Experiences of Transcendence in Guided Imagery & Music (GIM) – An Intersubjective Perspective

Professional Background and Context

As clinical psychologist and psychotherapist, my main interest is in the field of new developmental psychology, neurobiology and change factors in psychotherapy. I started as a clinical psychologist and therapist in child and adolescence psychiatry in the Swedish Stockholm area, and for 37 years, have worked in private practice as an individual psychodynamic psychotherapist, couples and family therapist, and supervisor. I worked as a trainer and supervisor in psychotherapy at the University of Ersta Sköndal, Stockholm. The Swedish professional context is based on licensures for psychotherapists and supervisors and they are developed professions on top of basic professions like psychologists, medical doctors, social workers, psychiatric nurses, physiotherapists, and music therapists. I started the GIM training in 1997 with Frances Smith Goldberg as an experienced, licensed psychotherapist, with a personally rooted relationship with music as a layperson. As private practitioner, I combined integrative psychotherapeutic work with adult clients using verbal psychotherapy, arts-oriented methods, and GIM. I also worked as GIM trainer in collaboration with Margareta Wärja (PhD, licensed psychotherapist, Music and Expressive Arts Therapist, Fellow of the Association for Music and Imagery, Primary Trainer) at The Expressive Arts institute in Stockholm.

Epistemological Preunderstanding

Before the clinical case study and PhD study, I published six articles and book chapters focusing on different process-issues in psychotherapy and supervision (Mårtenson Blom, 2002, 2003-2004, 2004a, 2004b, 2006, 2010). The first focused on how musical elements and ingredients in human interaction in a therapeutic context may resemble and inspire each other (2002). The second was about using GIM music in supervision (2003-2004). The third and fourth were two book chapters about different implicit relational and gender perspectives on the supervisory relationship (2004a, 2004b). The fifth reported a clinical research project on collaborative interviews with families and their children in a child guidance clinic (2006). The sixth article concerns the clinical case study (2010). All were included in the PhD thesis, and contributed to the development of my intersubjective and collaborative perspective on the transforming power of GIM. The intersubjective perspective is also connected to knowledge from research on change factors in psychotherapy indicating that relational ingredients provide for most of the change in psychotherapy (Huber et al, 2021; Wampold, 2010; Wampold & Imel, 2015). In sum, my theoretical preunderstanding is deeply rooted in the intersubjective perspective, as well as new developmental psychology. This field of knowledge is based on infant research, illuminating how the human sense of self emerges through interaction with crucial relational qualities (Stern, 1985, 2004). This is also similarly important in adult treatment (BCPSG, 2010; Beebe & Lachmann, 2005, 2013).

During the years of my GIM training (1997-2001) and the years of clinical practice that followed, I was personally and professionally inspired by relational psychoanalysts such as the work of Jessica Benjamin, relational psychoanalyst and feminist writer (1995, 2005); Emmanuel Ghent, psychoanalyst and music composer (1990/2003); and from the Swedish spiritual tradition, Wilfrid Stinissen, writer and Swedish/Dutch member of the Carmelite Order (2004). In my personal spiritual work, ways to understand, accept and practice ways of surrender, as well as experiences of transcendence, was at stake. This work fruitfully interacted with the work I did as a psychotherapist. I wanted to contribute and develop the possibility to assist clients in their processing of strong transcending experiences with music in GIM. A credo of mine is that people engage in psychotherapy because they 1) hope for a new relational experience of recognition different from previous negative and hurtful ones, and 2) sense a deep longing for (re-)connecting with the “true self” as well as the existential and spiritual dimension in life.

Background for the Clinical Case Study

In practicing GIM, I felt a growing need to develop new ways to assist processing clients’ experiences of transcendence through a relational, intersubjective perspective. Clients needed help to integrate how these experiences could be supportive in daily life as well as emotionally and relationally healing.

In the GIM work with a woman in her 30s with depressive and anxiety-related problems, I found interesting patterns in her interaction with me and the music. In the course of music experiences, the client moved through deeper and more adequately regulated experiential qualities. The sharing with me and herself, verbally and non-verbally, facilitated both interactive regulation and self-regulation of emotions and bodily responses. First and foremost, through sharing and regulating experiences of recognition, positive senses of being known, and then also in sharing and regulating experiences of challenge, distress, discomfort, and non-recognition. The process often moved back and forth in spirals, leading into a state, or moment when she surrendered. Seemingly to receive it but also being pushed or carried, and indeed deliberately opening to, a surrender. This sometimes moved the client into an experience of transcendence and/or an experience with a spiritual quality.

The following example is from one first ad-hoc clinical analysis of one session (nr 12, second semester) in one music experience, Liadov’s (1909) The Enchanted Lake. The client has given her consent to share the session material.

The client found herself by the sea, standing at a sandy shoreline watching the big waves. Her immediate feeling was fear of drowning. But in the presence of the music and the guiding, she stayed there. Eventually, the sand softened and she felt her body slowly move and sink, the sand being more and more wet and muddy, and the water coming closer. Feelings of surprise and ease mixed with her fear, and she gave in to the movements, slowly sliding into the sea. A sense of becoming one with the sea took over the experience giving her deep emotions of gratitude and peace. In the processing, she herself stated, “I gave myself to the sea”. The session brought her into a new state of relief, where she could experience less fear of losing control also in daily life, for example in her love relationship. The experience of a mode of surrender worked on a bodily level and expanded her “window of tolerance” (Siegel, 1999.)

I found a way to understand her process through really listening (and afterwards reading her transcripts) to how she described her ways of interacting with music and imagery, and me. Very obviously, apart from what she was occupied with – the content of her experiences – she also interacted, regulated, shared, and collaborated. She was in relation to her inner world, herself, the music, and me. When I listened carefully, I “heard” how she developed her ways of being in relation, her capacity to regulate inner states, of being and acting in the intersubjective field.

After this ad-hoc analysis, I started to formulate definitions of categories of analysis, to analyze GIM transcripts more systematically.

Methodology and Study Design

Findings from the clinical case study (Mårtenson Blom, 2010) entailed the exploration of usefulness of the categories of analysis in a larger study, the PhD study (Mårtenson Blom, 2014), whose study design will be illustrated in three figures. Research question and triangulation of data collection are depicted in Figure 1.

Figure 1

Study Design: Research Question and Data Collection.

Note: From Mårtenson Blom, Ersta Sköndal University ppt-presentation, 2015.

The focus of interest had, through the clinical study, developed into a defined phenomenon - The Process of Surrender. As a first step into the PhD project, I explored other GIM-therapists’ opinions about the clinical usefulness of the research questions. This was done through two focus group interviews, and the results confirmed and supported the further work (lower left triangle in Figure 1). The interviews explored the usefulness and meaningfulness of the categories of analysis among fellow GIM practitioners. The focus-group responses underlined the importance of developing the understanding of the GIM process through using the categories of analysis, as well as the relevance of the developed concepts, the Process of Surrender and the Relational Mode of Surrender.

The data collected through transcript analysis for the PhD study, was facilitated by collaboration with L.O. Bonde’s explorative study (Bonde & Mårtenson Blom, 2016) of non-clinical participants’ experiences of selected music programs, constructed with the purpose to support and facilitate experiences of transcendence. Altogether, 38 GIM transcripts were analyzed from sessions conducted by one GIM therapist from that study. The participants (n=10) configured a non-clinical sample, six with former experience of GIM receiving three sessions and four with no former GIM experience receiving five sessions (n= 38). The GIM music programs used the most were “Faith”, “Gaia” and “Sublime 1 & 2”, all developed by Kenneth Bruscia (as cited in Bruscia & Grocke, 2002).

Four collaborative interviews were also conducted (lower right triangle in Figure 1) with the therapist and four of the participants and facilitated a vertical analysis and a check in on what had been documented in the transcripts by the therapist as subjective experiences during the music. The interviews facilitated exploring the qualities of the collaboration between therapist and participant, and its importance to experiences of surrender and transcendence in the GIM setting. In this article the results from the collaborative interviews will not be presented, nor will the findings from the validating transcript analysis, but are available in the thesis (Mårtenson Blom, 2014).

The PhD study was in this way flexibly designed with a triangulation of data collection (Figure 1 & 2) and thematic analysis as main procedure.

Figure 2

Triangulation of Data.

Note: From Mårtenson Blom (2014, p. 107).

Data from all three sources, focus group interviews, transcript analysis, and collaborative interviews, were analysed thematically. The GIM music used in the sessions was analysed through music classification categories (Bonde & Nygaard Pedersen, 2014; Wärja, 2010), and the interaction between experiential categories (EC) and music classification categories (MCC) was explored.

Figure 3 illustrates an overview of the PhD study design with its meta-level, design level, and level of methodology.

Figure 3

Summary of Developed Study Design.

Note: From Mårtenson Blom, Ersta Sköndal University ppt-presentation, 2015.

Results

The focus group discussions put focus on the Process of Surrender as captured by experiential categories 4, 5, and 6. This influenced the further analysis of transcripts done as a second step in the data collection procedure.

Relational patterns in the interactional field of participant, therapist, and music could actually be identified through the transcript analysis. When interacting with the music or each other, the building blocks of shared lived experience developed very fast, in the here and now, and almost immediately connected and enhanced the complexity and quality of the interactional field. This is how the field of intersubjectivity deepens, and the quality can be noted in the present moment, the quality of presence in how we meet and move each other. In the PhD study, it was assumed that the degree of complexity in the interaction, and through that a developed quality of presence, depended on how relational modes in patterns as well as levels of complexity developed. The therapist and the music were assumed to contribute simultaneously, shifting in being in the foreground of the participants focus of attention.

To illustrate this consideration, three images will be presented. The Figures 4 and 5 depict the emergence of patterns.

Figure 4

Emerging Patterns in Experiential Categories, Excerpt Examples.

Note: From Mårtenson Blom, Ersta Sköndal University ppt-presentation, 2015.

Figure 5

Emerging Patterns in Experiential Categories, Categories.

Note: From Mårtenson Blom, Ersta Sköndal University ppt-presentation, 2015.

Figure 6 illustrates the emotional quality of each experiential category through a symbolic imagery. The three images at the bottom level show focus of attention, sense of movement, and intention and affectivity. Category 4, a sense of recognition, is illustrated by the image of clear and holding water over a soft sandy bottom, at second level. Category 5, a sense of non-recognition or challenge of safety, is illustrated by the image of deep sea with a vulnerable, lonely fisherman, also at second level. Category 6, transcendence, is illustrated by the image of a glorious sunrise on the third level.

Figure 6

The Quality of Experiential Categories Illustrated in Images.

Note: From Mårtenson Blom, Ersta Sköndal University ppt-presentation, 2015.

The process appeared to move in stages with an emerging complexity. Figure 7 depicts how interactive units connect into longer or larger sequences. The next image, Figure 8, illustrates how the most elaborated relational mode, with mature and flexible affect-regulation (adaptive defense-mechanisms), might open the experiential field for transcendence and even spiritual qualities.

Figure 7

Levels of Interaction Deepening into a Process of Surrender.

Note: From Mårtenson Blom (2014, p. 146).

Figure 8

Levels of Interaction Preparing for Experiences with Transpersonal or Spiritual Character.

Note: From Mårtenson Blom (2014, p. 146).

The following summarizes results from the transcript analysis, horizontal analysis (collaborative interviews and transcript analysis) and analysing process:

In the findings, and in the occurrence of a Relational Mode of Surrender, a difference, 61% compared to 40%, between GIM experienced and inexperienced participants was found. This argued for understanding this kind of experience as something dependent on habituation or training. This was also supported through the fact that 80% of the experiences (Relational Mode of Surrender) occurred in final sessions, compared to 30% occurring in a first session. The conclusion was that these experiences, in a therapeutic setting, do not occur completely by chance. From the point of view of the therapeutic process it was possible for the therapist to assist, when in collaboration with the client. The task seemed to be to stay as close as possible in tracking the client’s attention, intentionality, and affectivity. Alongside this, to follow the elements and developments in the music that captures attention, intention or movement, and affectivity, primarily in terms of intensity, and shifts in all three.

The findings supported the assumption that the strong transforming power of experiences of transcendence can be explained through their relational ingredients including their core affective qualities.

Further Findings from the PhD Study - Analysis of Music During Occurrence of Process of Surrender

The intersubjective field in GIM is very complex and includes both human interactive energies and musical-human interactive energies. In all parts and during the whole session, the process of a developed relational knowing is present. In the PhD study, it was important to map the role of the music in this interactive field, so the transcript analysis was followed by a music analysis.

Before moving into the results, my preunderstanding of the ontology of GIM music, will be accounted for.

In the music analysis, the music taxonomy developed by Bonde and Nygaard Pedersen (2014) and Wärja (2010) was used. However, the development of that taxonomy was in progress simultaneously in time with the PhD study, so four music classification categories were used (Figure. 9), not six as in the final version of the taxonomy (Wärja & Bonde, 2014).

The music used in the analyzed sessions was pre-selected for the study by Bonde (Bonde & Mårtenson Blom, 2016), for non-clinical GIM sessions with ten research participants. Altogether five GIM programs were used, comprising pieces of music categorized into four classification categories from the taxonomy.

Figure 9

Music Classification Categories.

Note: From Bonde and Nygaard Pedersen (2014) and Wärja (2010)

For a complete classification of all pieces used in the study, I refer to Mårtenson Blom (2014).

Through the music analysis, each participant’s experiential qualities could be connected to qualities in the music that was used. The interaction between experience and music could be understood in terms of relational modes.

The interaction between music classification categories (MCCs) and a Process of Surrender in terms of experiential categories (ECs) was analysed and interpretations were formulated. The connections between relational qualities in the different pieces of music were emphasized and compared to the relational modes assumed to be at hand in the experiential qualities. These assumptions relied on the written transcripts. The interpretation of data and results, encompassing and balancing the inherent gap between the implicit and explicit domains of representations, was done through connecting to the knowledge from the field of intersubjectivity and infant research presented in the theoretical background.

As a point of departure for the discussion a summarizing table is presented (Table 2).

Table 2 depicts the interaction between music classification categories (MCCs) and experiential categories (ECs). Horizontal row shows how often experiential categories 4, 5, and 6 respectively, occurred compared to total occurrence of all three (100%). Vertical column shows how often music classification categories 1, 2, 3, and 4 respectively, were used compared to total number of music pieces used (100%).

Experiential category 4 is the dominant quality of the three (4, 5, & 6), 53%, showing how the experienced emotional and relational quality of recognition in these GIM sessions is in a majority. It is also clear that the experience of a complete surrender and transcendence is the least frequent.

Based on the table, assumptions about interactive forces between analyzed experiences and musical qualities could be made. One single piece of music classified as explorative and deepening (MCC 3) and shared experiences categorized as recognizing and affirming (EC 4) or even experiences of surrender into transcendence (EC 6), had strong connections: 50% of EC 4 and 55% of EC 6 occurred/appeared during music classified as MCC 3.

Music programs (music pieces put together) with music pieces categorized as explorative and deepening (MCC 3) in a majority or embedded with at least one piece of music classified as explorative and challenging (MCC 4), provided for a majority of experiences defined as a process of surrender. For example, the program Sublime 2 (Bruscia, 1997 as cited in Bruscia & Grocke, 2002) elicited 67% of all noted 4-5-6 ECs (interpreted as a Process of Surrender) during a session that occurred (100%), as illustrated in Figure 10.

Figure 10

Music Program “Sublime 2” and the Process of Surrender.

Note: From Mårtenson Blom, Ersta Sköndal University ppt-presentation, 2015.

Through connecting ECs to MCCs I argued that it was possible to confirm the existence of a bridge, since the joint analysis showed reasonable and comprehensible interactions between music and analysed experiences. The complexity of the GIM music experiential process was illuminated and underlined. The connections between the different MCCs and qualities in the experiences confirm much of what is already known about the GIM process. However, I argued that the findings in the study developed knowledge towards a clearer understanding of how relational modes, building-blocks of implicit relational knowing, develop through interaction with music, therapist, and inner experiencing, and that shifts and transformations in altered states of consciousness can be assumed to establish connections to movements and shifts in inner representations of ways “to share, regulate, be, act, sense, feel” (Mårtenson Blom, 2010). The contents of imagery are also informing, but more as “signs” of an important transformation going on.

The relational complexity in the field of P-M-T was evidently needed for transformation to take place. The combination of all three parts, through their common and dialogically shared relational modes, triggers the change, and transcendence into the “third,” or the intersubjective field “in between.”

Clinical Implications - An Interactive Process-View on Experiences of Transcendence in GIM

The PhD study results put focus on the how in the GIM process more than on the what. As Daniel Stern described, therapeutic change happens in small as well as in highly emotionally charged “now-moments” and “moments-of-meeting” (Stern, 2004; Stern et al., 1998). In the here and now and in the relational meetings (with music and therapist), the study identified three central experiential qualities, or relational modes. Experiential Category 4 (EC 4) captures a recognition process - the sense of deeply being known (Sander, 2002). EC 5 captures a process of non-recognition and possible, or even threatening, ruptures in the relationship. EC 6 captures a shift or second-order change both in relational mode and in level of consciousness as a dissolving of a state of tension in mind and body.

For example, this happens in GIM, when the client is experiencing even deeper emotional qualities in feeling contained by music as well as therapist and manages to stay with both strong positive/recognizing and negative/non-recognizing emotions in a kind of turn-taking circular movement. Eventually, these relational experiences lead into the possibility to let go, to surrender, when the relational trust feels good enough established between client, the music, and the therapist. The process of surrender prepares for experiences of vulnerability, lack of control, state of uncertainty, when the relational mode of surrender remains the only, but also most adequate alternative way of being in relation. Here-and-now experiences in the GIM setting of a mature and useful attitude towards different challenges develops the capacity in real life to feel more relaxed for example in situations that previously evoked fear of being stuck and a sense of not being able to choose between different options. The deepening of relational modes develops implicit relational knowing (Lyons-Ruth, 1998) and the repertoire of emotional qualities in relationships. This provides for a deepening of consciousness with a developed capacity to be present.

This phenomenon does not exclusively appear in GIM therapy and music listening but also in good “verbal” psychotherapy, and of course in daily life’s emotionally moving meetings. The basic requirements can be found in our common and shared sense of presence, in the quality of our presence, which is connected to the consciousness and its different levels. The quality of our presence is also connected to the possibility to transcend or cross borders between different mental spaces within and between us. This may entail an experience of transcendence and a possible transpersonal spiritual experience. Figure 11 depicts how deepening levels of interaction in terms of emotional capacity, interacts with and deepens the level of consciousness. The image of a cross depicts the horizontal axis as level of interaction and the vertical axis as level of consciousness (Figure 11).

Figure 11

Levels of Interaction and Levels of Consciousness.

Note: From Mårtenson Blom, Ersta Sköndal University ppt-presentation, 2015.

In GIM, the dyadic regulation in music and dialoguing (guiding) creates a “here-and-now” change in the implicit relational knowing, through shifts between mutual recognition and non-recognition, possible to identify through transcript analysis as EC 4 and EC 5. The three relational modes, defined as a Process of Surrender (Mårtenson Blom, 2010), represents a leap, a qualitative change, into deeper levels of consciousness and possible experiences of transcendence. According to the Boston Change Process Study Group (BCPSG, 2010), this generates in the client feelings of getting better, being cured. For the therapist it is both helpful in the processing and theoretically clarifying, to understand the experience of a Process of Surrender as mirroring three important phenomena:

The PhD study provided support for the application of theories of intersubjectivity when a process perspective on GIM is needed. The perspective serves as a link between phenomenology and psychology. The vertical analysis in the study illuminated the phenomenological perspective and the horizontal transcript analysis illuminated the psychological perspective. The concepts Process of Surrender and Relational Mode of Surrender served as points of intersection in linking these perspectives. The GIM music as active force and relational agent, must simultaneously be understood both phenomenologically and psychologically.

In comparison to previous research, the findings were found to contribute with knowledge that brings the GIM process instead of its contents into focus of attention. This brought forth suggestions to apply concepts capturing the field “between” phenomena, like interaction, dialogue, collaboration between client and music, client and therapist, and music and therapist. In the thesis, the findings were also compared and discussed in relation to the knowledge developed by researchers like Denise Grocke (1999), Brian Abrams (2001), and Lisa Summer (2009).

Further Clinical Implications

The clinical usefulness of the experiential categories of analysis can be found both initially, as part of an assessment phase, and continually, in the processing together with the client. As an assessment tool, they may inform about the client’s readiness to go deeper and the capacity to regulate affective defenses. They may give the therapist indications of their own quality of presence and fit with the needs and capacity of the client. They also show potentials for which pieces of music are appropriate as well as the client’s optimal range of tolerable experiences, in their window of tolerance (Siegel, 1999), indicating risk for dissociative defenses to be evoked.

For example, in the assessment phase, the therapeutic relationship starts to build safety and the tolerance for music chosen by the therapist is often enhanced through the client’s preferred music or even chosen pieces by the client. The presence and level of consciousness in how the client travels can be noted through analysis of experiential qualities categorized as 1-2-3 with movement into 4. If the experiences stay in 1-2, with no connection to any emotionality and with a dominating cognitive attention, the client needs more of stabilization both in relation to therapist and music.

Towards a Developed Music Taxonomy of GIM Music

The music analysis discussed in the thesis focused among other things on the need for differentiation of more music classification categories for future research using the combination of Music Classification Categories (MCCs) and Experiential Categories (ECs). The analysis of the interaction between MCCs and ECs generated interesting knowledge about the GIM process. As previously described in this article, the strong connection between MCC 3 and EC 4, mirrors how certain emotional qualities in the experiences are crucial. The music categorized as MCC3, evoke strong affective movement crucial to change, on condition that it can be tolerated by the client, meaning that music must fit with the client’s window of tolerance (Siegel, 1999) and be offered within a good-enough safe and stable therapeutic relationship. Interaction and collaboration in the relational field was illuminated in the vertical analysis and identified as crucial in providing for a Process of Surrender. In the vertical analysis it was clarified how transcript analysis could be used clinically, in combination with an evaluating collaborative interview with a client, illuminating the level of quality of the therapeutic process.

A further developed music taxonomy (Wärja & Bonde, 2014) focused on interactive ingredients or qualities in pieces of music, more than on complete music pieces. This provided a better fitness with a process-oriented understanding of GIM music, and a relational perspective on GIM therapeutic process. The perspective also provided the therapist with a better understanding of how GIM music interacts with affect regulation and the autonomous nervous system including the vagus nerve (Porges, 2001). For example, through combining analysis of experiential qualities in terms of interaction, with a music classification sensitive to the client’s window of tolerance, the therapeutic process will better serve the needs of the client.

Applications in a GIM Training Context

From October 2017 to September 2019, the Scandinavian GIM training, level III was conducted, with twelve participants and six teachers and supervisors (Margareta Wärja, Katarina Mårtenson Blom, Lars Ole Bonde, Ellen Thomasen, Bolette Daniels Beck, and Svein Fuglestad) from Sweden, Denmark, and Norway. The education will be presented and described later in another article. Here, I will summarize some reflections on the implementation of the intersubjective perspective through using the experiential categories (Mårtenson Blom, 2014) and music classification categories (Wärja & Bonde, 2014) as tools in the training process. Based on the theoretical foundation of intersubjectivity and neuropsychology, participants were trained in the analysis of transcripts with experiential categories connected to music analysis with music classification categories, which helped tracking how the travels deepen in terms of level of consciousness and complexity of interaction. The perspective also contributed to development of therapeutic presence on behalf of the therapist, through sharing and regulating attention, intentionality, and affectivity with clients, in the guiding as well as during meeting and dialoguing. The education included an integrative perspective on GIM process, how and what happens in GIM, with the established traditional ways of understanding and using imagery and other contents.