will be used, and the type of session will be clarified.
1. Quantitative Research and Mixed Methods
GIM research has benefitted from studies done by research teams, particularly Dr Cathy McKinney and her colleagues Antoni, Kumar, and Kumar in the US, and the Swedish research team of Bjorn Wrangsö and Dag Körlin.
Preliminary Studies of Music and Imagery
Studies on healthy participants are essential in order to establish a model from which to compare studies of people with disorders/disabilities. It is a well-known principle of quantitative research that one researches the simple before moving to the complex. Dr Cathy McKinney’s earliest studies researched components of the GIM session to isolate aspects of the experience. First she studied the effect of a short piece of classical music (Vaughan-Williams’ Rhosymedre) in evoking spontaneous imagery in groups of participants (McKinney 1990). The subjects were 81 college students who had either music or silence following a physical relaxation induction with an image focus. McKinney found that the music used had no effect on the number of senses, types of imagery, vividness of the imagery, activity of the imagery or percentage of time engaged in imagery. The music condition however significantly increased the intensity of the feelings experienced (p = .003).
Next she investigated the effects of two different pieces of music on the imagery of two groups of subjects who were either low imagers or high imagers, as measured on the Creative Imagination Scale (McKinney and Tims, 1995). Both pieces of music increased the vividness and activity of the imagery for the high imagers, but not for the low imagers, the latter being more likely to experience feelings of relaxation with the music, rather than visual imagery. This study has implications for GIM research – it poses the question: Should we assess participants imaging capacity on entry to a study?
“Healthy” Participants Receiving Individual GIM Sessions
McKinney, Antoni, Kumar, and Kumar (1995) investigated the effect of GIM on levels of depression and beta-endorphin levels in eight healthy subjects, who were randomly assigned to either the experimental condition (GIM) or a wait-list control condition. The participants in the experimental group had a series of six weekly individual GIM sessions. Their moods were measured pre and post the series using the POMS (Profile of Mood States). The experimental group demonstrated lower scores on depression than the control condition. There were no significant differences however between the groups on levels of beta-endorphin activity.
In a further study conducted by McKinney and colleagues (1997), cortisol levels were measured before and after a series of six bi-weekly (fortnightly) individual Bonny Method GIM sessions and at 6-week follow-up. Cortisol is a hormone that effectively indicates levels of stress. 28 participants were randomly assigned into the experimental condition (six GIM) sessions, or the control group. The control group was wait-listed – they had GIM sessions once the data had been collected. Mood was assessed on the POMS (Profile of Mood States), and blood samples measured cortisol levels. Those in the GIM group showed reduced total mood disturbance (TMD), depression, fatigue, and lower cortisol levels. Importantly, these indicators were still significantly reduced seven weeks after the end of the study.
Wrangsjö and Körlin (1995) studied the effect of individual Bonny Method GIM sessions on 14 adults (aged 19-63), 10 of whom were rated as healthy and four who had mild to moderate psychiatric disturbance as measured by Hopkins Symptom Checklist-90. Participants had a varying number of GIM sessions, depending on the individual’s need. They reported a decrease in psychiatric symptoms (measured by HSCL-90) and interpersonal problems, and a significant increase in the participants' experience of life as more meaningful and coherent (measured by Antonovsky's Sense of Coherence Scale).
In a further study, Wrangsjö and Körlin (2002) grouped 30 participants into two groups based on scores on the Hopkins Symptom Checklist-90: functional (n = 20) and dysfunctional (n=10). Following a series of GIM sessions, 6 of the 10 people in the dysfunctional group improved sufficiently to be re-grouped into the functional group. For the total scores (n=30), Wrangsjö and Körlin found significant improvement particularly in areas that are typically hard to treat, such as managing anger. They argued that GIM is effective because it draws on the person’s inner resourcefulness to face issues, rather than in verbal therapies where the client relies on the therapist for guidance.
Assessment in GIM/BMGIM
Several recent studies have addressed the importance of assessment. Bruscia (2000) developed a scale to determine suitability of the Bonny Method of GIM for clients. The scale captures “ability” on each section of the GIM session and gives a total score. The scale was tested for validity and reliability by Meadows (2000).
Scott (2007-2008) studied individual differences in a single Bonny Method GIM session. Using the Manifest Anxiety Scale, 30 participants were grouped as either Sensitizers (n = 10) or Repressors (n = 10). There was also a control group (n = 10). Sensitizers and Repressors are identified as styles of coping strategies for anxiety. Participants were all given one GIM session using the Caring program. Imagery responses, called process variables, were scored as either positive or negative on: Affect; Memory; & Recognition of self. Other responses were: Transcendent; Body; and Messages. Results showed that Repressors’ imagery showed fewer positive affect responses, fewer negative affect responses and fewer memory scores than Sensitizers, who showed higher anxiety, although post session it had lessened. Levels of state anger decreased across both groups. Scott (2007-2008) explains that Repressors tend to not do well in psychotherapy. For example, five of the 10 had no issue to work with when they attended the session, but three engaged with emotional responses in the single session indicating music breaks through defenses. The Sensitizers on the other hand had no difficulty in identifying an issue for the session.
Medical Conditions - Hypertension
GIM has also been studied for efficacy in treating different medical conditions and illnesses. The earliest study was conducted by McDonald (1990) who examined the effect of GIM on hyper-tension. 30 participants (aged 21-75) were assigned to one of three groups:
- Six individual GIM sessions
- Six verbal therapy session
- No therapy
Blood pressure was measured prior to the sessions, weekly throughout the treatment phase, at the end of the therapy session, and again 6 weeks after the end of the sessions. The mean systolic and diastolic measures were used as data. Those in the GIM condition had significantly lower diastolic as well as systolic blood pressure than those in the other groups. Diastolic blood pressure reduced during the series of GIM sessions, whereas systolic blood pressure (which responds more slowly) reduced in the weeks after treatment.
Jacobi and Eisenberg (2001-2002) investigated the efficacy of the Bonny Method of GIM in the treatment of patients with Rheumatoid Arthritis (RA). Twenty-seven patients received ten individual GIM sessions. Data were collected on medical measures including erythrocyte sedimentation rate [ESR], an indicator of disease status, walking speed, joint count and perception of pain intensity, and general psychological status including mood, symptoms of distress/anxiety and “ways of coping.” Statistically significant results were found on lower levels of psychological distress and subjective experience of pain. Statistically significant differences were also found for walking speed and joint count. There were no statistically significant results however in disease status, and the authors argue that a longer period of treatment with GIM may be indicated for changes to occur in disease indicators.
Three studies have investigated individual Bonny Method GIM sessions for cancer patients. Debra Burns conducted a controlled study on the effect of GIM on mood and quality of life of cancer patients (Burns, 2001). There were 8 participants (4 in the treatment group, 4 in the wait-list control). The participants in the treatment group received 10 individual GIM sessions, and results showed significantly better scores on mood and quality of life in the group receiving GIM immediately when compared to the group who were waiting. The scales were the Profile Of Mood States [POMS] and the quality of life-cancer [QOL-CA] scale. In addition, mood and QOL-CA scores continued to improve after the post-test. However, it was a small study with only 8 participants.
Bonde (2004) studied the effect of individual Bonny Method GIM sessions on women recovering from breast cancer. The six women received 10 individual GIM sessions and anxiety and depression were measured on the Hospital Anxiety and Depression Scale (HADS), and quality of life on the EORTC-QLQ-30. Antonovsky’s Sense of Coherence Scale (SOC) measured meaningfulness and coherence in life. They were also interviewed about their experience of BMGIM. There was no control group in Bonde’s study, but he found significantly reduced anxiety scores from pre-test scores to follow-up (week 17) for the 5 of the 6 women in his study, and the effect size was large. Depression was reduced for 2 of the 6 women but not at a significant level. Scores on the EORTC-QOQ-30 indicated increased level of function and quality of life, and a decrease in symptoms, but not at a significant level. Bonde also interviewed the women re their experience (the qualitative component) and found that the imagery was very meaningful for the women, but was not related to their cancer. Instead the imagery was related to more global aspects such as self-understanding, and healing experiences related to their whole life.
A third cancer study (McKinney & Clark, cited in Bonde, 2007) investigated the effect of individual Bonny Method GIM sessions for women recovering from non-metastatic cancer. The women received six GIM sessions bi-weekly (6 over 12 weeks). Measures were taken on distress, quality of life, and endocrine markers. GIM reduced depressed mood and total mood disturbance, increased emotional and social well-being, decreased intrusive thoughts and avoidance behaviors. But these results were not sustained after 6 weeks. The authors suggest that 10 sessions may be needed for gains to be sustained.
A critical issue in a research agenda for GIM is to begin to recognise adaptations in a more systematic way. Currently anything other than the traditional 1.5 hours individual session can be referred to as a modification or adaptation of GIM. No other therapeutic method is restricted by such devotion to a single approach. In music therapy there are recognised schools of improvisation, each with it’s own theoretical framework, applications, techniques, and evaluation methods. It is crucial that there is some uniformity in how we refer to studies that involve modifications. Adaptations can be segments of a GIM session – for example, relaxation and music: relaxation and music and imagery/visualisations (no verbal interventions).
In Muller (2010)’s recent survey of current practices in Guided Imagery and Music, 107 GIM therapists 88 females (84%) and 17 males (19%) responded to an anonymous survey about GIM practice. Common modifications identified were:
- Length of session
- Length of music component of the session
- Choice/selection of music
- Verbal dialogue and guiding
The most common modification was to shorten the session, and therefore shorten the choice of music. About half of responding GIM fellows offer shorter sessions: 1) shortened traditional programs by eliminating pieces (86% of respondents); 2) used short programs designed by others (80% of respondents); 3) designed their own short programs beforehand (72% of respondents); and 4) programmed the music extemporaneously within the time frame (60% of respondents). When choosing music extemporaneously/designing new programs, 88% of the respondents to the question chose classical music "often + always." Other options were movie (14.6% often), world (6.4% often), and new age (8.2% often).
The Association for Music and Imagery (2008) found similar results in their survey of GIM Fellows. GIM Fellows were invited to complete the survey and there was a 80% response rate. 83% of respondents reported using group music and imagery sessions; and 77% used short, individual sessions. 70% reported using non-classical music.
In Muller’s (2010) survey, modifications were also made to verbal dialogue and guiding including more than 25% of respondents reported “sometimes” or “often” having the clients sit in an upright position during the music imaging. As well, 10% have clients image with their eyes opened “sometimes” or “often.” In addition, 25% of respondents reported at least “sometimes” introducing an image to the client during the music imaging (p. 104). Directive Guiding Techniques were used seldom (42.9% of respondents) or sometimes (24.7% of respondents).
Modification to Individual Sessions
Martin (2007) used modified GIM with five University students who identified as having music performance anxiety (MPA). She used standard measures of performance anxiety including the Kenny Music Performance Anxiety Inventory, the Cox-Kenardy Performance Anxiety Questionnaire, and a Social Phobia Inventory. Martin devised a series of six modified GIM sessions with a set theme for each. Outcomes demonstrated a trend for decreasing MPA, however, a longer period of GIM was thought necessary. Martin also interviewed participants and found rich data including images of mastery, relaxation, interesting symbols of strength or protection, barriers or walls that transformed and significant colors.
Group GIM and Psychiatric Disorders
Modifications to the traditional individual session of 1.5+ hours are required when working with people who have poor ego boundaries (Summer, 1988). Those with severe mental illness, for example, are particularly vulnerable and modifications are made to the length of session and the mode in which therapy is offered.
Moe (Moe et al., 2000; Moe 2002) studied “restitutional factors” for people with schizophrenia and schizoid conditions in a Group Music and Imagery (GMI) research project. Each GMI session had three phases: 1) a preliminary conversation with the group; 2) short music listening experience commencing with 2 minutes of relaxation and some guiding during the music; and 3) a closing conversation. Patients listened to 10 minutes of music either lying or seated in a chair. Typical selections were Pachelbel’s Canon, Beethoven 5th Piano Concerto slow movement. Patients were able to share after the music was over.
Nine patients participated in 23-32 sessions over approx 6 months. Seven of the nine improved on Global Assessment of Function (GAF) scores, with an average score of 36.5 before sessions commenced and 42.0 post the end of sessions. Questionnaires also indicated music and imagery were rated as highly important, as was the relationship with therapist. Eight of the nine felt supported and attendance was 98%. Patients were also asked to select a card representing an emotion after each session. Six of the nine patient’s first and second choice was consistently positive.
Moe (2002) also discusses the widely accepted view that individual GIM is not appropriate for people with psychiatric disorders. He believes group GIM falls in a space between external and internal world, which therefore “meets the client” exactly where they are. The music therefore may express a core emotion of self and “because the music contains both concrete and abstract elements, the patients are promoted in their imaginary treatment of themselves, which makes it possible for them to experience their lives in a new way . . . and thereby understand themselves better” (p. 154).
Qualitative research methods are used in GIM research to capture the “essence” of the therapy, to describe the symbolic meaning found in the imagery and to understand the interactive process between the client, the music and the therapist.
The most appropriate research methods that explore these qualitative experiences are: single or multiple case studies (narratives), therapist’s studies of client experiences (interpretational research), including studies that are hermeneutic phenomenological, based in grounded theory, and heuristic studies. Examples of these studies are presented below.
Much of the early research in GIM was written in the form of single (individual) case studies. This may have been due to the Association for Music and Imagery's requirement that advanced level trainees write a case study with a minimum 10 sessions. Many of these case studies published in the Journal of AMI are written from the authors/therapist’s perspective, where the therapist organizes the information to show the client’s development through "embedded analysis" (Creswell 1998, p. 63). The embedded analysis in GIM case studies may include symbolic changes in key images, in recurring patterns of imagery sequences, or through transformation of imagery or emotional responses.
Case studies may explore therapy for one client (an intrinsic case study) or they may describe several clients who have an aspect of common need (a collective case study) in which the commonalities between these clients are identified. Case studies may also provide knowledge about particular client issues (i.e., particular disorders, illnesses and symptoms) developing our understanding of different theoretical constructs underlying GIM practice (Gestalt, Jungian, psychoanalytic).
A number of case studies published in Inside Music Therapy (Hibben, 1999) have explored the GIM process from the clients’ perspective as expressed in personal narratives of the clients (Buell, 1999; Caughman, 1999; Erdonmez-Grocke, 1999; Isenberg-Grzeda, 1999; Newel, 1999; Schulberg, 1999).
Case studies however do not generally have a research question, but instead have a descriptive clinical focus and a structure that demonstrates the intention of the GIM therapy. The typical structure of the case study is: background on the client's history and presenting issues; goals for the GIM series; synopsis of key sessions with interpretation of the imagery and outcomes of the therapy in relation to the client's issues or goals.
Many GIM case studies draw on Jungian or Gestalt theory to interpret the meaning and context of certain images and imagery sequences in a client's GIM sessions.
Brooks’ (2000) study of anima imagery in male clients is an example of interpretational research in which a theory or construct is used as a basis for analyzing the clinical material. Brooks studied the transcripts of four male clients and analyzed the material according to how much the "anima" had been integrated. She examined and compared all references to women (real and imaginary) in the client’s imagery and the session discussion material and further analyzed positive and negative attributes in terms of whether the male client claimed the same qualities in himself.
Kirstie Lewis’ (1998-1999) study of transpersonal matrix is another example of a hermeneutic study, in which she placed her findings alongside Wilber’s Spectrum of Consciousness. Lewis reviewed 128 GIM session transcripts and categorized the experiences described. Eight themes/categories emerged:1)Body changes, 2) Past life/other psychic, 3) Light/Energy, 4) Deep Positive Emotion, 5)Archetypal/Spiritual, 6) Wisdom, and 7) Unitive experience. Lewis then related these to Wilber’s Spectrum of Consciousness. All categories fell in levels 5-9, with none below 5, indicating all experience were in the higher realms of consciousness. Lewis also ranked the music programs according to transpersonal experiences of the clients. The first six were: 1) Peak, 2) Mostly Bach, 3) Quiet Music, 4) Grieving, 5) Positive Affect, and 6) Nurturing.
Client experiences of the music in the Bonny Method of GIM were explored by Abbott (2004), using a phenomenological framework. The aims of the study were 1) to narrate client’s positive and negative experiences with the music in GIM and how those experiences affected them; and 2) to systematically analyze the narrations to describe similarities and differences. Twelve participated (nine female; three male), four had up to 24 sessions, six had 25-49 sessions and two had more than 90 sessions. The opening question asked them to reflect on “negative” experiences with the music. Interestingly the participant objected to the word “negative” saying that experiences that were challenging were often turning points in their therapy. They had no difficulty in reflecting on "positive" experiences with music however. The positive experiences were seen as desirable, helpful, or supportive. Sometimes the music changed the way clients felt about something. As the experience came to a close clients continued to image, or to have greater insight into the way they related to themselves and others.
“Negative” experiences with the music were described when the music was incongruent with their experience or had an undesirable or uncomfortable effect on them. As the client became more involved in the experience they tried to accommodate the music by using strategies to help. One was to reject the music and another to openly relate it to the imagery. Occasionally clients couldn’t relate the music to themselves at all. These experiences either ended with clients changing their strategies for coping with the music or continuing to view the music as incongruent.
In a later study, Abbott (2007-2008) explored therapists’ role within Bonny Method GIM sessions. She commences her study by pointing out there are no studies about how GIM therapists make decisions within the session nor about the intentions that underpin those decisions. She videotaped six GIM therapists while they were conducting a session then interviewed them about their intentions and experiences. Abbot used a phenomenological process to determine themes for each phase of the GIM session:
- Managing therapist-client relationship by fostering the relationship; being there for the client; maintaining the relationship; and maintaining appropriate boundaries
- Understanding the client through understanding issues; assessing readiness to work; and understanding main therapeutic issues
- Focusing and containing the client’s work by creating the structure; preparing to engage the client; and maintaining structure for client’s self exploration
- Helping client engage in therapeutic work by guiding in the here-and-now; helping image creation; guiding to deep self-exploration; and helping clients in growth and healing
Pivotal Moments in BMGIM
Another phenomenological study was Grocke’s (1999) exploration of pivotal moments in BMGIM. In the therapy literature, significant sessions or moments are referred to as "significant", "key", or "critical" moments. Böhm (1992) calls them "turning points" when there is “a momentary sudden change in quality, depth or direction . . . (as) if a metaphorical new door to a new unexpected room is opened” (p.675).
Data for the pivotal moments study was collected from:1) Interviews with clients about pivotal moments in their GIM experience, 2) Interviews with the therapists about their perceptions of those moments identified by the clients as being pivotal, and 3) Analysing the music that underpinned the clients’ pivotal moments. Seven clients volunteered to participate in the study, three male and four female. Three of the female participants and two male participants had experienced many GIM sessions. The remaining two participants (one male and one female) had been clients in GIM therapy for a short number of sessions (6-10).
From the seven client interviews, twenty themes emerged. Pivotal moments were (in part):
- Remembered and described in vivid detail
- They were emotional and embodied experiences
- They impacted on the person’s life
- Clients had insight into the meaning of the pivotal moment
- The effect was lasting
- The therapist’s presence, or interventions, or silences were important to the pivotal experience
- The pivotal experience often followed unpleasant feelings or images which were uncomfortable, unpleasant or horrible
Two GIM therapists were interviewed about their experience of witnessing the pivotal moments of their clients. From the therapists interviews 14 themes emerged, and these (in part) were:
- The therapists remembered the session identified by their clients as pivotal and also identified other sessions which they thought were pivotal
- The client’s pivotal experience was an emotional experience for the therapist and the therapists anticipated pivotal moments occurring
- The therapists noted observable changes in the client’s body language during a pivotal experience and intentionally intervened to facilitate the pivotal moment but they were often silent during the precise moment
- The therapist intentionally intervened to facilitate a moment which was pivotal
- The therapist felt time was suspended during a pivotal moment
A recent study (Lin et al, 2010) has reported on pivotal moments and changes in patients with depression. The study conducted in Taiwan interviewed five patients after each of eight BMGIM sessions. The forty transcripts were analyzed and coded into themes using a phenomenological process. These were: 1) pushing aside a barrier; 2) gaining new insight; and 3) moving forward. Meaningful moments were coded as releasing mind-body rigidity, awareness and inspiration, acceptance and inner transformation.
A Semiotic Study of BMGIM
Short, Gibbs and Holmes (2010) studied the symbolic meaning of words found in the transcripts of six clients who had undergone complex cardiac surgery and who had received up to six Bonny Method GIM sessions. Text from a total 31 sessions was used in the analysis. Short et al looked for meaning in the words of clients relative to their life story. For example, one participant mentally played a game of golf, imagining the difficulties he might encounter. Findings indicated that semiotic analysis has the capacity to integrate all aspects of the GIM therapeutic session and deliver a depth of experiential meaning relevant to the therapeutic management of clients’ post-surgical recovery.
Discourse Analysis of Metaphors in Bonny Method GIM Sessions
In Zanders’ (2008) study, nine participants, including the researcher as a participant, were chosen for interviewing. The participants were all music therapists and involved at varying stages of Bonny Method GIM training. Participants described their general view of GIM sessions before being asked for specific metaphors for each component of the session. A discourse analysis was then used to discern titles. Participants’ metaphors (in part) were:
- Prelude: An open wound , testing the water, sharing an internal space, a whirlwind, yoga scanning, talking with a friend, and cleaning out a closet
- Relaxation induction: Shutting the door, threading a needle, support of the earth, being connected, a mirror turning inward, and getting ready for the journey
- Music-imaging: A roller coaster, a tunnel, a story, a surrender, being in the cosmos, and quick sand
- The return: Space of silence, floating, a marking of change, another kind of knowing and coming back home
- Postlude: Piecing together a puzzle, a web/tapestry, someone agreeing with me, and waking up
A Study of Gender
How therapists relate to a client’s gender is a crucial dynamic in the development of the therapist-client relationship. Meadow’s (2002) studied gender implications in GIM therapists’ constructs of their clients. Eight Bonny Method GIM therapists compared ten client transcripts. Therapists used their own terms and language known as constructs to describe and compare clients. Therapists entered pseudonyms for 10 clients (5 male and 5 female), and the computer randomly selected groups of 3. Therapists used short phrases to describe how two clients were similar and the third different. Then therapists rated all ten along the continuum. The therapist continued with this process until all constructs had been exhausted. Once constructs were exhausted, therapists added two further constructs: male-like and no-male like and female-like and no-female like. Therapists could then view the overall map, and correct any aspect. An example given by Meadows is as follows:Aaron saw male-like clients as less engaged, resistant to guiding and intellectualising, where as he saw female-like clients as engaged, open to guiding and less reflective. Greg saw male-like clients as having a non-biographical process and being dominant in the therapist-client relationship, whereas female-like clients were emotional and having a biographical process.
Meadows (2002), concludes his article by commenting “If there are male-like and female-like qualities in clients, it is plausible that there are male-like and female-like qualities in therapists.” These qualities may impact on whether clients seek male or female therapist for psychotherapy.
Therapists Perceptions/Analyses of Client Imagery
In Bonde’s cancer study (reviewed above under quantitative research), he also interviewed clients about their experiences. He used a grounded theory analysis that included an initial open coding of themes, followed by axial coding of themes into categories (Bonde, 2007). Core categories were that the women experienced:
- New perspectives on past, present and future
- Enhanced coping
- Improved mood and quality of life
- Enhanced hope
- Improved understanding of self
- (New) love of music
Therapists’ Transpersonal Sessions
Abrams (2002) sought to define transpersonal moments in Bonny Method GIM using a computer-assisted program Rep-Grid. He interviewed nine GIM therapists on three occasions. In the first interview the therapists identified sessions from their own travels with BMGIM that they considered to be transpersonal, and those that were not. In the second interview, Abrams facilitated the therapists in identifying comparisons and inter-relationships between the sessions that were transpersonal and those that were not. Finally, in the third interview a definition of what was transpersonal was developed for each therapist.
A ground-breaking heuristic study was Bruscia’s (1998) study of modes of consciousness during a Bonny Method GIM session. Bruscia delineated different worlds of consciousness that he entered into (as therapist) during a GIM session: the clients world, the therapist’s personal world, and the therapist’s therapist world. He identified four levels of experiencing (as a therapist):
- A sensory level whereby the therapist "senses" what is happening for the client through his own body;
- Affectively, where the therapist can identify feelings and emotions which are aroused by what is taking place for the client;
- Reflectively, where the therapist tries to integrate meaning out of the sensory and effective experiences, and
- Intuitively, a level of spontaneous response to what is occurring for the client
Bruscia then demonstrated these worlds and levels of experiencing by presenting an extra-ordinary GIM session in which the client experienced a man being stoned to death. Bruscia’s own reflection is captured in these words:
It is very difficult to describe what Tom (the client) and I were experiencing in those last few moments of the man’s death. Both of our voices were cracking: our words fell into the same rhythm and tonality; and our bodies seemed filled with the tension and expectation (1998, p.504).
Studies of the Music
Studies of the music in the Bonny Method of GIM have been conducted using various methodologies, including phenomenological analyses, structural analysis, event analysis, repeated listening, an EEG study and a skin conductance study.
Ferrara, a musicologist, was the first to take a phenomenological perspective to analyze a contemporary piece of music for the first time (Ferrara, 1984). He described five ways in which to hear the music: 1) an open listening, 2) listening for syntactical meaning, 3) listening for semantic meaning, 4) listening for ontological meaning of the composer, and 5) a final open listening.
In the study of pivotal moments in GIM, Grocke (1999) used this phenomenological process to describe the music that underpinned pivotal moments. An example of a phenomenological description of Beethoven’s Violin concerto, slow movement was:
The music is written for solo violin with orchestra, and is in a major key. Its structure is simple, comprising two themes with variations. There is dialogue between the violin and orchestra, and between the violin and clarinet, bassoon and horn. The solo violin part often transcends the orchestra, with embellishments in high register. The mood is quiet and peaceful, but also expansive. The harmonic structure of the work is consonant, and the melodic line and harmonic sequences are predictable. There are no unexpected progressions, and the accompaniment is supportive throughout. The strings provide a section of pizzicato in the accompaniment, which contrasts with the legato line of the solo. The violin solo drifts away at the end.
Grocke (1999; 2007) also developed a Structural Model for Music Analysis (SMMA), which was also used in Bonde’s study of cancer patients, and studies of Marr (see below) and Lem (see below). The fifteen elements of the SMMA include: 1) style and form, 2) texture, 3) time, 4) rhythmic features, 5) tempo, 6) tonal features, 7) melody, 8) embellishments, ornamentation and articulation, 9) harmony, 10) timbre and quality of instrumentation, 11) volume, 12) intensity, 13) mood, 14) symbolic/associational, and 15) performance.
Grocke (1999) analysed the selections of music that underpinned pivotal moments using the SMMA, and together with the phenomenological depiction, found that:
The music was written in a structured form. The rhythmic features remained constant, and there was repetition of rhythmic motifs. The tonal structure was diatonic and consonant and harmonic progressions were predictable. The melodic line was an important feature, although the shape of the melodies differed. The main instrumental timbre differed: strings, woodwind, brass and human voices all played major roles but in different selections. There was dialogue between the instrumental parts, and the mood of the music was predominantly calm, with one selection very energetic and loud.
To condense this depiction further, the music that underpinned pivotal moments in GIM:
- Had a formal structure in which there was repetition,
- Was predominantly slow in speed, and tempos were consistent
- Was predictable in melodic, harmonic and rhythmic elements
- Featured dialogue between instruments
A Hermeneutic Study of Music in GIM
Lisa Summer (2009) studied clients’ perspectives on the music in GIM. She interviewed six participants following a music-centered GIM session using a modified approach to the Bonny Method of GIM. The modifications were: 1) repeated music – instead of a music program comprised of different pieces, the music program included repeated hearings of the same piece; and 2) music-centered guiding – instead of verbal interventions that focus primarily on imagery, the interventions focused primarily on the music. The four music therapist participants were able to use this process of deep listening as a means to listen to their internal world. They produced rich descriptions of their music experience. Each participant’s music experience was separated into music episodes that showed a successively changing listening attitude and hence, a changed relational capacity towards the music that deepened during the music program. For the two non-music therapist participants, there was a tendency to approach music listening from an analytical perspective, and their relational capacity towards the music did not deepen during the listening experience.
The Effect of Changes in Music on Imagery
Two Australian studies have focussed on studying imagery directly related to the music. Jenny Marr (2000) studied the effect of music on shifts in imagery. She conducted a series of 6 individual Bonny Method GIM sessions with four clients and recorded the music and imagery segment. She chose the Grieving program to analyse in detail. She wrote the imagery narrative across the score of the music for each of the music selections of the Grieving program. Marr looked for indications of changes in imagery related to what was occurring in the music. She used the SMMA to compare those events and found that imagery was evident when the music showed predictable rhythms, harmonic structure, and long and symmetrical melodic phrasing. In passages with rapid changes in tonality, dynamic range, rhythmic pulse and melodic fragmentation, imagery tended to be sparse with long, silent pauses in imagery reporting. Furthermore, tension and resolution that occurred in the music was matched in the imagery sequences. Images also expanded when the music indicated high pitches and light timbres and texture as they became embodied with low pitches and descending melodic lines. The use of solo instruments often matched somatic and kinaesthetic imagery in specific parts of the body and, when used in dialogue, allowed several aspects of an image to be examined.
Alan Lem (1995) conducted EEG studies on the effect of one selection of GIM music (Pierne’s Concertstücke for Harp and Orchestra) on brain activity in participants who listened to music and reported imagery at the conclusion of the music, as it is not possible to report on imagery experiences while attached to EEG electrodes, as talking activates muscles and thus creates artifacts in the recordings. Lem created a intensity spectrograph of the Pierne’s Concertstücke for Harp and Orchestra, the first piece on the Relationships program. He averaged the graphed brain-wave activity of the 27 participants. There were different graphs for posterior and anterior views. He laid these averaged graphs of brain activity across the spectrograph of the music, and explored relationships between the music and brain activity. Brain activity increased during moments of sudden and unexpected changes, such as the very soft cadenza of the harp towards the end of the piece. Lem explained that this finding has implications for how therapists might guide clients, in particular, that changes in the music may be sufficient to stimulate new imagery and that guiding may interfere.
In reviewing these research studies in the Bonny Method of GIM, certain elements stand out as important:
- Dosage: Quantitative studies indicate that a minimum of 10 sessions may be required in order to demonstrate significant change.
- Outcomes measures: European studies tend to favor Antonovsky’s Sense of Coherence Scale, and quality of life scales (e.g., WHO-QoL-BREF), whereas in the US, the Profile of Mood States is often the preferred measure. A consistency across future studies would allow pooling of results, possibly leading to a systematic review that shows effect.
- Recruitment for studies. Many authors describe difficulty in recruiting participants for studies that require a commitment over 6-10 weeks. Multi-site trials, particularly international trials, would assist in generating larger sample sizes.
- Research teams based in hospitals, or having access to healthy University students, can recruit larger samples. In addition, a multi-disciplinary research team has benefits of diversity of knowledge and experience.
Research studies in the Bonny Method of GIM indicate diversity of topics and research methods across quantitative, qualitative, mixed methods, and music analysis. Most are studies of individual Bonny Method GIM sessions, while others report on group music and imagery sessions. Many modifications are being used in order to responsibly “treat” people with severe illness (e.g., psychiatric disorders), and new music programs are being constructed, with contemporary music, and music specific to cultural needs. Given the small numbers of Bonny Method GIM therapists worldwide, it is encouraging to see just how much research has been done, and this augurs well for enhancing the status of the Bonny Method of GIM alongside comparable therapeutic methods.
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