Interventions are often chosen in the moment by the therapist and client/s together. As areas of strength, need, concern, and intrigue become apparent, the therapist offers suggestions for how to explore them in a safe, culturally relevant, and holistic way. Interventions are adapted in the moment to reflect and respond to the creative and verbal interactions. Below are examples of interventions often used in my practice. (*Note to student therapists: Please always have the client’s goals, strengths, and needs in mind before developing or choosing interventions.)
“Staying the course”(substance use disorder)
Staying the course is an important concept for people in early recovery from substance use disorder. As they face triggers and cravings, they must develop skills that help them to stay on their path to recovery and wellness. In this intervention, clients practice staying the course through referential improvisations. One person plays the role of staying the course by playing a beat on a drum or a percussive instrument of their choice. They may choose to do it alone or to seek support from another group member. The rest of the group plays the role of the triggers. As the central person plays their steady beat (with or without help), the triggers play erratically to attempt to disrupt the beat. Afterwards, the group engages in verbal processing and draw parallels to their lived experiences. What was it like asking for help? How did it feel to have agents working against you? What allowed you to maintain your rhythm or what caused you to stumble? How did it feel to be the supporter? As the clients describe insights they gained, they may redo the improvisation in the same roles, or use those insights as they switch into different roles. To celebrate their efforts and growth, the group then plays together to enjoy the sense of community and support that is often fostered by group music making.
“picture songwriting” (Young children with trauma)
Children who have experienced trauma benefit from creative expression, play, having a sense of control, and success experiences. Songwriting is a wonderful tool for creative expression, but can be challenging in a group of children who have a low frustration tolerance, difficulty taking turns, difficulty verbalizing, and who may struggle with reading and have related anxiety. Picture songwriting can address many of these potential barriers. This intervention starts with pictures of places, activities, characters, and modes of transportation. I use coloring pages of favorites like Black Panther, helicopters, and basketball. Each child takes a turn choosing a picture in order to tell a story. As they line up their picture the story unfolds. Everyone knows they will get a turn or two and the turns move quickly. The therapist recaps as the pictures are lined up (just like they would with written lyrics) or maybe a child can do the recap. Once the story is complete (with or without an opportunity for editing and reorganizing based on the group’s capacity to do so in the moment), the therapist offers options for the music. Fast or slow, loud or soft, rock or R&B, and perhaps a few choices of chord progressions. Throughout the intervention, the number of choices offered depends on what the group can tolerate. The group then chooses instruments and group members each have an opportunity to take a turn singing the story while the therapist and the rest of the group accompanies and supports. They may go back for more editing or start over with a new story for their song. The group then celebrates their success by coloring the pictures. An adaptation is to make miniature coloring pages so each individual can make their own story by gluing the little pictures on a piece of construction paper, with additional drawing and decorating. They perform their songs individually or choose a peer or the therapist to support them.
“Progressive muscle relaxation with live, improvised music”
Progressive muscle relaxation (PMR) reduces stress and tension by contracting and releasing muscle groups throughout the body. When I worked with people who were unable to physically tense their muscles due to neurologic impairments, I developed music to support the verbal cues of PMR that facilitated the feeling of tension and release. One of the greatest benefits of using live music is that the therapist adapts to the clients in the moment. The intervention starts with an explanation and a suggestion to use the time as each person see fit, whether that be following the therapist’s directive or rather meditating, praying, looking out the window, etc. Clients are encouraged to refrain from any painful movement and offered breathing into muscle groups as an alternative as needed. Next, the therapist directs deep breathing while supporting musically on guitar or piano by using different chords for the inhalation and exhalation, with a downward melody between chords to mirror the movement of the breath. Similarly, when the directives for the PMR begin, there is a chord for shifting attention to the next muscle group, for tensing, and for releasing. In addition to using chords that invoke tension harmonically, the therapist manipulates tempo, rhythm, timbre, and dynamics to enhance the feelings, of focus, tension, and release. After addressing all the muscle groups (at a pace that is responsive to cues from the clients), and reviewing.scanning the body, the therapist moves towards closing the exercise by providing verbal cues about noticing positive changes and holding them, while shifting the chords to bring attention to the here and now. Ensuing verbal processing serves to move out of the individual experience back to the group and informs the clients and therapist on what was helpful and what can be adapted next time. (My go to chords: breath in: Amaj7, walk down (A G F) to Em7. Shift focus: D with a series of suspensions back and forth with Amaj7, tension:Bm7b5 or a series of diminished chords to an Em#5, to an E7sus, to an E7 and back to release: Amaj7, attention to here and now: G, D Amaj7 and I end on an A)
“Healthy vs unhealthy RELATIONSHIPS psycho-education via song discussion”
This intervention can be used in a variety of settings, but this is written with adolescents in a behavioral health setting in mind. The intervention starts with a handout about healthy vs unhealthy characteristics of relationships for the group to review and briefly discuss (if they tolerate it). Next the group listens to a song describing a relationship that may reflect some of what is on the worksheet. “Smile” by PNB Rock is effective because the group members I work with love the song and it describes a relationship that is not clearly “healthy” or “unhealthy”. It is important to make it clear that the therapist is not judging the relationship described or the artist because being judgmental does not foster a trusting relationship and because adolescents often deeply identify with their favorite artists. To judge or demean the artist could feel like the therapist is directly judging and demeaning the clients. Before listening, the therapist gives the directive to listen, sing, and or/dance, while being mindful of how the song reflects the worksheet. When the group processes the song and analyzes lyrics, the therapist may ask the clients to relate their insights to their own experiences. The therapist takes the group’s lead on how to process the song and how to follow up and provide support. Discussion questions may include: 1.Should the partner in the song listen to their friends?/When and from who do you take relationship advice? 2. What is the feeling in the song and what does that tell us about how the artist feels about the partner/relationship? 3. Does it seem like they are fighting too much?/ How do you know when it’s time to move on? *Note to student therapists: This intervention may elicit memories and discussion about abusive relationships clients have been in or witnessed, so be sure that holding this type of space is within your competencies.
Healthy leisure skills and peaceful social interactions are important for teens and preteens (and every other age group) who have experienced trauma. We play a variety of music games that foster a stress free environment (because it’s important to take breaks from the deep work and the intensity of being hospitalized), have a predictable structure, and that reflect the clients’ cultural identities. The artists and music that adolescents love are a huge part of who they are and how they view themselves. Taking the time to create materials with their music and artists and of course listening to the music helps validate who they are. I usually include a few old school artists or songs, which elicits comments about people’s parents or grandparents and drawing in a connection to family. Hip-hop trivia (faces and facts): Pictures of favorite artists are spread out for all to see. The therapist or a group member reads facts about the artists and each team takes turns matching the facts to a face. Discussion over who is better at what and bonus questions are interspersed. Winners go to keep the pictures. Hip-hop trivia (real names): This can be challenging, which puts the true fans into the role of expert as the group works together to figure out what stage names match with artist’s given names, home town, birthdate, and one or two salient facts. The game is presented on paper with a grid full of names and facts and a stage name pool at the bottom to choose from. There is often discussion of what group member’s stage names would be and why. Some clients already have stage names and there is opportunity to talk about their experiences as artists. Hip-hop bingo: This is straight forward and can be made using an on-line bingo card generator. The pool of songs are numbered, so group members take turns choosing numbers, which prompts the therapist (or helper) to play the song. The group identifies the song and marks it off on their cards. The group decides if they want to listen to the entire song or skip to the next. The winners reward is to have song requests when the game is over. Coloring pages of favorite artists are made available to use while the requests are being played.
“In Charge”: exploring empowerment (adolescents in behavioral inpatient settings)
There are often several levels of loss of control for adolescents in behavioral hospitals. Trauma such as witnessing violence, experiencing abuse, or suffering a loss or multiple losses creates feelings helplessness and of loss of control. Experiencing trauma often causes a person to struggle with controlling their own behavior, leading to inpatient hospitalization. Once hospitalized, a person experiences further loss of control as they are boxed into following rules and schedules, while removed from their loved ones, and unable to engage in their normal activities. This intervention addresses the concept of being in control, both by offering choices in every step (as tolerated) and through musical and verbal exploration of the topic.
To start, the group is offered a choice of songs to listen to that explore control. “If I Ruled the World” by Nas, featuring Lauryn Hill (despite being from 1996) is often well liked and leads to fruitful discussions. (Yes, the lyrics talk about marijuana use. This will not cause the clients to start using marijuana, but it does create an opportunity for dialogue, if indicated.) Next, the group is divided into smaller subgroups and given the directive to choose something they would like to be in charge of such as the hospital, their school, the city, or the world. They brainstorm a list of what they would change and present their findings to the group by either sharing music and lyrics they create or a by sharing a recording of an existing song that reflects their list. The group exchanges feedback about what part they can play in creating the changes they would like to see.
Referential Recovery Improvisation
This improvisation explores holistic recovery strategies. To start, group members identify the various practices that nurture their recoveries. Next they discuss what each practice might sound like and choose an instrument or two to express it. Each group member then chooses which practice they will be responsible for playing. Depending on the size of the group, multiple people may cover one practice. So now we may for example, have “prayer” being played on the rainstick, “talking to friends” on the xylophone, “going to meetings” on guitar, and “working out” on the djembe. Group members play together focusing both on their own roles and on how their “practice” fits in with the rest of the music. The music therapist supports, using a variety of improvisation techniques. When the music ends, the group discusses the experience of the music making and how the practices felt and sounded. Insight about how the music paralleled their lived experience or how it reflects changes they want to make are discussed. The group may play again with adjustments to sounds or trading roles.
Coping with Anger (Young children)
Here is a song I composed to help young children cope with anger. Techniques such as grounding through a repeated root note are described in the captions. I chose to use rich chords like AM7/E and Bm7/E instead of the typical I IV V often found in children’s songs.
this is who I really am
Whether it’s the stigma of mental illness or substance use, or prejudice, or hindered communication between loved ones, being misunderstood can be harmful and very painful. In order to explore these feelings and work towards developing a healthier sense of self, I start a session with a check-in that asks, “What do people get wrong about you?” This is often followed by a lyric analysis. Since 2019 seems to be the year of A Boogie wit da Hoodie in Philly, I’ve been offering, “You Don’t Understand”. This may be followed by further song discussions and/or song writing. In the song writing, there may be a verse about what others get wrong, followed by a verse about what is true about the clients with a focus on strengths. The chorus may sum up the group’s strengths as a whole. Once the group creates the music and performs the song, they are encouraged to reflect on how they will put the strengths they identified into action as they go about the rest of their day.