By: Lynette L. Taylor, MT-BC
Many of you probably use music therapeutically on a daily basis without even realizing it. How many of you listen to music that is more upbeat than usual when you need a little extra energy? Or, conversely, when you are feeling a little blue, pop in that perfect sad song? Music is covertly serving as a conduit for releasing or expressing emotion. Still, many people ask the question: “What exactly is music therapy?” The American Music Therapy Association (AMTA) defines music therapy as “the prescribed use of music by a qualified person to effect positive changes in the psychological, physical, cognitive, or social functioning of individuals with health or educational problems.” This article will explore a few facets of music therapy interventions and results for eating disorder clients in an intensive treatment setting.
Music therapy interventions allow clients to express their thoughts, opinions, and feelings, in a nonverbal, safe, and constructive manner. Music evokes a response that is immediate and genuine. In essence, one cannot falsify their initial response to music – it is the authentic emotion coming to the surface. One client, who had buried her feelings for years, described the powerful influence of music in resurrecting those feelings: Nothing seemed to get through the barriers I had erected in my mind and in my heart. In regular therapy they would try to get me to talk about my feelings. I just couldn’t seem to find the words, like words were such an inadequate way of describing what was going on in my mind. My first day in music therapy, I cried, really cried for the first time since I was told not to cry as a little girl. I’m not sure what happened, but the music seemed to pierce my stone heart and break down all of the defenses I had. It was hard because I felt vulnerable and defensive at first.but the girls were so supportive, and I felt safe. -Former Patient
As a newly admitted patient, an eating disorder client may experience several conflicting emotions including feeling overwhelmed, fear of rejection by other residents, vulnerability, and lack of conviction in their choice to seek treatment. In addition, many of these people have learned to please others and neglect themselves, resulting in unhealthy interpersonal skills. Due to the secrecy and shame of the disorder, they have not had much practice in being honest in relationships (Priestly, 1975).
By participating in a structured music therapy group, the eating disorder client is able to work through these issues by restructuring the way she views herself in relationship to the other residents. She gains an awareness of her unique attributes which enhance the group experience and provide her with the sense of being a necessary and integral part of the group.
Structured music therapy groups include, but are not limited to: group song writing, drumming, and karaoke.
Often, people who have failed to make desired progress in outpatient treatment have struggled because they either cannot use words, or use words extremely well as a defense (Justice, 1994). Some, who have been in treatment and have struggled for years, can talk circles around their therapists. Music can be used to move past these defenses to connect with deeper issues through symbol and metaphor (Kenny, 1982). These symbols can be solidified through graphic arts or writing. For example: clients were asked to write a song describing feelings associated with their eating disorder. The following verse demonstrates how powerful symbolism and metaphor can be used to accurately describe the acuity of pain and fear.
I dreamed a dark and narrow path
where I faced a dragon’s grasp,
He held me tight within his fist
and breathed a suffocating mist,
He choked me and stole my voice
believing there was no other choice,
Creating lies, I paved the way for a path that led astray.
Not only is a client able to express feelings associated with her disorder while engaging in song writing, but she is able to experience being a part of a cohesive group, where her input is valued. Original melodies and lyrics leave a lasting impression on those who had a hand in creating them – impressions which will stay with them long after treatment. About a year and a half after her treatment at Center for Change, a former client wrote: “I’ve often thought about the song ‘Shine Through Me’ that we all made up and it has brought me comfort so many times and helped me to get through the difficult moments.”
According to Carl Seashore in Psychology of Music (1967 pp. 140-145), there are eleven basic ways by which rhythm affects our perception. In effect, rhythm does the following:
- Favors perception by grouping;
- Adjusts the strain of attention;
- Gives us a feeling of balance;
- Gives us a feeling of freedom, luxury, and expanse;
- Gives us a feeling of power;
- Stimulates and lulls (contradictory as this may seem);
- Is instinctive;
- Finds resonance in the whole organism;
- Rouses sustained and enriching association;
- Reaches out in extraordinary detail and complexity with progressive mastery; and
- Results in play, which is the free self-expression for the pleasure of expression
During a drumming activity, one client reported that she was able to imagine her eating disorder as a separate entity, not inside of her, but on the head of the drum. For the first time in years, she was able to feel a sense of empowerment over her eating disorder as she repeatedly hit the head of the drum and thought the words “F-You, Eating Disorder!” The sense of power she felt during the drum circle was the antithesis of the powerlessness often felt by eating disorder clients. Feeling such power can give clients a taste of their own strength and ability to forsake their eating disorders.
Prior to attending a music therapy drumming group, a client reported that she wanted to leave treatment early. She was unmotivated and showed little to no desire to overcome her eating disorder behaviors. After engaging in a drumming exercise, this client described feeling a profound change in her entire outlook on staying in treatment. She said, “Something just clicked inside me that night when I listened to the drums beating.the voices of the drums fit together and I felt a bond with the other girls that I hadn’t felt before.” Commenting on the client’s change, a care technician said “Her outlook on her time here has changed dramatically since that night. She is forming great relationships with the girls and said it was a beautiful experience for her.”
As aforementioned, clients have shown success in using symbolism and metaphor to express feelings associated with their eating disorders. Commonly used symbolic words, such as “suffocate,” “mute,” “blocked,” and “alone,” convey feelings of frustration due to deficits in the eating disorder client’s communication skills.
Whether due to lack of self-esteem or fear of rejection, communication is often strained with eating disorder clients. Karaoke, or singing a solo in front of a group, is a strong medium in the development of assertive communication skills. Fear of rejection, lack of perfection, vulnerability, etc., make most clients resistant to participating in karaoke exercises. When a client pushes herself to work through her fears, she learns that there is a well of personal power within her, and that she has the ability to overcome her issues related to performance anxiety. Following discharge from the Center, a former client wrote: Guess what?! I sing in a contemporary singing group at church. I love it and find it very fulfilling. To be honest, I don’t think I would have the courage if it weren’t for your “assertive communication” group. Karaoke made me be more assertive.
The interventions described in this article represent only a fraction of music therapy interventions implemented in the treatment of clients with eating disorders. Music therapists and music therapy can provide several levels of experiences that facilitate further goals and processes.
Justice, R. Music Therapy Interventions for People with Eating Disorders in an Inpatient Setting, MI: National Association of Music Therapy, Inc., 1994.
Kenny, C. The Mythic Artery . Atascadero, CA: Ridgeview Publishing, 1982.
Priestly, M. Music Therapy In Action . New York: St. Martin’s Press, 1975.
Seashore, Carl E. Psychology of Music , pp. 140-145, New York: Dover Publications, 1967.
Revised September 2014