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Qualitative Research Proposal

How do musicians with performance anxiety that are in therapy, perceive and describe their experience of humanistic counselling/psychotherapy?

Anastasia Christidou Athens Synthesis Center GR, Middlesex University UK, June 2010

TABLES OF CONTENTS ABSTRACT.3 INTRODUCTION...4 Background of the research proposal and personal motivation...5 Research questions..6 Audience, aim and goals of the research.7 LITERATURE REVIEW Performance anxiety and its prevalence.9 Known effective treatments for performance anxiety...10 Humanistic counselling/psychotherapy researches on performance anxiety11 METHODOLOGY Heuristic inquiry13 Research preparation.15 Collecting data..16 Organizing and Synthesizing data.17 EPILOGUE...20 REFERENCES..21

ABSTRACT Most musicians despite their diligent practice, talent and creativity, experience performance anxiety while performing. It is an interruption in the flow of their creativity in the form of physical, cognitive and emotional symptoms. According to researches most musicians use primarily medication or alcohol to deal with stage fright. As a professional musician I had difficulties of dealing with stage fright myself. I have been interested in this topic for many years and participated in many workshops focused on this topic. The literature on the issue of what performance anxiety is and how to deal with it, is extensive. Nevertheless it seems that no research have been published on how musicians with performance anxiety experience being in humanistic counselling/psychotherapy. My aim is to explore and provide insight and information to practitioners and policy makers in music institutions on the experience of musicians that deal with performance anxiety. I chose to conduct my research using heuristic inquiry which focuses on the meaning and experience of the co-researchers. It is an approach that requires from the researcher personal experience with the phenomenon being researched and emphasis is given on her internal frame of reference, self-awareness and intuition.

INTRODUCTION Most musicians are familiar with the term stage fright or performance anxiety. Almost all the musicians I have met the 27 years that I studied music and work as a professional musician, they have experienced performance anxiety at least a few times in their lives. The flow of creativity is interrupted during a performance by physical, cognitive and emotional distractions and with symptoms such as tachycardia, tremulousness, nausea, vomiting, abdominal pain, diarrhea, hyperventilation, negative thoughts, feelings of inadequacy and others. These symptoms are usually being referred as performance anxiety. Sometimes performance anxiety is so impairing that it can end a career. It takes out the joy from performing, it blocks people that are gifted and it doesnt allow them to express their creativity. Since the career of a musician depends on his ability to handle his stage fright, it is of great importance that a musician will deal with it. Sadly most musicians I know turn to beta-blockers, sedatives, alcohol, cannabis and hard drugs in order to deal with their stage fright. Given the seriousness and the prevalence of performance anxiety and the fact that few musicians seek professional help, it s vital that this topic still needs to be addressed and researched.

Background of the research proposal and personal motivation Being a professional cellist for 15 years and playing music since I was 7 years old, I have performed in many exams, concerts and competitions. Nevertheless, I had always problems of handling my stage fright. It was not always in front of big audiences, sometimes my teacher was enough for me to experience debilitating physical, cognitive and emotional symptoms. With the years I learned to look as if I control my physical symptoms better, I appear to be calm while I was in excruciating abdominal pain that obliged me among others to take ulcer medication even though I have no ulcer! I have been interested in the issue of performance anxiety for many years. I have read many books and studies, I have participated in coping skills seminars and I have followed lessons of Alexander Technique, Feldenkrais method, meditation, breathing exercises, muscle relaxation e.t.c. The last 3 years I have been in personal therapy (Integrative and Gestalt Therapy). I observe how I handle performance anxiety now and it s such a difference from the past. I have exchanged experiences with fellow musicians that have been also in humanistic therapies and learned that their therapeutic experience was mostly beneficial for their stage fright. Since I started my training in Integrative Counselling, I start to comprehend better the literature relevant with the topic of performance anxiety. How come there are mainly Cognitive-Behavioural approaches to this topic? Why musicians are reluctant to talk openly about stage fright? How come Music Institutions are aiming for short term relief symptom oriented therapies to help their students in some cases and other Institutions

even ignore the topic of stage fright? Why there is almost no literature available from humanistic/holistic therapies in performance anxiety or anxiety disorders? My questions lingered for a long time till now that I am writing my research proposal and I have the opportunity to explore them.

Research questions What approaches are used mostly to work with performance anxiety? Is humanistic counselling/psychotherapy an approach that is used to deal with performance anxiety? Are there any researches or case studies concerning humanistic therapists working with performance anxiety? What is the experience of musicians with performance anxiety when working with a humanistic therapist? How the client-musician perceives events occurring in therapy? What are the clients expectations of therapy?

Audience, aim and goals of the research As therapists, we do our best to help our clients to express their feelings, accept their desires and their agency, and to develop constructive, dialogical relationships with the other people in their lives. As therapy researchers we seem to find it very hard to achieve any of those goals. The mainstream of researchbased writing about therapy is unreflexive, distanced, permeated by a scientific ideology that is neither appropriate nor satisfying. - John McLeod (2001: 172)

Rowan (1992) observes that those who conduct research in psychotherapy have become remote from the ones that practice it, he goes further to suggest to move to a new kind of research that doesnt talk about variables but about people to people. My research is addressed to other practitioners and policy makers with the aim to explore and provide insight and information on the experience of musicians that deal with performance anxiety. I hope that my research will stimulate more researches on the experience of clients in humanistic therapy and will influence policy makers in music institutions. My goals are to explore how clients construe their experience of therapy, to allow their voices to emerge and to see what happens in humanistic therapy. What the clients are looking for in this period of their life, what they think/ feel/ sense, how

they perceive the effectiveness of therapy, if they see themselves as having benefited from therapy or not, how important is the therapeutic relationship for them and other goals that will emerge in latter phases of my research.

LITERATURE REVIEW Performance anxiety and its prevalence Salmon (1990: 3) stated that performance anxiety is the experience of persisting, distressful apprehension about and/or actual impairment of performance skills in a public context, to a degree unwarranted given the individuals musical aptitude, training, and level of preparation. According to DSM-IV-TR (American Psychiatric Association, 2000: 456), stage fright meets criteria for social phobia when it is marked with significant distress, anxiety, and/or avoidance.

A survey of 2,212 professional classical musicians indicated that medication [beta-blockers]

was the most frequently tried treatment for severe stage fright, followed by psychological counselling and aerobic exercise. (Fishbein, Middlestadt, Ottati, Straus, & Ellis, 1988).

A survey among 65 professional musicians in the Royal Philharmonic Orchestra and in the London Philharmonic Orchestra summarized the following means to cope with performance anxiety: 21% of musicians used medication, 32% used some form of meditation and 51% used alcohol before performing (Steptoe & Fidler, 1987: 242). Van Kemenade et al. (1995) surveyed 155 professional musicians playing in symphonic orchestras in the Netherlands. The authors reported that 58.7% of the musicians experienced performance anxiety with 55% reporting that the anxiety severely impaired their professional life.

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Known effective treatments for performance anxiety Researchers have studied various approaches as coping strategies against performance anxiety. There are literally thousands of books and researches on the issue of how to deal most effectively with performance anxiety. I will refer briefly to the known effective approaches with a representative literature sample. These approaches include: behavioural therapies : Systematic desensitization (Gerow, 1986), Deep muscular relaxation (Jacobson, 1938), Autogenic training (Linden, 1994), biofeedback (Egner & Gruzelier, 2003; Reynolds, 1984). cognitive therapies: (Currie, 2001; Hipple, 2005; Green & Gallwey, 1986), Rational Emotive Therapy (Robin, 1993). cognitive-behavioural therapies: (Clark & Agras, 1991; Nagel, Himle, Papsdort, & James, 1989; Steptoe & Fidler, 1987). mindfulness meditation : (Kabat-Zinn, 1994; Oyan, 2006). guided imagery: (Esplen & Hodnett, 1999). Alexander technique: (Valentine, Fitzgerald, Gorton, & Hudson, 1995). hypnotherapy (Stanton, 1994). music therapy : (Holland, 1995). classroom and group therapies (Dews, 1989; Esposito, 1999; Currie, 2001).

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Humanistic counselling/psychotherapy researches on performance anxiety The last 20 years there has been an increasing emphasis on empirical validation of approaches in psychotherapy. Health insurance companies began to pay for psychotherapy provided by several mental health professionals. There was a shift from psychotherapy as an art and a relationship to a more medical model focused in symptom relief within a time-limited frame (Gold & Zahm, 2008: 28). As a result, in 1993, APA developed a list with empirically supported treatments. Hundreds of researches on psychotherapy outcome of particular approaches were conducted with the goal of having these approaches added on the list. Behavioural and Cognitive approaches that are more applicable to quantitative research became the most studied . The meaningful differences among the psychotherapy approaches studied in that list, are non existent (Wampold, 2001). Based on meta-analysis (Hubble, Duncan & Miller, 1999), it has been concluded that the list reflects that the approved methods included in the list have been researched and others havent. A similar shift occurred in UK when the National Health Service adopted a policy of evidence-based treatment (Roth & Fonagy, 1996; Rowland & Goss, 2000). Few therapy researchers believe that qualitative research has a lot to offer in the study of the effect of counselling/psychotherapy on clients. Humanistic psychotherapies tend to be more like an artful application (an improvisation) of a theory/method than a fixed method that can be easily quantified and replicated. Humanistic therapies need to generate their own research in order to expand their theory and open new ways in the understanding of the therapeutic experience of clients.

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Discovering all those issues while working in my research proposal is of great importance for me.

There are some major themes that emerge in the literature review. The first is that performance anxiety is experienced by most musicians in an impairing and stressful way. The second is that there is a considerable amount of literature that explains what performance anxiety is and proposes various approaches to deal with it. The third is that it seems that no research have been published on the experience of musicians with performance anxiety being in therapy. It seems there is nothing describing or researching of how musicians make sense of their therapy within the context of their lives as a whole. I didnt find a research that could contribute to my understanding of how humanistic therapy may or may not help musicians to deal with their performance anxiety.

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METHODOLOGY We can never achieve a complete scientific understanding of the human world. The best we can do is to arrive at a truth that makes a difference, that opens up new possibilities for understanding. John McLeod (2001: 4)

I propose a qualitative study using a heuristic approach. Heuristic inquiry The word heuristic comes from the Greek word heuriskein that means to find. It refers to a process of internal search through which one discovers the nature and meaning of experience. (Moustakas, 1990: 9). Heuristic inquiry explores how behavior is determined by personal experience rather than an external objective reality, it is a subjective approach. It differs from mainstream phenomenology since the latter focuses on the objects of human experience. Whereas phenomenology encourages a detachment from the researched phenomenon, heuristic inquiry focuses on connectedness. (Douglass & Moustakas, 1985: 43). In heuristic research the researcher is present through the process, she attunes herself to the meaning and experience of the co-researchers and at the same time she experiences growing self-awareness and self-knowledge. The researcher is personally involved, emphasis is given on her internal frame of reference, self-awareness, autobiographical reflections and intuition.

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Moustakas (1990: 13) observed that the heuristic process requires a return to the self, a recognition of self awareness and a valuing of ones own experience. It is necessary that the researcher has a personal experience with the phenomenon being researched. Frick (1990: 79) emphasized that heuristic inquiry requires rigorous definition, careful collection of data and a thorough and disciplined analysis. It places immense responsibility on the researcher. The six phases of heuristic research are: 1. Initial engagement: the researcher engages in a deep inner search in order to discover a passion and an intense interest for a research subject/question. 2. Immersion: the researcher merges with the question, he lives and grows in knowledge and understanding of it. 3. Incubation: the researcher retreats from focusing deeply on the question and allows inner workings and intuition to expand the knowledge of the question. 4. Illumination: the researcher reviews all the data acquired, she is receptive to new awareness and to something that has been present all along but has remain hidden. 5. Explication: the researcher listens to her own awareness, feelings, thoughts, beliefs and judgments, dominant themes of the subject are developed. 6. Creative Synthesis: the researcher puts all the components into a synthesis of narrative depiction or any other creative form (poem, painting, e.tc).

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Research Preparation 1. Defining the phenomenon I am interested in and my motivation. 2. Exploring the field from a Gestalt therapy perspective. The field is part of our awareness, our awareness is part of the field. In a relativistic universe, we are part of what we are observing, describing or measuring. Reality and experience are inseparable (Latner, 2000: 20-22). 3. Starting a research diary to catch ideas as they emerge spontaneously. 4. Talking to colleagues, finding a research mentor for support and also to challenge my blind spots. 5. Examining the literature and previous studies in the topic. 6. Defining the research question and my goals. 7. Identifying the resources needed for the research and the limitations. 8. Developing criteria for the selection of co-researchers (experience of stage fright and humanistic psychotherapy/counselling, age, sex, nationality, education, socioeconomic situation, interest, cooperation e.t.c) 9. Locating co-researchers by contacting Universities of Fine Arts Education in the Netherlands where I reside and contemplating research venue and co-researchers. The number of co-researchers that will respond to my invitation and will match the set criteria will be 10 .

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10. Making a contract which includes issues of informed consent, privacy, time, place, confidentiality, welfare of co-researchers, feedback of the results, permission to record the interview and use the material for research purposes/publication. 11. Making sure that ethical principles are covered. Ensure that the interests of participants in research are safeguarded (British Psychological Society, 1996: 1).

Collecting data The chief presupposition for the rise of genuine dialogue is that each should regard his partner as the very one he is. Martin Buber (1965: 79)

A common way of collecting data in heuristic research is through interviews that have the form of dialogues. Dialogue is the preferred approach since it aims toward encouraging expression, elucidation and disclosure of the phenomenon being researched (Moustakas, 1990: 47). In genuine dialogue the uniqueness of each person is valued, one is encouraged to express himself naturally. That means receiving the co-researcher as a partner, accepting and affirming him. According to OHara (1986) and Barrineau & Bozarth (1989) the core conditions vital for therapeutic personality change as they were identified by Rogers (1957) were congruent with qualitative research processes and the concepts of heuristic research.

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McLeod (2001: 138) points out that a qualitative interview involves a meeting of two people and the formation of a relationship. Genuine dialogue cannot be planned but I will take the opportunity when appropriate to ask a few specific questions each co-researcher. The interviews will be recorded on a digital voice recorder in order to be transcribed and analysed afterwards. The duration of each interview will be 40-60min depending when they come to a natural end. After each interview I will record my own thoughts and feelings and make notes in my diary.

Organizing and Synthesizing data Being informed and led by the field is part and parcel of the drama of being a qualitative researcher. (Barber & Brownell, 2008: 49).

Adapted from Moustakas (1990: 51-52) 1. The researcher gathers all the data from one co-researcher (recording, transcript, notes, artwork) 2. The researcher enters into immersion until she understands the whole and the detail of the experience of the co-researcher. 3. The researcher may become awash with data. It helps breaking off for a while to return to the task afresh (Barber & Brownell, 2008: 49). The researcher identifies

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the themes manifested in the data and he makes an individual depiction of the experience of the co-researcher. 4. The researcher returns to the original data. If the individual depiction of the experience contains the themes of the original data, then the researcher moves to the next co-researcher. The depiction can be shared with the co-researcher for affirmation of its accuracy. 5. The researcher follows these steps until he has constructed an individual depiction for each co-researcher. 6. The depictions are gathered together and the researcher enters again into immersion and intervals of rest to discover the universal qualities of the depictions. The researcher then develops a composite depiction ( narratives, conversations, illustrations) that includes the core meanings of the experience of each co-researcher and of the group as whole. 7. The researcher returns again to the original data and the individual depiction of each co-researcher. The researcher selects 2-3 co researchers who clearly represent the group as a whole and develops individual portraits of these persons. 8. The final step is the development of a creative synthesis of the experience. The researcher as an artist presents the essence of the phenomenon through a narrative, poem, work of art, talee.t.c.

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EPILOGUE Throughout the research proposal I have stressed how important is the topic of performing anxiety for musicians. Unfortunately many musicians dont seek professional help and turn to medication. It is important to raise the awareness of therapists and policy makers of music institutions that humanistic counselling/psychotherapy also works with this issue. I chose heuristic inquiry as a method of research due to its autobiographical and subjective character. It seems that there are no researches published on how musicians with performance anxiety construe their experience of humanistic counselling/ psychotherapy. I believe that my research will give valuable information and insight to therapists and policy makers of music institutions.

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