Music Therapy Techniques for Treatment of Mental Disorders
Music Therapy treatments assisted individuals diagnosed with mental disorders by helping correct difficulties in interpersonal communication. Music Therapists worked with individuals from all walks of life that have been diagnosed with varying mental and emotional disorders using many different specialized techniques in order to help clients communicate more effectively with their surroundings. Specifically, Music Therapy helped treat and diagnose cases of Autism Spectrum Disorder, Post-Traumatic Stress Disorder, and Alzheimer’s Disease by using music as a medium to target difficulties in interpersonal communication. Understanding how Music Therapists worked with clients required a deeper look into the symptoms and communication difficulties associated with certain mental disorders.
Music Therapy for Autism Spectrum Disorders in Children
Understanding Autism
Although Autism Spectrum Disorders affect the individual for life, the majority of research into Autism focused on diagnosis in children and how families adapted to help love and nurture their children with the disorder (Silverman, 2012). In order to understand how Autism affected interpersonal communication, one must understand that “Autism” is a broad term that includes many different disorders with varying symptoms.
Autism Spectrum Disorder Symptoms and Diagnosis
The Diagnostic and Statistical Manual of Mental Disorders defined Autism Spectrum Disorder as a “developmental disorder involving qualitative impairments in language, communication and social relationships” (Silverman 2012, p.2). While early diagnoses of Autism centered primarily around repetitive behaviors, psychologists broadened the scope of symptoms as more research into the many disorders classified as Autism Spectrum Disorders emerged. The term “Autism” encompassed many disorders that all involve impairments in communication and social functioning.
Autism Spectrum Disorder and Communication. Autism Spectrum Disorders typically displayed many different difficulties in communication and social functioning. The etymology of “Autism” showed that the word has its origin in the Greek Word “autos,” which means, “self.” An individual with Autism often seemed to live in their own separate, individual reality. This often showed up in both verbal and non-verbal elements of communication (“Autism Spectrum Disorder”, 2018).
Verbal Communication and Autism. Individuals with Autism differed in their ability to use language as a communication medium based on their basic emotional and intellectual development. Generally, children diagnosed with Autism Spectrum Disorders used language in repetitive and rigid ways to try to get their ideas across. Specifically, in a condition called echolalia, children continuously repeated words that they had been exposed to. In echolalia, children often answered a question by asking the same question in return. Along with repetitive and rigid language, children with Autism often have suffered from undeveloped and uneven language development. Some children had an impressive vocabulary when it comes to an area that they are interested in but struggled in simple concepts such as responding to their name or learning how to read because of an inability to make connections and inferences between words and meanings (“Autism Spectrum Disorder”, 2018).
Nonverbal Communication and Autism. Along with uneven speech development, children with Autism Spectrum Disorders often had underdeveloped nonverbal conversation skills. Many children had difficulty understanding hand movements, making eye contact, and making facial expressions. Many children had trouble using gestures to reinforce what they are trying to communicate verbally which led to frustrated vocal outbursts (“Autism Spectrum Disorder”, 2018).
Spontaneous Songwriting to Diagnose and Treat Autism Spectrum Disorders
In treating children with Autism Spectrum Disorder, Music Therapists often used a technique called Spontaneous Songwriting where children created songs with the guidance of a therapist. One of the leading music therapy centers in the country, The Croft Unit for Child and Family Psychology, utilized this practice for several years in evaluating children from all backgrounds. This technique gave music therapists and psychotherapists a deeper look into the emotional world of the child, how the child thought, and the child’s general strengths and weaknesses in communication through the words that the child wrote and the role of the music. The therapy session consisted of the child walking into a friendly and spacious room equipped with a piano, several guitars and many percussion instruments and sitting down in a chair across from the music therapist. The therapist then allowed the child to choose what he or she wants to do by guiding them through different songs. Therapists analyzed the nonverbal and verbal elements of each improvised song as a part of diagnosis and to know what the next steps were in treating the child’s symptoms (Baker & Wigram, 2005).
Verbal Communication During Spontaneous Songwriting. In one specific case, a child named Allen suffering from violent outbursts associated with Autism Spectrum Disorder, sang along with the Therapist’s musical themes on piano. Allen composed a song about a troll named albert who went swimming. The music therapist introduced an alligator to the story to see how Allen would adapt as he sang along to the piano-led song. Allen immediately responded by going into an unconnected rap that had nothing to do with the song. The therapist asked Allen what happened to the alligator and Allen replied, “The alligator exploded. That’s the end of the story.” The therapist noticed Allen’s hesitancy to incorporate her verbal recommendations into his song and his purposeful shying away from talking about violence, indicating Allen’s awareness to these issues but not wanting to discuss them at the time.
Allen, like many children with Autism, connected nonverbally with the therapist but struggled to verbally express his ideas. Many therapists verbally incorporated elements of adversity to the story to see how the child adapted to confrontation. The child came up with the entirety of the song while the therapist asks questions to get the child thinking. Often, verbal analysis came from the types of animals and objects that the child chose to incorporate into his story. For example, Thomas, a child with Autism at the Croft Center, wrote a song about an alien and a dinosaur named Bailey that went to “another world.” The therapist and psychotherapist deciphered the song to mean that Thomas connected to the alien and dinosaur, feeling vulnerable on earth and connecting to the idea of another world in the form of an “autistic withdrawal.” The verbal content of many of these songs display the child’s emotional needs as well as aspects of how they saw themselves (Baker & Wigram, 2005, p.29-30).
Non-Verbal Communication During Spontaneous Songwriting. In some cases, non-verbal expressions in spontaneous songwriting give a more in-depth look into how children with Autism think and communicate. For example, a child named Joe at the Croft Unit had trouble coming up with any words during a spontaneous songwriting session, but the moment that the therapist changed the tune to a major key, Joe began rocking back and forth, saying, “I always laugh when I’m happy.” The song continued to develop into the story of a boy going the park when the therapist introduced a fox into the story for conflict. Joe responded by violently banging a cymbal. The therapist pieced together the events of the session as an attempt for Joe to express inner turmoil that emerged from the connection formed between Joe and the therapist. In many children like Joe, non-verbal communication served as the primary mode of for therapists to understand how their patients think and break down some of the communication barriers caused by Autism Spectrum Disorders (Baker & Wigram, 2005, p.35-36).
Music Therapy for Post-Traumatic Stress Disorder (PTSD)
Music Therapists used songwriting in many other ways to help individuals cope with trauma in various forms. Specifically, Music Therapists used different techniques in helping the seven percent of the United States population suffering from PTSD cope with trauma by writing songs and using guided imagery (“How Common is PTSD”, 2018).
Understanding PTSD
Dr. Anna Baranowsky, a clinical psychologist from Toronto, defined Post-Traumatic Stress Disorder as “an anxiety disorder that can occur following a traumatic event diagnosed through a series of clinical tests that inquire as to whether you have experienced specific symptom responses for at least one month” (Baranowsky & Lauer, 2012, p.3). PTSD, caused by overwhelming or unexpected emotional or physical trauma, has many symptoms that influenced communication in patients.
PTSD Symptoms and Diagnosis. A PTSD diagnosis followed symptoms such as flashbacks, bad dreams, and frightening thoughts that lasted for at least one month and have started within three months of a traumatic incident. Some individuals suffered from anxiety, angry outbursts, a loss of interest in certain activities and negative thoughts about the world and about themselves (“Post Traumatic Stress Disorder”, 2018). Major risk factors for Post-Traumatic Stress Disorder included living through a childhood trauma, having a family history of substance abuse, or living through a disaster of some sort.
PTSD and Communication. Post-Traumatic Stress Disorder affected communication by creating dissociation between the mind and body and making individuals feel like “nothing was real” (Baranowsky & Lauer, 2012, p.16-17). Dissociation caused a detachment of emotion from past experiences, depersonalization, and inability to remember details from events. Individuals struggled to communicate because they feel distanced from themselves and feel detached emotionally.
Music Therapy Techniques for PTSD Patients
Music Therapists used certain techniques to treat Post-Traumatic Stress Disorder including writing and developing songs and also guided imagery to help individuals reconnect and cope with reality.
Therapeutic Songwriting. “Songs can bring forth emotions and images from preverbal and visceral levels, beyond conscious and verbal recall,” said Jaqueline Robarts, describing the case of an 11-year old girl named Lena suffering from PTSD after surviving sexual abuse and early trauma. Through writing songs, Lena and her therapist created a transformational music space that allowed for Lena to express “unbearable feelings and paradoxically valued aspects of self” with her therapist and allowed for her therapist to listen and respond resourcefully. Lena’s music therapy sessions consisted of playing multiple instruments, expressing her dominance by demanding that her therapist listen as she frantically played varying percussion instruments. As Lena and her therapist spontaneously wrote songs, her therapist realized a few common themes. First, Lena saw herself very idealistically, as good but “much less than perfect” which became a common theme. Her therapist responded by playing a motif of a common children’s song on piano followed by a transition to a minor key. Lena sang about a group of children playing outside while one child sat inside by herself. Her therapist asked questions to see what Lena meant, but Lena quickly changed the subject and became defensive of her arising emotions. The songs Lena wrote in her therapy sessions allowed her to express her emotions and created a space for her to connect emotionally with her therapist in ways she could not have without music (Bruschia, “Survivors”, 2012, p.39-66).
Guided Imagery and Music. Another technique Music Therapists used in treating PTSD patients was guided imagery, which consisted less of songwriting and more of creative thinking and visualization while the therapist played music. An example is the story of a therapist named Lauren, who coped with her own personal trauma by participating in guided imagery sessions in which she described things she saw as her therapist played music. Lauren described vibrant colors and flowers which served as healing expressions. As her sessions went on, Lauren confronted her failed marriage by describing a church she visited with her husband while they were on a trip in France. She described the feeling of losing something but not being able to find it and revealed a common pattern of failed relationships within her family. She described the session immediately following as “being out of her body after being weighed down by rocks” as she described more colors and flowers. The images that Lauren described as her therapist played various songs expressed deep emotional wounds caused by trauma throughout her life (Bruschia, “Survivors”, 2012, p.31-38).
Music Therapy for Alzheimer’s Disease
Just as Music Therapists used specific techniques such as spontaneous songwriting and guided imagery to help individuals with Autism and PTSD communicate with their surroundings, Music Therapists used a cognitive-behavioral approach to help treat dissociative effects of aging. Music Therapists for patients with Alzheimer’s Disease consisted of songwriting to establish a therapeutic relationship and help facilitate communication. Music Therapists used songwriting as a communication medium to facilitate self- expression, enhance self-esteem, promote the exploration of meaning and hope, and address existential and spiritual needs during the process of dying” (Heath & Lings, 2012, p.110).
Understanding Alzheimer’s Disease
Alzheimer’s Symptoms and Diagnosis. Individuals diagnosed with Alzheimer’s Disease often suffered from memory loss, difficulties in problem solving, completing familiar tasks and personality. While general signs of aging such as forgetting the date or misplacing things were present in the elderly even if they were not dealing with Alzheimer’s, individuals with Alzheimer’s typically dealt with more extreme cases of communication decline such an inability to keep a conversation or quickly becoming confused, suspicious, or anxious (“10 Early Signs”, 2018).
Communication and The Aging Brain. While not all people aged exactly the same way, the brain generally declined in cognitive functioning over time. As aging occured, the ability to reason, to understand, to use language and attach meaning to perceived sensory information and pay attention all decline significantly in patients suffering from Alzheimer’s Disease and Dementia. Working memory began to fail dramatically as the elderly could not maintain sensory information during the performance of cognitive tasks and store sensory data (Whalley, 2015, p.163-169). Cognitive psychologists suggested that as the speed of processing declines with age, cognitive performance declined, leading to a slower ability to process discourse, fewer understandable stories, and a common use of vague pronouns and changes in events (Carozza, 2016, p.26-32).
Music Therapy Techniques for Alzheimer’s Patients
Music Therapists utilized the power of songs to help Alzheimer’s patients communicate significant stories and memories. Instead of writing spontaneous songs, as therapists did with Autism and PTSD patients, Music therapists helped Alzheimer’s patients write songs within their own cultural context to help them reconnect with memories and cultural elements of their own life to fight the decline in cognitive functioning.
The Cognitive-Behavioral Approach. Cognitive-Behavioral Approaches in Music Therapy used familiar stimuli to help patients get involved in activities, used cues to increase desired responses, and then withdrew cues to help the patient become independent. One specific example of the Cognitive-Behavioral was the case of Anne, a 68-year-old dementia patient at a day care center that specialized in Alzheimer’s treatment. After undergoing an assessment to determine her cognitive function, Anne began a series of 12 therapy sessions with traditional music therapy techniques such as singing and playing musical instruments. Anne displayed many of the symptoms of Alzheimer’s such as physical and verbal outbursts, mood changes, and delusions, and at the start of her therapy sessions, she was very shy and would only speak if specific questions were asked by her therapist. As soon as the sessions introduced singing and playing instruments, Anne began to be more relaxed in her body language and sang confidently. Singing and writing songs became a reinforcing medium for Anne and her social isolation decreased as she began to participate more freely in other sessions as she was able to piece memories together through songs she used to sing (Bruschia, 2012, “Alzheimer’s”, p.19-28).
Culturally-Centered Music Therapy. Music therapy helped patients recall experiences through enjoyable emotions associated with memories. As individuals aged and their ability to use language deteriorated, songwriting functioned as a “powerful catalyst for reminiscence, both joyful and sad” (Bright, 1982). For Vonnie, an 83-year-old woman in the early phases of dementia, music therapists centered their approach around her Indonesian heritage in order to help her communicate. Vonnie lived in the former Dutch East Indies during World War II, where she and her family faced much hardship as Indonesia fought for independence before she was forced to move to the Netherlands with her husband. She had never been outside of the tiny village in Indonesia where she grew up until then and grew very close with her husband as they were alone in the Netherlands with no support. Vonnie was widowed for ten years at the time she started music therapy and had a son who lived close by that did not visit her often. She developed a severe cognitive disorder and suffered from depression, confusion, social isolation, and paranoia. Her individualized therapy sessions consisted of an atmosphere that reminded her of Indonesia, pairing her with a therapist who had family ties to Indonesia, and Indonesian musical instruments, which served as visual cues that helped her reminisce. She played ukulele and wrote songs with her therapist while they looked at pictures of family. The manner of communication helped establish the fact that Vonnie was understood. Her therapist observed a drastic change in Vonnie’s participation, improvement in social settings and her ability to express emotions associated with grieving after music therapy sessions centered around her cultural context (Bruschia, 2012, “Alzheimer’s”, p.29-37).
Conclusion
Music Therapists used a variety of techniques in treating patients with mental disorders in helping them relate with their surroundings despite difficulties in both verbal and nonverbal communication. Through various cases of working with patients with Autism Spectrum Disorder, Post-Traumatic Stress Disorder, and Alzheimer’s Disease, Music Therapists effectively used music as a communication medium to help individuals cope with their communication hindrances.