Ep. 61 | Music Therapy and Harm Model

Today, we chat with Brea Murakami about the music therapy and harm model she developed, and its applications.

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 Brea Murakami about the music therapy and harm model she developed, and its applications.

Brea is a board-certified music therapist and the director of the Music Therapy program at Pacific University in Oregon. Her clinical work has focused on dementia care and neuro-rehabilitation. In her free time, she enjoys practicing yoga and baking.

[Podcast intro music plays]

Erica: Well, welcome, Brea, to the podcast. Thank you for being here, I really appreciate your time. I’m excited – we’re gonna talk about the article that you recently published about the music therapy and harm model. But I wanted to ask you first – I ask this question to everybody that comes on – is: how did you originally become interested in music therapy?

Brea: Yeah, uh, thank you so much for having me on. I am one of those nerds that knew I wanted to be a music therapist like before I went off to college, which is really lucky, ‘cause I know some folks don’t hear about it until, you know, halfway into their first career or something.

Erica: Mmhmm.

Brea: So, I found out about music therapy from a book I got at Border’s – back when bookstores were a thing. I knew I wanted to do something in music,but I had very bad performance anxiety. So I, you know, just got a book called like Careers in the Music Industry – it’s probably still at my parents’ house if I rummaged around – was flipping through, and I saw this, you know, profile on music therapy, and I had never heard of it before. It just really captured me that, you know, you can help people with music – that you can think about health in a different way that isn’t like cutting them open with surgery, or like—

Erica: Mmm—

Brea: Directly changing their chemistry through medication or something like that. So, you know, just kinda started asking everyone I knew, hey, I’m interested in this thing called music therapy. Through my network, I was able to do some observations, and then just – that’s uh – I’ve been involved in music therapy for half my life — as a student, and then, you know, as a professional.

ERICA; Yeah, totally – absolutely. So I’m curious: why did you develop the music therapy and harm model?

Brea: Yeah, developing this model uh was a process of multiple, multiple years. You know, in academia, they say publish or perish, so— [chuckles]

[Erica chuckles]

Brea: But yeah, it started off because I was doing advocacy work for music therapy, uh going to the state capitol in Illinois, where I lived at the time, and so we were trying to advocate for music therapy license. If you’ve ever done legislation stuff, it’s like you’re running around these like marble floorways just trying to get like 3 minutes in with a decision-maker. So I got one of those meetings, and they asked me, you know, a license is about protecting the public from something — what harm can music therapy do?

And it felt like a gotcha question, but it was, I think, a very fair question. And I really was like grasping at like, sometimes there’s like – you know, seizures can come from listening to music, but like, maybe I, as a music therapist can avoid that. And so it kinda just opened up this like, hey, there’s a huge gap in our understanding of the possibilities of what music can do. ‘Cause like, music therapists focus a lot on how we can help folks with music as our tool for change, but it really made me realize, hey, what about the reverse side? What about, you know, if music can cause harm, or whether it can be the basis for harm? So, you know, 5 years later uh was able to publish my manuscript. But there’s just a lot to kind of wrestle with and think about  which, hopefully the paper starts the conversation around that.

Erica: Totally. Yeah, we talk about harm at the Music Project frequently — especially because we have a full time internship program, it’s really important that, as the music therapists - and then the interns that are coming - as they’re developing their skills and awareness of different things, that we recognize both um the ethics of things, and contextualizing like, clients don’t just show up in a vacuum where they just need music — they show up in a vacuum coming with all of who they are, and all of their different identities, and what that all means. And so harm plays into all of those different layers. Which you kind of go through a little bit, talking about how important context is, and cultural competency is, when thinking about harm.

Um, before we keep using the word harm too often, I want to acknowledge that harm is just kind of an ambiguous term: it can be kinda subjective, depending on the context. So how are you defining what harm is?

Brea: Yeah. That was something that I had to sit with for a long time. So I ended up going to the like psychotherapy literature because there wasn’t – originally, when I went out to understand this topic, there wasn’t a lot in the music therapy literature. So I looked at kind of like hey, how are psychotherapists talking about this subject.

Erica: Mmhmm.

Brea: So, first there’s this idea of a negative effect. A negative effect is a negative experience that a client or a person has that they believe is caused by an interaction in their care. So, you know, a negative effect might be: you go to physical therapy and you’re sore after, you know, your first or second session, but that soreness is like in service of making, you know, you stronger — for helping that healing process. Harm, on the other hand, I think, are negative effects that don’t really have a purpose — they’re not really like in service of the goals of why you’re in music therapy.
And so, in my paper, I kind of separate those out into physical versus psychological harm – or both could happen. The model kind of outlines where these – both of these types of harm can arise. But, as far as I’ve figured so far, it manifests in us as humans either like in a physical way: so it might be getting physically injured. Or, you know, physical harm might be, you know, if I’m working with someone with a stroke and I practice an error too many times, maybe I’m like rewiring their brain in an unhelpful way—

Erica: Mmm—

Brea: Where they’re not able to communicate as fluently. You know, we might be able to measure physical harm by like telemetry, and like heartrate, you know issues,  or cortisol — if we somehow could  do that in a session — but, you know, we’re seeing it in the body, or some kind of physiological system. 

On the other hand, psychological harm would be similar: some kind of negative experience the client has that they attribute to being in music therapy, but it manifests in like our psychological or emotional selves. So it might be like triggering past trauma, it could be becoming emotionally dysregulated: we might capture that through client report, or maybe therapist observations, or in their lyrics that they write. So it’s a little harder to pinpoint psychological harm, but again, like, that’s how it can manifest—

Erica: Yeah—

Brea: In folks we work with.

Erica: That makes a lot of sense. We’re going to include – if it’s okay with you, I’m gonna pull the graphic from the paper and put it – imbed it into the transcript, so listeners can go to the transcript um and see it, if looking at it visually is most helpful to you. But, can you give us a brief description of what the model is?

Brea: So, when you’re thinking of the model, think of an equilateral triangle, with like kind of these 3 orbit rings around the whole triangle — something like that—

Erica: Mmhmm—

Brea: My shape could be applied to any music therapy session. So, let’s talk about the triangle. The corners of the triangle are the ingredients that are present in every single music therapy session, or else it’s not music therapy. Uh, so at like the top corner would be the client, you know, someone who’s seeking help. The bottom left corner is the music, right, our tool for change. And then the right corner of the triangle is the music therapist. And we got 3 corners.

The sides of the triangle are kind of the interactions between those 3 players/those 3 ingredients. Uh, so on the right side of the triangle, between the client and thetherapist at the bottom corner: that’s the therapeutic relationship. Um, on the bottom of the triangle — that side connects the therapist to the music: that’s what I call the therapeutic application of music — it’s like the therapeutic, or the strategic, or musical decisions that the music therapist is making. And then, the third side on the left connects the client and the music, and these are what I call the client-specific associations with music: um, so like their musical preferences, their conditioned responses to music — things like that that are kind of harder to predict—

Erica: Mmm—

Brea: Um, and then those 3 kind of orbital rings um outside um surrounding the entire triangle are what I call ecological factors. And so this is like those complex, multi-layered, just contextual environments. So like, the most immediate environment — the smallest ring around the whole triangle — could be the immediate session environment, what’s the temperature in the room? Are there other group members, if we’re doing group music therapy? Are there other staff members? What’s the time of day? Like, the physical environment. Uh, maybe another layer out, these are parts about the clients’ cultural identities, or my cultural identity, and how those are interacting in the space. And then the third/outermost ring are like these huge societal factors: what is the clients’ access to healthcare — you know, maybe their insurance only pays for 5 music therapy sessions, we have a breakthrough on the 4th one, and then their inability to pay or the lack of funding might be a source of harm, because we can’t continue to do that work. Something like that.

Erica: mmm. Yeah, it’s a real thing to think about the – how different systems of oppression or axes’ of oppression work against a client to keep them out of receiving support for mental health issues or physical health issues that they may be wanting. In your paper – I loved this quote! I underlined it so many times [chuckles]—

Brea: Okay [chuckles]

Erica: It says uh, “negative effects may not always be harmful, but harm always arises from a negative effect.”

Brea: Mmhmm.

Erica: So I’m wondering: why is considering how harm happens important?

Brea: I – I like being as articulate as possible, ‘cause I feel that so much information out there—

Erica: Mmm—

Brea: The world is so complicated. And so I try to make these very, almost formulaic, definitions of harm. But the truth is: is that all of this is contextual, and it’s subjective to some degree — so even whether harm has even occurred. I might, you know, apologize to a client — oh, I’m so sorry that I – you know, I didn’t mean for that negative interaction to happen. They might not have even noticed it, or, you know, I might be projecting my own stuff onto that situation. You know, maybe the reverse is happening. Maybe I didn’t even realize that I had caused harm, but based on some kind of piece of the client’s background or their temperament. SO all of this is really complex.

And we need to understand how harm happens if we’re gonna be able to predict it, if we’re gonna avoid it, if we’re gonna respond to it. And yeah, that quotation about - negative effects exist, right – challenging experiences/negative experiences are just a part of life. And my paper – I didn’t want, you know, clinicians, including myself, to say, you know, harm! That sounds like such a scary word. You know, the point isn’t to like bubble-wrap the clients’ experiences; there’s still gonna be tough things to get through or tough things to process. It’s really about, you know, finding that balance, and responding when we are aware that harm is happening, and minimizing it as much as possible.

You know, this is a conversation I wanna keep having amongst the music therapy community: how are we talking about this? How can we define this as a group of clinicians — together? ‘Cause it’s just really complicated. But, you know, before this paper came out, there wasn’t even like  much of an acknowledgement that it could happen—

Erica: Mmm—

Brea: Or it was like very anecdotal. So this is just like an initial like, hey, here’s some like labels we can put on this – here’s one way to talk about this – let’s see where it goes. This is kinda my ideas - in kinda opening it up to the community of clinicians — and clients — um, so we can at least – if we don’t have labels to point at things or talk about it, it’s really hard to have that shared terminology and move forward with what do we do now? What are our best practices?

Erica: Totally. In your experience thus far in talking about harm, what are some of the ways that clinicians, students, interns, or yourself are talking about and thinking about the ways to minimize potential for harm?

Brea: You know, in the paper I give some examples of what harm can look like – you know, times that I’ve caused harm or allowed harm to occur. And writing that made me feel really vulnerable. Like putting it out there like, hey, sometimes I do a bad job, or I, you know, my intent doesn’t match the impact of an intervention I’m trying to lead. So I’m hoping that kind of normalizing those experiences, right – ‘cause there’s gonna be a spectrum of the intensity of the harm—

Erica: Mmhmm—

Brea: It might be something like oh, that – the timbre of the drum you’re playing is way too loud, we switch out the instrument, we fix the harm  in that situation. Versus ongoing, chronic, like a really unhealthy therapeutic relationship might, you know, cause damage to the client that lasts like for years – or time after the session.

So, just knowing that it’s a possibility, and doing your best to recognize that – um, I think coming to terms with that emotion: like, sometimes, my intent is not gonna match the impact – I think that’s already like kind of an uphill thing to accept about oneself. ‘Cause in helping professions we wanna believe that we’re always being helpful. I think also, regularly inviting authentic feedback from our clients to let us know, hey, you know, this intervention isn’t working out for me, or verifying their experience. And so, if they say, oh, you know, I’m not feeling great – okay, is that in purpose of the goal/is it part of the processing, or is it something that I can be aware of and be responsive to, and change out a song?

Or, sometimes like, you know, if we’re just in the beginning of that therapeutic relationship with our client, they might still be getting a feel for us, and whether they can be transparent and authentic about stuff like that. ‘Cause sometimes, our clients wanna, I don’t know, please us to some level. Like, I’ve – I’ve been in talk therapy before, and I’m like, oh, I hope my therapist likes me—!

[Erica chuckles]

Brea: Like it’s a really complicated back and forth thing.

Erica: Yeah.

Brea: Um, so, you know, having that be a part of the therapeutic relationship, or also, I think, sometimes seeking out peer supervision, if you’re a professional, or if you’re a student, having these conversations with your supervisor about like what the looked like, and just – just talking about it, I think, can normalize it, and make it much more immediate and relevant to our practice.  Harm isn’t just this theoretical thing. It’s probably happening every day on some level. We wanna just reduce the intensity/reduce the occurrence as much as possible.

Erica: Yeah. I really resonate with what you said about the vulnerability of admitting um that you have caused harm or been involved in a harmful process. And I agree with you that normalizing it is super important. And I think normalizing the ability to recognize your responsibility in causing harm is super important, both within therapeutic relationship contexts, but also in general. It’s a generally great skill to have if you can recognize harm within other types of relationships, and be able to recognize it, uh speak to the person about it if appropriate—

Brea: Mmhmm—

Erica: And resolve said situation if possible. Um—

Brea: Yeah. And just to like kind of jump in on that, I feel like a lot of American culture – or, at least, I don’t know, I like grew up in like a suburban, you know, nice, Christian-centric, white neighborhood kinda thing – like, I feel like I didn’t really see like outright healthy conflict, you know—

Erica: Mmhmm—

Brea: Um, at least in my own family. Or like, oh, just don’t mention it – just don’t kinda fix things behind the scenes, don’t bring it to something directly. And so I think there are probably cultural things that all of us are probably intrenched in. And yeah, just like, talking about it can kinda – we don’t have to be super protective – it doesn’t mean we’re a bad person, you know - we should be doing our best to remediate that harm or to – to do better in the future. But um, you know, at least, I don’t wanna feel like I’m a bad person, but like, I also know that like I’ve caused harm or allowed harm to happen. So like, it’s kinda like this dialectical – these 2 things can be true at once.

Erica: Yeah, holding space for both things at the same time—

Brea: Mmhmm.

Erica: Yeah, absolutely. I agree with you. In your role within the music therapy community kinda at large across the United States, um, how do you see the model supporting current music therapy curriculum, and also professional development opportunities to support building culturally competent therapists?

Brea: Yeah. So I’m a faculty member um at Pacific University, where we have a music therapy program. And so, a lot of times, my students will say – you know, they’ll ask me any – almost any question about music therapy, and I try and say like, it depends – and like that’s the annoying answer I give.

[Erica chuckles]

Brea: Because so much of our work — so much of music — is based on the things that are surrounding it—

Erica: Mmhmm—

Brea: The – the context that it’s in. So I’m hoping that, you know, within that complexity, my model and my definitions for harm can like allow us to like solidify that a little bit, like something to anchor these conversations onto. SO you know, maybe something didn’t go quite as planned, and during clinical seminar/debriefing, we can say, like hey, let’s look at the model, like what kind of pieces do you think weren’t operating at their best? Um, what other components of the model might we have changed or tweaked to make that a more clinically-relevant experience for the client?

Again, it’s not necessarily like having a Pollyanna, happy, pleasant experience—

Erica: Mmhmm.

Brea: Um, having fun is a great part of music therapy; it can be motivating. But again, it’s about clinical relevance towards the goal.

Erica: Mmhmm.

Brea: Also, just um, yeah, just something to kinda like point to – just something to wrestle with, and then talk about the subtleties or the shades of gray in between that. Um, ‘cause that’s the truth of it. But hopefully, like just making these kind of categorical things. Yeah, we can’t always stay abstract. We need to be able to point at something, or hold onto something, um so we have that shared terminology.

Erica: Yeah. I love that – that shared like mutual understanding of what you’re talking about, so that you’re kind of able to um understand each other, and not be like, well what are you talking about, and what are you talking about, and yeah. I was just having a conversation earlier this week about therapy in general with somebody, and I was like, yes, everything is an it depends answer — which it frustrates me sometimes when I have to give an it depends answer. But I think it’s super important, especially in any sort of helping profession, that it depends because we really care about the people that we’re working with, and no one person comes to us the same as the person that came before them, that stands in line next to them, or like, everybody is different. And they deserve the recognition of their differences and how that makes them, them.

Brea: Yeah. Or even, I’m a different person form week to week—

Erica: True, yes—

Brea: Or sometimes hour to hour, depending on whether it’s before lunch or afte lunch.

[Erica chuckles]

Brea: Um, so, you know, like the ground’s always like a little bit wobbly. We can never walk into a session and be like, I know exactly how this is gonna go—

Erica: Yeah—

Brea: ‘Cause that’s not the world we live in — we don’t live in some like 8-bit videogame version of reality.

Erica: Totally.

Brea: Yeah, but it’s always – you know, as the clinician, it’s always my responsibility to maintain the safety of the session, of the environment, of the group.

Erica: Yeah, totally. Um, we are coming to the end of our time today, so I just have a couple more questions for you.

Brea: Sure.

Erica: My next question is: what have you learned in your process that you would want to offer to others?

Brea: Something I’ve really realized through all of this, and thinking, well, how does this – how does this apply to, you know, music in healthcare at large? I really have come to appreciate that lots of people — volunteers, or musicians, or whomever — there’s a lot of good that can be done with music to help out other people. And that’s – you know, I talked earlier – like that’s what I thought music therapy was, like helping other  through music. I really think that, you know, music therapists are the most formally educated, I’ll say, of the music healthcare professionals, and I think that this – our ability to recognize and minimize harm as much as possible, or to respond to harm, is actually the thing that should define our profession, more than our ability to do good. Of course we wanna maximize the good, but we should be emphasizing this or having these conversations more. I know it’s happening — I’m just kinda like – this was never mentioned to me in neither of my degrees, um, or none of my supervisory relationships, but I really think that our ability to respond to ham in a positive  therapeutically-helpful way, is actually the thing that defines music therapists more. We shouldn’t have to feel like we have to compete with volunteers with good social skills — that are also doing good work — but, again, they don’t have that formal education and that experience of like framing what’s happening in terms of harm reduction.

Erica: Yeah, that’s a good point. And the last question is: how can listeners connect with you online?

Brea: Yeah. Uh, I’m on Twitter, so if you wanna follow me @BreaMurakami — uh so just my name. Um, I have my own podcast if you’re interested in hearing about some music and science stuff. Um, I haven’t put out any new episodes recently, but it’s called Instru-Mental – you can find it at InstrumentalPodcast.com, it’s got kind of like a yellow lightbulb with headphones icon, or you can find it wherever you find your podcasts. [Chuckles]

[Erica chuckles]

Brea: Uh, my email is Murakami, my last name, M-U-R-A-K-A-M-I @pacificu.edu if you wanted to reach out and just chat or uh connect.

Erica: Awesome. Perfect, well, thank you so much for being here, and for sharing all this and everything you’ve learned. I really appreciate your time and uh contributions to music therapy, it’s much appreciated.

Brea: Yeah. Thanks for having me on, it was really nice to get to know you and to share this with your listeners.

Erica: 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. If you want to follow along and receive notifications when new episodes are released, we encourage you to subscribe and follow us on social media @SCMusicProject.

Thanks again to Brea for being here today. Thank you, listeners, for listening. And we will talk to you next time.

[Podcast outro music plays]