"I will die without my music"

This blog article was authored by Carmen Cheong Clinch
Music Therapist and Adolescent Specialist at Logan Child and Youth Mental Health Services.

Young people who have been traumatised and have mental health difficulties lack the language to identify, reflect and communicate their difficult emotions (Venta, Hart & Sharp, 2012), struggle with emotion regulation (Compas et al., 2001) and are likely to be disengaged from school and social activities (Al-Yarman, Bryant & Sargeant, 2002). This is a grim picture. Young people certainly get a bad rap – from strong body odour, smelly socks to sullen and moody grunts. It is not often we hear “positive” stories about young people who are struggling. Rather what we do hear are stories of violence perpetuated by young people who are angry and/or disconnected.

It is also a sobering reality that current statistics from the youthbeyondblue website indicate that one in 4 young Australians has a mental health condition, and an average of one young person aged 15-24 die by suicide everyday.

To make matters worse

A recent article from the Medical Journal of Australia (MacKee, 2016) reported that current treatments do not produce the much needed gains and psychological therapies do not have a good alignment with the needs of the patient. It is time we look beyond to therapies that do align with patient needs and interests. I have used music to work with children and young people for almost 20 years, with the last 9 years as a music therapist in an adolescent inpatient unit. I have met many young people who feel that life with mental illness is miserable and hopeless. I have also encountered many young people who after a long hard road, begin to live more hopeful and meaningful lives. I would like to share a snapshot of this here.

“Music is second nature to me”

Young people love their music. It is a well- researched and documented phenomenon (e.g., Bull, 2006; North, Hargreaves & O’Neill, 2000). It has been suggested that music listening is a young person’s natural coping strategy (Frydenberg, 2008). Increased portability and availability of music on mobile phones have seen more studies (e.g. Krause, North & Hewitt, 2015; McFerran & Saarikallio, 2014; Skanlan, 2010) investigating the use of preferred music as a technology of health (Ruud, 2002). My own completed doctoral study examined the music engagement of young people with mental illness and found that these young people used their music to identify and manage their difficult emotions on a daily basis, and engaged with their emotions in music therapy during a hospital admission (Cheong-Clinch, 2013). The young people reported their strong belief in the transformative powers of their music to cope with their ongoing difficulties. Many of them swear and declare that music is their best friend.

In everyday life young people report their music is a way for them to express themselves especially when they find it hard to say it in words (Cheong-Clinch & McFerran, 2016). Their song choices relate to their own experiences, reflect their inner life, resonate with their identities and search for meaning. However often clinicians find it difficult to engage with the young people, and most of us are familiar with their shoulder shrug or grunt. Likewise the young people find it difficult to engage with us. There are good reasons young people stay silent. At an emotionally critical and vulnerable time such as an acute inpatient hospital admission, where words are few and not forthcoming, music therapy and their preferred music may be a way for them to “talk”. There was overwhelming feedback from young people and clinical staff about the importance and role of music therapy in a recent quality assurance project conducted in an adolescent inpatient unit (Cheong-Clinch, Burke & Hatherill, 2016).

Behind every favourite song there is an untold story

Hearing the young people’s story on their terms is a crucial aspect of any therapeutic engagement and especially when doing an assessment. Generally a young person is admitted to the ward, on the basis of a concerned adult, parent, carer, teacher or counselor, and therefore it is also their version of the truth. This is not to say it is inaccurate or incorrect, but nothing beats what comes from the horse’s mouth. If a young person and/or family communicated in a different way, we would find various and/or common ways to communicate and connect with them. Given that young people with mental health difficulties already struggle with emotional words and are likely to be disconnected, but continue to engage with and through music, why are there not more music therapists facilitating the engagement process in adolescent mental health?

Young people’s preferred music and music therapy go beyond the hook for engagement. Engaging with young people through music therapy gives us different perspectives - new eyes to see and ears to hear the young person’s story. Events of trauma and stories of mental health struggles can often blend together to form one big mess. Similar to the evening news in the background, sometimes it is hard to discern one bad news report from another. For me listening to a young person’s song or connecting through a music activity allows me to keep being curious to hear their emotion behind the music on their terms, and in a language familiar to them. Perhaps for the first time, a young person might actually feel safe enough to be sad or angry, to tell their story, and feel heard and understood.

Music therapy meets the needs for safety and emotional connection

Recent studies have examined the role of music therapy practice with young people and adults within school and mental health settings, and highlighted the use of music as a resource in recovery (Hense, McFerran & McGorry 2014; Solli & Rolvsjord 2015; Solli, Rolvsjord & Borg 2013). Through a familiar engagement like music, we are able to build a safe, relevant and meaningful therapeutic relationship with them in music therapy. Particularly through group music therapy, they begin to “see” and “hear” each other’s stories and learn more about intra- and inter- personal reflection and emotional engagement (Cheong-Clinch & McFerran, 2016). These are foundational for therapeutic engagement and recovery outcomes. More importantly, music therapy engagement provides and meets the young people’s needs for safety and emotional connection at an acute and vulnerable time of their lives during a hospital admission.

Beyond the walls of therapy

Research has shown that young people regularly use online services to seek help and find out about mental health topics (Kauer, Mangan & Sanci, 2014). It is important that these facilitate pathways to face-to-face engagement for young people across the health continuum. In 2011, I collaborated with award-winning youth health portal Tune In Not Out (TINO) to develop a music-based e-platform - Project Tune Your Mood www.tuneinnotout.com/music to engage with and invite young people to tell their stories by submitting their playlists of songs. Professionals in the field can access Facebook posts www.facebook.com/tuneyourmoodTYM for ideas and ways to connect with young people through music.

Conclusion

Meaningful therapeutic engagement must emerge from the young people’s daily experiences – what makes them excited and engaged in their daily ordinary lives, and to “begin taking control of their lives” (Larson, 2000, p. 172). Furthermore, developing and reinforcing positive adaptive resources, such as their music listening, towards well-being and healthy living during adolescence, are essential for these to continue into adulthood (Keyes, 2006), especially those who are struggling and recovering from acute mental illness and trauma.


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References

Al-Yarman, F., Bryant, M. & Sargeant, H. (2002). Australian children: Their health and well-being (AIHW catalogue number PHE 36). Canberra, Australia: AIHW.

Bull, M. (2006). Personal stereos and the management of everyday life. Oxford: Oxford International Publishers Ltd.

Cheong-Clinch, C. (2013). Musical diaries: An investigation of preferred music listening by young people with mental illness in various contexts and conditions (Doctoral thesis). Melbourne, Australia: The University of Melbourne.

Cheong-Clinch, C., Burke, C. & Hatherill, S. (2016). “What they said” – Perspectives from young people and nursing staff about the role of music therapy in an adolescent inpatient unit. Poster presented at the Princess Alexander Hospital Symposium, Brisbane, Australia.

Cheong-Clinch, C. & McFerran, K. (2016). Musical diaries: Examining the daily preferred  music listening of Australian young people with mental illness. Journal of Applied Youth Studies, v.1, n.2, pp.77-94.

Compas, B. E., Connor-Smith, J.K., Saltzman, H., Thomsen, A.H. & Wadsworth, M.E. (2001). Coping with stress during childhood and adolescence: Problems, progress, and potential in theory and research. Psychological Bulletin, 127(1), 87-127.

Frydenberg, E. (2008). Adolescent coping: Advances in theory, research and practice. Hove, UK: Routledge.

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Larson, R. (2000). Toward a psychology of positive youth development. American Psychologist, 55(1), 170-183.

MacKee, N. (2016). No gain from rise of antidepressant. Medical Journal of Australia. http://www.doctorportal.com.au/mjainsight/2016/18/no-gain-rise-antidepressants/

McFerran, K. S. & Saarikallio, S. (2014). Depending on music to make me feel     

better: Who is responsible for the ways young people appropriate music for            health benefits. The Arts in Psychotherapy, 41(1), 89-97. doi:       http://dx.doi.org/10.1016/j.aip.2013.11.007

North, A. C., Hargreaves, D. J. & O'Neill, S. A. (2000). The importance of music to adolescents. British Journal of Educational Psychology, 70, 255-272.

Ruud, E. (2002). Music as a cultural immunogen: Three narratives on the use of music as a technology of health. In I.M. Hanken, S. Graabraek & M. Nerland (Eds.), Research in and for higher music education. Festchrift for Jarald Jorgensen. Oslo: NMH-Publications, 2002: 2.

Skanland, M. S. (2010). Mp3-players as a technology of affect regulation. Paper presented at the International Conference on Music Perception and Cognition, Seattle, USA.

 

Solli, H.P. & Rolvsjord, R. (2015). ‘“The opposite of treatment”: A qualitative study of how patients diagnosed with psychosis experience music therapy’, Nordic Journal of Music          Therapy, v.24, n.1, pp.67-92, doi:10.1080/08098131.2014.890639

Solli, H.P., Rolvsjord, R. & Borg, M. 2013, ‘Toward understanding music therapy as a recovery-oriented practice within mental health care: A meta-synthesis of service users’ experiences’, Journal of Music Therapy, v.50, n.4, pp.244-73.

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