Nordisk Tidsskrift for Musikkterapi

ISSN: 0803-9828 (Print) (Online) Journal homepage: http://www.tandfonline.com/loi/rnjm19

The “AQR” – an Analysis System to Evaluate the

Quality of Relationship during Music Therapy

Karin Schumacher & Claudine Calvet-Kruppa

To cite this article: Karin Schumacher & Claudine Calvet-Kruppa (1999) The “AQR” – an Analysis
System to Evaluate the Quality of Relationship during Music Therapy, Nordisk Tidsskrift for
Musikkterapi, 8:2, 188-191, DOI: 10.1080/08098139909477974

To link to this article: http://dx.doi.org/10.1080/08098139909477974

Published online: 13 Jul 2009.

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 FROM THE PRACTICAL WORK

Nordic Journal of Music Therapy, 8(2), pp 188-191.

The "AQR" - an Analysis

System to Evaluate the
Quality of Relationship during
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Music Therapy
Evaluation of interpersonal relationships through the
use of instruments in music therapy with profoundly
developmentally delayed patients
Karin Schumacher and Claudine Calvet-Kruppa

Summary
The "AQR" is an Analysis System to assess the Quality of a therapeutic Relationship. A music the-
rapist in teamwork with a developmental psychologist has devised a scale on the basis of infant
research to evaluate music therapy and keep a record of music therapy work. A video-film (availa-
ble from the authors) shows how the analysis system "AQR" can be used to assess the quality of
relationships and thus helps to evaluate the work of music therapy. The development of the ability
to express themselves and build relationships in profoundly disturbed children is demonstrated
through the detailed analysis of the instrumental expression. The mimical, gestural and physical-
emotional communication and the vocal pre-speech expression is the topic of further research.

KARIN SCHUMACHER
was born in 1950 in Graz/Austria. She studied music therapy at the Academy of Music and Drama in Vienna and
later music and dance education at the Academy of Music and Drama in Salzburg (Orfflnstitut) to become a teacher.
She worked as a music therapist in a psychiatric hospital in Berlin from 1974-82, specialising in psychotically dis-
turbed adults and emotionally disturbed and mentally retarded children. Over the last 14 years she has been working
in an institution for children with early disturbances of development, especially with autistic children. All children
have severe contact- and relationship disturbances. Since 1984 she has been working at the Academy of Arts in Ber-
lin as Professor of music therapy, founding and continuing the development of the training for music therapy.
Address: Prof. Dr. Karin Schumacher, Schorlemerallee 36, 14195 Berlin, (D). Tel. (+49) 82 35717, or HdK Berlin,
Seminar Musiktherapie, Mierendorffstr.30, 10589 Berlin. Tel. (+49): 31 852551/2553, E-mail:
kaschuma @ hdk-berlin.de

188 Nordic Journal of Music Therapy, 1999, 8(2)

 THE "AQR" - AN ANALYSIS SYSTEM TO EVALUATE THE QUALITY OF RELATIONSHIP ...
Context
I (Karin Schumacher) work in a day school for
autistic children and children with autistic cha-
racteristics between 5 and 13 years old. The
children normally live at home and are cared for
and taught daily from 9 to 3 o'clock by social
educators and teachers for special education. I
work with each child once a week, alone, for up
to 45 minutes. Music Therapy is the only thera-
py within the institution. Parent and teamwork
are also integrated.
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Basic ideas
Every human being needs another person to help
develop his predisposition. Accordingly, when
the ability to make contact to another human
being is impaired, this person might suffer not
only from cognitive developmental disturban-
ces, but also from emotional isolation. The main
problem is that through this lack of contact and
the feeling of isolation the possibility to organise
one's personal environment is disturbed and the
motivation to further development seems lost.
The ability to relate to oneself, to other people
and to objects, is based on the ability to co-ordina-
te sensory perceptions and to process them mea-
ningfully. In the development of a normal child
this possibility to co-ordinate sensory perceptions
probably starts during the prenatal period and in
the first months of the first year. If this ability and
CLAUDINE CALVET-KRUPPA
studied psychology at the University of Paris Sor-
bonne. She has been working since 1990 in research
projects in developmental psychology at the Freie
University of Berlin and as a counsellor for the
mental health of infants and their families at the
University of Potsdam. She is a specialist of mot-
her-child-interaction with children with and without
handicaps, and she developed together with Karin
Schumacher the Analysis System "AQR". Address:
Dip]. Psych. Claudine Calvet-Kruppa, wiss. Mit-
arbeiterin im Forschungsprojekt: Musiktherapie
und Sauglingsforschung der VW-Stiftung an der
HdK Berlin, Fehlerstr. 7, 12161 Berlin (D).
Tel. (+49) 82 24393. E-mail:calvet@hdk-beriin.de
other inborn abilities such as eye-contact, the
ability to imitate and to share emotion with anot-
her person are missing, well-known symptoms
such as stereotyped behaviour, problems in regu-
late emotions, and later play and speech distur-
bances, are the result. Even when autistic chil-
dren learn to speak, the thought processes are
limited to the same themes and most of the time
they do not develop a "theory of other minds".
Presentation of an evaluation system
to Assess the Quality of Relationship
Music Therapy should help the autistic and other
early disturbed patients to develop the ability for
interpersonal relationships and free him from his
isolation. Impairments in the development of
contact and relationships are especially evident
in the way the autistic child uses his body, the
deficient use of his voice and the way he uses
musical instruments. We first analysed the
instrumental expression because it was easy to
differentiate from the other ways of expression.
In the course of long-term therapy we can see
the development of an initial visible lack of con-
tact to the ability to interact. Through playing
together with the therapist the child makes the
experience that feelings can be shared with
another person. This ability, which the infant
researcher Daniel N. Stern (1985) calls "Inter-
affectivity", creates an interpersonal relation-
ship and is the basis for all further cognitive-
emotional development.
A video-film (available from the authors)
shows how the analysis system "AQR" can be
used to assess the quality of relationships and
thus helps to evaluate the work of music therapy.
We differentiate between seven degrees of
relationships, here called modi:
Definitions of the modi 0-6
0 Lack of Contact
The instruments in the room are not appealing to
the child. He is not aware of their function; he is
probably not aware that they are something to
be played with. First therapeutic intervention
such as making sounds on the instruments has
Nordic Journal of Music Therapy, 1999, 8(2)
 KARIN SCHUMACHER AND CLAUDINE CALVET-KRUPPA
no obvious effect. Sensory integration is lac-
king, the child tries to overcome this through
stereotype behaviour and stays trapped in it.
1 Contact-Reaction
First awareness in the form of a short reaction to
an instrument. However, the child does not find
the instrument inviting and does not play it him-
self. This means the child is still not aware of its
function. Therapeutic intervention such as
making sounds on or offering the instrument
leads, at the most, to a quick touch but not to
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playing on the instrument. Also there is no awa-
reness of the therapist as a person. It seems that
only tactile or visual sense is activated at a time.
2 Functional-Sensory Contact
Utilisation of a person or instrument for his own
needs. The instrument is licked, touched and felt
with the mouth, hands or feet without making of
any sound. Two sensations (touch and see) at
least are co-ordinated.
3 Contact to himself/Self-Awareness
A movement becomes audible and the child is
aware of himself as the cause of the sound. He
connects the sound, usually caused by chance
through his movement, with his own action or
through intervention from the therapist, who
gives him an instrument which makes his move-
ment audible. If the child looks at the instrument
with which he is playing with, the sensory quali-
ties "feel, hear and see" are co-ordinated and cre-
ate the basis for the first concrete awareness of
the function of an instrument. The specific cha-
racteristics of the instrument are considered for
the first time. The child plays, looks at the instru-
ment, begins to play again and explores the
instrument through his continued attempts. He
becomes aware of sound and differences of pitch
and some short melodic and rhythmical patterns
emerge. The relationship to the instrument beco-
mes clearer as three sensations are co-ordinated.
4 Contact to Others/Intersubjectivity
(Awareness of Self and Other - or I and You)
The relationship to himself is established; the
child is aware of his own vocal and/or instru-
Nordic Journal of Music Therapy, 1999, 8(2)
mental expression. The importance of this
modus is that the child's awareness finds confir-
mation in another person (social referencing).
At least three sensory areas are co-ordinated. "I
hear what I see and feel", i.e. I receive, become
aware and look for confirmation in the other.
5 Relationship to Others (to another person)/
Interactivity
(Self-Awareness and You-Consciousness )
I hear, see and sense the other (person) and
react: I reply to his activity. The sensory impres-
sions are integrated and meaningfully proces-
sed. Musical attunement in sound, rhythm and
melodic patterns can be recognised; patterns are
exchanged and varied. Each player gives some-
thing from himself and assimilates something
from the other player.
6 Joint experience/Interaffectivity
A shared emotion develops in that both players
(therapist and child) make the experience of sha-
ring their feelings with each other. The ability to
develop and form dynamic changes is decisive.
The ability to "play" becomes clear. There
exists not only a qualitative, but also a quantita-
tive difference between the modi. Thus the time-
span of the readiness to make contact and relati-
onships, according to modus 5, increases.
A short description as viewed by
the child
Modus 0 "I without me".
I attempt to compensate for lack of contactabili-
ty through stereotype behaviour. I do not react
visibly to external stimuli such as music or other
people.
Modus 11 notice "something".
Modus 2 I use "something" (I use people and
instruments for my own needs).
Modus 3 I hear myself.
Modus 4 I hear myself and want to know if the
other person perceives this in the same way.
 THE "AQR" - AN ANALYSIS SYSTEM TO EVALUATE THE QUALITY OF RELATIONSHIP ...
Modus 5 I hear myself and I hear you.
Modus 6 I hear us.
A short description as viewed by
the therapist
Modus 0 It seems you are not aware of my per-
son or my interventions.
Modus 1 You are aware of "something" (in the
form of a short reaction).
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Modus 2 You use my person like an object and
you use as well the instruments as if they would
be part of your body or of yourself.
Modus 3 You explore the instrument and listen
to yourself. I pay attention to your realisation
that you are the agent of what you can hear, of
your own play.
Modus 4 I feel that you include me in your own
experience, so that I notice that you sometimes
gaze at me. I follow your play with concentrati-
on and I hope that you feel my acceptance.
Modus 5 I play with you and you with me.
Modus 6 We play together and I feel and see that
we both have a lot of pleasure.
The development of the quality of the relation-
ship depends on the ability to co-ordinate the
senses. If the child touches an object, but
doesn't follow this process with his eyes, so,
only a contact-reaction (modus 1) is registered.
If he thus follows the process, e.g. "touch-see",
the contact becomes functional-sensory (modus
2). If he feels, sees and hears it, he becomes
aware of himself, he achieves self-awareness.
The more channels that are co-ordinated, the
more ability for relationships is developed.
Further research projects
The results of our research show that the deve-
lopment of an ability to make contact and form
relationships can be proved through the analysis
of video-filmed long-term treatment. This first
film shows the development through the analysis
of instrumental expression. In an other project we
have analysed how the relationship to the music
therapist develops in the domain of the vocal pre-
speech expression. The next project, will analyse
the emotional communication which reveals
itself through mimic, gesture, posture and physi-
cal expression. We expect that the analysis of all
domains of pre-speech behaviours, especially
with people without ability to express themselves
musically at the beginning of the therapy, will
show the influence of music therapy on the deve-
lopment of the ability to relate to someone and to
establish a relationship to someone.
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B. (1999): Entwicklungspsychologische
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Kleinkindern: Friihforderung bei Kindern
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Miinchen: Ernst Reinhardt.
Domes, M.(1994): Der kompetente Sdugling.
Die prdverbale Entwicklung des Menschen.
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Nordic Journal of Music Therapy, 1999, 8(2)