#HowAreYouReally: Mental Health in Caregivers and Parents

May has come to be known as the Month of Mental Health. On May 15 the Mental Health Coalition started a new online campaign using the hashtag “How are you, really?”. Its purpose? To be more transparent about everyday mental health struggles and open up a dialogue about honest and real feelings. 

While a large concentration has been on maintaining and supporting children’s mental health during this crisis, acknowledging the strains of caregivers’ and parents’ mental health is equally important, especially if there is a child with special needs involved. The Mental Health Coalition estimates that 1 in every 4 people will experience some type of mental health condition at some point in their lives (The Case for Mental Health, para. 1). With this in mind, knowing how to best give or recommend support to caregivers and parents of children with special needs is crucial.

With school and business closures, online work has been a hallmark of COVID-19. Parents and caregivers have become full-time teachers overnight, therapy facilitators, and entertainers in addition to job responsibilities. Despite the World Health Organization and American Academy of Pediatrics recommendations that children ages 6-10 only receive 1-1.5 hours of screen time a day with that limit increased to 2 hours for children 11-13 (EyePromise, 2019, para. 3 &4), an increased amount of screen time for everyone–children and parents alike– has become inevitable. In a 2018 study, researchers found that an increased amount of screen time in children correlated with lower psychological well-being and less emotional stability, as well as increased anxiety and depression (Twenge, 2018, pg. 272). Additionally, a 2017 study found that the amount of TV watching and computer use can predict the depression level among adults (Madhav et. al, 2017, pg. 68). To combat these effects,  Amy Kelly– Devereux Advanced Behavioral Health National Director of Family Engagement– recommends “unplugging” from screens for set periods of time for the entire family (Kelly, para. 10). 

Juggling various responsibilities can be overwhelming. Having times dedicated to engaging in realistic self-care practices can help alleviate feelings of anxiety and stress. While yoga and mindful meditation are effective strategies, it can be difficult to block out set amounts of time. Seattle Children’s “Realistic Ways for Parents to Manage Stress” article suggests going on a short walk outside or 5-minute stretching or single-song dance party as a quick self-care practice (Ibarra, 2020, para. 23). Taking 5 deep breaths periodically as well as bringing awareness to water intake and posture are additional easy self-care practices as well (Ibarra, 2020, para. 24 &25).

For those families who desire for self-care practices to be inclusive of all family members, board-certified music therapist  Stephanie Leavell’s “Yoga Song” is intentionally written for children and is family-friendly. Stephanie’s song is based on 11 different yoga poses that are easy for beginners and children. During the song, she slowly counts to 10 before transitioning to the next pose. At the end of the song, she focuses on breathing before gently ending. Her song is part of her album “Move It, Move It!” and can be found on Spotify and iTunes music, as well as YouTube (with visuals of the poses). The song can help decrease heart rate, increase oxygen, and encourage mindfulness for all parties participating. 

Seattle Children’s also recommends 5 steps for caregivers and parents to take during times of frustration (Take 5 When You’re Overwhelmed or Frustrated, 2020): 

1. Stop and step away

2. Take a short break to breathe

3. Remind yourself “I can do this” or “It’s important to stay calm.”

4. Ask yourself, “How can I handle this situation in a way that I will feel good about?”

5. If possible, ask for support from a partner or family member. Call or text a friend or neighbor. It’s ok to ask for help. 

Per step 5, speech-language pathologist Jim Mancini from Seattle Children’s recommends to “practice physical distancing, not social distancing” (Ibarra, 2020, para. 38). He points out that regularly talking–via phone call, via video chat, or text message– can help all individuals regulate during this time of quarantine and isolation. Affirming feelings and checking in by asking “How are you, really?” can let others know that they are not alone. 

-Sarah Deal, Music Therapy Intern 

References: 

Eyepromise (2019). Screen Time Guidelines by Age. Retrieved May 16, 2020 from https://www.eyepromise.com/wp-content/uploads/2019/05/Screentime-Recommendation-Chart-Final_AAP-WHO.pdf 

Ibarra, R. (2020). Don’t Have an Hour for Yoga? Realistic Ways for Parents to Manage Stress. Retrieved May 16, 2020 from https://pulse.seattlechildrens.org/dont-have-an-hour-for-yoga-realistic-ways-for-parents-to-manage-stress/ 

Kelly, A. (2020). COVID-19: Helping families with special needs during a public health crisis. Retrieved May 16, 2020 from https://www.devereux.org/site/SPageServer/?pagename=helping_families 

Madhav, K. C., Sherchand, S. P., & Sherchan, S. (2017). Association between screen time and depression among US adults. Preventive Medicine Reports, 8, 67–71. 

The Mental Health Coalition (2020). The Case for Mental Health. Retrieved May 16, 2020 from https://thementalhealthcoalition.org/cases/ 

Twenge, J.M. & Campbell, W.K. (2018). Associations between screen time and lower psychological well-being among children and adolescents: Evidence from a population-based study. Preventative Medicine Reports, 12, 271-283.

Behavioral Strategies in Music Therapy for Children with an Emotional-Behavioral Disorder

Emotional-behavioral disorders (EBD) is an umbrella term that encompasses a vast range of diagnoses. In the educational setting, this term is used to describe a child or adolescent whose behavior is viewed as disruptive and whose actions inhibit the individual’s academic performance (Jacob, 2018). The emotional component of EBD is that the child/adolescent is unable to effectively control their emotions. Examples of emotional disorders include anxiety disorders and depression. The behavioral component is thus the manifestation of emotional dysregulation. Behavioral disorders include oppositional defiant disorder (ODD), conduct disorder (CD), and obsessive-compulsive disorder (OCD). Symptoms displayed can be categorized into externalizing behaviors and internalizing behaviors. Externalizing behaviors include acting out, fighting, using inappropriate language, destruction of property, and other deleterious behaviors. Internalizing behaviors are focused inward and may include being withdrawn, exhibiting nervousness, physical symptoms such as headaches and stomachaches, changes in sleeping patterns, and changes in eating patterns (Jacob, 2018).

         Since each individual is different and thus displays symptoms differently, it may be difficult to pinpoint which disorder a child or adolescent may suffer from. This may be why EBD is used as an umbrella term to describe multiple diagnoses (Jacob, 2018). Although there are common behaviors displayed, each child/adolescent requires individualized attention and care in regards to treatment.

An emotional-behavioral disorder affects virtually every facet of a child/adolescent’s life, including school, family, and community functioning and performance (Bakken, Obiakor, & Rotatori, 2012). A common thread amongst children/adolescents diagnosed with EBD is their lack of social skills. They are unable to form and maintain interpersonal relationships with both school-aged peers and adults. This incapability can present a major challenge in social development and emotional wellbeing.

Behavioral theories suggest that human behavior is shaped through conditioning and observational learning (Gfeller & Thaut, 2008, p. 225). A main premise of behavioral theories is that an individual is more likely to display a certain behavior if it is consistently rewarded or reinforced. A child or adolescent may be inclined to display a disruptive behavior if it is constantly acknowledged by their teacher or caregiver. Positive Behavioral Support (PBS) is a range of preventive and positive interventions designed to create a supportive and successful environment for individuals who demonstrate behavioral issues (Adamek & Darrow, 2018, p. 196). The ultimate goal of PBS is to improve the daily lives of individuals in all settings, such as school, home, and community (Adamek & Darrow, 2018, p.196).

Positive Behavioral Support (PBS) utilizes three features: a behavioral assessment, comprehensive intervention, and lifestyle enhancement (Adamek & Darrow, 2018, p. 196). Similar to music therapy treatment, the assessment stage of PBS involves tracking the child or adolescent’s problem behaviors by observing the frequency and factors leading up to them. A comprehensive PBS plan involves altering the individual’s environment in order to remove triggering stimuli, teaching new skills to replace problem behaviors, and minimize natural reinforcements for inappropriate behavior (Adamek & Darrow, 2018, p. 196). 

 Behavioral techniques can be used in the music therapy setting to promote appropriate, desired behavior among children and adolescents with an emotional or behavioral disorder. Utilizing behavioral strategies in music therapy sessions allow for the client to make progress towards more appropriate behavior in unique, engaging ways. Participating in music-based interventions serves as a distraction from displaying inappropriate behaviors. For example, providing a child or adolescent with an instrument to play may counteract their ability to interact negatively with peers. Secondly, learning to play an instrument or read an instrument requires the child or adolescent to remain focused and engaged. By learning a musical concept, the child or adolescent exhibits appropriate behavior such as remaining seated, holding an instrument, and/or reading music. Finally, music can serve as a contingency for displaying appropriate behavior for a specific length of time. Once the specific time length of desired behavior is reached, the music therapist could reward the client by incorporating the client’s prefered music into the session or allowing the client to play their prefered instrument choice.

Music therapy sessions implementing behavioral strategies would involve structure and expectations set by the music therapist. The music therapist can set the expectation for the session by creating the session’s schedule at the beginning of the session and implementing a reward chart. If the client completes a set amount of interventions during the session, they will be rewarded with a prefered music activity. For example, if the client’s goals measure fine motor skills and remaining on-task, the client would be rewarded after sitting at the piano for a determined time length and isolating their fingers to play piano scales or a piano piece. If the client completes this intervention, the client could be rewarded for their positive and appropriate behavior by being given their prefered instrument. For example, if the client’s prefered instrument is the drum, the client and music therapist could engage in an improvisational intervention that provides the client with an opportunity for self-expression and autonomy by assuming the lead role in an intervention that they favor.

-Jasmine Bailey, Music Therapy Intern 

References

Adamek, M., & Darrow, A. (2018). Students with behavior disorders. In M. Adamek & A. Darrow (Eds.), Music in special education. The American Music Therapy Association.

Brigham, F.J., Bakken, J.P., & Rotatori, A.F. (2012). Families and students with emotional and behavioral disorders. In J. Bakken, F. Obiakor, & A. Rotatori (Eds.), Behavioral disorders: practice concerns and students with EBD (pp. 207-231). Emerald Group Publishing Limited.

Gfeller, K., & Thaut, M. (2008). Music therapy in the treatment of behavioral-emotional disorders. In W. Davis, K. Gfeller, & M. Thaut (Eds.), An introduction to music therapy: Theory and practice. American Music Therapy Association. 

Jacob, L.M. (2018). Emotional and behavioral disorders. Salem Press Encyclopedia of Health. Retrieved from http://eds.a.ebscohost.com/eds/detail/detail?vid=1&sid=feb9e3e5-0cf8-435f-b0ec-7c7493b6d4b2%40sdc-v-sessmgr01&bdata=JnNpdGU9ZWRzLWxpdmUmc2NvcGU9c2l0ZQ%3d%3d#AN=93787442&db=ers

Effect of Music and Movement in Older Adults

Exercise is essential for all populations but may be most imperative for older adults. The World Health Organization [WHO] recommends that adults aged 65 and older should get at least 150 minutes of moderate aerobic activity per week (World Health Organization [WHO], para. 1). However, a 2014 study by the CDC reported that 26.9% of adults aged 65-74 and 35.3% of adults >75 had no physical activity outside of work or daily living in the previous month (Watson et. al.,, 2014, 954). The benefits of physical activity are practically endless, reducing the risk for cardiovascular complications, recurrent falls, ADL limitations and cognitive decline, dementia, and depression. Overall, an increased quality life and improved cognitive functioning are the greatest outcomes (Cunningham, 2020, para. 1). 

In a 2001 music therapy case study, results indicated that there was a significant difference in the adherence to six of 14 various exercises presented with and without music during a physical therapy rehabilitation session for older adults (Johnson et. al, 91). The researchers credit the presence of music and the element of rhythm for increased fluidity and increased range of motion. Without music, the researchers noted that some patients had an increased number of repetitions per movement but some exercises required slower movements to gain maximum benefits (Johnson et. al, 2001, 92). Overall, unsolicited comments recorded during the session by the patients indicated a preference for music in the sessions (Johnson et. al, 2001, 82). 

Neurologic Music Therapy pioneer Dr. Michael Thaut gives further insight as to how rhythm aids in motor processes: “Rhythm provides temporal structure through metrical organization, predictability, and patterning….Rhythmic entrainment provides immediate time regulation but can be accessed to enhance long-term training effects” (Thaut, 2005, pg. 83). The temporal lobes are located on either side of the brain located near the ears. While their most prominent function is auditory processing and encoding memory, the right temporal lobe is involved in learning and remembering non-verbal information. This aids in visuo-spatial material as well as processing the structures of music (Queensland Government, 2017, para. 2). The rhythm of music allows auditory processing and the motor system to work in tandem through rhythmic entrainment, priming of the auditory-motor pathway, and cuing of the movement period (Thaut, 2005, 141). While the rhythmic structure of music can help individuals in real-time–in terms of the 2001 case study, while the individuals were exercising– rhythm can also be used to cue long-term memory recall, aiding in movement. 

While research is limited on examining individual’s music preference and effect on movement, a 2016 study revealed that key features of music preferred by older adults included “duple meter, consistent rhythm, major key, rounded melodic shape, legato articulation, predictable harmonies, variable volume, and episodes of tension with delayed resolution” (Clark, 2016, 364). An outline of songs from the 2001 Johnson et. al study that fit these characteristics and their respective implementation can be found below: 

Overall, fitness and movement is essential for all populations but can greatly increase the quality of life of older adults. Having input from a board-certified music to pair appropriate music selections with fitness routines can help maximize the intended effects of the exercises.

-Sarah Deal, Music Therapy Intern

References: 

Clark, I.N., Baker, F.A., & Taylor, N.F. (2016). Older Adults’ Music Listening Preferences to Support Physical Activity Following Cardiac Rehabilitation. Journal of Music Therapy, 53(4), 364-397. 

Cunningham, C., O’Sullivan, R., Caserotti, P., & Tully, M.A. (2020). Consequences of physical inactivity in older adults: A systematic review of reviews and meta‐analyses. Scandinavian Journal of Medicine & Science in Sports, 30(5), 816-827. 

Johnson, G., Otto, D., & Clair, A.A. (2001). The Effect of Instrumental and Vocal Music on Adherence to a Physical Rehabilitation Exercise Program with Persons who are Elderly. Journal of Music Therapy, 38(2), 82-96.

Thaut, M.H. (2005). Rhythm, Music, and the Brain. Routledge. 

Watson, K.B., Carlson, S.A., Gunn, J.P., Galuska, D.A., O’Connor, A., Greenlund, K.J., & Fulton, J.E. (2014). Physical Inactivity Among Adults Aged 50 Years and Older. Morbidity and Mortality Weekly Report, 65(36), 954-958. 

Queensland Government (2017). Brain Map: Temporal Lobes. Retrieved April 25, 2020 from   https://www.health.qld.gov.au/abios/asp/btemporal_lobes 

World Health Organization [WHO] (n.d). Physical Activity and Older Adults. Retrieved April 25, 2020 from https://www.who.int/dietphysicalactivity/factsheet_olderadults/en/

Music Therapy for Clients with Hearing Impairments

In 2014, it was estimated that about 17% of the American population, or 36 million individuals, have some degree of hearing loss (Lathom & Peters, 2016, p. 175). Hearing impairment affects an individual's ability to hear and process speech, which in turn causes deficits in social and communication skills. Although hearing loss varies among individuals, at least 90% of the individuals who have hearing impairments have some degree of residual hearing (Lathom & Peters, 2016, p. 171). Hearing impairments can affect the intensity in which a sound is heard, the clarity in which the sound is heard, or both (Lathom & Peters, 2016, p. 172). 

Hearing impairments are categorized based on age of onset, type of hearing loss, and degree of hearing loss (Gfeller & Darrow, 2008, p. 370). Hearing loss can be present at birth or can occur after birth. Acquired hearing losses can occur before learning a language, while learning a language, or after a language (Gfeller & Darrow, 2008, p. 371). Hearing impairments can ultimately lead to difficulty developing or maintaining communication skills, depending on when it occurs in an individual’s life. 

In addition to potential deficits in communication and social skills, individuals with hearing impairments often struggle academically. Children and adolescents with hearing impairments often have poorer academic performance in comparison to their peers without a known hearing impairment (Lathom & Peters, 2016, p. 176). This may cause children and adolescents with a hearing impairment to become frustrated in the academic setting. Hearing impairments may additionally cause other issues in relation to academic learning, such as a short attention span due to difficulty concentrating on auditory activities (Lathom & Peters, 2016, p. 176). 

Adults who have acquired hearing loss struggle socially, emotionally, and cognitively while executing activities in daily life. Adult individuals with hearing loss are faced with adjusting to their reduced level of hearing. This may cause them to struggle in social settings in which they once thrived due to difficulty hearing and understanding conversations. Difficulty understanding and hearing conversations may lead to an increase in social isolation (Lathom & Peters, 2016, p. 176). Acquired hearing impairments may also affect an individual’s job performance because it has become more difficult to decipher conversations. 

It is a common misconception that individuals with hearing loss cannot engage and enjoy music related activities. Music therapy interventions benefit individuals with hearing impairments by assessing auditory functioning, assisting in auditory training, enhancing speech production, encouraging language development, and promoting social skills (Lathom & Peters, 2016, p. 185). Listening to musical cues allows for individuals to maximize their use of residual hearing. Music therapists working with hearing impaired clients often work to increase the client’s ability to detect the presence or absence of a sound as well as differentiating between different auditory stimuli. Musical elements, such as tempo, pitch, timbre, rhythm, and duration of sound  allow for clients to exercise their auditory discrimination skills in an engaging way.

Rhythm is often used in music therapy interventions to improve speech production in clients with hearing impairments (Lathom & Peters, 2016, p. 187). Music therapists often address speech production with hearing impaired clients by aligning speech production to rhythms. Rhythmic chanting of a word or phrase allows for the client to become aware of their speech rate. Music therapists also work to improve vocal intonation and inflection by increasing awareness of pitch movements (Lathom & Peters, 2016, p. 187). Music therapy interventions can allow for a client with a hearing impairment to become aware of their speech production, improve their vocal quality, and enhance their articulation skills (Lathom & Peters, 2016, p. 189).

Individuals with hearing impairments often self-isolate due to difficulty understanding others in conversations. Music therapy interventions can improve a client’s social skills by allowing for communication in a group setting. Structured music therapy interventions such as songwriting provides opportunities for the client to engage in topic-related interactions and provide targeted responses. Singing in group settings allows for clients to participate, whether they are verbalizing the lyrics, using signed language, or using a communication device. Additionally, group settings may improve the client’s overall comfort level in social settings. 

In order to provide individualized treatment, the music therapist should consult with other professionals involved in the client’s treatment, such as a speech language pathologist or audiologist, to obtain information regarding the client’s receptive and expressive communication levels (Lathom & Peters, 2016, p. 193). Music therapists should have an understanding of how a client’s assistive hearing devices work, if used. Room fixtures, such as carpeting, curtains, and upholstery can serve to minimize environmental sounds. The music therapist should also consider the client’s intensity of hearing and place them closer to sound sources if needed. Finally, the music therapist should consider the use of visual aids, tactile cues, and multisensory strategies to emphasize auditory information.

-Jasmine Bailey, Music Therapy Intern

References

Gfeller, K., & Darrow, A. (2008). Music therapy in the treatment of sensory disorders. In W. Davis, K. Gfeller, & M. Thaut (Eds.), An introduction to music therapy: Theory and Practice, (pp. 365-404). American Music Therapy Association

Lathom, W. & Peters, J. (2016). Music therapy for hearing impaired individuals. In W. Latham & J. Peters (Eds.), Peter’s music therapy (pp. 171-200). Charles C. Thomas.

The Emotional Benefits of Songwriting among the Adolescent Population

     Adolescence, the transition from childhood to adulthood, is not always a seamless developmental stage. A major trait seen in the adolescent population is emotional dysregulation (Doak, 2012, p. 172). Adolescents are entering a phase in life in which they are given the task of identifying themselves, and for some, this may be a daunting responsibility. Additionally, adolescents are attempting to find their place in the world and may be susceptible to peer pressure (McFerran, 2010, p. 61). Researchers have defined four key elements that contribute to adolescent health: identity formation, resilience, competence, and connectedness (McFerran, 2010, p. 61). 

            Music therapists have identified common diagnoses seen among adolescent clients (Doak, 2012, p. 170). Emotional dysregulation may manifest itself in diagnoses such as depression, anxiety disorders, personality disorders, and less commonly schizophrenia (Doak, 2012, p. 171). According to the Substance Abuse and Mental Health Services in 2016, about 2.2 million adolescents have had at least one experience with major depressive disorder (Johnson & Heiderscheit, 2018, p. 464). Adolescents with these diagnoses or those who are exhibiting symptoms of these disorders are often struggling with the concept of self-identity and interpersonal functioning. 

            It has been estimated that the average adolescent spends two and a half hours daily listening to their preferred music (McFerran, 2010, p. 60). In general, adolescents use music to relax and escape reality, become in touch with oneself, foster creative thinking, connect to personal experiences, access subconscious thoughts and feelings, and as a means of communication (McFerran, 2010, p. 70). It can be assumed that adolescents listen to songs in which they can relate to on some level, and their preferred music can serve as an indication to their thought process and mood. 

Music therapy has been shown to improve the social, emotional, and cognitive skills of adolescents with various diagnoses. Music therapy provides a safe environment in which adolescent clients are encouraged to engage in self-expression and self-reflection. The music therapy space allows the adolescent to develop and foster communicative patterns with the music therapist and/or peers and provides experience for relating to others (Baker & Wigram, 2005, p. 68). Music therapy can serve as a method of support and assistance in which the adolescent can identify their needs and ways to address them (Baker & Wigram, 2005, p. 68). Among this population, music therapists address emotional regulation by providing safety, support, and calming experiences while developing coping skills, self-awareness, and problem-solving skills (Doak, 2012, p. 172). 

Songwriting is a technique commonly used in music therapy treatment. Although different methods exist, the act of songwriting involves creating original lyrics based on the writer’s thoughts regarding a topic. An adolescent client may initially be hesitant to engage in songwriting. However, introductory methods of songwriting exist that can allow the client to become more comfortable with the technique. An introductory method to songwriting is the Cloze procedure. This procedure uses a fill-in-the-blank method that encourages the client to provide new words for a pre-composed song (Johnson & Heiderscheit, 2018, p. 472). An additional introductory method to songwriting is piggyback songwriting. This method involves using pre-existing music to compose original verses (Johnson & Heiderscheit, 2018, p. 172).

Free-form songwriting is the process of creating an original composition in all aspects of the music (Stewart & McAlpin, 2016, p. 184). This form of songwriting is very involved, and there is often as much focus on the process of songwriting as the final product. Although the method of free-form songwriting varies, the first step usually involves brainstorming a topic (Baker & Wigram, 2005, p. 72). The topic or theme of the lyrics is usually tailored to address a difficulty the client is facing. The subsequent steps of free-form songwriting involve writing lyrics and deciding on the type of music accompaniment. The finished song allows for discussion between the music therapist and client regarding the client’s thought process regarding the lyrical content, development of the music accompaniment, and opinions regarding the final product. 

Improvisational songwriting involves creating new song content in a spontaneous method. This method is designed for the client to verbalize thoughts regarding certain themes without much consideration. In this way, the music therapist and client can address the content created. The final method of songwriting is creating a song collage. This method involves taking lyrics from pre-composed songs, arranging them in a different structure, and creating a new melody (Johnson & Heiderscheit, 2018, p. 472). 

            An example piggyback songwriting intervention utilizes “My Fight Song” by Rachel Platten. As the song title implies, Platten describes overcoming hardships of her life and becoming empowered. Adolescent clients who are experiencing various hardships may relate to this song. This song may represent their desire to prevail over their identified struggles. Using the framework of this song, the music therapist may introduce this intervention by retaining the original chorus, but providing opportunity for the client to create personalized verses. These verses can describe what the client desires to overcome or gain control over. 

            The process of songwriting provides adolescent clients with an effective means of self-expression and self-awareness (Baker & Wigram, 2005, p. 68). Songwriting can serve to empower the client and foster independence. The music therapist assists the client throughout this process by offering empathy, support, and validation. The four key elements of adolescent health can be addressed and fostered through songwriting interventions. Songwriting provides an adolescent with insight into their own thoughts and identity. Songwriting allows the client to discuss coping skills and problem solving skills through composing lyrics. Finally, songwriting in the music therapy setting provides the client with a safe, supporting environment to flourish. 

This period of uncertainty caused by COVID-19 has affected our society in many ways. For the majority of adolescents, their school has either transitioned to online learning or ended completely for the school year. Memorable high school events, such as graduation and prom, have been canceled. Their normal daily life has been completely altered for the foreseeable future. It is important for our adolescents to explore their feelings during this pandemic and to have their feelings validated. Songwriting is an excellent way to foster self-expression, collect and organize thoughts, and maintain creativity. Music therapy telehealth sessions can allow adolescent clients to retain their therapeutic relationship and continue to have an outlet for self-expression.

-Jasmine Bailey, Music Therapy Intern 

References

Derrington, P. (2005). Teenagers and songwriting: Supporting students in a mainstream secondary school. In F. Baker and T. Wigram (Eds.), Songwriting: Methods, techniques and clinical application for music therapy clinicians, educators, and students (pp. 68-81). Jessica Kingsley. 

Doak, B. (2012). Children and adolescents with emotional and behavioral disorders in an inpatient psychiatric setting. In L. Eyre (Ed.), Guidelines for music therapy practice in mental health (pp. 168-204). Barcelona Publishers.

Johnson, K., & Heiderscheit, A. (2018). A survey of music therapy methods on adolescent inpatient mental health units. Journal of Music Therapy, 55(4), 463-488.

McFerran, K. (2010). Adolescents, music and music therapy: Methods and techniques for clinicians, educators and students. Jessica Kingsley.

Stewart, R., & McAlpin, E. (2016). Prominent elements in songwriting for emotional expression: An integrative review of literature. Music Therapy Perspectives, 34(2), 184-190.