Music therapy and Treating Children Who Experienced Abuse and Trauma

Trauma can occur at any age, however, children who experience trauma may experience effects on many parts of their development. Developmental trauma or reactive stress disorder is when a child is in a constant state of stress (Drevitch, 2018). A situation that can cause constant stress is abuse. The constant stress disrupts a child’s development (Drevitch, 2018). According to Drevitch, “Development of upper parts depends upon prior development of lower parts. In other words, the brain is meant to develop like a ladder, from the bottom up” (p. 1, 2018). If a child is raised in a healthy environment, the upper and lower parts of the brain have a good foundation to continue to develop and grow. However, for children who have experienced trauma such as abuse, that crucial part of their foundation during development is missing. These delays in development can manifest as sensory processing disorder, attention-deficit/hyperactivity disorder (ADHD), and speech delays (2018). Children who experience trauma need therapy to process their experiences and address their needs.

An assessment created by Bruce Perry called Neurosequential Model of Therapeutics (NMT) is used to assess the brain development of those who have developmental trauma (Drevitch, 2018). The areas of the brain that are assessed include sensory integration, self-regulation function, relational function, and cognition (Douglas, 2022). After the assessment is complete, the scores show the neuro-developmental needs of the child being assessed. Information collected in this assessment includes the history of the child’s past and present and 32 areas of the brain (Douglas, 2022). The assessment maps out the brain to show the child’s current functions, age development, and relational health (Douglas, 2022).  

How does music therapy address the needs of a child who experiences trauma? Music therapists use a variety of methods including re-creative, improvisation, compositional, and receptive music therapy techniques. For instance, a music therapist used improvisation with an 8-year-old girl named Kelly who experienced sexual abuse (Strehlow, 2009). The music therapist began by giving Kelly space to reenact of the trauma through music (Strehlow, 2009). Kelly would play the recorder by herself first, but once she was comfortable she allowed the music therapist to play along with her using the xylophone. After the music therapist had gained her trust, they reenacted the trauma through the instruments and role playing. The music therapist’s role was to support the child’s expression of the trauma and promote self-expression.

A music therapist using re-creative technique focusing on a child named Larna (3 years old) who experienced physical abuse (Pasiali, 2013). The music therapist used singing songs with instruments/props to address the child’s needs. The goal was to learn to play and explore (Pasiali, 2013). The songs used were age-appropriate songs, tunes with different modalities, and chants with instruments and props such as using a scarf to put over Larna’s head to pretend she was a princess while singing (Pasiali, 2013). Larna would sit on her mother’s lap and cuddle with her when singing songs. Other interventions included sitting on a parachute and playing games that involve singing short melodic phrases while touching another person at the end of each phrase pretending to “buzz” them (Pasiali, 2013).

Another music therapist who treated a child named Sally who experienced sexual abuse using a receptive technique. Sally went to music therapy from the age of 7 to 14. Music therapist worked on developing trust between Sally and the therapist (Robarts, 2006). The goal of each session included self-regulation and sensory integration (Robarts, 2006). The music therapist would play music and encourage her to play along. The music therapist would base the tempo and rhythm of the music on Sally’s mood and flashbacks during the session (Robarts, 2006). During the session, the music therapist was viewed as one of her abusers and the music therapist would address this by playing a steady rhythm and melody. The music would help to ground Sally and bring her back from her flashbacks (Robarts, 2006). It even inspired her to play with the music therapist (Robarts, 2006).

Another music therapist who treated a 5-year-old child named Leah who experienced sexual abuse, physical abuse, and neglect using a technique called compositional (Christenbury, 2015). The music therapist treating Leah used a compositional intervention called songwriting. The songs written during the session were based on Leah’s emotions such as being happy or sad (Christenbury, 2015). Emotions such as anger were more negative emotions and related to her trauma. Leah would draw pictures of what her emotions look like to her and the music therapist would work with her to create music to go along with her pictures. Leah would direct the music therapist to color with her using specific colors (Christenbury, 2015). All the pictures and lyrics were put into a book and the music therapist recorded all music for Leah to take with her. The pictures and music such as using minor keys for sad emotions reflect what Leah was feeling and process her feelings of sadness.

Music therapy supports children who have experienced trauma to process, self-regulate, cope, and build healthy relationships with others. For instance, in the case studies of Larna and Kelly the music helped them to build relationships with others by learning how to trust. In Sally’s case, she was able to entrain to the beat to bring her out of her flashbacks and prompted her to participate in making music (Robarts, 2006). Entraining to the beat helped Sally to learn how to self-regulate. Leah’s songwriting helped her to process current and past events (Christenbury, 2015). Music therapy supported these children in their journey to reach their goals and move past their trauma to trust and grow to be the best they can be.

-Teresa Dominguez, Music Therapy Intern

References:

Christenbury, R. K. (2015). I will follow you: The combined use of songwriting and art to promote healing in a child who has been traumatized. Music Therapy Perspectives, 35(1), 1 – 12. https://doi.org/10.1093/mtp/miv005

Douglas, A. C. Meeting children where they are: The neurosequential model of therapeutics. National Council For Adoption. (2022, March 15). ttps://adoptioncouncil.org/publications/meeting-children-where-they-are-the-neurosequential-model-of-therapeutics/

Drevitch, G. (2018). What is developmental trauma? Psychology Today. Sussex Publishers. https://www.psychologytoday.com/us/blog/expressive-trauma-integration/201808/what-is-developmental-trauma

Pasiali, V. (2013). A Clinical Case Study of Family-Based Music Therapy. Journal of Creativity in Mental Health. 8(3), 249 – 264. http://dx.doi.org/10.1080/15401383.2013.821925

Robarts, J. Z. (2006). Music Therapy with Sexually Abused Children. Clinical Child Psychology and Psychiatry.

Strehlow, G. (2009). The use of music therapy in treating sexually abused children. Nordic Journal of Music Therapy. 18(2), 167 – 183. https://doi.org/10.1080/08098130903062397

Music Therapy in the Neonatal Intensive Care Unit (NICU)

What is the Neonatal Intensive Care Unit (NICU)? The NICU is a unit in the hospital for babies who are preterm (born before 37 weeks), have low birth weight (less than 5.5 pounds) or sick babies who need more intensive care. Babies can also be admitted into the NICU if they are not sick, but need specialized nursing care. Other causes for infants to be admitted include the health of the mother during birth such as high blood pressure, what happens during delivery such as fetal distress, or the health of the baby after birth such as low blood sugar. The treatment team in the NICU consists of a neonatologist, neonatal fellow, and pediatric resident. (Stanford Medicine Children’s Health, 2024). The doctors and nurses do a great job in caring for babies in the NICU, but how can music therapy help?

NICU Music Therapy is the use of musical elements by a certified MT-BC to address goals of infants in the NICU (AMTA, 2021). There are many benefits to music therapy being involved during an infant’s stay in the NICU. Benefits include increased parent/caregiver satisfaction, increased cost effectiveness, and increased cultural efficacy (2021). For instance, the AMTA fact sheet talks about increased weight gain and decreased length of stay as a result of music therapy. One of the ways this is achieved by a music therapist using a device called Pacifier Activated Lullaby (PAL) System (2021). The PAL system has a pre-recorded lullaby that is only activated by the sucking motion of the infant. Learning the sucking motion helps the infant feed and gain weight. The result of the infants learning how to feed and gain weight, decreases the length of their stay in the NICU (Cevasco A. & Grant R., 2005). By decreasing the length of their stay, it reduces the cost for both the family and the hospital.

Music therapy can also help the parent/caregiver to bond with their infant. The music used include lullabies and songs related to the culture/tradition of the parents/caregivers. Music therapy also reduces the parents/caregivers stress and boosts their confidence in their parenting skills (Gooding, J. et al., 2011). 

Although music therapy is beneficial for infants and their families, there are a few cases in which an infant would not be eligible to receive music therapy. For instance, infants under the age of 28-weeks should not receive music therapy because they are highly sensitive to light and sound. Infants in the NICU are sensitive to environmental factors such as light and sound. They can get overstimulated easily, which can cause their heart rate to increase (AMTA, 2021).

NICU-music therapists bring joy and comfort to both the parents and the infant. Music therapy can reduce the amount of time the infant stays in the hospital, which reduces the parents/caregivers stress. It also can help the infant learn the skill of sucking for feedings and bond with their parent/caregiver through the music of their culture/traditions. If the NICU-music therapist follows the guidelines of the facility and uses their training, they can help many babies in the NICU go home sooner and begin to reach developmental milestones. For more information on other intervention or information on training sites for NICU-music therapy visit www.musictherapy.org.

-Teresa Dominguez, Music Therapy Intern

References:

AMTA (2021). Music therapy and the Neonatal Intensive Care Unit (NICU). American Music Therapy Association. (2024). https://www.musictherapy.org/assets/1/7/FactSheet_Music_Therapy_and_the_Neonatal_Intensive_Care_Unit__2021.pdf

Cevasco, A. & Grant, R. (2005). The effect of the Pacifier Activated Lullaby on weight gain of premature infants. Journal of Music Therapy, 46(3), 273-306.

Gooding, J., Cooper, L., Blaine, A,, Franck, L., Howse, J., & Berns, S. (2011). Family support and family-centered care in the neonatal intensive care unit: Origins, advances, impact. Seminars in Perinatology, 35(1), 20-28.

Stanford Medicine Children’s Health (2024). The Neonatal Intensive Care Unit (NICU). https://www.stanfordchildrens.org/en/topic/default?id=the-neonatal-intensive-care-unit-nicu-90-P02389

Music Therapy and Parkinson’s Disease

What is Parkinson’s Disease (PD)? PD is a degenerative disorder of the central nervous system (Magee, 2013). Symptoms begin slowly and may be barely noticeable such as tremor in one hand. Other symptoms include stiffness, moving slowly, impaired posture and balance, lack of facial expressions, changes in writing, and soft or slurred speech. Causes of PD include environmental toxins, genetic factors, Lewy bodies in the brain or Alpha-synuclein found within Lewy bodies. The average age of someone being diagnosed with PD is 60 or older. It is rare for someone younger to be diagnosed with PD, but it is possible. Women are less likely than men to be diagnosed with PD. Currently there is no cure for PD, but there are medications to improve symptoms and surgery can help regulate the affected regions of the brain (Mayo Clinic, 2024).

How can music therapy help people diagnosed with PD? Music therapy has been shown to improve motor skills, mood and coping skills, and voice quality. Interventions used to improve PD symptoms include rhythmic auditory stimulation (RAS) and group singing. RAS is a music therapy technique that addresses motor control in rehabilitation by using rhythmic cues to cue motor movements. Group singing is a music therapy technique that uses singing in a group to address speech goals and gives the person the opportunity to socialize with others.

A study done by Chumma (2007) uses RAS to treat gait disorder in those with PD. Gait disorder causes imbalance, shuffling, frequent falls, staggering, and freezing. RAS was used to keep a steady beat during exercises. The results showed improvement in the patience’s motor function and the possible benefits of RAS during exercise training (Chumma, 2007). 

An interview with a music therapist Ruth Breuer conducted by Williams (2019), discusses the use of regulative music therapy to address a client with PD’s mood and coping skills. Breuer used mindfulness exercises in addition to regulative music therapy (Williams, 2019). During the interview, Breuer shared that regulation music therapy encouraged discussion and the development of coping skills (Williams, 2019).

Another study conducted by Elefant et al (2012), worked on speaking, singing quality, and depression symptoms with those diagnosed with PD. Some people with PD have difficulties with speaking and may avoid social situations (Elefant et. al., 2012). This study had 10 participants and was conducted over the course 20 weeks. The music therapist used group voice and singing techniques in weekly sessions. The results of the study showed improvements in their voice and singing range, but not in their speech quality. Even though their speech quality did not improve, the quality of their speech did not decrease (Elefant et. al., 2012). The data supports the use of group singing to improve the quality of a person’s voice with PD. However, more research needs to be done to see all the benefits that this method has to offer.

Music therapy has many benefits for treating those with PD. As the research demonstrates, music therapy can improve motor skills, mood and coping skills, and voice quality. Further research will certainly continue to support these and other benefits.

-Teresa Dominguez, Music Therapy Intern

References

Chuma, T. (2007). Rehabilitation for patients with Parkinson’s disease. J Neurol 254, IV58-IV61. https://doi.org/10.1007/s00415-007-4010-1

Elefant, Cochavit, PhD., M.T., Baker, Felicity A, PhD., R.M.T., Lotan, Meir, M.ScP.T., PhD., Lagesen, S. K., M.A., & Skeie, Geir Olve,M.D., PhD. (2012). The Effect of Group Music Therapy on Mood, Speech, and Singing in Individuals with Parkinson's Disease - A Feasibility Study. Journal of Music Therapy, 49(3), 278-302. https://ezproxy.queens.edu/loginurl=https://www.proquest.com/scholarly-journals/effect-group-music-therapy-on-mood-speech-singing/docview/1181173563/se-2?accountid=38688

Magee, Wendy I. (2013). Guidelines for Music Therapy Practice in Adult Medical Care. Barcelona Publishers.

Mayo Clinic (2024). Mayo Foundation for Medical Education and Research. (2024, April 5). Parkinson’s disease. Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/parkinsons-disease/symptoms-causes/syc-20376055 

Williams, E. T. (2019). Development of Regulative Music Therapy guidelines for early to mid-stage Parkinson's disease. The Australian Journal of Music Therapy, 30, 54-66. https://ezproxy.queens.edu/login?url=https://www.proquest.com/scholarly-journals/development-regulative-music-therapy-guidelines/docview/2407609042/se-2?accountid=38688

Bonny Method of Guided Imagery and Music

Music therapy is a great outlet to achieve goals such as cognitive and motor skills. But what about goals that address emotions, well-being, and mental health? There is a method called the Bonny method of Guided Imagery and Music (GIM) created by Helen Bonny. GIM method addresses goals in the socio-emotional domain. GIM is a music therapy method that uses pre-recorded music to put the client in a relaxed state to explore feelings, memories, and imagery in the subconscious. The philosophy behind GIM is that the music and therapist work together. Musical elements such as tension and melodic flow prompt a person’s journey into their subconscious (Knight et. al., 2018). Music therapists assist by guiding the person on their journey through the subconscious.

In 1969, Bonny was invited to help researchers to study the effects of LSD to expand consciousness. Bonny’s job was to research the effects of listening to music during an LSD experience (Knight et. al., 2018). During each session, she would use relaxation techniques with participants that took LSD. Next, Bonny tried the same relaxation techniques, but the participants did not take LSD (Knight et. al, 2018). The results of the study showed that the participants who did not take LSD had the same effects as the participants who did take LSD (Knight et. al., 2018). These findings paved the way for Bonny to create GIM. 

A GIM session uses recorded music from a pre-set classical list and has 5 steps (Knight et. al., 2018). The first step is to have a discussion with the client to see what is on their mind and what they would like to explore. The second step is to help the client relax using relaxation techniques. The music therapist will provide a bridge between the music and beginning the imagery (Knight et. al., 2018). The third step is listening to the music. The client describes the images they see while listening to the music and the music therapist guides them through those images. The fourth step the music therapist guides the client back to state of alertness. The music therapist may ask the client to draw a mandala or images of their experience (Knight et. al., 2018). The fifth step is where the music therapist and client will process what they saw and drew.

Guided Imagery and Music is a useful method that relaxes the client and brings thoughts/emotions from the subconscious to the conscious. It offers a way to then process these thoughts/emotions without the use of medication. Thanks to Helen Bonny, we have another way to address the emotional needs of the client.

-Teresa Dominguez, Music Therapy Intern

References

Knight, A. J., LaGasse, B., Clair, A. A., & Pasiali , V. (2018). Chapter 7: Approaches to  Music Therapy . In Music therapy: An introduction to   the profession (pp. 144–145). essay, American Music Therapy Association.

Short, A. E., & Heiderscheit, A. (2020, April 1). Directory of open access journals.  Approaches: An Interdisciplinary Journal of Music Therapy. Retrieved March 28, 2023, from https://doaj.org/article/edcf029c0e564b80bd650b5fa978690a

Music Therapy and Children with Dyslexia

Music therapists work with a variety of different clients, from those with disabilities to those with mental health diagnoses. However, an area that may be unfamiliar to the public is music therapy working with children with dyslexia. What is dyslexia? According to the Mayo Clinic (2017), dyslexia is a learning disability involving difficulties with reading stemming from problems identifying speech sounds and relating them to letters and words. Dyslexia affects the parts of the brain that process language and can be diagnosed at any age.

When children with dyslexia are in school, they can display symptoms such as below-average reading levels, issues processing and understanding what they hear, trouble finding the right words to form an answer to a question, problems remembering the sequence of things, difficulty seeing or hearing similarities and differences in letters and words, inability to sound out the pronunciation of an unfamiliar word, difficulty spelling, spending long periods of time with tasks that involve reading or writing, and avoiding tasks involving reading (Mayo Clinic, 2017).

Dyslexia has genetic and environmental causes. There are genetic links, such as a family history of dyslexia or other learning disabilities, that can cause a child to have difficulties processing language and reading skills (Mayo Clinic, 2017). Environmental aspects include exposure to nicotine, drugs, alcohol, or infections during pregnancy. It may change brain development in the fetus. Other causes that can alter the brain of the fetus include premature birth or low birth weight.

Where do music therapists work with children with dyslexia? Music therapists might encounter children with dyslexia in schools or private clinic and will address needs using a variety of methods, including re-creative, receptive, and compositional techniques. According to Hintz, “music therapy literature focuses on the use of re-creative methods for individuals with learning disabilities to address specific underlying cognitive, behavioral, and social functioning” (2013, p. 174).

Hintz (2013) describes re-creative methods used in music therapy such as musical play, adaptive lessons, and structured movement. Musical play methods include musical interventions using action songs, playing instruments with songs, instrumental songs, and musical games (2013). Adaptive music lessons are individual music lessons that address goals such as sequencing ability, self-awareness, and self-regulation (2013). The most common adaptive lessons include voice, piano, and guitar. Structured movement methods include using musical elements such as rhythm and tempo to address goals targeting cognitive and processing and motor coordination (2013).

A study done by Colwell and Murlless using a re-creative technique compares the effects of chanting vs. singing with elementary students diagnosed with learning disabilities, addressing reading accuracy and their behavior during music and non-musical activities (2002). During the study, the students were tested on a different word list each week for four weeks. In week one, the students were in a typical reading program. In the second week, the students were assigned to either chanting or singing (2002). The main focus of each group was to work on targeted words. During week three, the students switched groups and worked on new words. In the fourth week, the students went back to the reading program. After two weeks, the students were retested on all the words. The results of the study show that the students' reading accuracy improved, and they stayed on task more during the music intervention (2002).  

In 2013, Przybylski et al. conducted a study using a receptive method called external rhythmic auditory stimulation, which uses musical rhythm to address syntax processing. They used the rhythmic structure to see if it would improve syntax processing in children with dyslexia and specific language impairments (2013). The children in the study were prompted to either listen to regular or irregular musical prime sequences along with blocks of grammatically correct and incorrect sentences. For each auditory sentence, the children were required to display what they had learned (2013). The results showed that rhythmic structures have the potential to boost linguistic structure processing (2013). 

Compositional methods, such as songwriting, are used to address nonmusical goals (Hintz, 2013). Goals include improving behavior, attention, and working memory. Often, these goals are the basis of the lyrics. According to Hintz, “Composition arises out of the client-therapist’s musical interaction or musical themes from the session. At other times, the composition can arise out of a verbal discussion of interpersonal struggles or emotional difficulties” (2013, p. 182). Songwriting can give kids with learning disabilities such as dyslexia an outlet to express themselves and their experiences, in addition to the goals mentioned before. 

In conclusion, music therapy can address the needs of children with dyslexia. It addresses goals such as self-awareness, cognitive skills, reading accuracy, etc. Music can offer a fun and new way for a child with dyslexia to grow and reach their goals. Individualized music therapy sessions offer a way to address a child with dyslexia’s needs while building their confidence. For instance, re-creative methods using instruments or compositional methods using songwriting. Music therapy makes reaching a child with dyslexia goals fun and individualized to their specific needs.   

-Teresa Dominguez, Music Therapy Intern

References

Colwell, C. M., & Murlless, K. D. (2002). Music activities (singing vs chanting) as a vehicle for reading accuracy of children with learning disabilities: A pilot study. Music Therapy Perspectives, 20(1), 13–19. https://doi.org/10.1093/mtp/20.1.13

Hintz, Michelle R. (Ed.). (2013). Guidelines for music therapy practice in developmental  health. ProQuest Ebook Central. (p. 165 – 182)

Mayo Foundation for Medical Education and Research. (2017, July 22). Dyslexia. Mayo Clinic. Retrieved December 16, 2021, from https://www.mayoclinic.org/diseases-conditions/dyslexia/symptoms-causes/syc-20353552

Przybylski, L., Bedoin, N., Krifi-Papoz, S., Herbillon, V., Roch, D., Léculier, L., Kotz, S. 

A., &   Tillmann, B. (2013). Rhythmic auditory stimulation influences syntactic processing in children with developmental language disorders. Neuropsychology, 27(1), 121–131. https://doi.org/10.1037/a0031277