Qualitative Research Proposal Final

1Qualitative Research ProposalHow do musicians with performance anxiety that are intherapy, perceive and describe their experience ofhumanistic counselling/psychotherapy?Anastasia ChristidouAthens Synthesis Center GR, Middlesex University UK, June 2010

2TABLES OF CONTENTSABSTRACT……………………………………………………………………………….3INTRODUCTION………………………………………………………………………...4Background of the research proposal and personal motivation…………………………...5Research questions………………………………………………………………………..6Audience, aim and goals of the research………………………………………………….7LITERATURE REVIEWPerformance anxiety and its prevalence………………………………………………….9Known effective treatments for performance anxiety…………………………………...10Humanistic counselling/psychotherapy researches on performance anxiety……………11METHODOLOGYHeuristic inquiry…………………………………………………………………………13Research preparation…………………………………………………………………….15Collecting data…………………………………………………………………………..16Organizing and Synthesizing data……………………………………………………….17EPILOGUE……………………………………………………………………………...20REFERENCES…………………………………………………………………………..21

3ABSTRACTMost musicians despite their diligent practice, talent and creativity, experienceperformance anxiety while performing. It is an interruption in the flow of their creativityin the form of physical, cognitive and emotional symptoms. According to researches mostmusicians use primarily medication or alcohol to deal with stage fright.As a professional musician I had difficulties of dealing with stage fright myself. I havebeen interested in this topic for many years and participated in many workshops focusedon this topic.The literature on the issue of what performance anxiety is and how to deal with it, isextensive. Nevertheless it seems that no research have been published on how musicianswith performance anxiety experience being in humanistic counselling/psychotherapy.My aim is to explore and provide insight and information to practitioners and policymakers in music institutions on the experience of musicians that deal with performanceanxiety.I chose to conduct my research using heuristic inquiry which focuses on the meaning andexperience of the co-researchers. It is an approach that requires from the researcherpersonal experience with the phenomenon being researched and emphasis is given on herinternal frame of reference, self-awareness and intuition.

4INTRODUCTIONMost musicians are familiar with the term stage fright or performance anxiety. Almost allthe musicians I have met the 27 years that I studied music and work as a professionalmusician, 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 andemotional distractions and with symptoms such as tachycardia, tremulousness, nausea,vomiting, abdominal pain, diarrhea, hyperventilation, negative thoughts, feelings ofinadequacy and others. These symptoms are usually being referred as “performanceanxiety”.Sometimes performance anxiety is so impairing that it can end a career. It takes out thejoy from performing, it blocks people that are gifted and it doesn‟t allow them to expresstheir creativity. Since the career of a musician depends on his ability to handle his stagefright, it is of great importance that a musician will deal with it. Sadly most musicians Iknow turn to beta-blockers, sedatives, alcohol, cannabis and hard drugs in order to dealwith their stage fright.Given the seriousness and the prevalence of performance anxiety and the fact that fewmusicians seek professional help, it „s vital that this topic still needs to be addressed andresearched.

5Background of the research proposal and personal motivationBeing a professional cellist for 15 years and playing music since I was 7 years old, I haveperformed in many exams, concerts and competitions. Nevertheless, I had alwaysproblems 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, cognitiveand emotional symptoms. With the years I learned to look as if I control my physicalsymptoms better, I appear to be calm while I was in excruciating abdominal pain thatobliged 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 readmany books and studies, I have participated in coping skills seminars and I have followedlessons 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). Iobserve how I handle performance anxiety now and it „s such a difference from the past. Ihave exchanged experiences with fellow musicians that have been also in humanistictherapies and learned that their therapeutic experience was mostly beneficial for theirstage fright.Since I started my training in Integrative Counselling, I start to comprehend better theliterature relevant with the topic of performance anxiety. How come there are mainlyCognitive-Behavioural approaches to this topic? Why musicians are reluctant to talkopenly about stage fright? How come Music Institutions are aiming for short term reliefsymptom oriented therapies to help their students in some cases and other Institutions

6even ignore the topic of stage fright? Why there is almost no literature available fromhumanistic/holistic therapies in performance anxiety or anxiety disorders?My questions lingered for a long time till now that I am writing my research proposal andI 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 client‟s expectations of therapy?

7Audience, aim and goals of the research“As therapists, we do our best to help our clients to express their feelings, accepttheir desires and their agency, and to develop constructive, dialogicalrelationships with the other people in their lives. As therapy researchers we seemto find it very hard to achieve any of those goals. The mainstream of research-based writing about therapy is unreflexive, distanced, permeated by a scientificideology that is neither appropriate nor satisfying”. - John McLeod (2001: 172)Rowan (1992) observes that those who conduct research in psychotherapy havebecome remote from the ones that practice it, he goes further to suggest to moveto a new kind of research that doesn‟t talk about variables but about people topeople.My research is addressed to other practitioners and policy makers with the aim toexplore and provide insight and information on the experience of musicians thatdeal with performance anxiety. I hope that my research will stimulate moreresearches on the experience of clients in humanistic therapy and will influencepolicy makers in music institutions.My goals are to explore how clients construe their experience of therapy, to allowtheir voices to emerge and to see what happens in humanistic therapy. What theclients are looking for in this period of their life, what they think/ feel/ sense, how

8they perceive the effectiveness of therapy, if they see themselves as havingbenefited from therapy or not, how important is the therapeutic relationship forthem and other goals that will emerge in latter phases of my research.

9LITERATURE REVIEWPerformance anxiety and its prevalenceSalmon (1990: 3) stated that performance anxiety is “the experience of persisting,distressful apprehension about and/or actual impairment of performance skills in a publiccontext, to a degree unwarranted given the individual‟s musical aptitude, training, andlevel of preparation.”According to DSM-IV-TR (American Psychiatric Association, 2000: 456), stage frightmeets 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 psychologicalcounselling and aerobic exercise. (Fishbein, Middlestadt, Ottati, Straus, & Ellis, 1988).A survey among 65 professional musicians in the Royal Philharmonic Orchestra and inthe London Philharmonic Orchestra summarized the following means to cope withperformance anxiety: 21% of musicians used medication, 32% used some form ofmeditation and 51% used alcohol before performing (Steptoe & Fidler, 1987: 242).Van Kemenade et al. (1995) surveyed 155 professional musicians playing in symphonicorchestras in the Netherlands. The authors reported that 58.7% of the musiciansexperienced performance anxiety with 55% reporting that the anxiety severely impairedtheir professional life.

10Known effective treatments for performance anxietyResearchers have studied various approaches as coping strategies against performanceanxiety. There are literally thousands of books and researches on the issue of “how todeal most effectively with performance anxiety”. I will refer briefly to the knowneffective approaches with a representative literature sample.These approaches include:behavioural therapies : Systematic desensitization (Gerow, 1986), Deep muscularrelaxation (Jacobson, 1938), Autogenic training (Linden, 1994), biofeedback (Egner &Gruzelier, 2003; Reynolds, 1984).cognitive therapies: (Currie, 2001; Hipple, 2005; Green & Gallwey, 1986), RationalEmotive 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).

11Humanistic counselling/psychotherapy researches on performance anxietyThe last 20 years there has been an increasing emphasis on empirical validation ofapproaches in psychotherapy. Health insurance companies began to pay forpsychotherapy provided by several mental health professionals. There was a shift frompsychotherapy as an art and a relationship to a more medical model focused in symptomrelief 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 wereconducted with the goal of having these approaches added on the list. Behavioural andCognitive approaches that are more applicable to quantitative research became the moststudied . The meaningful differences among the psychotherapy approaches studied in thatlist, are non existent (Wampold, 2001). Based on meta-analysis (Hubble, Duncan &Miller, 1999), it has been concluded that the list reflects that the approved methodsincluded in the list have been researched and others haven‟t.A similar shift occurred in UK when the National Health Service adopted a policy ofevidence-based treatment (Roth & Fonagy, 1996; Rowland & Goss, 2000).Few therapy researchers believe that qualitative research has a lot to offer in the study ofthe effect of counselling/psychotherapy on clients. Humanistic psychotherapies tend to bemore like an artful application (an improvisation) of a theory/method than a fixed methodthat can be easily quantified and replicated.Humanistic therapies need to generate their own research in order to expand their theoryand open new ways in the understanding of the therapeutic experience of clients.

12Discovering all those issues while working in my research proposal is of greatimportance 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 impairingand stressful way.The second is that there is a considerable amount of literature that explains whatperformance 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 ofmusicians with performance anxiety being in therapy. It seems there is nothing describingor researching of how musicians make sense of their therapy within the context of theirlives as a whole. I didn‟t find a research that could contribute to my understanding ofhow humanistic therapy may or may not help musicians to deal with their performanceanxiety.

13METHODOLOGY …We can never achieve a complete “scientific” understanding of the humanworld. The best we can do is to arrive at a truth that makes a difference, that opens upnew possibilities for understanding.John McLeod (2001: 4)I propose a qualitative study using a heuristic approach.Heuristic inquiryThe word heuristic comes from the Greek word heuriskein that means to find. It refers toa process of internal search through which one discovers the nature and meaning ofexperience. (Moustakas, 1990: 9). Heuristic inquiry explores how behavior is determinedby personal experience rather than an external objective reality, it is a subjectiveapproach. It differs from mainstream phenomenology since the latter focuses on theobjects of human experience. Whereas phenomenology encourages a detachment fromthe researched phenomenon, heuristic inquiry focuses on connectedness. (Douglass &Moustakas, 1985: 43).In heuristic research the researcher is present through the process, she attunes herself tothe meaning and experience of the co-researchers and at the same time she experiencesgrowing self-awareness and self-knowledge. The researcher is personally involved,emphasis is given on her internal frame of reference, self-awareness, autobiographicalreflections and intuition.

14Moustakas (1990: 13) observed that “the heuristic process requires a return to the self, arecognition of self awareness and a valuing of one‟s own experience”. It is necessary thatthe researcher has a personal experience with the phenomenon being researched. Frick(1990: 79) emphasized that heuristic inquiry requires “rigorous definition, carefulcollection of data and a thorough and disciplined analysis. It places immenseresponsibility 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).

15Research Preparation1. 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 .

16 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 hispartner as the very one he is”. Martin Buber (1965: 79)A common way of collecting data in heuristic research is through interviews that have theform of dialogues. Dialogue is the preferred approach since it aims toward encouragingexpression, elucidation and disclosure of the phenomenon being researched (Moustakas,1990: 47). In genuine dialogue the uniqueness of each person is valued, one isencouraged to express himself naturally. That means receiving the co-researcher as apartner, accepting and affirming him. According to O‟Hara (1986) and Barrineau &Bozarth (1989) the core conditions vital for therapeutic personality change as they wereidentified by Rogers (1957) were congruent with qualitative research processes and theconcepts of heuristic research.

17McLeod (2001: 138) points out that “a qualitative interview involves a meeting of twopeople and the formation of a relationship”.Genuine dialogue cannot be planned but I will take the opportunity when appropriate toask a few specific questions each co-researcher. The interviews will be recorded on adigital voice recorder in order to be transcribed and analysed afterwards. The duration ofeach interview will be 40-60min depending when they come to a natural end. After eachinterview 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 qualitativeresearcher”. (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

18 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, tale…e.t.c.

19EPILOGUEThroughout the research proposal I have stressed how important is the topic ofperforming anxiety for musicians. Unfortunately many musicians don‟t seek professionalhelp and turn to medication. It is important to raise the awareness of therapists and policymakers of music institutions that humanistic counselling/psychotherapy also works withthis issue. I chose heuristic inquiry as a method of research due to its autobiographicaland subjective character. It seems that there are no researches published on howmusicians with performance anxiety construe their experience of humanistic counselling/psychotherapy. I believe that my research will give valuable information and insight totherapists and policy makers of music institutions.

20 REFERENCESAmerican Psychiatric Association. (2000). Diagnostic and statistical manual of mental thdisorders (4 ed. text revision). Washington, D. C.Barber, P. & Brownell, P. (2008). Qualitative Research. In P. Brownell (eds), Handbookfor theory, research, and practice in Gestalt Therapy. Newcastle: Cambridge ScholarsBarrineau, P. & Bozarth, J.D. (1989). A person-centered research model. Person-Centered review. 4(4), 465-474.British Psychological Society (1996) Code of conduct, ethical principles and guidelines.Leicester: BPSBuber, M. (1965). The knowledge of man: a philosophy of the interhuman. Introductionby M. S. Friedman. New York: Harper & RowClark, D. B., & Agras, W. S. (1991). The assessment and treatment of performanceanxiety in musicians. American Journal of Psychiatry, 148(5), 598-605.Currie, K. A. ( 2001). Performance anxiety coping skills seminar: Is it effective inreducing musical performance anxiety and enhancing musical performance quality?(Doctoral dissertation, Virginia Polytechnic Institute and State University).Dews, C. B., & Williams, M. S. (1989). Student musicians‟ personality styles, stresses,and coping patterns. Psychology of Music, 17 (1), 37-47.Douglass, B.G., & Moustakas, C. (1985). Heuristic inquiry: The internal search to know.Journal of Humanistic Psychology. 25(3), 39-55.

21Egner, T., & Gruzelier, J. H. (2003). Ecological validity of neurofeedback: Modulation ofslow wave EEG enhances musical performance. Cognitive Neuroscience andNeuropsychology, 14(9), 1221-1224.Esplen, M. J., & Hodnett, E. (September 1999). A pilot study investigating studentmusicians experiences of guided imagery as a technique to manageperformance anxiety. Medical Problems of Performing Artists, 15, 127-132.Esposito, J. E. (1999). No more stage fright! A course to overcome the fear of publicspeaking and performing. (Online). Available Internet: http://performanceanxiety.com.Fishbein, M., Middlestadt, S., Ottai, V., Straus, S., & Ellis, A. (1988). Medical problemsamong ICSOM musicians: Overview of a national survey. Medical Problems ofPerforming Artists, 3 (3), 1-8.Frick, W. B. (1990). The symbolic growth experience: a chronicle of heuristic inquiryand a quest for synthesis. Journal of Humanistic Psychology, 30(1), 64-80.Gerow, J. R. (1986). Systematic desensitization. In Psychology: An introduction (560-561). Glenview, Illinois: Scott Foresman and Co.Gold, E. K & Zahm, S. G. (2008). The need for Gestalt Therapy research. In P. Brownell(eds), Handbook for theory, research, and practice in Gestalt Therapy. Newcastle:Cambridge Scholars.Green, B., & Gallwey, W. T. (1986). The inner game of music. Garden City, New York:Anchor Press/Doubleday.

22Hipple, J. (December 2005). Performance anxiety: Letting go of the tiger‟s tail.[Unpublished pamphlet for students with music performance anxiety at theUniversity of North Texas].Holland, P. (1995). The role of music therapy in the effective use of stress. T. Wigram, B.Saperston & R. West (eds). The art and science of music therapy: a handbook. Sydney:Harwood Academic.Hubble, M., Duncan, B. & Miller, S. (1999). The heart and soul of change: what works intherapy. Washington, DC: American Psychological Association.Jacobson, E. (1938). Progressive relaxation. Chicago: University of Chicago Press.Kemenade, J. F. van, Son, M. J. van, & Heesch, N. C. van. (October 1995).Performance anxiety among professional musicians in symphonic orchestras: Aself-report study. Psychological Reports, 77(2), 555-562.Latner, J. (2000). The theory of Gestalt Therapy. In E.C.Nevis (eds.), Gestalt Therapy:perspectives and applications. Cambridge, MA: GestaltPress.Marshall, A.J. (September 2008). Perspectives about musician‟s performance anxiety.(Mini-dissertation, University of Pretoria).Mc Leod, J. (2001). Qualitative research in Counselling and Psychotherapy. London:Sage.Moustakas,C. (1990). Heuristic research: design, methodology, and applications.Newbury Park: Sage.

23Nagel, J. J., Himle, D. P., & Papsdorf, J. D. (1989). Cognitive-behavioral treatment ofmusical performance anxiety. Psychology of Music, 17, 12-21.O‟Hara, M. (1986). Heuristic inquiry as psychotherapy: The Client-Centered Approach.Person-Centered review, 1(2), 172-184.Oyan, S. (May 2006). Mindfulness meditation: Creative musical performance throughawareness. (Doctoral Dissertation, Louisiana State University and Agricultural andMechanical College).Reynolds, S. B. (1984). Biofeedback, relaxation training and music: Homeostasis forcoping with stress. Biofeedback and Self Regulation, 9 (2), 169-179.Robin, M. W. (1993). Overcoming performance anxiety: Using RET with actors, artists,and other “performers.” Innovations in rational-emotive therapy “, 160-184. NewburyPark, CA: Sage.Roth, A. & Fonagy, P. (1996). What works for whom? A critical review ofpsychotherapy research. New York: Guildford Press.Rowan, J. (1992). In a response to, Mair, K . The myth of therapist expertise. In W.Dryden & C. Feltham (eds.), Psychotherapy and its discontents, Buckingham: OpenUniversity Press, 160-166.Rowland, N & Goss, S. (2000). (eds). Evidence- based counseling and psychologicaltherapies: research and applications. London: Routledge.

24Salmon, P. G. (1990). A psychological perspective on musical performanceanxiety: a review of the literature. Medical Problems of Performing Artists, 5(1),2-11.Stanton, H. E. (1994). Reduction of performance anxiety in music students. AustralianPsychologist, 29(2), 124-127.Steptoe, A., & Fidler, H. (1987). Stage fright in orchestral musicians: A study ofcognitive and behavioral strategies in performance anxiety. British Journal ofPsychology, 78, 241-249.Thurber, M. R. (December 2006). Effects of heart-rate variability biofeedback trainingand emotional regulation on music performance anxiety in University students. (Doctoraldissertation, University of North Texas).Valentine, E. R. (2002). The fear of performance. In J. Rink (Eds.), MusicalPerformance: A Guide to Understanding. Cambridge: Cambridge University Press, 168-182.Valentine, E., Fitzgerald, D., Gorton, T., & Hudson, J. (1995). The effect of lessons in theAlexander Technique on music performance in high and low stress situations. Psychologyof Music, 23(2), 129.Wampold, B. E. (2001). The great psychotherapy debate: models, methods and findings.Mahwah New Jersey: Lawrence Erlbaum Associates.

Qualitative Research Proposal Final

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