gms | German Medical Science

The question of “which methodology serves the profession better” is rarely debatable in medical studies. There is a clear hierarchy of evidence in that field which emphasizes the importance of quantitative studies, in as large a number as possible [1]. This is an acceptable attitude in the health sciences nowadays and the author of this article has also been a practitioner in that field. During the seven years that I studied pharmacy, I rarely relied on any other epistemological school than empiricism and any better way of approaching facts than with pure objectivity. I spent years reading about and later collaborating in conducting randomized controlled trials, translating outcomes into numbers, and making mostly dichotomous clinical decisions based on the p-value. However, my determination to quantify my lived experience as a student of music therapy soon led to frustration. Even though I believe that the quantitative methods are highly sufficient when dealing with the effectiveness of a medication, I have decided to doubt that they are the best tools when it comes to investigating complex and not yet so well-standardized myriads of ways by which CATs could benefit the clients. Hence, in this perspective article, I aim to reflect on the journey of finding my research stance in the realm of creative arts therapies.

Phenomenology is a study methodology that aims to capture the essence of a phenomenon by looking at it from the viewpoint of individuals who have experienced it. In terms of what was experienced and how it was experienced, phenomenology seeks to describe the experience per se as accurately as possible. A popular definition of phenomenology is the study of phenomena as they appear in human experience, our perception and understanding of phenomena, and the significance that phenomena have for our individual experiences. Phenomenology, to put it another way, is the study of how people experience the world. Examining an experience as it is subjectively lived allows us to create new meanings and appreciations that can reframe how we perceive the experience [2].

There are many known schools in phenomenology. Transcendental (descriptive) phenomenology [3] and hermeneutic (interpretive) phenomenology [4] are among the most studied of them. In their exploration to integrate these two approaches in a LifeWorld approach, Dahlberg and Dahlberg (2020, [5]) highlighted the importance of the inseparability between human beings and the world. The human experience is created within and by the world, and it must be viewed within this context to be fully understood. When he speaks about co-constitution, Husserl clarifies that experience does not originate from the subject as a single creator or an objective reality. It results from a person's subjective involvement in a meaningful world. As a consequence of inseparability, the researcher is a part of this world and therefore, a part of this experience. With this stance, the researchers have a more important task to do rather than eliminating their subjectivity. That is to move between subjectivity and objectivity and study the relationship between the two [5].

For instance, although we can run a randomized controlled trial to compare the effectiveness of music therapy to that of an anti-depressant for major depressive disorder, many of the musical and therapeutic components will be lost in the resulting quantification. Embodiment, aesthetic experience, and symbolization are among the joint factors of CATs that do not compare with many other modes of therapy [6]. Although many of these factors can be quantified with questionnaires, the holistic experience of CATs has a higher chance of being captured through a phenomenological lens. Apart from the incomparability of CATs with taking medications in essence, some transformations happen through art but remain silent in the inner world of the client. For example, in working with people who have severe disabilities, are barely conscious, or are in a coma, reflecting on the inner world of the therapist (as in somatic countertransference) can be a valuable source to access the inner experience of the client. By rushing to numbers in these instances, one might deprive these populations of one of the few modalities that can access and translate their inner experience.

Having said that, neglecting other research methodologies can also be destructive to the future of these professions in several ways:

1.

As creative arts therapists, we aim to advocate for the integration of CATs into the health care system, and for that, we need easy-to-communicate evidence. This underscores the importance of quantification as a means of easing communication and decision-making.

2.

As the practice of CATs is not fully regulated and the profession is not protected in most places around the world, leaving all the interpretation to the phenomenological approach of the therapist can lead to the relegation of the profession to mystical and magical phenomena, which harms the public trust in the practice and its predictability and reliability. Therefore, I suggest the parallel implementation of qualitative phenomenological research for the internal improvement of the profession, and quantitative studies to externally communicate the role of CATs in the healthcare system. Needless to say, with a stronger theoretical foundation which can be better obtained with qualitative studies, we can develop sharper quantitative measures to capture the essence of CATs in practice and therefore, feel less lost in translation.

To conclude, I would like to acknowledge the complementary role that all sorts of research methodologies can have in the improvement of the profession in different dimensions. By taking a more process-oriented approach and paying full attention to the phenomena under investigation, we, as the researcher and a significant part of the experience, can judge whether we should quantify the experience or let it manifest through a phenomenological description. When dealing with such an interdisciplinary realm of arts, health, and therapy, being equipped and familiarized with both of these major approaches and combining them when necessary in a mixed-methods study seems to benefit the profession most.

The authors declare that they have no competing interests.