On safe use of music in music therapy

I facilitated a workshop last week for group of about 30 counsellors. This was the first time I’d facilitated a workshop for complete voluntary participants – as opposed to facilitating an inservice for a group of colleagues or presenting a paper at a conference. These people had paid to see me present, learn about music therapy and use of music in therapy – as well hear about how I use music to facilitate the best outcomes for the people I work with. I was asked really appropriate questions – but also questions that had me digging for how to talk about the techniques and skills that I use in a way that made sense.

One of the questions I was asked – was to talk more about how music has the potential to be ‘unsafe’ for people. While, I think I gave a fairly adequate answer that enabled a conversation – I’ve thought more about this question and how it relates to neuroscientific principles of music therapy. So…I’d like to share some ideas that I am playing with in my mind (based on interpersonal, music and trauma neurobiology) – and I’m curious to see how it might resonate or resist. So here goes.

Music has the capacity to impact people at a neurological level – which means they don’t always have the capacity to control how it will impact their physiology, emotions, thoughts and behaviours. This can often work in our favour in the therapy setting – but there are times that we have to be more careful. These times, are the times I’m interested in. People who have compromised capacities – do not always have the neurological, emotional, cognitive or social capacities to manage some music or elements of music.

For example. We know that music has the capacity to impact heart rate, blood pressure, breathing rate and oxygen saturation – so much so, that when working with an infant in the intensive care unit – we use elements of music to ensure physiological safety for the patient. We often introduce one source of stimulation at a time in order to avoid overstimulating or triggering a stress response. And we know – that if we do this well – we have the capacity to stabilise and regulate the infant’s physiology, provide a sense of safety within a chaotic environment, which enables their capacity to engage with their senses, their loved ones and their environment. However, if music is not provided in a way that is sensitive to the infant’s needs – there is potential for it to contribute to a stress response, impact their physiology, sense of safety – and there is less potential for this infant to engage with and respond to their loved ones and their environment.

Similarly with children and adults whose resilience has been compromised in some form. There are times when a piece of music, sound or noise has the potential to trigger a stress or trauma response. That is, the sound goes straight through the ear canal to the brainstem, where it triggers a threat to their physiological system; evoking a sense terror or fear – in which the brain responds with fight, flight or freeze. At this point, the cortex (the part of the brain that governs logical thought, problem solving, 'top down emotional regulation' etc) is offline – and often their capacity for social engagement is impacted. When the cortex is offline, we, as therapists are required to go directly to the part of the brain that is online and available.

We can’t avoid these situations – however, I am interested in how we use music therapy in a ‘bottom-up’ fashion in order to regulate an individual’s physiology, provide a sense of safety, engage their social engagement system (in essence regulate these core neurological functions) to enhance an individual’s capacity to feel, express and regulate emotions, engage their logic and problem solving skills – while reducing the stress and/or trauma response. Music therapy is inherently a 'bottom-up' therapy so we're naturally armed with the necessary skills and techniques to manage these complex and challenging situations. However, while we have the skills and techniques - do we know how to apply them to the real life setting while feeling backed by science?

I do now - but it wasn't always that way.

I used to work quite reactively in those moments - I would personally respond with my own fight, flight or freeze. Then with time (and quality supervision!), I developed an intuitive approach. However, in more recent times (after connecting with neurobiology of stress and trauma), I've become more aware of my processes, allowing me to explain what I'm doing and why. This has seen a shift in my practice from personally freaking out to replicating what has worked for someone else towards providing intervention for the individual's specific and unique needs.

We know that music is not always safe. So how do we use music, the elements of music and the therapeutic relationship to provide a sense of safety in what might otherwise feel unsafe?

Have you had similar experiences? What resonates? What brings resistance?

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