認知症高齢者の自発性を引き出す集団音楽療法における介入スキル

Abstract

本研究の目的は,認知症高齢者の自発性を引き出す集団音楽療法における介入スキルについて明確化することである.認知症高齢者5人に対して8回の集団音楽療法を実施し,セラピストによる介入を帰納的に分析した結果,以下のことが示された.1)セッション中にみられた認知症高齢者の自発性の変化として,「覚醒時間が増加する」「演奏の始まりがスムーズになる」「演奏中のテンポやリズムの乱れを修正していく」「演奏後に満足感を表出する」「場を創造していく」の5つが見出された.2)セラピストが用いていた介入タイプは,「音楽への同調を促す」「注意・関心をひきつける」「巻き込む」「ほめる・支持する」「場の発展・拡張を期待して仕掛ける」の5つに分類された.3)認知症高齢者の自発性を引き出す集団音楽療法における介入スキルには,セラピストが楽曲ごとに(1)演奏に向かうまで,(2)演奏の始まり,(3)演奏中,(4)演奏の終わり,(5)演奏直後の5つの時点において5つの介入タイプを使い分け,参加者が音楽に同調していこうとする自発性を助けること,参加者自身が自分の演奏に満足し自尊心や自信が回復していく体験を積み重ねることで,自ら場を創造していく力を発揮できる機会を仕掛けていくことが見いだされた.The purpose of this study was to clarify therapeutic intervention skills for eliciting spontaneity of the elderly with dementia in a group of music therapy session. Subjects were five elderly persons with dementia guided by one music therapist. Group music therapy sessions focused on rhythm synchronization were held once a week during 8 weeks. The intervention types for eliciting the spontaneity of the elderly with dementia were extracted by the inductive method form description of spontaneous responses of the elderly and the therapist\u27s intervention. The following results were obtained. 1) The change of spontaneous responses among the elderly with dementia in the group music therapy session included (1) increasing time of awaking, (2) smooth participation to singing songs and playing instruments, (3) correcting the tempo of singing and playing, (4) expressing the gratification of playing music, and (5) creating a scene spontaneously in the session. 2) The intervention that the therapist used included (1) inducing synchronization to the rhythm and melody, (2) attracting to pay attention and interest, (3) involvement, (4) admiration and supporting, and (5) prompt to anticipation of evolvement in the group. 3) It is suggested that a music therapist should have a skill to select appropriate intervention for aiming 5 different timings of intervention when a therapist plays a tune, which is (1) before the execution, (2) at the beginning of the execution, (3) in the middle of the execution, (4) at the end of execution, (5) after the execution. It is also found that a skill to organize the combination of 5 types of interventions while focusing on these 5 points is important for a music therapist working for the elderly with dementia