Some more of my writing. Instead of a book — I’m just pouring out onto the blogosphere.
In preparing to work in the field of trauma and abuse, the main tasks are to: establish where the evidence base is for designing treatment, and narrow down how to specifically utilize music prescriptively. Current literature and research points to the trauma-focused therapies as the industry standard for treatment. The way that a traumatized person responds to life as opposed to someone who has not been traumatized is very different. Trauma has such an all encompassing effect on a person and their family involving the family system, one’s perception of the world, spirituality, social life, sexual development and so on. So it makes sense that when treating someone specifically for recovery from trauma, you would look to any number of trauma-focused literature to help conceptualize treatment for your client.
To start with, lets take a look at how trauma effects the brain. Then let’s take into account how music effects the brain and then we can combine the two inquiries to determine how music can affect a traumatized brain. The work of Dr. Bruce Perry is a helpful resource to begin with. The current research in trauma suggests that trauma affects the brain concurrent with the developmental stage in which the abuse or trauma occurs. In particular, research suggests that the amygdala, hippocampus and prefrontal cortex are specifically involved . What happens in a child survivor of trauma can manifest as a maladaptive reaction to everyday occurrences or minor stressors such as: losing a shoe, being denied a snack or having a bad experience on the playground with a peer. In response to a minor stressor, for example, the brain activates a stress response, completely bypassing the executive centers of the pre-frontal cortex. Cortisol is released and the child experiences a fight or flight response. Unable to process the minor stressors through problem solving and reasoning, the child may find them selves later trying to explain to peers, teachers or family why they reacted in such a way (for example with an impulsive decision, aggressive behaviors or self harm).
We know that music effects the brain in a myriad of ways. As a music therapist or student of music therapy you are well aware of the foundational and current literature about how music effects the brain. Some interesting research that I think is helpful in terms of looking at trauma would be to examine some recent research that targets how music helps with regulation. I will incorporate that information a little later in this chapter when I tie in how music can help the traumatized brain.
Before we look at how a music therapist can use music to help a client with abuse related trauma, lets take a quick look at the current body of literature for trauma. The current industry standard for treating abuse is defined as any one of the “trauma- focused” therapeutic approaches. It is a good idea to get familiar with some of these before moving towards looking at how to apply music therapy to treat trauma. Two different therapeutic approaches that stand out among the various available types of treatment for abuse in the current literature are: are Trauma Focused Cognitive Behavioral Therapy (TF-CBT) and the Chadwick Center’s Trauma Assessment Pathway (TAPChadwick). I would like to share a little information about these approaches in particular because I feel that they are helpful when looking at adapting music therapy interventions for this population.
First, the current literature in the field of child abuse points to the use of Trauma-Focused Cognitive Behavioral Therapy (TF-CBT) as the primary and most evidence-based method of treatment for survivors of child sexual abuse. Widely adopted by licensed professional counselors, this method has been proven effective for the treatment of trauma. The music therapist can work adaptively within this model.
Trauma Focused Cognitive Behavioral Therapy, or TF-CBT follows a specific protocol. The TF-CBT (typically used with clients aged 3-18 years of age) model contains the following steps and you can use the word “PRACTICE” to remember the steps (taken from Child Welfare Information Gateway http://www.childwelfare.gov/pubs/trauma): Psychoeducation and parenting skills (including teaching the child about the trauma and the associated emotional and behavioral reactions while providing parenting skills to parents or adult caregivers focusing on behavior management and effective communication), Relaxation (teaching relaxation skills including breathing techniques, progressive muscle relaxation and imagery), Affect Expression and Modulation (learning about feelings –how feelings are experienced and learning how to identify and express feelings, managing reminders of the trauma ) Cognitive coping and processing (learning the connection between feelings, thoughts and behaviors), Trauma narrative and processing (telling the story of the abuse in a literal or symbolic manner and the subsequent processing of the same), In vivo exposure (Mastery of trauma reminders or triggers, coping with memories of the abuse as they are experienced in current daily life), Conjoint parent child sessions, and Enhancing future safety and development (anti-victimization skills, healthy relationship skills, healthy sexuality, managing future stressors and ongoing coping skills).
In another frequently used model, the Trauma Assessment Pathway, the Trauma Wheel (TAP, Chadwick Center for Families) provides a framework for the primary mechanisms of treatment. The trauma wheel contains the following sections: Psycho-education and Skill building, Addressing Maladaptive Cognitions, Affect Regulation, Trauma integration, and System Dynamics with overall consideration for cultural norms, developmental level and therapist/client rapport.
Keeping up with current or new literature in the field of child traumatic stress can be a challenge because it is a rapidly growing field of treatment and research. I have also found it helpful to sifting through various interventions used by other treatment modalities to see about how to adapt the ideas to music therapy. In addition, I occasionally come across other discliplines using music in therapy (song lyrics, listening to music, creating “songs”) and it is helpful to back to foundational knowledge of music therapy to determine the effectiveness of the intervention for a client (checking for contraindications, making adaptations, etc).
So, now, let’s take a quick look and summarize how can a music therapist help someone recover from abuse-related trauma? It’s up to the MT to design treatment within the scope. Beginning with the obvious, music therapy is a great way to develop the client-therapist relationship. Music Therapy is a tool for affect regulation https://academic.oup.com/jmt/article-abstract/50/3/198/1007477?rss=1 and Kimberly Sena Moore has some wonderful research in this arena. http://www.musictherapymaven.com/my-publications/
Music-assisted relaxation is a wonderful way to help clients work on #3 and #4. Songwriting can be used to deal with maladaptive cognitions. Songwriting can also be used to create a format for memorizing anti-victimization skills. To work on the trauma narrative or integration the MT can utilize improvisational music therapy, music and writing, music and movement or music and other arts. Traumatic memories and feelings don’t connote actually recounting every detail of the trauma verbatim. Often it may be something that the client can easily remember but not necessarily something they can translate into words that come from their mouth. As a matter of fact, that almost always is something that the child takes care of in the forensic interview and probably won’t have to revisit completely unless there is a court date or trial in which the client or child is asked to testify as to details of the abuse (preparing for court experiences like this is another aspect of treatment to discuss). Rather, I would suggest that you think of this in terms of “trauma integration” and look at is as the client expressing the feelings related to the abuse, retelling the story in different times during therapy using a variety of mediums, talking about feelings in a before and after context, and so forth. The process of trauma integration because what is considered to be a “gradual exposure”. It is not always necessary or therapeutic for a client to tell the exact details of the abuse and often times it may not be the most difficult aspect of the abuse recovery process. It may be completely unnecessary for the client. Often times I think the therapists and adults involved with the client are the ones who need to process the child’s abuse because we can do that as observers and we probably have more insight and need to process this with another helpful person. A lot of times, in my experience, the hardest parts of recovering from abuse for a client are more about the changes in the family or social support system since the abuse happened, because when a child is abused it is usually by a known person and that relationship is now severed and the family system or social support is now damaged. As a result, people choose sides and those aspects of recovery create a long hard road for the client to navigate.