Abstract:
Background and objectives: Whilst Active and Receptive Music Therapy techniques have been widely
researched and are employed within a range of contexts and with diverse client populations, this study
reports on their specific qualitative musical and verbal affordances in major depressive disorder and
schizophrenia-spectrum psychotic disorders. The study also describes and compares the respective
and joint contributions of the music therapy techniques in giving rise to the affordances as well as
reporting on the similarities and differences within and between diagnostic groups. This is the first
study of its kind within the South African context.
Methods: A qualitative research approach using a case study design, sampled purposefully twenty
patients of the above mentioned diagnostic groups for participation in this study comprising a course
of eight twice weekly music therapy sessions. The primary data sources were transcribed video
recordings of therapy sessions and an individual in-depth semi-structured interview after the course
of therapy. Clinical session notes served as a corroborative data source. In-depth content and thematic
analysis explored and compared qualitative affordances during music therapy comprising active and
Receptive Music Therapy techniques. The qualitative affordances under investigation were i) musical
qualities, and ii) verbal expressions. Emerging from these affordances were the respective and
combined affordances of the music therapy techniques as well as the similarities and differences
between the diagnostic groups.
Findings: Thirteen themes emerged from the analysis of clients' verbatim verbal responses to both
active music making and Receptive Music Therapy techniques. These themes are: i) not to feel; ii) to
do or not to do; iii) grappling with the desired future; iv) hurt and fear of undesirable outcomes; v)
sadness, brokenness and futility; vi) anger, trust and vulnerability; vii) desire for connection with and
affection of others; viii) barricaded from being present, now; ix) tensing and un-tensing; x) personal
relating to one’s musical expression; xi) reflections on the music and music making in therapy; xii)
resilience and courage and xiii) invigoration and liberation.
The Active Music Therapy techniques comprising clinical improvisation, structured musical exercises,
drumming, vocal work, songwriting and movement, gave rise to ten themes expressing the musical
affordances. The themes that emerged were i) reciprocal responding; ii) the explicit use of symbols
through music; iii) regularity; iv) disturbance and difficulty; v) turning points; vi) energy bursting or
lacking; vii) bodily synchrony; viii) intensified emotional expression; ix) exploring new territory and Active Music Therapy techniques comprising clinical improvisation, structured musical exercises,
drumming, vocal work, songwriting and movement, gave rise to ten themes expressing the musical
affordances. The themes that emerged were i) reciprocal responding; ii) the explicit use of symbols
through music; iii) regularity; iv) disturbance and difficulty; v) turning points; vi) energy bursting or
lacking; vii) bodily synchrony; viii) intensified emotional expression; ix) exploring new territory and x) resolution and arrival.
The emerging themes express the extent of musical and verbal expression of all clients representing
both diagnostic groups. Most saliently among clients with depression the affordances were the
themes on accessing creativity, accessing and articulating internal feelings, experiencing resilient parts
of self, reflecting on and integrating symbolic material, motivation to act and extending musical and
verbal expression during social interaction. Among clients suffering from schizophrenia spectrum
disorder, the most striking affordances were experiences of regularity and flow within disorganization,
orientation to ‘here and now’ experiences through active music making and working with symbolic
material expressed on a continuum of concrete to abstract. Clients from both diagnostic groups
experienced a reduction in unwanted symptoms as expressed through increased energy levels,
experiences of pleasure in music making and spontaneous musical and verbal self-expression.
Conclusion: This study revealed qualitative affordances of specific music therapy techniques
expressed through verbal content and musical qualities. These showed responses within a therapeutic
relationship that express inter- and intra-personal connection, give voice to what is not always verbally
accessible and facilitate multi-sensory, creative experiences, increased motivation, emotional
expression, and the reclamation of energy, spontaneity and resilience.
