Design of the Study

In order to explore the implications of the use of a psychotherapeutic approach to vibroacoustic therapy with patients with functional neurological symptom disorder, a single case study was implemented. This pilot case study consisted of hour-long sessions, twice a week, for 10 weeks, for a total of 20 sessions beginning in November 2017. Phase one of treatment, comprised of 7 sessions, and took place from November 16 – December 14, 2017.

Following phase one was a one-month washout period, with phase two of treatment beginning on January 18, and continuing to March 8, 2018. The washout period was included to accommodate holiday schedules as well as to monitor any prolonged effects of phase one of

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the therapeutic process. Questionnaires were administered prior to the first session of phase one, prior to the first session of phase two, and prior to the last session of phase two. Visual analog scales were administered before and after the vibroacoustic treatment on the second session and last session of phase one, and before and after the vibroacoustic treatment of the first and last sessions of phase two. A diagram with a clearer depiction of the study design, along with external therapeutic procedures can be seen below, in Figure 1.

FIGURE 1. Study design.

4.5.1 External Therapeutic Procedure

The overarching structure of the therapeutic process was divided into three main sections:

assessment period, working period, and closure period. The Music Psychotherapy Assessment (Loewy, 2000) was completed during the assessment period, using the music therapist’s clinical observations and active assessment interventions from the first five music therapy sessions. At the conclusion of the assessment period, the therapeutic aims and objectives for the client were established based on the completed assessment. The music therapist and client worked toward these clinical aims throughout the working period, which is the largest portion of the therapeutic process. To offer sufficient closure for the client (and the music therapist), the final four sessions were dedicated to providing closure to the therapeutic relationship, as well as the various themes that developed throughout the process. The overall structure of the external therapeutic procedure is outlined below in Figure 2.

FIGURE 2. Structure of the therapeutic process, outlining the 20 sessions.

4.5.2 Internal Therapeutic Procedure

The structure of each individual session was kept consistent throughout the therapeutic process. The consistency from session to session is important to offer the client a sense of familiarity and comfort even though aspects or dynamics within the therapy may change from session to session such as the therapeutic relationship development, progress towards aims, etc. Each session began with a brief verbal check-in with the client. It was during this time that the client would be free to inform the therapist of any significant happenings since the previous session, any processing that the client had done between sessions, experience of physiological symptoms between sessions (if any), and/or anything that the client felt the need to discuss with the therapist at the beginning of the session. The therapist would take this time to briefly assess the client’s current state (physically and psychologically) and take this assessment into account for the remainder of the session, making appropriate changes to the program selected for the vibroacoustic treatment, the music selected to accompany the vibroacoustic treatment, and how to appropriately transition and guide the client into the vibroacoustic treatment.

The vibroacoustic treatment took place on the Next Wave Physioacoustic Chair, with accompanying computer software to select and monitor the treatment programs. Treatment programs chosen for this therapeutic process were all soft/non-activating – relaxation and insomnia. These programs were each 20 minutes in length, and had varying intensities, with programs centering around 40 Hz. Client preferred music was played in the background for the duration of the vibroacoustic treatment using the clinic’s sound system and mounted speakers. The music was selected not only to be suited to the client’s preferences, but also to lend to the relaxing program itself. Thus, the therapist selected music from the classical and romantic eras with relatively slow tempos, no drastic or rapid changes in tempo or dynamic, instruments with a soft timbre, and music that was relatively safe and predictable in nature.

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Following the vibroacoustic treatment, the client would reflect to the music therapist about her experience. Following the client’s free reflection, the therapist would provide any intervention to ensure the client’s feeling of safety and comfort, and to guide the client to the present state (if needed). The therapist ensured that all areas of experiences on the cognitive, symbolic, emotional, and sensorimotor levels were processed, by discussing the client’s experience of thoughts, images, memories, bodily sensations, and/or emotions during the treatment (Punkanen & Ala-Ruona, 2012). After this second level reflection discussion with the therapist, the therapist would once again provide any intervention to ensure the client’s feeling of safety, comfort and orientation to the present (if needed).

The processing of the thoughts, images, memories, bodily sensations, and/or emotions was done using various verbal and musical interventions. These interventions were psychotherapeutic in nature and addressed the present experiences and state of the client, while simultaneously contributing to the overarching therapeutic aims and objectives. For this case, the active music intervention used throughout the therapeutic process was clinical improvisation. Following the processing portion of the music therapy session, the session would conclude with a brief period of closure, to wrap up the day’s themes, recap the process, and leave the session looking to the future. This is important to the session’s structure to ensure the client is leaving in a comfortable and safe state, looking ahead to the next session.

The outline of the internal structure of sessions was defined prior to the beginning of this case. Though the originally established outline remained unchanged for this particular case and individual client, the internal flexibility remained, in order to suit the client’s individual needs as the therapy progressed. An outline of the session procedure can be seen in Figure 3.

FIGURE 3. Outline of music therapy session procedure.