MED-GIM Adaptations of the Bonny Method for Medical Patients: Individual Sessions

Transcription

1 Guided Imagery and Music: A Spectrum Approach MED-GIM Adaptations of the Bonny Method for Medical Patients: Individual Sessions Theoretical Orientation Introduction The Bonny Method of Guided Imagery and Music (BMGIM): The Association for Music and Imagery (AMI) has recently approved the definition of The Bonny Method as a music-assisted integrative therapy, which facilitates explorations of consciousness that can lead to transformation and wholeness. It evolved as a Method through the research and practice of Helen L. Bonny, Ph.D. In its one-on-one application it is known as The Bonny Method of Guided Imagery and Music (AMI, 2005). Several authors have reported adaptations of the (BMGIM) since Helen Bonny first developed it in the early 1970 s. The literature describes some changes, such as duration of the music, selection of the music, and bodily position during the music listening (Blake, 1994; Gimeno, 2010; Goldberg, 1998; Picket, ; Short, 1991; Summer, 2002; West 1998). Goldberg (1998) recommended the use of music with a narrow intervallic range to allow a very brief imagery experience without the dynamic unfolding that is characteristic of a standard session. Blake (1994) suggested a short duration of music no longer than 10 minutes with new age or classical style. She also recommended having the client in a sitting position rather than lying down on a couch, as is the case in a regular BMGIM session. Summer (2002) referred in her study to the importance of giving supportive therapy when clients need to be held to reinforce any positive feelings that might emerge during the session. In the same study she encourages the use of task-oriented induction as opposed to one induction that encourages exploration. She cites examples where the direction is to create a safe place or to provide a 1

2 relaxing image that holds the client in a common, positive feeling. Summer (2002) states that an induction should clearly present self-affirmation rather than a conflictual feeling. A positive image allows for increased feelings of safety and good self-esteem. MED-GIM Adaptations of the Bonny Method for Medical Patients: Individual Sessions I have developed two techniques that might be given to patients in a hospital. One is called MIR, which stands for music and imagery to induce relaxation. The second one is called MIJ, which stands for music and imagery journeys. Both adaptations fall under the umbrella of what I call MED-GIM, which stands for guided imagery and music in the medical setting. As a music therapist/ practitioner, I did this work in a hospital setting with an adult patient. The two types of interventions, MIR and MRJ, have two different purposes. The MIR technique is given to provide greater calmness to the patient about to face surgery or potentially traumatic procedures. The duration of the MIR session is around minutes. The MIJ technique is longer, around 30 minutes, and is given when the patient needs emotional support. MIJ helps the patient to connect to internal resources of confidence, possibly unknown by the patient beforehand, through a process that is stimulated by the music. MED-GIM, like the Bonny Method, is client centered and mirrors the regular BMGIM session. Both MIR and MIJ have the same structure and include prelude, induction, music listening, and postlude. While in MIR the only purpose is to relax the mind, in MIJ the purpose is to help the client find an inner source of power. The music and the induction stages help the patient reach inside for some inner resource of relaxation, potential confidence, or selfempowerment. MIJ includes a dialog between the patient and practitioner that would require the 2

3 music therapist to be trained in the specialized Bonny Method. Instead, MIR can be used by all music therapists. The MIR Technique MIR is considered less complex in the continuum of the Bonny Method. During the prelude, a therapeutic rapport is developed by facilitating or encouraging a state of mind of well being or enjoyment that is known to the patient. The good experience must be remembered or conjured to create a sense of comfort for the patient. If the patient can reach that state of mind, the session will have been successful. If not, the music therapist must be able to provide a narrative to help the patient reach that point. During the prelude, the music therapist tries to draw out key images that will be related to the client s experience of comfort. For example, if the client reports having had a good time while being with her/his cat, the image of her/him with the cat on a couch or in a comfortable room will help the patient be distracted from the stress that s/he is facing in the current moment anytime in the hospital. In the prelude, the therapist wants to collect the key knowledge of the experience to develop a script that she can use later in the next phase, induction. The music is played as the induction is given, and the therapist talks to the patient using the context that she collected from the prelude. The aim is for the patient to have a vivid experience or physical sensation of being with the cat. The therapist provides a brief relaxation exercise followed by a script elaborated from the patient s story. All the senses are utilized--visual, auditory, kinesthetic, gustatory, olfactory as well as thoughts, including feelings and emotions. All this is needed to make the imagery as vivid as possible. The therapist keeps the key words of the prelude in the mind of the patient. If the 3

4 patient falls asleep because of the tone of voice or the success of relaxation, it is alright, but there is no postlude. If the patient does not fall asleep, the therapist brings the patient back to the present moment or alert state by closing the imagery. Postlude is the fourth phase in which the therapist and the patient process the session that has been completed. The processing in MIR is short: the therapist helps the patient check her/his comfort afterwards to know if the session was satisfactory. After that, the experience of the session becomes an anchor to which the patient can return when s/he feels distress. If the music can be recorded or made available to the patient on an ipod or other device, the patient can listen to and feel a good experience again whenever s/he chooses. A negative experience must also be processed in the postlude to find one good positive image that the patient can take away. For MIR, the therapeutic intention is relative to the context or the client/patient. The intention is to encourage complete relaxation in the patient and to distract the patient from the upcoming worries. The intention is fulfilled by finding key words from a patient s own experience of relaxation or wellbeing to be used later as an inner resource. Below is an example of an MIR induction. In this technique the music is played in the background from the beginning of the induction. Suggestions from the patient s experience of wellbeing, gathered during the prelude: A hike in Yosemite park to climb Half Dome Her best friend Mary was with her The autumn season was a perfect temperature for a hike Beauty in the park Light backpack, patient states what she carried It was difficult, challenging and rewarding 4

5 Huge satisfaction getting to the top Full moon on the return to the campground Great rest Induction (including then patient s key words): Just allow yourself to lie back and relax for a few minutes Take a deep breath in and exhale through your mouth Do it again and let your body sink and soften into the bed that is supporting you If you hear external sounds just let them pass and concentrate on your inner world Find a comfortable position and gently close your eyes Notice the gentle rise and fall of your stomach with each breath Allow the breath to be in your natural rhythm, coming in through your nose and out through your mouth And now allow the music in as we imagine together the scenery of your enchanted hike. It is early morning and you are ready to begin the adventurous hiking trip Your boots are well tied, your backpack is light and only contains the things that you need for the hike: a light raincoat, a flashlight, a canteen of water, some nutritious granola bars, dry fruits, and fresh fruit You are wearing your hat, sunglasses, and have your hiking sticks You can feel the weight of the backpack All is right, all is ready Mary is with you and you both are very excited to begin the journey. As you start walking you can feel the support of the ground beneath you Bring the strength of mother earth into your body The time is early morning dawn Just before the sunrise Allow the autumn colors (pink, yellow, and indigo) to gradually rise into your awareness Feel your feet connecting to the ground As you look down, imagine your feet 5

6 comfortably stepping on a sandy stone path Notice the length of the trail before you; become enveloped in the beauty of the open horizon Take in the stillness, and enjoy the moment. As you continue walking, you feel the sun is rising; all is filled with beauty You are trying to concentrate on the pacing of your walk; it is a long journey ahead and you want to arrive safe to the top As you move on, you find yourself standing in a beautiful meadow on a clear, fall morning You notice the crunching of leaves under your feet Take in the aroma of autumn morning air Notice the dampness from the dew. Really feel the cool air on your skin Watch as the colors transform from pastels to vibrant hues as the sun s rays begin their ascent. You are a part of Earth s daily yet sacred ritual notice how you feel in your body at this moment The quiet songs of the birds and wildlife intensify to welcome the sun as it peeks over the horizon The music supports your breath Filling your body with the beautiful tranquility of this majesty With the sun s light to guide your way, explore your surroundings Let your fingertips gently caress the waxy surface of the plants Feel the water that trickles from their leaves Take this time to quench your own thirst with pure water from your canteen. Savor the satisfying refreshment on your tongue and in your throat Notice again the vast stillness You ve come to experience the living world that awakens to the sun s greeting through each of your senses Acknowledge how your body and mind feel with these vibrant images in your mind And allow yourself to just be in this place in the music with your breath. As you continue walking on your path to Half Dome You are getting close and notice the way the sun warms your face a soft breeze blowing gently moving the soft grass around your feet Around you, there is an array of wild flowers bowing and bending in the breeze Inhale deeply 6

7 and notice the fragrance of your favorite flower and the crisp air as you move through the meadow... Become aware of the sounds of nature around you... A birdsong in the distance Or the croak of a frog. There is a clearing in the meadow that leads to a path, and the sounds of a gentle waterfall in the near distance invite you to follow As you follow the path, you notice the sun glistening off a flowing stream guiding you And as you draw closer to the waterfall, there are cool smooth rocks and patches of grass where you may choose to rest a while and fill the canteens with clean water Take in the calming sounds of the water feeding into the winding stream You may choose to put your feet in the cool water or simply rest. Notice the feel of the sun on your face...the reflection of the blue sky in the water And as you rest, take in a few deep breaths, filling your lungs with the clean air Feeling a soft mist off the waterfall Thankful for the day and knowing you can keep this feeling inside and return to it whenever you wish Now you are at the foot of the rock wall, ready to climb let your breath bring you the strength you need to hold onto the lateral robes to get to the top In silence you climb only with awareness of your steps on the rock and the desire to reach the top Here you are at the top with your friend and companion, Mary you look at each other under the spell of such beauty Be still and quiet in this place Listen You are astonished and aware of the majestic beauty The entire scenery of the valley is in front of you as you enjoy the views of the Nevada and Vernal Falls You ve rested for a while and are ready to come down the mountain As you venture back, you notice the sunset, and a full moon is rising that brightens the trail on your return You walk on and you notice that you are reaching the campground ready to take a nap and dream under the stars after this gorgeous day of hiking Just as the sunlight trickled into the dawn, the sensations and images begin to slowly fade. It is 7

8 time to leave this place. Know that you possess the power and resources to return to this vast beauty and light whenever you wish. As the images and music fade, re-connect with a steady breath in and out. Invite into your awareness the sounds within this room... the feeling of the air on your skin and notice the places where your body connects in the bed And as gradual as the ascent of the sunrise, allow a bit of light to peek through your eyelids as you invite some gentle movement into your fingers and toes. When you are ready, bring yourself back into this moment in this place and open your eyes. The MIJ Technique The purpose of the MIJ technique is to help the client find inner resources to cope with the present stress. It is a supportive as well as an educative technique; it takes longer than MIR, has a different goal, and needs a facilitator trained in the Bonny Method of GIM. During the prelude stage, the facilitator creates a safe container in which the client is able to disclose a concern. A therapeutic relationship is created where trust is built between the patient and the therapist. In this safe place, the patient can disclose her/his concerns that may hold pain or distress. The therapist becomes aware of the mood and state of mind of the patient. This rapport takes approximately 10 minutes to establish. During this time, the therapist might learn about a family issue or a difficult concern that the patient reveals. The therapist can ask questions to help focus the patient and get key information for the subsequent music listening journey. Once the patient has disclosed her/his distress, one focus or direction of the disclosure is found for her/him to travel and explore imagery. Because of the potentially troubling nature of the conflict, the therapist must be sensitive in the induction to be able to invite the patient to bring an image that has a positive outcome, to alter the negative experience and find a positive 8

9 resource. Then the induction starts with a brief relaxation exercise before the mind of the patient is invited to the positive focus that was opened in the prelude. For example, if a patient discloses difficulties with her daughter s lack of support, the focus for the travel can be to understand how to communicate with the daughter. During the induction when the patient is invited to focus, the music starts playing. In this focus, the therapist encourages a positive image instead of asking the patient to be connected with the negative feelings of lack of support; the therapist might state: Allow your mind to bring an image of a time where communication with your daughter was fluent. The music comes in and continues for 10 or 15 minutes. The type of music used is the client s preferences: New Age, light jazz, a soundtrack, or classical. During this time, there is a dialog between the therapist and the patient to allow for the patient s self-exploration. The patient listens, finds an impression, and responds to the dialogue with the facilitator; the music plays the role of co-therapist. The therapist does not control the imagery for the patient, but rather guides it. When the music ends, the patient is returned to a state of alertness. Finally, the session is processed by the therapist and the learning is anchored to reinforce the emotional internal sources. For MIJ the therapeutic intention is elaborated during the prelude. Usually a negative experience or concern is guided towards a positive outcome. The intention is always to help the patient to find inner strength that will help her/him to face the stressor in the present moment. The patient might be lying in bed or sitting in a comfortable chair. Below is an example of an MIJ induction. In this technique the music is played after the induction is given. The induction phase starts with a brief relaxation consisting of breathing exercises and body awareness followed by a second part, where the music therapist will be give a supportive 9

10 imagery suggestion. Notice that the client has expressed during the prelude that her focus is to find support. Induction as follows: Make yourself as comfortable as possible Shifting your weight so you are allowing your body to be fully supported by the bed/chair Loosen your uncomfortable clothing and feel free to close your eyes Take a nice deep breath through your nose and hold it for a few seconds let it out through your mouth with a sigh As you breathe in and out notice the comfort of the blanket covering you feel the safety of your environment With each breath, take what you need When you exhale release what you do not need Take another breath, a breath that brings to you the feeling of relaxation, peacefulness Continue to focus on your breath as it goes in and out Be aware of the rhythm of your breath and allow it to become natural As you breathe in, feel the fresh air coming down to your lungs and expanding through your whole body As you breathe out, let any worries or tension fade, and slowly follow your breath from your toes through your ankles through your legs to your knees through your thighs up your hips through your lower back to your tummy through upper back to your chest through your shoulders up your arms elbows forearms wrists hands fingertips up your neck face forehead and finally to your head As the music begins to play, allow your mind to bring an image of a recent situation in which you were able to cope well, and let the music to be with you. 10

11 Specific Differences between the Bonny Method of GIM, Music Imagery Relaxation (MIR) and Music Imagery Journey (MIJ) Overview of how this approaches differs from the traditional Bonny Method individual form: BMGIM MIJ MIR purpose self-exploration self-exploration to quiet the mind type of therapy re-constructive supportive and Supportive re-educative positioning lying down lying down or lying down eyes closed sitting on a couch eyes closed or open eyes closed or open prelude preliminary preliminary creating rapport to find key conversation finding conversation finding words of the patient s the focus for the the focus for the experience of session session wellbeing/relaxation induction brief relaxation; brief relaxation; spoken with music that image invitation to image invitation to contains patient s experience the focus the focus with a of wellbeing/relaxation positive outcome. music listening dialogue between dialogue between played at the same time as patient and BM patient and BM the induction is given practitioner practitioner 11

12 music genre classical patient preferences: patient preferences: Helen Bonny new age, new age, programs soundtrack, light jazz, light jazz classical classical music length minutes minutes 5-10 minutes postlude review of imagery session is processed no process of reflection if experiences; through supportive the patient falls sleep; exploration of how therapy, validating when awake, check our how the imagery relates feelings and the experience was. to client-stated reinforcing a focus of the session; positive experience; client draws anchor must be parallels and clear and connected meaning from for the client to imagery. relax. mandala yes no No practitioner BM trained BM trained music therapist training 12

13 Music Selection for MIR and MIJ With regard to the music used, when relaxation for the patient is the goal, the first choice is the patient s preferences. If the patient has no preference, then the therapist chooses the music. The piece of music should have a slow tempo, steady beat, around beats per minute, be predictable, and have a repetitive melody with minimum instrumentation. It is better not to use classical music because of its complexity which allows the imagery to expand too much. For the purpose of relaxation, the contrary effect is needed and the imagery should remain focused. New Age and light jazz might be used. In general, the music therapist needs to be aware of the patient s preferences in music and at the same time be prepared with a collection of pieces that might work for this purpose. If the patient prefers music with lyrics, s/he can be focused on the lyrics instead of having the talk over by the music therapist. Focusing on the lyrics helps the client to experience the relaxing effects of the song selected. The key is to empower the patient, giving back to her/him what s/he already owns. The length of the music is between 5-10 minutes, and the same piece can be played twice. The music should cover the duration of the induction period. The therapist should pay attention to the volume to make sure that the sound is comfortable and smooth to the patient. Another characteristic to consider while selecting music is to match the client imagery. For example, if the story from the patient involves a purring cat, it would not be appropriate to choose crashing waves on the beach for music. For using the MIJ thechnique, there should be more dynamic music to allow for more expansive mind travel or a journey. Movie soundtracks or New Age pieces can work well. Classical music is appropriate if it is repetitive within a narrow dynamic range, like the Pachelbel s Canon in D. These pieces allow for the imagery not to travel too far. The music should have grounding qualities: melodic lines, regular tempos, reliable chord structures with no 13

14 major contrast or dissonance. The melodic lines should have small intervals and narrow range to allow a brief imagery experience. Vignette Brief History, Assessment and Intervention Pilar was a 41year-old woman from Mexico who attended 6 sessions of Music Imagery Journeys (MIJ). She left her husband and moved to the States seven years ago with her four children. Pilar was a resilient woman who had overcome many difficulties in her life. She had a history of childhood neglect and an abusive marriage. The patient had a good relationship with all of her children, ages They were still living in their mother s home, even though two of them were married with young children. She used to work in a restaurant with her children, but was now on disability. She reported having had a transitory depression when she had her first child. She did not smoke or drink and was not on antidepressive medication. Her level of education was limited to elementary school, and her score for the Mini-Mental State Examination was 27. Pilar was diagnosed with breast cancer, stage I, with one of eighteen auxiliary lymph nodes showing positive for tumors. She underwent surgery and had a right modified radical mastectomy. The patient is Catholic with a strong faith in God and her imagery was related on many occasions to spiritual themes. In her first session she was quite anxious and worried regarding the treatment. As she was able to express her thoughts and concerns, however, she felt better. The patient s focus for this session was to release her tension and to communicate whatever was on her mind. In this session she traveled with music, choosing the selection of Nature Sounds, the cuts Faces of Earth and Estes Moon from the album The Rocky 14

15 Mountains. During her travel, she encountered the Lord, who was walking toward her with His arms open. She felt embraced by Him, which took away all her anxiety. By the end of the session she stated, I have no pain, no worries, no stress. The patient continued reporting that her sadness moved away and that she was feeling more relaxed. In her second session the patient reported that she was feeling better. Her major concerns were related to her children, who were experiencing sadness on account of their mother s disease. Her focus was to find tranquility in her mind. During her travel she sat at the lake surrounded by pine trees. The water was crystalline and she put her feet into it, expressing playful joy. Pilar felt the peace and tranquility of nature and noticed that she was not worried. By the end of the session, the investigator/therapist suggested having a family meeting. Days later the investigator/therapist did a home visit to support the children and listen to their concerns. As reported, after this meeting the children were also more relaxed and had a better understanding of the mother s diagnosis and prognosis. By the third session, the patient had started losing her hair and she was processing the loss. She wanted to be positive, but at times it was difficult. She was concerned with her older daughter, who was not taking care of herself. This session was with music, and she traveled with the selection Lotus Reflection from the album Harp of the Healing Waters. Her focus was related to her need to be patient and not to let her mind be preoccupied. She visualized a field where people were working, and she was an observer. She reported that she felt the freedom of a bird and the tranquility of this space where she was healthy, happy. In her process she became aware of the need to be an observer and establish some distance to stressful situations. In her fourth session, Pilar stated that she was feeling calmer and that everything was quieter around her. She tended to be overprotective of her children, but it now seemed that she 15

16 was learning to let them go, becoming more detached. She began to pay more attention to her needs. The focus for this session was to find her own strengths. Her safe place was a church filled with pilgrims. In this space she had a transpersonal experience. She encountered the Lord, whom she observed healing the sick. She sensed His blessings and felt full of energy. The patient reported the significance of her imagery. For her it was a communion with the Higher Power, who gave her the joy, strength, and self-confidence. She stated, My soul is rested. The following session was Pilar s fifth. During the prelude the patient reported feeling less worried and more positive regarding the outcome of her cancer. She stated, God does not need me in Heaven. Life is beautiful and I have a lot to offer. I am learning to love myself more. In this session the patient reported the abusive relationship with her husband. She felt relieved of so much pain being held in her heart. Her focus in this session was to be happy and to release stress. The patient traveled through the selection called Spiegel Im Spiegel from the album Alina by Arvo Pärt. She visualized herself in a park. She lay down on the grass and was contemplating a beautiful meadow. In the park there were children playing and she felt the joy of the children. She felt relieved from pain and free from worries. During her last session the patient reviewed the learning during her encounters with the therapist. She realized that she was feeling less upset and taking the challenges of her disease without so much stress. She came to the realization that she could be as normal as before and was allowing herself to feel happy. She verbalized how helpful it had been for her to be able to share her concerns with the therapist and greatly appreciated the insights during this time. The focus for her session was to concentrate on her needs and taking better care of herself. During the induction she visualized the white color protecting her and found herself in a beautiful place with the Holy Mary and an Angel. She was in her bed at home, and they were sprinkling her 16

17 with holy water. She stated it was relaxing and healing. She reported that in her imagery the Holy Mary embraced her and covered her with a tunic. The patient felt completely surrounded by the Divine presence and trusted the power of faith to help her move on. She stated, I feel I have been born again. Pilar reported by the end of the session feeling much more comfortable with her living situation. Conclusion: More research is needed on MIR and MIJ. Since working on adaptations of the Bonny Method with patients in crisis since 2008, I have found inspiring results in MIR and MIJ for the field of music therapy. The studies that I did were related to MIJ, but there needs to be more work done on the MIR technique. We need to consider the state of mind of a person in need of help and personal empowerment. There is no contraindication in using MIR; it can always be used. In using the MIJ technique, the facilitator must be aware of the mental condition of the patient before giving a session. The patient s medical condition also needs to be considered. For example, if the patient is using a breathing device and cannot breathe deeply, there could be greater anxiety for the patient to concentrate on breathing exercises. The level of fatigue or exhaustion is also an issue. The patient may not be able to hold or focus intensely if overly tired. In MIJ, psychotic, schizophrenic, or demented patients cannot benefit as they are using mind-altering medications. They will not be able to comprehend or process the words, music, or imagery. Awareness of the client s first language is important to measure the extent of comprehension of the language spoken during the induction. Any music therapist can practice the MIR technique, even one who is not trained in the Bonny Method, as there is no dialogue between the music therapist and the client during the music/mind travel. On the other hand, in 17

18 MIJ there is the need for the practitioner to be trained in the Bonny Method as there is dialog as the patient travels with the music. The other point is that MIJ has a deeper component of supportive and self-explorational or reeducative work. A music therapist needs to be better trained in the understanding of the unconsciousness in this process. References Association for Music and Imagery. (n.d.). Core elements of The Bonny Method of Guided Imagery and Music. Retrieved November 11, 2005 from Method.com/ami (The Association pro Music and Imagery. The Bonny Method of Guided Imagery and Music). Bonde, L. O. (2005). The Bonny method of guided imagery and music (BMGIM) with cancer survivors. A psychosocial study with focus on the influence of BMGIM on mood and quality of life. Aalborg: Institute for Musik of Musikterapi, Aalborg Universitet. Bruscia, K.E. & Grocke, D. E. (2002). Guided imagery and music: The Bonny method and beyond. Gilsum, NH: Barcelona Publishers. Gimeno, M. M. (2010). The effect of music and imagery to induce relaxation and reduce nausea and emesis in patients with cancer undergoing chemotherapy treatment. Music and Medicine Journal, 2(3), Goldberg, F. S. (1998). Images of emotion: The role of emotion in guided imagery and music. Journal of the Association for Music and Imagery, 1, Short, A. (1991). The role of guided imagery and music in diagnosing physical illness or trauma. Music Therapy, 1,

19 Summer, L. (2002). Group music and imagery therapy: emergent receptive techniques in music therapy practice. In Bruscia, K. E. & Grocke, D. E. (Eds), Guided Imagery and Music: The Bonny method and beyond. Gilsum, NH: Barcelona Publishers (pp ). West, T. (1994). Psychological issues in hospice music therapy. Music Therapy Perspectives, 12, Wigle, J.R., & Kasayka, R.E. (1999). Guided imagery and music with medical patients. In Dileo, Appendixes Ch. (Eds), Music therapy & medicine: Theoretical and clinical applications, pp Silver Spring, MD. American Music Therapy Association, Inc. Appendix A: Music Selection List Composer Title of Main Work Selection Andy Brown Ilan Eshkeri & London Stardust Metropolitan Orchestra Alex North Music for Relaxation, Unchained Melody Concentration and Meditation Avo Part Alina Spiegel Im Spiegel (MR) Beethoven Piano Concerto #5 Adagio Beethoven Violin Concerto Rondo Carlos Nakai Dreamscapes: Spiral Passage Canyon Trilogy Dean Evenson Sound Healing Memory of Monet Harol Moses Edges of the Soul Cantadora C. G. Deuter Reiki Hands of Light Loving Touch (MR) C. G. Deuter Reiki Hands of Light Mystic Voyage 5 Hans Zimmer The Last Samurai A Small Measure of Peace Jimmie Pinkstaff Sounds Of The Rocky Faces of Earth Mountains Mary Kahmann The Stirring Solo Folk Harp National Parks Series Nature Symphony The Water is Wide Michael Hope Yeaning: Romances for Alto Lilies of the Lake Flute Michael Hope Solace The Majestic Land Michael Hope Solace So You Rufino Zaragoza A Sacred Place Lady Poverty Ryuchi Sakamoto BTTB (2000) Aqua Secret Garden Passacaglia Fairytales: Highlights from Secret Garden 19

20 Secret Garden Secret Garden Songs from a Secret Garden Solitudes Forever by the Sea The Beckoning Sea Solitudes Among The Lady Slippers Wildflower: Solo Piano with Nature Sounds Dedication This chapter is dedicated to my sister Teresa Maria Gimeno i Domènech who died at age 50 after losing her battle with cancer. She continues to be my inspiration and guide. Another inspiration is my dear friend Florence Austin who impacted my life and influenced my work with positive imagery. Also, to my parents Francesc Gimeno i Jordá, and Teresa Domènech i Ramón, I give my gratitude as special role models in my life with their constant care and encouragement. Acknowledgments I extend my gratitude to my first academic writing teacher in Barcelona, Mary T. Donnenworth. She continues to give her honest and direct guidance and supportive editing. I also want to give special thanks to all the patients with whom I have been in touch. They have opened their lives to share their sacred space with me. This interaction and sharing has helped me understand how future patients can benefit. I have appreciated these patients as teachers who have helped me develop the adaptation of the Bonny Method to help others in hospitals and hospices. Ultimately, I want to thank God, and the Holy Mother, for the wonderful gifts bestowed upon me. 20