The assessment of the quality of relationship by people with severe disabilities in a music educational setting

The assessment of the quality of relationship by people with severe disabilities in a music educational setting Shirley Salmon, Lecturer, Carl Orff Institute, Mozarteum University Salzburg Paper presented at ISME 2012 at the Commission for Music Special Education and Music Therapy Abstract: The AQR-Instrument (Assessment of the Quality of Relationship) - an instrument to observe and assess the quality of relationship based on developmental-psychological knowledge - was developed for use in music therapy with children with profound developmental disorders (Schumacher/Calvet 2001, 2005, 2007). The AQR-Instrument consists of 4 scales that focus on differing phenomena of expression: instrumental expression, vocal pre-speech expression, physical- emotional expression, the therapists and his/her interventions. Within each scale, 7 modi are used to assess the quality of the inter-personal relationship indicate and give important indications for methodical approaches. The research presented here, the first to apply the AQR-Instrument in a music educational setting with adults with disabilities, assesses the ability of 3 group members to form relationships according to the handling of instruments. It aims to ascertain the ability of the participant to take part in group sessions as well as to examine the methods used by the teacher and whether these were appropriate for the participant and also gives important indications for further music educational approaches. Examples will be shown on DVD. The paper includes information and DVD examples about the setting and the didactical considerations for the musical-educational work with this group of adults with severe disabilities and finishes with thoughts and implications for future work. 1 Keywords: AQR-Instrument, Elemental Music, Expression, Instruments, Relationship The assessment of the quality of relationship by people with severe disabilities in a music educational setting 1. Introduction This research documented in the DVD Between Freedom and Ritual (Salmon / Kallos 2010) discovered a number of questions in relation to the participants (adults with severe disabilities) concerning the structure of the sessions, the relevance of rituals and the type of instruments offered. Part I of the DVD History and Developments gives an insight into the practice of Elemental Music and Dance Education according to Orff-Schulwerk with people with disabilities at the Orff Institute. Part II Insights into practical work consists of an Introduction, and chapters on Theme Centred Activities, Materials and Instruments and Qualities of Relationship. The AQR-Instrument used in the chapter Qualities of Relationship was developed by Schumacher and Calvet (Schumacher 1999, Schumacher/Calvet 2001, 2005 , 2007) for use in music therapy settings. This research presents its first application in a music education setting with people with disabilities. The goal of this research was to ascertain the ability of the participant to take part in group sessions as well as to examine the methods used by the teacher and whether these were appropriate to the level of the ability to build relationships shown by the participant. Participants who are not yet ready for working in a group can be thus recognized and their ways of communicating and playing taken into consideration within 2 group sessions. If the participant is not yet able to imitate, then the usual educational methods make excessive demands on the participant and other methods must be found. 2. Setting Over many years, a group of approx. 12 adults with various cognitive and physical disabilities from 2 Lebenshilfe sheltered workshops in Salzburg meet once a week for a music and movement session. This group is one of the classes in ‘practical didactics’ within the bachelor degree course Elemental Music and Dance Pedagogy and is led by one of the lecturers. 2 – 4 degree students participate each term - they observe, support particular members, teach parts of the session, reflect together and protocol the sessions. The group is usually constant for the whole academic year. There are usually 3- 4 participants who use a wheel-chair and many who have no active speech. The fundamental assumption is supported that musical, rhythmic and artistic activities can trigger a central, emotional awareness also amongst people with different degrees of disability. Music, with its inherent expressive and interlinking possibilities, implicates an immeasurable opportunity for the development of elemental interactivity using varying levels of communication. (Pauls 2010) The particular structure of the lessons has proved to be useful: The Exploration phase takes place at the beginning of the session and offers a wide selection of instruments to enable experimentation, encounters, dialogues etc. The interests and the abilities of the participants can be well observed and maybe incorporated into the lesson later on. 3 Greeting song: the rituals at the beginning and the end of the sessions take place in a large circle. A greeting song is used for many weeks or months with many variations and includes singing and movements/gestures so that everyone can join in some form. Warm-up: the warm-up intends to physically activate the participants and to support sensory sensitization. Theme-centred activities: particular themes provide a focal point for one or more lessons. The themes are related to the participants’ world of experience and link music, movement/dance and speech and often materials. A variety of different types of instruments is necessary so that the abilities and interests of individual participants can be catered for. Rounding off: The end of a session is marked by a ritual with all the participants, usually in a circle, with a rhyme or song. 2.1 Didactical considerations The principles from the pioneering work in elemental music making by Wilhelm Keller (Keller 1979, 1984, 1996) are particularly important in this group. These are complimented by the principles of integration/inclusion as defined by Georg Feuser (1990, 1997, 2001, 2008). There are significant parallels between Keller’s thoughts and demands and Feuser’s definition of integration that are relevant for the didactics and methods of elemental music making. 4 Feuser’s principles of a ‘general (integrative) pedagogy’ are central to the music educational work with all groups and particularly with integrative1 groups. Integrative education means that all children (without excluding anyone due to the type or severity of their disability) work, play and learn together in cooperation with each other within one theme, activity or task at their respective developmental levels (taking into consideration their present levels of competence in perception, cognition and behaviour). (Feuser 1997) And in order to realize this, 2 aspects are essential - Cooperation within one theme/ task or activity: - Inner differentiation: each person at his/her own developmental level. Wilhelm Keller (1979, 1984, 1996) recognized the value of elemental music making which enables so-called normal, talented and disabled people to play together in one group without any participant being under or over-challenged. The music should be adapted so that tasks and roles suit the possibilities of the individuals instead of the group having to adapt to a fixed musical form. 3. The Application of the AQR- Instrument2 to assess the quality of relationship. Here ‚Integration‘ is to be understood in its widest sense and means the inclusion of people with differing abilities, age, background, language, race etc, who learn, play and work together in a group. It does not mean only working with people with and without disabilities. 1 5 The AQR-Instrument, that has been developed since 1990 by Karin Schumacher und Claudine Calvet, is an instrument to observe and assess the quality of relationship, that is based on developmental-psychological knowledge und was developed for music therapy with children suffering from profound developmental disorders. The AQR-Instrument objectifies the quality of the ability to form relationships. (The first publication from Schumacher appeared in 1999. Further publications with Calvet followed: 2001, 2005 , 2007 as well as unpublished training films 1999 – 2002.) “The goal is, with the help of particular characteristics, to discover how and in what form the ability for interpersonal relationships manifests itself, to assess it correctly in order to understand it and act upon it.” (Schumacher et.al 2005, p. 75 transl. Salmon). The AQRInstrument can be applied for diagnosis, methods in practical-clinical work and for research documentation. The writing of protocols and case studies can be facilitated and theoretically explained through AQR analyses. (Schumacher et.al 2005, p. 86) The results of the reliability validation of the AQR Instrument as a newly developed instrument to prove the effects of music therapy were documented by Schumacher et al. in 2005. A complete overview of the instrument is in preparation and will be published in 2011/2012. The AQR-Instrument consists of 4 scales that focus on differing phenomena of expression: instrumental expression, vocal pre-speech expression, physical- emotional expression, the therapists and his/her interventions. The 4 scales correspond to Daniel Stern’s concept of self in their structure and follow the logic of normal development (Schumacher/Calvet 2005) 2 The application of the AQR Instrument is not possible merely by studying the literature on it. In order to apply it successfully it is necessary to have a basic training such as the Certificate Course “EBQ-INStrment und seine entwicklungspsychologischen Grundlaen” (the AQRInstrument and its developmental basis): http://www.udk-berlin.de/sites/musiktherapie/content/zertifikatskurse/index_ger.html 6 In this research, the ability to form relationships is assessed according to the handling of instruments. In instrumental expression the following aspects can be focussed upon: the choice of instrument, the relationship to the object, the musical media (sound, rhythm, melody, harmony, form and expression) and the room to play, especially the tonal space. Schumacher/Calvet (2005) state that each scale differentiates between 7 or 8 modi i.e. the way contact and relationship are developed. Each modus is characterized by specific features. “There is not only a qualitative but also a quantitative difference between the modi. The length of contact and the readiness for contact increase from modus 0 – 6.” (Schumacher 1999, p. 248 transl. Salmon). Examples (to be shown on DVD) Scenes from the 6 filmed group sessions showing 3 of the participants were chosen that were typical for their behaviour. These scenes were analysed using the AQR-Instrument. The scenes chosen for the chapter in the DVD (Salmon / Kallos 2010) show the spectrum of modi and also the range of needs of the three group members. The scenes took place during the phase of free exploration at the beginning of the group sessions. Modus 0: Lack of contact / contact rejection is never absolute and means a non-visible reaction to people or objects (Schumacher 1999, p. 246). 7 Gerda, a woman with severe cognitive and physical disabilities and without active language has been a member of the group for many years and usually attends the group together with her mother or carer. Gerda sits across from the teacher and holds a scarf and a rattle during one of the exploration phases at the beginning of the session. The teacher plays 2 rattles, sometimes playing on Gerda’s rattle, and sings a known greeting song. Gerda’s facial expression shows that she cannot accept the teacher’s offer. The character of the song, as well as the playing of the teacher on Gerda’s rattle, are stimulating. Gerda, however, remains in her state and cannot get involved in the teacher’s offer. Modus 1: Sensory contact, Contact-reaction means the awareness of a stimulus that can lead to making contact. It is a question of time, whether contact emerges from a reaction. The contact-reaction is the moment which is still open as to whether the child uses the chance of a possible relationship or closes up again. (Schumacher 1999, p. 246) Gerda holds a wristlet made of nutshells in one hand and a small rattle in the other. The teacher holds 2 rattles and establishes contact with Gerda’s rattle by touching it with one of her own and playing on it. Gerda looks up briefly at the teacher’s rattle. Gerda doesn’t use the opportunity to make contact with the teacher. In a second scene Gerda takes the sleigh bell wristlet offered by the teacher and appears to be pleased about it. Gerda handles the wristlet in a sensory manner but doesn’t however recognize its function as a musical instrument. 8 Modus 2: Functionalizing Contact Functionalizing contact in the sense of destructive and aggressive handling of instruments could not be observed in the 6 filmed sessions. This does not mean that it never took place, but merely that it was not filmed during the 6 sessions. Modus 3: Contact to oneself Leaving a non-reflexive state of self-recognition leads to a growing perception of oneself. A secure sense of person furthers the ability to explore with one’s own voice and with instruments. The player hears him/herself and the specific characteristic of the object e.g. the sound of an instrument (Schumacher 1999, p. 247) Simon sits next to a student teacher. They play together with a scarf. Music from a CD (new to the participants) is played as a stimulus for working with a partner. Later, Simon explores the guitar’s possibilities during a group improvisation with instruments. He can join in the improvisation, listen, make pauses and play the ending. He recognizes the function of a music instrument. The typical state of modus 3 – calmness and attention can be clearly seen. Modus 4: Contact to another / inter-subjectivity When the existence of oneself is experienced as secure, then the need to share perceptions and feelings with the other person appear. The ability to share joint wishes and interests and observations also becomes clearly visible and can be sensed. (Schumacher 1999, p 247) 9 Philipp and Simon are at the piano during the exploration phase. Simon sits on the piano stool while Philipp stands on his left. Philipp plays single, usually low, notes while Simon plays several middle range notes and then watches and listens with interest. The ability to share attention can be well observed. Simon looks briefly at Philipp and shows he is happy about that which has been played. Simon shares his attention in a second scene with the student teacher who plays a slide whistle. The student plays the slide whistle while Simon holds a frame drum and watches and listens carefully. He is emotionally affected and makes eye contact with her, is happy and laughs about some of her ways of playing and is very observant. Modus 5: Relationship to another / interactivity The player hears, sees and feels the other person, reacts to him/her and answer his/her actions. Similarities in sound, rhythmic and melodic expression can be recognized. Changes in timbre, small motifs are taken up alternately and varied. Each player brings his/her own ideas and takes up those that come from the other person.’ (Schumacher 1999, p. 247) Werner and a student teacher play together on a conga and a frame drum during one of the exploration phases. Werner plays single sounds and short rhythms that are repeated by the student. Werner reacts to the student’s playing dialogically. Taking it in turn to make pauses is characteristic as is the expectation to get an answer from the student teacher Modus 6: Joint experience / interaffectivity The encounter between 2 people generates lively emotions that can lead to a jointly experienced emotion. The ability to share the developed dynamics and to take it in 10 turns to change it leads to the ability to play with each other whereby the play may also consist of other associations. (Schumacher 1999, p.248) Werner and the teacher play the conga together during the exploration phase. They use their voices and facial expression. Different ways of playing and physical contact develop. A joyful to-and-fro develops from this game whereby the theatrical elements take over from the instrumental playing. 4. Consequences for clinical work In summary one can say that with these three participants, the level of disability corresponds to the level of the ability to form relationships. Gerda is a woman with profound cognitive disability who can communicate only by means of a few vocal sounds. Gerda’s ability to form relationships lies between modus 0 and modus 1. It is only possible to make contact with the teacher for short moments and these moments are not further developed. Gerda handles instruments but doesn’t recognize their function as music instruments. She cannot take part independently in the group but can be in group sessions when she has constant support from an extra teacher who is not leading the session. The teacher must proceed from Gerda’s actions and means of expression in order to make contact with her. As Gerda cannot yet imitate, she has to be supported during the sessions. Gerda’s possibilities to play and make sounds must be built into the elemental music making of the group. Simon (modus 3 – 4) is already able to experiment with an instrument, to play it meaningfully and to play in relation to others. Once these abilities appear, then tasks such as playing in front of other, playing with others and imitating others’ playing can be accomplished. Simon can listen and watch attentively. He is emotionally involved when playing with a partner but 11 usually observes. He recognizes the function of instruments and materials and can play with them with a partner. He is probably over-taxed when in a large group if he does not have the support at least some of the time from another teacher. Phases in small groups or with a partner are appropriate for his abilities rather than activities in a large group. Werner (modus 5 – 6), who doesn’t use speech actively, has, as many other people with Down’s syndrome, dialogic and theatrical talents. Werner enjoys forms of contact and dialogues and can play with a partner dialogically. He shows his own ideas, reacts to his partner and brings theatrical elements into the playing. It can be assumed that he can be enthusiastic about musical activities in the large group, that he can join in and that he doesn’t need extra support. 5. Summary In this context insight into the practical work of the appraisal of the qualities of relationship is especially remarkable. For the first time music and dance teachers, as well as therapists have a research instrument available which reliably shows them the quality of personal relationship which, in its turn, empowers them to work more accurately, specifically, carefully and individually. (Pauls 2010) The application of the AQR-Instrument gave indications as to whether participation in a group was suitable for the individual, which methodical procedures were appropriate and which musical instruments were played as means of expression. It would be of interest here to conduct long-term studies. The relevance and the application of the AQR-Instrument in other (integrative) groups in music-educational settings should be researched further. 12 Acknowledgements: The chapter ‘Quality of Relationship’ in the DVD Between Freedom and Ritual (Salmon/Kallos 2010) was developed in collaboration with K. Schumacher, C. Calvet and S. Reimer. References Feuser, Georg (1990): Grundlagen einer integrativen Pädagogik im Kindergarten und Vorschulalter. In: Behinderte in Familie, Schule und Gesellschaft, 1/1990, 13. Jg. Feuser, Georg (1997): Inclusive Education - Education all Children and young people together in pre-school establishments and schools: http://bidok.uibk.ac.at/library/feuserthesis-e.html Feuser, Georg (2001): Prinzipien einer inklusiven Pädagogik. In: Behinderte in Familie, Schule und Gesellschaft, 2/2001, S. 25-29. Feuser, Georg (2008): “All Men will Become Brothers ” – Time and Rhythm as Basic Processes of Life and Understanding. In: Salmon, Shirley (2008) (Ed.): Hearing – Feeling Playing. Music and Movement for Deaf and Hard-of- Hearing Children. Wiesbaden (Reihe Forum Zeitpunkt). Keller, Wilhelm (1979): Gruppenmusizieren mit Geistig- und Mehrfachbehinderten. In: Finkel, Klaus (Ed.): Handbuch Musik und Sozialpädagogik. Regensburg. Keller, Wilhelm (1984): Elementare Musik von und mit Behinderten. In: Musik und Bildung, 12/1984 Mainz Keller, Wilhelm (1996): Musikalische Lebenshilfe. Ausgewählte Berichte über sozial- und heilpädagogische Versuche mit dem Orff-Schulwerk. Mainz. 13 Pauls, Regina (2010): Introduction. In: Salmon, Shirley/ Kallós, Coloman: Booklet to the DVD Between Freedom and Ritual. Means of expression with music and movement for people with disabilities. UNIMOZ-002 Mozarteum University Salzburg. ISBN 978-3 -9502713-1-7 Salmon, Shirley (Ed.) (2008): Hearing – Feeling - Playing. Music and Movement for Deaf and Hard-of- Hearing Children. Wiesbaden (Reihe Forum Zeitpunkt) Salmon, Shirley/ Kallos, Coloman (2010): Between Freedom and Ritual. Means of expression with music and movement for people with disabilities. DVD and Booklet (German/English). UNIMOZ-002 Mozarteum University Salzburg. ISBN 978-3 -9502713-1-7 Schumacher, K., Calvet-Kruppe, C. (1999): The AQR - an Analysis System to Evaluate the Quality of Relationship during Music Therapy, in: Nordisk Journal of Music Therapy, 8 (2), pp. 18 – 192. Schumacher, Karin/ Calvet, Claudine/ Stallmann, Martina (2005): Zwischenmenschliche Beziehungsfähigkeit – Ergebnisse der Reliabilitätsprüfung eines neu entwickelten Instrumentes zum Wirkungsnachweis der Musiktherapie. In: Müller-Oursin, Barbara (ED.): Ich wachse, wenn ich Musik mache. Musiktherapie mit chronisch kranken und von Behinderung bedrohten Kindern. Wiesbaden, S. 75-104. Schumacher, Karin (20043): Musiktherapie und Säuglingsforschung. Zusammenspiel. Einschätzung der Beziehungsqualität am Beispiel des instrumentalen Ausdrucks eines autistischen Kindes. Frankfurt/Main. Schumacher, K. / Calvet, C. (2007): The "AQR-Instrument" (Assessment of the Quality of Relationship) - An Observation Instrument to Asses the Quality of a Relationship. In: Wosch, Th., Wigram, T. (Ed.): Microanalysis in Music Therapy. Methods, Techniques and Applications for Clinicians, Researchers, Educators and Students. S. 79-91, 2007, Jessica Kingsley Publishers Ltd.: London, Philadelphia Schumacher, K. / Calvet, C. (2008): Synchronisation/Synchronization- Musiktherapie bei Kindern mit Autismus/ Music Therapy with Children in the Autistic Spectrum. Unter Mitarbeit 14 von Manfred Hüneke und Petra Kugel. DVD-Box, German/English. Göttingen: Vandenhoeck & Ruprecht Schumacher, Karin/ Calvet Claudine/ Reimer, Silke (2011): Das EBQ-Instrument und seine entwicklungspsychologischen Grundlagen. DVD and booklet Göttingen. Stelzhammer-Reichhart/Salmon (2008): Schläft ein Lied in allen Dingen. Musikwahrnehmung und Spiellieder bei Schwerhörigkeit und Gehörlosigkeit. Wiesbaden Shirley Salmon BA, PGCE, MPhil Studied Music at York University, England and piano with Susan Bradshaw, London; Postgraduate Certificate of Education at London University; Studied Educational Science at Innsbruck University. 1974 –1976 employed as a school music teacher in London and at an adult education college. Has lived in Graz, Austria since 1977. 1978 – 2001 Free-lance work in Kindergartens, in groups for disabled children and their mothers and in integrative projects. 1981 – 2003 employed by the county of Styria, Austria working in various institutions for disabled adults, for behaviourally and emotionally disturbed children, for deaf and hearing impaired children, on holiday camps for disabled children and their families. Lecturer at the Orff-Institute, University Mozarteum Salzburg since 1984 in the area of “Music and Dance in the Community and in Integrative Education” (Fundamentals of integrative education, Didactics, Teaching practice). Lecturer in Music and Movement Education at universities for teacher-training in Graz since 2001. Articles in various journals, Author. Courses, lectures and workshops in Austria, Germany, Spain, Italy, USA, Japan, Croatia, Mexico, Hungary, Hong Kong, Turkey, South Korea 15