Music as a metaphor for life is a common thread in my work as a music therapist. Though I implement this practice with my clients to nurture their growth, I recently had the opportunity to cultivate this concept outside of the clinical setting. This past September, I was invited to lead a 2-hour music therapy experience for a group of psychiatrists.
The Southern California Psychiatric Society has a committee called the Art of Psychiatric Medicine. This committee aims to support the artistic nature of psychiatry, and hosts events with guest artists to promote creativity and community among clinicians. I discussed with Dr. Michelle Furuta, the event’s organizer, how music therapy could support this purpose. We conceptualized a project titled, “Life as A Song: Personal Melodies and Collective Rhythms.”
On a Sunday afternoon, the group gathered to share a creative music experience. The psychiatrists in attendance brought a wide range of clinical experience, knowledge, and musical interests. I felt inspired and honored to be in the presence of these dedicated medical doctors who were taking valuable time for their personal growth, connection, and artistic exploration.
My goal for the day was to use music as a lens to enhance self-reflection and as a bond to enrich positive social connections. We used music as a metaphor to explore individual traits and roles, and to celebrate the collective rhythms present in the group. We spent time with music on a personal level. Then, we created music together.
This seven-minute video captures the essence of our 2-hour session and the product of our creative efforts. Below the video is a brief explanation of the session and process (a full step-by-step guide for the interventions are available in my e-book, The Harmony Handbook, Vol. 1).
Prior to the songwriting experience captured in the video, the session opened by first exploring the elements of music in relation to the self and others. We looked at how our individual lives can be described in musical terms…our voices as melodies, the tempos at which we move, the dynamics we emanate and prefer, the harmonies that exist within and around us, and the rhythms in our everyday lives. These elements exist in unique combinations for all of us. Our group also explored how these elements differed in personal and professional roles.
With this musical language in place, we moved into improvisation, creating music spontaneously. The freedom of expression that improvisation brings allows for a non-verbal social connection and making music for enjoyment, with openness, cooperation, and fluidity. Here, the elements of music exist in pure form, and this allowed the group a break from words before getting into songwriting.
I chose the song “Times Like These” to facilitate a songwriting experience because of its universal themes, adaptability, and form. This song is structured so well for the encouragement of songwriting to describe oneself and reflect on the present moment. Originally written and performed by the band Foo Fighters, this song is also versatile and can be played as a rock or folk song, and I have even seen adolescents turn this song into hip-hop. Our group played the original version together to get a feel for the melody and rhythm, and then each person was encouraged to write his or her own lyrics to the song.
With these new lyrics, we collectively created a group song that represented each individual and the group as a whole. As seen in the video, each person chose a part of a verse they wrote, and together we wrote a group chorus. With this, we created our own version of the song that allowed each person’s voice to be heard, and for the group to unify. Their song flowed with honesty, vision, and courage, and the support and cohesiveness of the process was powerful to witness and share.
I admired each person’s willingness to reveal their creative side, as the nature of music requires a certain level of audacity, especially in the presence of peers or colleagues. This was also out of my comfort zone, and allowed growth for me as a clinician. Though I have worked with thousands of psychiatric patients over the years, to work with their doctors was new for me. In the end, I was left with a strong sense of gratitude and validation that music therapy may not only be recognized in psychiatry, but that there are clinicians also willing to take a step in.
This day was a compelling reminder that music is not only therapeutic and beneficial for those we as practitioners define as clients. For all of us, practitioners included, music is a catalyst that awakens an awareness of who we are and why we do what we do. Music connects us to each other and to ourselves.
I remember the moment I was accepted into graduate school. And I remember what I did immediately after- I went online and looked over the curriculum of the Master of Arts in Music Therapy program at St. Mary-of-the-Woods College with fierce anticipation. I looked at this list many times before, but it suddenly transformed into a list of courses I was actually going take. Of all the courses, the one I was most excited about was called MU584: Music Psychotherapy. I took the class in the spring of 2014, and it lived up to my high expectations. I am now a better music therapist because of it.
Dr. Yasmine Iliya was my music psychotherapy professor and is a music therapist and licensed creative arts therapist in New York City. In this interview, Yasmine shares her knowledge of music psychotherapy along with her experiences in combining the art of psychotherapy with the power of music to help people with mental illnesses, grief, and homelessness.
What is music psychotherapy, and what makes it a unique approach for treating people with mental health challenges?
I define music psychotherapy as the use of music in a psychotherapeutic relationship to achieve psychosocial and emotional outcomes, such as developing insight, self-expression, and self-esteem. It makes a unique approach for treating people with mental health challenges because these are often the very improvements they are seeking. Traditional psychotherapy may leave clients feeling stuck, because perhaps the level of expression or insight did not get deep enough, or all the time spent talking keeps the therapy and progress on a cognitive rather than somatic level. The arts, and music in particular, can provide opportunities for progress that are deeper, more creative, and more somatic. Music can also be a motivating factor, so that people who may not seek other psychotherapy modalities are more open to working and playing in music. I have been working in a psychiatric hospital in Brooklyn for almost six years, and I find that music has the additional benefit of providing socialization for people with severe and persistent mental illness, like schizophrenia and bipolar disorder. Sometimes my clients may struggle with interpersonally connecting with others due to paranoia and disorganized thinking, but we can sit and play music all together, which is really unique. In talking, cognitively-oriented groups, those clients may instead remain disconnected, isolative, and withdrawn. I believe that every human being deserves the opportunity to connect, because we are all always seeking that feeling of love. We all just want to be heard and seen, and I often remind myself that music psychotherapy is doing just that most of the time.
How did you become a music therapist, and what kind of training did you go through in order to practice music psychotherapy?
The story goes that I first heard of music therapy through random google searches a few months after graduating college! I had never heard of music therapy prior to landing on the AMTA website and realizing that this was my destiny. It felt like I had been utilizing music therapy in some capacity for myself for most of my life, and I could not believe a helping profession existed where I could use music as a tool for healing. My undergraduate studies at Tufts were in Biological Psychology, and although I sang and played flute in several ensembles, I needed to learn piano, guitar, and music theory in order to become a music therapist. I worked full-time in cancer research for a couple of years in New York City while preparing to apply to New York University’s graduate music therapy program. Thankfully, after all that preparation, I was accepted and did my music therapy training there. After I graduated NYU, I did Diane Austin’s 2-year advanced vocal psychotherapy training. That kind of training was necessary to practice music psychotherapy. Supervision and experience are also key elements of ongoing training. Recently, I obtained an advanced certification from the Association of Death Education and Counseling. As a Fellow in Thanatology (Death, Dying, and Bereavement), I had to demonstrate many hours of education and research in this field, and take an exam determining my competencies as a grief therapist.
How can music influence the therapeutic process when working with people who are experiencing grief?
As part of my doctoral studies at Lesley University, I studied music’s influence on the therapeutic process when working with people who are experiencing grief. Music holds tremendous potential for grieving individuals, as it can intrinsically help facilitate the expression of emotions, which is a necessary component of grieving according to J. William Worden. I used music to help facilitate and maintain a connection between the grieving individual and the deceased person, based on new theory and research emerging in the field of thanatology. The intervention I created and studied asks individuals to improvisationally sing to their deceased loved one, and then sing back to themselves from the role of the deceased person. It has some elements of Gestalt therapy and drama therapy, and is highly influenced by Diane Austin’s method. In addition to eliciting emotion, this imaginal dialogue has the potential to allow for resolution of unresolved issues (i.e., exchanging apologies and forgiveness) and can help people move forward in their grief. I think it’s important to also add that grief is commonly overlooked and misunderstood by clinicians. Grief is not sadness, anxiety, nor trauma; it is a unique experience that can overlap with those other experiences, but needs to be understood and addressed all on its own. One of my music therapy studies with bereaved adults with mental illness will be published soon in Death Studies journal. People with mental illness have drastically higher rates of prolonged, complicated grief than people without mental illness, and this needs to be addressed by mental health professionals. Prolonged grief puts people at greater risk of suicide, cancer, and poor quality of life, overall.
You have also done work with people with mental illnesses who are homeless. How did you use music therapy when working with them? How did they respond?
I loved working with men with mental illness who are homeless. This was during my internship with Noah Shapiro, an incredible music therapist, at the largest and most well-known men’s shelter in New York City. It was a beautiful and enriching experience. Noah taught me to trust myself as a musician and to trust the process of therapy. Therefore, I used mostly improvisational methods. I played flute in the groups, and our improvisations would often continue for 30 minutes or more. I also explored the use of the voice, and wrote an article in Music Therapy Perspectives about those interventions and experiences. The men were very open and willing to try all my vocal improvisational methods! We just played using our voices. One of my clients sang about how getting a state ID helped him feel like he had an identity, and I remember feeling very moved by that. An identity! Aren’t we all searching for who we are? I felt like it was about more than just the ID card, but that he was healing and finding himself in the process of therapy, and that was a beautiful process to witness.
What is the most challenging part of your role as a music psychotherapist?
The most challenging part of my role as a music psychotherapist is being patient when people are not ready to move forward in their process. There are good reasons for these defense mechanisms; they were developed to protect us and help keep us safe. But, I often ask people, are these mechanisms still serving you? Many times the answer may seem clear to me, but the person is just not ready, and that’s what matters. Patience is key in those moments. Robert Neimeyer, a wonderful grief therapist and researcher, talks about the intersection of “Need Street” and “Readiness Boulevard.” People need to be ready to risk letting go of those mechanisms in order to really try and live healthier, more insightful lives.
What is the most rewarding part of your role as a music psychotherapist?
I think the most rewarding part of my role as a music psychotherapist is developing intimate relationships with people. The trust and connection that develops with individuals and groups within a psychotherapeutic relationship is a true privilege for me. I am often struck by the willingness and courage people have to open up, be vulnerable, and trust me. From that, I have the additional privilege of watching people unfold, grow, and gain beautiful insights about themselves. It’s an honor.
What do you love about music?
I love many things about music, but mostly I love the way music can symbolically communicate emotion. I am thinking about the philosopher Susanne Langer and her thoughts on music and symbolism. Music is incredibly powerful, and for me, the way it can help us feel and express joy, pain, and sorrow is why I love it. I also love how music is universal; it is listened to, played, enjoyed, and ritualized all over the world. It is within all of us. I love the impermanence of music, too. When we play or sing without a recording device, the magic happens in the moment, and then it’s over. That reminds me to live in the moment. Music is abstract and difficult to describe using words, which I also love. We need to feel it to understand it, and that is a welcome gift. Lastly, I am grateful to music for helping me survive many difficult times in my life, and for giving me wonderful moments of connection, joy, and love with so many people in my life.
Dear Music,
What I love about you is YOU.
Love,
Me
Adolescents are one of the most important populations served by music therapists. A teenager’s relationship to music holds immense therapeutic value, but can also be a tricky one to navigate. I find my own work with adolescents to be both rewarding and challenging. Serving a sensitive and impressionable generation is a privilege not to be taken lightly.
One resource that has helped my practice and understanding of music therapy with teens is the book Adolescents, Music, and Music Therapy: Methods and Techniques for Clinicians, Educators and Students, by Dr. Katrina Skewes McFerran. As a music therapist, researcher, and educator, Dr. McFerran specializes in treating young people and has a breadth of knowledge to share about supporting adolescents with music therapy.
Can you share your story of how you came to specialize in music therapy with adolescents?
I honestly think it was the music that was the biggest draw card. I have always been a pop music fan, and once it clicked that it would be possible to learn more of my favorite songs as a part of my work, I was enthusiastic. That includes both contemporary pop, and classic hits that are still well known to young people. Of course, this combined with opportunities that presented – I was the youngest professional in my workplace (a community based hospice care service) and so it was natural that I would be involved in providing bereavement care for children and teenagers. That led me to my PhD topic, which was exploring the experience of music therapy for bereaved teenagers, this time in schools. A lot of things lined up to support this interest, but there was so little literature describing this kind of practice that I felt it was necessary to study it further myself.
What makes an adolescent’s relationship to music unique and/or important?
I think it is the combination of time and intense emotions. Teenagers listen to more music than any other generation. In addition, they are experiencing hormonal triggers for the first time, and for some young people, this can be a very emotional experience. Combined with their desire to focus more on their peers than family, and to share in activities that help them identify with one another, it all seems to point to music really. Suvi Saarikallio (see Laiho, 2004) wrote a great article in the Nordic Journal of Music Therapy that summarises the literature on this topic.
What are some of your favorite music therapy interventions to facilitate with adolescents struggling with depression?
Like all music therapists, I would need to get to know the young person/people before we could decide how we might use music. So I am purposefully avoiding the word ‘intervention’ because I favor collaborative, mutually agreed therapy processes over expert-determined practices. I am also placing the individual and their context as a more powerful influence over the potential of therapy than their diagnosis, since people deal with illness in different ways, and depending on the support networks they have available to them. All that said, I do seem to use song writing more often than anything else. The combination of original words and music seems to serve many teenagers well, and they can choose which they place more emphasis on – it may be essentially an electronic piece with a lyric riff, or it might be a whole narrative with a simple song structure sitting underneath it. I wrote a whole book about this, called Adolescents, Music and Music Therapy (2010) if you’d like to read more about it.
Client preferred music is an important element in music therapy. What do you do when a client’s preferred music contains offensive or aggressive content?
This is a part of my practice that has changed a great deal in the past ten years, based on some research I have done on the topic, and will continue to do. I used to adopt a Humanist approach, and to positively revere individual choices without question. I have argued frequently that it is critical for young people to express their identity through their music choices, and that they should not be judged for those choices. However, I have more recently adopted a more critical approach, where I push more to understand the connections that young people have with music. I have discovered that some young people use music to ruminate and that the process can be largely unconscious. This demands that the therapist consider a more psychodynamic lens, and to explore the projections that may be present. This is just as likely to occur with a pop song as it is with a metal piece, but it makes sense that people use music to reinforce and strengthen the pathological aspects of their psyche, as much as it can be a potential resource to support positive growth. Just look at what Hitler did with music. Randi Rolvsjord’s Resource Oriented Music Therapy (2010) provides some fantastic explanations that balance more traditional humanistic and psychodynamic practices.
When working with a teenager who is resistant to treatment or extremely guarded, how do you approach him or her?
With deep respect, and removing my own need to prove myself as a therapist. Andrew Malekoff (Malekoff, 2014), a social worker, beautifully describes this as leaving your ego at the door. I truly believe that adolescents know when people are truly available to them. They are surrounded by peers who are experimenting with different roles and trying on different ways of being in the world, that they sniff inauthenticity. So I try and see what I can do for the young person. And sometimes, it’s nothing – they’re just not ready. But I always start by asking ‘So, what kind of music are you in to?’ That’s a good beginning for most relationships.
What is the most rewarding part of your role as a music therapist working with adolescents in mental health settings?
I used to like the sheer honesty of young people and the faith they had in music. It meant that they would share themselves authentically and I really enjoy mutually authentic relationships. These days, as a researcher and a teacher, I enjoy listening to their perspectives about music, why and when it helps, and what we could do better. Although sometimes I challenge their blind faith in music (McFerran & Saarikallio, 2013).
What is the most challenging part of your role as a music therapist working with adolescents in mental health settings? And how do you deal with these challenges?
When they have to go back into home situations that are damaging and that they are too young to leave. That breaks my heart.
What have you learned from your clients?
That music is more powerful when you are having the worst time of your life. That music can be your best friend and your worst enemy, so sometimes you need help to work on your relationship with music.
What do you love about music?
That it provides opportunities to explore new dimensions of self and to discover capacities and emotions that were previously hidden. Music affords energy, understanding and connection – so it creates ideal conditions for therapeutic encounters.
References
Laiho, S. (2004). The psychological functions of music in adolescence. Nordic Journal of Music Therapy, 13(1), 47-63.
Malekoff, A. (2014). Group work with adolescents (2nd ed.). New York: Guildford Press.
McFerran, K. S. (2010). Adolescents, Music and Music Therapy: Methods and Techniques for Clinicians, Educators and Students. London: Jessica Kingsley Publishers.
McFerran, K. S., & Saarikallio, S. (2013). Depending on music to make me feel better: Who is responsible for the ways young people appropriate music for health benefits. The Arts in Psychotherapy, 41(1), 89-97. doi: http://dx.doi.org/10.1016/j.aip.2013.11.007
Rolvsjord, R. (2010). Resource Oriented Music Therapy. Gilsum, NH: Barcelona Publishers.
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Despite how powerful and simple gratitude can be, it can also be easy to forget, especially in times when we need it most. When interwoven, music and gratitude can bring the beauty of life front and center, reminding us that in any moment there is something to be grateful for.
Here are three songs that provide a lens of gratitude for me.
What song reminds you to be grateful?
Grateful by Nimo Patel/Empty Hands Music (Download the song for free here)
Thank U by Alanis Morissette
Thank You by The Makepeace Brothers (Lyrics and song download can be found here)
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Music helps us celebrate our greatest moments in life, and soothes us through the worst. It joins us in the car, at the movies, in restaurants, at the gym, and in simple moments with loved ones. Music honors individuals, cultures, trends, love, heartache, friendship, pain, and humanity.
Even inside of us, elements of music are constantly expressed through the rhythm of our heart, melody of our voice, and the tempo at which we choose to walk on the earth.
As an expressive art, music conveys our journey and reminds us that life is a shared experience. Some of the greatest music is not only an expression of human challenges, but also an attempt to overcome them, and heal.
As a science, music is measurable, and made of ratios and frequencies that our brain knows how to process before we are even born.
As a therapeutic tool, music is a powerful and practical way to reach the whole person. Music has the power to influence behavior, inspire emotion, and create harmony in all stages of life. Music therapy is a health profession that harnesses the artistic, scientific, and therapeutic components of music.
The American Music Therapy Association defines music therapy as “the clinical and evidence-based use of music interventions to accomplish individualized goals within a therapeutic relationship by a credentialed professional who has completed an approved music therapy program.” Research has shown that music therapy is a valuable and effective mental health treatment that can improve self-esteem, decrease anxiety, increase self-expression, increase motivation, and support emotional balance.
Music therapists are board-certified practitioners who integrate the power of music with a therapeutic relationship to help clients attain an improved experience of life. Music therapists serve people of all ages and abilities, and no musical skill on the client’s part is necessary to participate. Music therapy participation may be active or receptive, and an individual’s treatment plan is based on personal music preferences, goals, abilities, and challenges.
5 Ways Music Therapy is Used to Improve Mental Health:
1. Listening
Listening to live or recorded music allows clients to validate feelings and experiences, and process themes with a therapist through self-reflection and lyric analysis. Music listening is also a tool for refocusing attention for pain management, crisis intervention, and relaxation.
2. Creative Expression & Composition
Through singing, songwriting, composition, creative writing, or art activities, music is used to nurture creativity and healthy emotional expression. Creative expression can increase motivation and self-esteem, while increasing insight into feelings and identity.
3. Improvisation
Improvisation involves creating music in the moment for a spontaneous expression of feelings. Using instruments or voice, clients are able to freely express musically what may be difficult to put into words. In group settings, improvisation promotes bonding, community, and support through positive musical and social interactions.
4. Relaxation, Meditation, & Imagery
Live or recorded music is used to facilitate music-assisted meditation and relaxation practices. By reducing muscle tension and anxiety, music therapy interventions support stress management and mindfulness. In psychotherapeutic and transpersonal practices, guided imagery through music is used to explore inner experiences and promote integration.
5. Music as a coping skill
The use of music in daily life is explored as a way to cope with stressors and change, as well as improve quality of life. Learning to play an instrument as a meaningful hobby, participating in music as an alternative to drugs or alcohol, and learning to intentionally use music in daily practices helps increase motivation and encourages a healthy lifestyle.
“Where words fail, music speaks.” -Hans Christian Anderson
Music therapy may serve as a primary or complimentary mental health treatment, and music therapists often work in inpatient, residential, or outpatient facilities. Music therapists also work in private practice, and often collaborate with other mental health professionals.
I have worked with clients with psychosis who cannot even tell me their name, but can sing with me and enjoy a few minutes of reprieve from their hallucinations. I have worked with clients hospitalized after failed suicide attempts, who were able to find their first inklings of hope in a song lyric. I have worked with people piecing their sense of self back together after losing the most important person in their life, and finding the strength to persevere in the sound of an instrument. And I have worked with people facing their own death, using music as way to review their life and capture the unique qualities they brought to the world, and what they will leave behind.
I have also worked with clients in treatment for depression, anxiety, drug and alcohol addiction, eating disorders, PTSD, trauma, sex addiction, personality disorders, schizophrenia, grief, and mood disorders. The beauty in this work is found in the process itself that is both personal and universal. We all know what music is, yet we all have our own relationship to it. It is this relationship that is nurtured and cultivated in music therapy in order to connect to collective themes and create transformative and unique internal shifts.
“The best music…is essentially there to
provide you something to face the world with.” -Bruce Springsteen
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