The Healing Process of Music Therapy: The Use of Therapeutic Song Writing with a Veteran

By Sarah M. Miller, MT-BC

*This is an article from the Winter 2021-2022 issue of Combat Stress

In 1996 in Saudi Arabia, a truck bomb was detonated near the building being used as living quarters for coalition forces. One Service Member assigned with his team to support the defense of the no-fly zone, was three buildings away from the explosion that day. He since describes the event as “confusing and chaotic. Dust and debris were everywhere. Broken glass. Dismembered bodies. The wounded calling for help. People yelling from every direction.” This event changed everything for him. The shock, panic, fear, and anxiety. The guilt. Up all hours of the night, trouble sleeping. The marital disconnect. Continuously feeling unsafe. The excessive consumption of alcohol as his numbing comfort of choice. In the commentary described in this article, this Veteran’s thoughts, feelings, and behaviors were to continue for the next twenty-five years, during which he has been admitted to in-patient care numerous times.

In my work as a Board-Certified Music Therapist serving Veterans, this scenario is all too common. One traumatic event can alter a person’s capacity to relax, maintain inner peace, access joy, or find pleasure, satisfaction, and meaning in life. When I (the Therapist in this case) started working with Veterans in January 2021 at a Veterans Affairs Medical Center in Ohio, Music Therapy was new to the unit. The Veteran described had no prior knowledge of or experience with Music Therapy and was referred for treatment of his post-traumatic stress disorder, depression, and anxiety. He agreed to participate in individual and group Music Therapy.

What is Music Therapy?

Music Therapy has been defined as “the systematic process of intervention wherein the Therapist helps the client to promote health, using music experiences and the relationships that develop through them as dynamic forces of change.”1 Music Therapy is known for its holistic approach using the CAMES Model, which integrates Communication, Academic/cognitive, Motor, Emotional, and Social areas to assess, set goals, and design treatment plans for clients.2 When working with adults, especially Veterans who have medical and mental health conditions, a Psychodynamic Model is often used. Psychodynamic Therapy involves the interpretation of mental and emotional processes rather than focusing on behavior.3 Psychodynamic Music Therapy proposes that with music-assisted interventions, individuals can become aware of their inner states and can communicate these through performed musical expression. From a psychoanalytic viewpoint, music portrays meaning and gives the individual the experience of being mirrored, accompanied, and therefore feeling personally understood.4 Given a variety of musical opportunities for self-reflection and self-examination, Music Therapy clients can identify their psycho-emotional states quickly, gaining a better awareness of who they are, how they feel, and why.

Music Therapy Methods

There are four Music Therapy methods used as core interventions:

  1. Improvisatory, which can be a vocal or instrumental improvisation and can be presented as a solo or as a co-improvisation with a group.
  2. Re-Creative, such as song discussion/lyric analysis, or music supported art media such as music and art experiences or a movement to music intervention.
  3. Composition/Song Writing (described below.)
  4. Receptive, also known as song re-creation, which is individualized or a stylized group vocal or instrumental performance of a preferred song.5

Therapeutic Song Writing Within Treatment

Therapeutic Song Writing is the process of creating, notating, and recording lyrics and music by a client and Therapist within a therapeutic relationship to address psychosocial, emotional, cognitive, and communication needs of the client. In Therapeutic Song Writing, the Therapist purposefully engages the songwriter (the client) in a creative process whereby (s)he crafts a song that has personal meaning and simultaneously leads him/her through a journal of personal discovery. The song that an individual creates becomes a tangible record of his/her journey or representation of his/her transformed state or the expressed desire to be transformed.6

The Veteran described here is a male in his fifties with approximately twenty-seven years of service. He met for individual Music Therapy once a week with the Therapist for one hour for eight consecutive weeks, while also attending group Music Therapy once a week for forty-five-minute sessions. As the Veteran and I got to know each other and develop rapport during our weekly sessions, he journaled often, typically carrying around a notebook and pen. He appeared to take notes of conversations and social interactions within a variety of settings around the unit. Because of his observed comfort with writing, Composition (Song Writing) was selected for our individual sessions.

Finding the Voice Within

The Veteran’s first step in his Song Writing process was to journal about whatever he wanted to journal about, knowing these thoughts/ideas would eventually be put to song. The assignment was deliberately open and general. He was instructed to think about a message or theme he might want to communicate to others who would hear the song. After three weeks of journaling, we met for our weekly session and began constructing his reflections into three verses and a chorus. His lyrics were points of reference for our discussion, which ultimately led to his sharing the details and impact of his traumatic experience in Saudi Arabia from twenty-five years ago. His post-traumatic stress, depression, anxiety, fear, and alcohol abuse were all topics of discussion during the Song Writing process. His song, however, is written about being placed in an in-patient unit that isolated him from visitors during COVID-19. So instead, he chose to write about how he was going to use his time within the unit to grow as a person and overcome areas he felt he needed to work on. As we talked about his trauma issues, he was able to connect the dots, e.g., identify the triggers that take him back to his war trauma, and why alcohol has been a way to avoid his pain. He did not want to feel his deep grief and face the memories of the explosion’s impact on a score of Service Members who were killed, hundreds who were wounded, and many more family members who were affected; alcohol was his method of numbing painful memories.

Once the lyrics were written and their therapeutic implications discussed, he was presented with choices for musical structure, tone, mood, and instrumentation. First, I played chord progressions using major chords, and then played darker and more contemplative minor chords. He chose the minor progression with a slower tempo and developed a melody for the verses and chorus. A soundscape (or sound vocabulary) of instruments was also presented for the Veteran to choose primary instruments for the song and other accompanying instruments to be used throughout. He chose the guitar as the primary instrument and the keyboard to accompany it.

When those foundational musical decisions were finalized, I played and sang his song on the guitar for him.

I came from the shadows, dark into the light of grey,

 evaluate surroundings, hope for a brighter day.

I’m learning to overcome all our past mistakes,

 conquering our struggles, build for another day.

We want to take the time and smell the roses,

 we want to see our personal growth, the dirt and the rain

 although we don’t like it supports who we become.

 Time is not all our own, I miss the way I feel when I’m around you,

 let’s enjoy the brighter day.

We want to take the time and smell the roses,

we want to see our personal growth, the dirt and the rain

although we don’t like it supports who we become.

We become the inspiration.

As the song ended, tears streamed down his face and he said, “You bring the release of pent-up emotion and depression. In my mind that makes you a hero. You are an inspiration.” This moment served as a testament to his resonating in the healing power of music and the process of Song Writing in working through deep trauma.

I asked the Veteran what his thoughts were on the Song Writing process. He responded, “Song Writing is a release of energy to help myself and help others understand and see inside my mind. My mind goes to a creative process, and I don’t think about the bombing at all. My mind is usually like a child in a playpen and all I want is to get out of the playpen. Song Writing was what took me out of the playpen, and I learned it is ok to have joy. I do not have to hold up those deep emotions like anger and take it out on others. Music took me to the other place—a place of relaxation and excitement. It is very emotional, and I cried when writing my song and when I heard the finished song, and I don’t feel bad about it. Being vulnerable is good.”

Connecting Veterans: Group Music Therapy

We discussed the benefits of sharing this song with others on the unit. The Veteran particularly wanted his close friends to hear it. He hoped they would feel encouraged and be inspired to try something like this too. He chose egg shakers, the cabasa, and claves as additional percussion instruments to incorporate as accompanying instruments for his comrades to play. He asked his close friends and others on the unit to play along with him as the song was performed during group Music Therapy as the Therapist lead and sang the song. The Therapist recorded the song on the guitar the day prior and played it back through a Bluetooth speaker the day of group Music Therapy and played the keyboard and sang the song live while all the Veterans played along using their percussion instrument of choice.

What had started as an individual therapeutic experience emerged into a group shared experience. Veterans in the group each had the opportunity to share how they feel about being an in-patient on the unit and what it has been like for them not being able to see family and friends in-person due to COVID-19. They were also able to identify how they want to use their time on site and discussed long term goals for themselves. Using the Veteran Songwriter’s original song (and other Music Therapy interventions over time), the group began discussing the traumatic events they each experienced over the years and how those memories have robbed them of joy and hope. Positive coping skills and relaxation techniques were discussed as well as suggestions to try leisure activities that may boost mood and improve their quality time.

As a result of these discussions, some Veterans requested piano (keyboard) and guitar lessons and set new goals for themselves in other Therapies. For example, one Veteran from group Music Therapy set the goal to walk again with the assistance and help found in Physical Therapy. His first goal is to walk with the help of a walker and then he decided to set the long-term goal to walk independently one day. While trauma deadened their joy and silenced some voices, Music Therapy has sparked their readiness to look within, allow themselves to feel and acknowledge their hurt and sorrow, and reclaim some of their inner light. Ultimately, music has helped them move forward on their path of healing.

Growth Through Music

CLICK ON PICTURE TO HEAR SONG

About a month following the Song Writing experience, the Veteran had the opportunity to share his original song in a video recorded by Public Affairs within the VA which was emailed to staff and posted on the facility’s Facebook page. The Veteran is still an in-patient and continuing with weekly individual and group Music Therapy and has offered to assist the Therapist during sessions however needed. He has taken a leadership role, including walking room to room to invite other Veterans to attend group Music Therapy; passing out and collecting instruments during sessions, hanging visuals on the wall, pushing his wheelchair-bound comrades to their rooms or to another area when group is over, etc. He has recently opted to learn piano (using a keyboard) and has starting sight-reading beginner music.

This experience has been a great confidence builder for this Veteran. It was something he did not think he could do and is currently making musical progress at every session. He is determined to develop a variety of skill sets and has even expressed an interest in learning guitar. He is slowly overcoming his anxiety, depression, and atypical sleep schedules. The more therapeutic discussion that is processed between him and the Music Therapist either in individual or group Music Therapy, the more intentional and observable changes are being made and applied to his day-to-day routine. He has even expressed during group Music Therapy recently that he doesn’t want to be an alcoholic. He hasn’t had alcohol in eight months while being an in-patient. He is looking forward and has set goals to connect with friends and loved ones and make healthy changes so that he no longer will need in-patient care. Although it may take more time, he is determined to hit a “reset” button on his life. He is learning the importance to care for himself and be the best possible person for his loved ones and one day soon thrive within his community.

If one person can make this kind of progress after twenty-five years, any Veteran has potential to tap into his or her musical capacity and be inspired to do whatever it takes to be the best possible version of themselves.

Additional Information

If you would like to learn more about Music Therapy, please visit the following website which explains Music Therapy in detail, how to find a Music Therapist, and settings in which Music Therapists can work: American Music Therapy Association | American Music Therapy Association (AMTA).  If you would like more information about Music Therapy with Veterans, please view: Music Therapy in Military Populations and NEA Military Healing Arts Network.

References

  1. Bruscia, K. E. (1998). Defining Music Therapy (2nd Edition). Gilsum, NH: Barcelona Publishers.
  2. William B. Davis, Kate E. Gfeller, & Michael H. Thaut (2008). An Introduction to Music Therapy: Theory and Practice (3rd Edition). Silver Springs, MD: The American Therapy Association.
  3. Strupp, H.H., Butler, S.F., & Rosser, C.L. (1988). Training in psychodynamic therapy. Journal of Consulting and Clinical Psychology, 56(5), 689-695.
  4. Susanne Metzner, J Edwards (2016). Psychodynamic Music Therapy. The Oxford Handbook of Music Therapy. Augsburg University, 448-471.
  5. Bruscia, K. E. (1998). Defining Music Therapy (2nd Edition). Gilsum, NH: Barcelona Publishers.
  6. Felicity Baker (2015). Therapeutic Songwriting: Developments in Theory, Methods, and Practice. New York: Palgrave Macmillan Publishers.

 

ABOUT THE AUTHOR

Sarah M. Miller grew up in Maumee, Ohio and graduated Cum Laude from Baldwin Wallace University in Cleveland, Ohio. Sarah received her bachelor’s degree in Music Therapy and then completed her Music Therapy internship in Pennsylvania. She has been working as a Board-Certified Music Therapist since 2003 and serving a variety of populations throughout Ohio and working in the Greater Dayton Area since 2009. She serves as a Supervising Music Therapist for Undergraduate Music Therapy students at the University of Dayton, Department of Music. She also serves Miami Valley Music Therapy llc as a District Music Therapist for Beavercreek City School’s Special Education Department working with students who have a variety of special needs. She has started her own private practice entitled, Composing Minds Music Therapy llc and serves Greene and Montgomery Counties working for families and facilities with children and adults who have a variety of special needs as well as working with Veterans who have medical and mental health conditions. Please feel free to reach out and connect with Sarah via email at [email protected] or find her on LinkedIn at: www.linkedin.com/in/musictherapistmiller.

 

Combat Stress Magazine

Combat Stress magazine is written with our military Service Members, Veterans, first responders, and their families in mind. We want all of our members and guests to find contentment in their lives by learning about stress management and finding what works best for each of them. Stress is unavoidable and comes in many shapes and sizes. It can even be considered a part of who we are. Being in a state of peaceful happiness may seem like a lofty goal but harnessing your stress in a positive way makes it obtainable. Serving in the military or being a police officer, firefighter or paramedic brings unique challenges and some extraordinarily bad days. The American Institute of Stress is dedicated to helping you, our Heroes and their families, cope with and heal your mind and body from the stress associated with your careers and sacrifices.

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