MUSIC THERAPY: CONSIDERATIONS FOR TREATMENT AND RECOVERY

Jim Borling, MM, MT-BC, Fellow of the Association for Music and Imagery

On their website www.musictherapy.org, The American Music Therapy Association (AMTA) defines music therapy as:

…the clinical and evidence-based use of music interventions to accomplish individualized goals within a therapeutic relationship by a credentialed professional who has completed an approved music therapy program.

The AMTA goes on to suggest that clinical interventions using music can effectively be designed to promote wellness, manage stress, assist with emotional expression, improve communication, enhance community and more.

While a professional, board certified music therapist may be employed in any number of clinical settings (special education, hospice, physical/medical rehabilitation, dementia care and much more) the application of music therapy practice to early and on-going treatment for substance use disorders (SUD) may efficiently fit into three principle categories. These categories of recovery (physical, emotional, and spiritual) are considered fundamental
to long-term sobriety and a life of quality recovery. It is common, particularly in 12-step settings, to view addiction as a disease of body, mind, and spirit. The board certified music therapist is uniquely positioned to address each area in treatment models that include in-patient, outpatient, and aftercare settings.

Music therapy is often referred to as an ‘experiential therapy’, and in the case of working with addictions, addressing recovery by focusing on physical, emotional, and spiritual issues of recovery contributes to the overall treatment standards that any given treatment setting may address. Generally speaking, we can experience music in a variety of ways. We listen, sing, move, create, relax, improvise, discuss. We can experience music on many levels simultaneously. Music can concurrently make us think, feel, socialize, communicate and much, much more. This experiential and multi-dimensional aspect of music lends itself well to an integrated and all-inclusive approach to the recovery process.

Music Therapy and Physical Recovery
Physical recovery is an ever-present challenge for individuals dealing with an addiction. Not only are withdrawal symptoms often present, the client in early treatment is likely dealing with elevated stress levels, irritability, anxiety, and an emotional liability specific to physical issues, all of which can be triggers to use one’s drug of choice. Examples of clinical music therapy goals related to physical recovery include:

• To participate in active and receptive stress management techniques in a group setting
• To practice receptive stress management techniques outside of group music therapy sessions
• To participate in active music-making experiences
• To participate in group movement exercise/creative movement experiences

While stress management is a skill developed over time, encouraging a healthy relationship with one’s physical being (body) may be more of a challenge. The music therapist may engage the client in active music making experiences (drumming, musical improvisation, vocal chant etc.) or may challenge the client on a physical level with creative movement.

John, after participating in an energetic movement exercise to the song “New Attitude Dance” by Patti Labelle, stated that although he felt a bit awkward doing this with a group of people, he felt his body ‘waking up’ …and a sense of ‘fun’ he had not felt for some time was present for him.

Re-establishing that heathy relationship with one’s physical self is critical to a healthy recovery. The music therapist, by engaging the physical self outside of traditional cognitive or psycho-educational lines, may assist the client in reawakening the body in a safe and contained way on the journey of recovery.

Music Therapy and Emotional Recovery
We know that without clear and direct attention given to emotional recovery, strong feelings may begin to surface that the client is unprepared to deal with in a clean and sober manner. Additionally, co-morbid issues of depression, anxiety, or even past trauma may begin to surface in the treatment setting. Giving appropriate clinical attention to these issues is critical to a sustained life of sobriety.

Music touches us deeply. Regardless of how we are participating in the music experience (singing, listening, creating, relaxing) music has a way of bringing our emotional needs right to the surface. Examples of clinical music therapy goals related to emotional recovery include:

• To actively participate in group lyric discussion
• To actively contribute to and participate in group song-writing exercises
• To identify areas of emotional challenge and growth in the early stages of recovery
• To actively participate in expressive music-making exercises and improvisations, including drumming

Any time the client is engaged in a music experience, the likelihood of emotions beginning to surface is strong. These emotions may be challenging but they may also be quite positive and life-affirming

Shirley, when reflecting on the lyrics to a Don McLean song
(‘Crossroads’), was able to open up and discuss her internal conflict that seemed just out of reach in other discussion-based groups. She particularly resonated with the lyrics from verse one:
But I’m all tied up on the inside,
No one knows quite what I’ve got;
And I know that on the outside
What I used to be, I’m not anymore.

Shirley was able to feel on a deep level what these lyrics represented for her. The music gave Shirley that opportunity to stay with the emotions thereby moving to a more relaxed, affirmed, and positive emotional posture after the music therapy group was over.

Music Therapy and Spiritual Recovery
While spiritual recovery is a phrase that can be widely interpreted by people in treatment as well as professionals in the addictions community, it is generally agreed that some attention to spirituality is essential if long term abstinence and a sense of well-being is to be sustained. The music therapist is in a unique position to assist this developing relationship with spirituality and one’s own Higher Power as professed by the 12-step community. Music, by its very nature, has the ability to touch us deeply and to call forward those aspects of our being that are ready for growth and healing. For some, the simple reclamation of feelings and of human-ness is spiritual in nature. For others, spirituality is a more traditional and familiar experience of a God of the Churches. Examples of clinical music therapy goals related to spiritual recovery include:

• To develop an introductory relationship with the 12-steps of recovery; emphasis on steps 1-3
• To explore a personal relationship with a ‘power greater than oneself’
• To actively participate in structured music and imagery experiences, where appropriate, in a group setting
• To explore personal qualities that contribute to the recovery process

It was Carl Jung, Swiss psychiatrist, who so clearly shared the phrase ‘Spiritus contra Spiritum’ in a personal letter to Bill W., co-founder of Alcoholics Anonymous. Jung was clearly suggesting that attention to spiritual development was central to the recovery process.

During a group music and imagery exercise, clients were asked to reflect on some of the phrases often heard around 12 step meetings. Some of the typical phrases heard at meetings include ‘Easy does It’, ‘One Day at a Time’, ‘Let Go, Let God, ‘First Things First’.

During the music and imagery experience, Mary almost immediately connected with her chosen phrase “Let Go, Let God”. For her, and in a quite spontaneous manner, the inner message was clear: Forgiveness was the key. She felt forgiven by her Higher Power; she understood forgiveness of self; she felt, not just thought about, but actually felt the process of forgiveness that was emerging within her extended family and friends.

This pivotal and healing moment fits well into the ‘music and imagery generated’ spiritual event for Mary. The experience came from within her, be was felt deeply as a healing that was equally beyond her; connected to a power greater than herself.

Music therapy as an experiential therapy, offers individuals with substance use disorders a means to reconnect with their body, mind, and spirit. Through meaningful and purposeful music therapy experiences, the client can experience a return to a productive manner of living. Participation in music therapy processes as stated above will lead to experiences of openness, creativity, and responsibility in all areas of one’s life. This journey toward psychological maturity can be awakened through the music therapy process and will support continued recovery outside of the treatment environment with other members of the recovery community. Music therapy, as described here, is a meaningful and impactful addition to the traditional treatment milieu. ‘Clinical outcomes’ become ‘experiential outcomes’ as clients come to ‘know a new freedom and a new happiness’, ‘comprehend the word serenity and know peace’, and consider a ‘whole attitude and outlook on life’. (Big Book, Alcoholics Anonymous)

Jim Borling is a board certified music therapist (MT-BC), Fellow of the Association for Music and Imagery (AMI), and Professor Emeritus at Radford University in Radford, Virginia. Jim provides trainings in the Bonny Method of Guided Imagery and Music (BMGIM) and has offered workshops/trainings in Spain, Germany, Mexico, Japan, South Korea, and the USA. He specializes in work with Substance Use Disorder and Trauma. He may be contacted at ‘jborling@radford.edu’