Ep. 056 | Asking Big Questions
Today, we chat with Alyssa Monas, a board-certified music therapist, about her music therapy training with Cognitive Behavioral Therapy (CBT) techniques and what she’s unlearned since.
TRANSCRIPT
Erica: Welcome, friends! You’re listening to The Feeling is Musical — as presented by the Snohomish County Music Project. My name is Erica Lee, and today, we chat with Alyssa Monas about her music therapy training with Cognitive Behavioral Therapy (CBT) techniques, and what she’s unlearned since.
Alyssa is a board-certified music therapist who works for a nonprofit in King County, serving kids and families through a community mental health model. She focuses her work on breaking the barriers and power dynamics that exist within traditional therapist-client relationships to build genuine partnerships and meet people where they are.
Please note that this episode content includes mention of ABA therapy and eating disorders.
Also, exciting news: we have our very first sponsorships. So, today’s episode is sponsored by the Seattle Storm and Angel of the Winds Casino Resort.
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And, the very last thing before we get started. We want to say thanks for all of your support over the last year. We’re looking forward to continuing to explore music therapy, and chat with more amazing guests. However, we want to let you know that we are changing our production model to shift from weekly episodes to season-based content. This will be a more sustainable model for us at the Music Project and ensure we can continue to have meaningful conversations. So we’ll be taking a break for a few weeks at the end of March, and encourage you to follow us on social media @SCMusicProject so you don’t miss any new episodes.
[Podcast intro music plays]
Erica: Well, thank you for coming back to the podcast, I appreciate it. Before we jump into our discussion about CBT, though - just as like a warmup question: what music - what song are you loving lately? You can pick one - you don’t have to share all your favorites ‘cause I’m sure you have multiples.
Alyssa: For me, during this whole pandemic, I feel like I’ve been gravitating towards familiar things. Like re - you know, listening to stuff that I’ve always listened to.
Erica: Mmm.
Alyssa: I’ve been enjoying um Adrianne Lenker - she’s the like the singer from Big Thief. There’s this song called Zombie Girl - the first time I heard it, I feel like it just kind of immediately caught my attention —
Erica: Mmm —
Alyssa: And it was this song that I just wanted to listen to over and over. It kind of is one of those songs - it’s more of a like if you need to cry song.
Erica: Mmm.
Alyssa: Yeah, I would say that’s - that’s what comes to mind.
Erica: So, we’re gonna talk about CBT —
Alyssa: Mmhmm —
Erica: Um, not in a super straight forward way today. Just, listeners, for your awareness - in case you really like linear things - today’s probably not gonna be your episode [chuckles].
Alyssa: Mm-mm [chuckles] Agreed. That’s a good disclaimer.
Erica: [Laughing] Yeah. Um, so, Alyssa - just like as background that I know about you is that you got your bachelors and your masters from Florida State University. And that school - those programs have a really big CBT focus, right?
Alyssa: Mmhmm —
Erica: Yeah —
Alyssa: Yeah. Um, a big medical music therapy program, and kind of within that there’s a lot of - like, the CBT techniques are kind of what we focused on um —
Erica: Mmm —
Alyssa: During the time.
Erica: Yeah.
Alyssa: Yeah.
Erica: So, can you tell us um what is CBT? It stands for cognitive behavioral therapy - we’ll start there. What does that mean, and then like how was that implemented in your training?
Alyssa: So yeah, CBT stands for cognitive behavioral therapy. And so, CBT is its own approach to - to psychotherapy or talk therapy. Um, it’s very structured. Meant to be kind of a um more short term uh treatment, which is, I think, a reason that it - you know, if we’re looking at things through like a capitalistic framework, and that linear healing - you know, it makes sense that CBT is one of the highest regarded forms of therapy. It’s meant to treat - uh, I think it started as a treatment for depression?
Erica: Mmm
Alyssa: But it - you know, CBT can be used with kind of a wide variety of - of issues. You know, things like OCD, anxiety, phobias, um eating disorders - I believe it’s used quite a bit. Uh, this is not gonna be comprehensive - I’m kind of trying to be a - a bit general - make sure I cover the sort of important parts. But um, the purpose is to kind of help identify the um thoughts and the behavioral patterns surrounding these issues, and then find ways to challenge them/to change them. So, it’s about kind of identifying where you might be engaging in more quote unquote maladaptive behaviors, and how can you kind of shift and restructure those things.
Erica: I’m curious about um like how it works.
Alyssa: Yeah.
Erica: Like, what’s the basic premise of it?
Alyssa: Well, so the reason I’m defining kind of CBT on its own is that, you know, it’s kind of its own thing outside of music therapy. And when - in - in schooling for music therapy, it’s more - the idea is to implement cognitive behavioral techniques into a music therapy context.
Erica: Mmm.
Alyssa: I would say, you know, in school, we kind of learned about different sort of CBT techniques. You know, things like uh structuring, and cuing, and prompting - um, you know, creating task analyses to uh create opportunities for success and, you know, kind of, you know, knowing where to start in addressing like a certain behavior. And uh using music therapy techniques to um explore behavior. So, I would say, you know, um things like music-assisted relaxation, or um using songwriting, or kind of using music therapy interventions to use as coping tools for whatever kind of identified problems quote unquote there are… is kind of what it looks like in - in the context of treatment . And my - most of my experience in school, I worked mostly with uh kids who are - had a range of abilities; I did work with a lot of autistic kids. So, in that context, I did a lot of group work, and - and what it looked like with using kind of those cognitive behavioral approaches: it was very much about sort of that group facilitation, using music to - to keep kids engaged - to reinforce sort of those positive behaviors. And so you would do things like ignoring, you know, bad behaviors and praising the good ones, or using music as a reward or a positive reinforcement, or, you know, doing a certain task. You know, it’s very structured, very goal oriented.
And I think this is something I didn’t mention that is important to mention when it comes to cognitive behavioral therapy in general: it’s meant to be um therapy that addresses what’s happening in present time - not taking into account the underlying things quite as much - or the systemic things. It’s more about like what is happening in the moment, what are the behaviors happening in the moment, and what tools can we build to um fix [chuckles] the - the behaviors, or the things that um either the client or society has deemed maladaptive. And, to go back to my schooling, and just my experiences - and especially how I received information and operated at that point in my life: I wasn’t ever thinking about sort of the underlying reasons a behavior might be there. It’s very just focused on meeting goals that are gonna just like make things better in the moment for the individual - um and what - what behaviors and - and thoughts um need to be kind of challenged/restructured/redirected and replaced with better —
Erica: Yeah —
Alyssa: Behaviors [chuckles].
Erica: What did you - after you finished school - finished your internship - started being your own professional self, what did you start learning about your education or your training? Or what did you discover?
Alyssa: Um, you know, I would say: I - I think I came out of my training - on one hand I felt very confident —
Erica: Mmm —
Alyssa: Going into the workforce. And - and at the same time, I would say that throughout my entire education - and even, you know, during my internship and going into the workforce - I think I’ve always felt a lot of just insecurity, and I felt like I questioned a lot of things. Like, something just didn’t feel right I guess. Um, it just started to feel like I was doing things within a therapeutic context because it was just what I thought I had to do - and I thought that’s what it meant to be like a good therapist.
Erica: Mmm.
Alyssa: And it’s interesting because, especially with something like cognitive behavior therapy and using that within, you know, a music therapy context, there’s sort of this - for me, the way I internalized it was you know, you do this thing in order to make that happen.
Erica: Mmm —
Alyssa: And if you do this thing, and that thing that you want to happen doesn’t happen, then you did something wrong - there’s something wrong with you - like, you’re not a good therapist [chuckles]! And so, it’s like I was kind of holding these like very like different things I guess in my - in my mind I guess.
And, something that I didn’t mention is that uh: with the work that I did, working with autistic kids, and ABA being sort of the evidenced-based approach that, you know, works… Um, and I guess I should have said, like, CBT - to me, it’s kind of an umbrella term, ‘cause there’s different types of kind of behavioral approaches to therapy. And - and ABA, applied behavior analysis, kind of fits under that umbrella of like behaviorism. I think that um I wanted to fit in with - by doing the type of work that was gonna get me clients, and potentially help me towards bill - you know, being able to bill - and one way that I did that early in my work was working with neurodivergent kids - and sometimes working directly with a BCBA. And they would come in and have me, you know, use music as this reward every time the kid, you know, hit their sticks together. And i remember just like - I never felt right about it, and I don’t know that I can put it into words, but… These types of things started to cross my mind, where I was like, am I just kind of doing these things because I feel like that’s what I’m supposed to do? And if I don’t do, you know, specifically these types of things that I’m doing something wrong? Um, so I think, for me, uh having to unlearn the like - the - the - the expert mentality, or feeling like I have to be the expert, which I think I even talked about in the last episode - but I think that’s really related to how I learned to quote unquote do music therapy.
Erica: In the music therapy program that I was in for a couple of years before I switched majors, which is a different story… I think that’s still true. That like, at a different university in a different program - on the other side of the country —
Alyssa: Right —
Erica: There’s still that expectation being implied —
Alyssa: Yeah —
Erica: Into training and education. Even if the professor never says —
Alyssa: Right —
Erica: You’re the expert. You fix, you teach, you - whatever verb you wanna put in there.
Alyssa: I think the music therapy profession, as a whole, what it kind of feels like to me is that we’re mostly concerned about like protecting music therapy. Oh, that person’s doing something with music, and ooh there should be a music therapist ‘cause they’re the ones that know how to - like we have the right education and this person doesn’t, you know. That seems to be more the focus: is like kinda moving our own agenda forward, rather than understanding that we might not always be the experts in certain contexts. And that - like, this opens up a bigger conversation around like the therapy industrial complex, which is a term I’m taking from you - uh —
Erica: Which I took from our staff, so —
Alyssa: Okay —
Erica: It’s being passed around.
Alyssa: Well, and it’s perfect, right. Because - my brain is swirling, and it’s making it hard to stay on one track - but to me, I feel like it’s all - it’s all related. And I think it’s all - it’s all related to the question of what it - what it’s looked like for me, in terms of unlearning, and - and getting that lived experience - being in the real world. Because I was that therapist that was kind of just like well, that’s not music therapy, and this - you know. And, when you’re also in environments - you know, for example, I worked for many years in, you know, a memory care and assisted living community. And there are often performers that come in, or, you know, life enrichment directors or assistants that are musical, and there’s always this - I think, for me, it did bring up a lot of insecurities around, you know, like the realization that, just because I’m a music therapist, doesn’t always mean that I’m the best person to bring a musical experience into a room. You know?
Um, but, when I was thinking about the idea of cognitive behavioral therapy - as just a - a general concept - um and - and what my like issues with it are, I had the transfer - uh, as Dr. Madson from FSU, he made us write transfers every day —
Erica: Mmm —
Alyssa: Where we took a concept that we had learned in class, and transferred it to a real life situation. So, this is my transfer. I was thinking about policing, and um policing being this uh this solution, rather than figuring out the underlying um issues that lead to, you know, crime - quote unquote. You know, so like, lack of resources in communities, housing issues, um, you know, and - and thinking about the underlying uh causes of addiction and trauma. Like, it - it feels the same to me. Like - and that feels like the issue.
I guess I would say this applies to the question of what has the process since school looked like. I think that while I was in school, the approach was very individual focused. It was just focused on putting it on the individual to kind of develop coping skills, and develop tools and resources to make the condition better. And, in certain contexts, that’s really useful, right. Like, if you’re thinking about a phobia - if you’re thinking about OCD. And so, when I’m saying these things, I’m certainly not implying that CBT is all wrong. I think that, you know, we have to look at things as: learn the structure so you can break it, or so you can challenge it, or so you can take what works and leave what doesn’t. I don’t know that education or in any therapy profession gives opportunities for that, but that’s what I believe.
Erica: The idea of presenting a concept and learning a structure in order to break it… Um, my music theory professors talked about that —
Alyssa: Mmhmm —
Erica: That we learn about parallel, fifths and parallel octaves, and Roman numeral analysis, and all these - all these very specific ways —
Alyssa: Mmhmm —
Erica: That people compose - and what Mozart did, and what Bach did, and… And then, if you were a composition major —
Alyssa: Right —
Erica: Then they spent the next x amount of years teaching you to not do those things all the time.
Alyssa: Right.
Erica: And to find new ways of doing them. When we’re talking about therapy programs and therapy education, there is the learning of the original/learning of the historical - all of that matters - and then also um breaking it down and doing questioning. And like questioning that approach, questioning - even your professor - because humans are not infallible beings.
Alyssa: Right.
Erica: And your professors are not infallible. And so, one of the things that you and I had talked about in a different conversation than this one, was that you have to start doing that questioning —
Alyssa: Mmhmm —
Erica: And encouraging students, interns, professionals to do that questioning —
Alyssa: Yeah —
Erica: work. And to start breaking down what they know, to realize what they think they know, to realize what they don’t actually know.
Alyssa: No, you’re completely right. And, you know, it’s highly likely that a lot of students do engage in this questioning and sort of this challenging - and that professors encourage it. But it is hard when you’re doing it within these like very structured frameworks, and kind of having to fit within this society. Um, and I guess, you know, that kind of goes back to, you know, even the comparison to like policing versus like - abolition versus reform. And, you know, it’s like: what really needs to happen, in so many contexts - in my humble opinion - um is that things need to be completely broken down. And like, we need to start over.
I think - and that’s been my biggest I think why I - I struggle every single day. And I struggle with, you know, kind of that imposter syndrome - that feeling like I’m not doing enough. Or I’m feeling like there’s only so much I can do in my role -and wanting to do more systemic work. How do we like hold all of these, but like also recognize that like this is where we are right now. And then how can we - like, what would it look like to use some of these things as one part of treatment - like CBT - and then also be thinking more about the bigger systemic things, rather than trying to just like stay in our little bubble and like leave it to other people. But there are so many ways that we - we are limited, because of the society that we live in. Um, so I mean - I guess all to say: like, obviously, CBT and some of those - the concepts within that framework are not bad or wrong. And they’re super helpful for a lot of people, but it’s only one piece of a much bigger puzzle. And I think that when I was in school, I viewed it as like the end all be all, you know?
Erica: Yeah.
Alyssa: As I’ve changed as a human being, I’ve learned so many things, but the more I learn, the more I feel like I either have to unlearn, or like - the more questions I have, or the more I feel like I don’t know - which I think I’ve always viewed as a problem —
Erica: Mmm —
Alyssa: And I’m starting to think that maybe it’s - it’s actually a very good thing, because, if we’re doing this, and we’re not just sort of trying to stand in this like, I’m a music therapist, and I - I do good, and I know all the things, and - I think there’s - there’s a lot of harm that can be done if we’re not constantly questioning things and different approaches being taught. Even if they’re the ones that are the evidence-based ones. You know, things are deemed evidence-based within this bigger context of like a capitalistic, white supremacist environment.
Erica: Mmm.
Alyssa: So then, like what does that mean when we’re trying to use these approaches that we’re taught in marginalized communities?
Erica: Mmm.
Alyssa: Um, and I would say, as an example, thinking about the ways that I’ve used the cognitive behavioral techniques of positive reinforcement, or using music to cue a certain thing, and - or, you know, structure the session…I remember, when I went into a group with young kids who all had a number of complex traumas, a lot of those approaches - for that like group facilitation quote unquote - like really didn’t work. And one of the reasons was because, you know, my training sort of taught me that, you know, if there’s a kid doing something that’s considered like the incorrect behavior at that point in time - like, let’s say they’re standing up and like wiggling —
Erica: Mmm —
Alyssa: And they’re all supposed to be sitting. You know, the way that I internalized the information and used it is kind of this like, what I should do in that moment is saylike, oh, I see so-and-so is sitting, and I see so-and-so is sitting. But, I think for me, whats really changed is, instead of viewing it as like, oh this kid is doing the wrong thing, it’s sort of looking at it as okay, what do they need right now?
Erica: Mmm.
Alyssa: Even if a kid is doing something that, you know, society deems as quote unquote attention seeking, um, which I don’t use that term myself anymore - I used to. I think it was Vee that encouraged me to shift it to connection-seeking, and I appreciate that much more.
Erica: Yeah.
Alyssa: I think that during my schooling, and during my early years as a music therapist, I wasn’t really thinking as critically about behaviors. Every behavior has a purpose. You know, obviously there are some behaviors - in my opinion, if a behavior is harming yourself or harming someone else, that is a behavior that’s gonna need to change - you’re gonna need to find a different - something different.
Erica: Yeah.
Alyssa: I have concerns about sort of the ways - what we, as a society, decide are good versus bad, or what - what’s considered maladaptive, um or needs to be changed. Um, in my current work, I’ve been starting to be more focused, not just on sort of looking at behaviors and changing them, but just really getting deeper into the why, and what function they’re serving. But, I guess my thinking around how I approach my work has - has become a little more I guess nuanced - I don’t know if that’s the word I’m looking for. But it’s just shifted a lot towards just the bigger picture, rather than just behaviors and kind of fixing these like things in the moment.
And it’s been a lot of - a lot of critical conversation. And its been helpful to have these conversations, because, especially when you’re in your own brain all the time, feeling like you’re the only one thinking this, and not wanting to say anything - because so many - you know, I even told you this listening to the podcast, I’m like, everyone just sounds so sure of what they’re doing. Everyone sounds like, you know, they are the experts. And I’ve never felt that way as a music therapist. I’ve never felt super confident in what I’m doing. Which, it makes sense now, right? Like, maybe I wasn’t realizing that this was part of why I was questioning things at the time. But it makes sense for us to question things when we’re being taught how to quote unquote do therapy in this environment that doesn’t work for everyone - this society —
Erica: Mmm —
Alyssa: That doesn’t - that doesn’t work to uplift everyone.
Erica: Mmm.
Alyssa: But, I don’t know. I wonder if these conversations are being had right now with students in their programs. I - I would love to see, you know, what it looks like right now for music therapy students. Um, are we getting past sort of those just like, [puts on a voice] alright, everyone, do lyric analysis. You know, everyone do this intervention, and now we’re gonna learn how to do this - you know, like —
Erica: Mmhmm —
Alyssa: Are we getting past some of those things, and really starting to think more critically about every approach? Another thing is: every program is different, and every program is gonna have - like, it - it’s hard when we’re all in this profession with - receiving very different educations I would say? Like, we’re all - there’s different approaches to music therapy. You know, I think there are some programs that focus on one approach, and some that are more - more broad, in terms of like theoretical orientations. But, you know, I hope that current students are really given the opportunity to explore a lot of different approaches. And starting to maybe view learning music therapy and learning music therapy approaches similarly to learning music theory.
Erica: Mmhmm —
Alyssa: Like, learning the structure to be able to shift it and break it in some ways. Or take what works and leave what doesn’t. And really keep things focused on your client, and really start to operate from the perspective of like your client knows what they need, um and you’re there to partner with them. Um, and I think CBT - you know, not to say that like CBT therapists don’t do that. But um… anyway, that was a lot.
Erica: Oh, it’s good though. It’s a good a lot. Um, yeah. Well, I appreciate you taking time to like have this conversation. It’s a very big - there’s a lot of facets to —
Alyssa: Yeah —!
Erica: Talking about this. And yeah, I just appreciate you taking time to think about it and then share what’s on your mind with us.
If you’d like to know more about the Music Project, please visit our website at S as in Sam C as in cat Music Project dot org (SCMusicProject.org). On our website, you can also find transcripts for every podcast episode. Also, as a reminder, connect with us on social media so you don’t miss any new episodes after our break.
Thanks again to Alyssa for being here today. Thank you, listeners, for listening. And we’ll talk to you next time.
[Podcast outro music plays]