MT Building Rapport . Foundations in MT with the traumatized client

I was thinking of writing a book.    I wrote 12 chapters a couple years ago.   I stopped, I reviewed it, I wanted to rework it…..I needed to revise as research and modalities continued to change and evolve.   I realized that things are changing so fast in this field so ….  I have decided to release my thoughts into the blogosphere instead.    ……

 

There are many decisions to make when providing treatment for someone recovering from child abuse.   I will introduce a few tools that I have found helpful in developing a plan for treatment.  The latest research keeps changing and the field is a constantly moving target to find the best mode of treatment.   Still, as a music therapist, return to the foundations of the profession.   Things that remain the same:   the effect of music and rhythm on the brain and state/trait anxiety, how music effects emotions, the effect of music on mood, referential music, preferences of the client, the benefit of music involvement in a social group, the benefit of music for an individual, the contraindications of music and sound stimulation in certain instances.   The improvisation model of Music Therapy and the 64 clinical techniques (Bruscia, 1987) applied in various settings.     The foundations of music therapy and the training a music therapist receives is valuable and relevant.  Various models  have entered the field of trauma as “new” and left as new models come in to better the old ones.   I currently love using the TAP model developed by the Chadwick Center in San Diego (2009) as my compass. It’s not the latest but it is proving to be a good clinical model in my work and fits nicely still with the models available and with Music Therapy and our scope of practice.  In short, or first, I like to envision music therapy treatment for this population in my mind in this order: building rapport, client safety and containment, developing coping skills, processing, mastery.  There are many ways to conceptualize this in practice.     I have noticed that  survivors of child abuse  perceive what happened to them very differently at different developmental stages so these steps are repeated each time a survivor returns to therapy.   It is common to see a child at 8, and again at 12, and then at 16 years of age and so on.  This is congruent with what the literature reveals as well.  I’ve had clients return at different ages and they don’t seem to have vivid memories of the therapy process itself but the skills seem to hold over time. The need to build upon the skills, however,  in an age appropriate way is still evident.

The first step for treatment in this population is to meet your client “where they are” and build rapport.       Clearly, this is the same for every population.  Improvisational skills and techniques can be invaluable tools at this point because it provides for a nice “agility” within the music therapist skill set in navigating client needs during a session. Building rapport can take a variety of forms and it is basically the stage in therapy where you want to try to connect with your client so that  later you can move into the work of giving them the skills they need to heal and navigate their world.   One of the nice benefits of music therapy is that basic rhythmic interventions such as drumming or simple music making can be designed to help build rapport with your client while working on brain stem modulating goals to assist with client stabilization and sense of safety or containment.  A stable brain is a safe brain and a stable brain contains the trauma.  So building rapport can take on more than one goal and count towards treatment of neurologic or physiologic symptoms in addition to establishing the client/therapist relationship.   The beauty of what the music therapist can do in a session for the trauma client is amazing and complex.

What the current brain based research indicates to us  is that brain stem-modulating interventions are very successful in dealing with the basic problems of abuse related trauma and dysregulation.  Dealing with triggers, grief, false guilt, etc. can be enormously helpful but if the client leaves the session and has no way to turn off the autonomic nervous system or cope with any feelings that come up during the week, then you may find that the therapy takes two steps forward and three steps back.  So don’t get ahead of yourself or the client.   It is OK to stay in this stage for a while.  Maybe that is as far as you can get with your client.   That’s ok .  If your client doesn’t want to process it may be because they don’t need to or are not ready.   The agenda of the therapist or the adults in the child’s life may observe a need but the child may not be ready.  (In turn, as a clinician, if the clinician doesn’t feel ready to process, then the child’s need to process may not be met and should not be met until the therapist feels equipped — that’s another issue but as therapists we know how to deal with how to educate and equip ourselves right?)  It makes sense that the music therapist would work from the “ground up” so to speak and start with experiences and interventions that target these basic brainstem functions as the therapy begins.   Simple interventions like drumming and basic music and movement can activate and regulate through providing repetitive experiences while building non-threatening rapport.  Bruce Perry suggests that rhythmic activity be set at 80 beats per minute, or subrhythms of 40 or 60, to match the primary maternal heart rate in utero (Perry 2006) .

There is a lot more to add and discuss.   This is a small excerpt of some things I have been writing.   I wanted to share them with you.

 

Bruscia, K, (1987).  Improvisational Models of Music Therapy.  Springfield Illinois: Charles C. Thomas Publishers.

Chadwick Center for Children and Families. (2009). Assessment-Based Treatment for Traumatized Children: A Trauma Assessment Pathway (TAP). San Diego, CA: Author.  Copyright 2009 by the Chadwick Center for Children and Families, Rady Children’s Hospital and Health Center, San Diego. All Rights Reserved.

Perry, Bruce D. (2006). Applying Principles of Neurodevelopment to Clinical Work with Maltreated and Traumatized Children.  The neurosequential Model of Therapeutics, Chapter 3, 27-51.  Ripreinted from Working with Traumatized Youth in Child Welfare edited by Nancy Boyd Webb.  Copyright 2006 by the Guildrod Press 72 Spring Street, New York, NY 10012.

 

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