Ep. 013 | Music Therapy & Mental Health

Today, we chat with guest, Amy Hines, a board-certified music therapist, about the intersections of music therapy and mental health.

LEARN MORE

Music Therapy & Mental Health by the American Music Therapy Association | Online Article

Edwards, J. (2006). Music Therapy in the Treatment and Management of Mental Disorders. Irish Journal of Psychological Medicine, 23(1). | Journal Article

McIntyre, J. (2007). Creating Order out of Chaos: Music Therapy with Adolescent Boys Diagnosed with a Behaviour Disorder and/or Emotional Disorder. Music Therapy Today, 8(1). | Journal Article

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, in honor of national mental health month during May, this week we are starting a 4 part series on various topics within the field of mental health care. Today, we are talking about Music Therapy in Mental Health, with board certified music therapist, Amy Hines.

Amy works with people facing a wide variety of challenges, including dementia, developmental challenges, mental health concerns, and transitions from homelessness. She has worked with adults in both civil and forensic mental health settings, using a wide variety of musical strategies to address cognitive, social, and emotional needs.

[Podcast intro music plays]

Erica: Well, thank you, Amy for joining me today.

Amy: Yeah!

Erica: We are practicing our social distancing and podcasting from Zoom for the first time, so we will just see how this goes. Please bear with us if um anything goes awry in the middle of our conversation. Today, we’re just going to do like a basic overview of music therapy in mental health, and what that means and what that looks like. To help get everybody on the same plane - on the same - a common understanding of words we’re gonna be frequently using, could you describe for us, what does the term mental health mean? And what does the term mental illness mean? Are there any differences within those two terms?

Amy: Mmhmm. Yeah, it’s kinda vague, and there’s some disagreement on it. But I think I think it’s important to kinda start with that overarching theme, because the first thing you think of when you think of mental health is you think of people with mental illness – and like, what can go wrong with mental health. And so, um, people don’t really think about mental health as being something broad and something that belongs to all of us, but it - it is something that everybody struggles with, and it is something that nobody can do perfectly. It’s kind of a challenge for everyone - and there isn’t one like specific, concrete def - definition of mental health everybody agrees on. But I think it has to do a lot with coping with reality and all the stresses that that entails, having a positive relationship with yourself and others, and being able to face challenges as they come.

Mental illness is kind of a term for really anything that can go wrong - anything in your brain or in your mind that makes it difficult to go through your day to day life - school, work, relationships, basic taking care of yourself - like eating and personal hygiene - things like that. And so, usually, when the term mental illness is used, that is somebody that has something that makes it really really challenging - more challenging than it is for most people - to just live life. And that can be either acute, which is when it comes on suddenly and doesn’t last for very long, or it can be chronic - it can be something that lasts for years of your life, or maybe effects your entire life for the rest of your life. So those are kind of what those terms are talking about.

Erica: Okay. Would it be an accurate statement that mental illness falls like under the umbrella of a mental health issue? So - like the idea of all squares are rectangles, but not all rectangles are squares kind of? Where like, every - everybody has mental health, and then your status of that is kind of always in flux and might be better some days, worse some days - but you can have mental health, and then within that, you may have a mental illness that is also, um, more severely or more chronically in its impact of your mental health? Does that make sense?

Amy: That’s kind of how it is. Yeah. Mental health is just a very - very broad term, and usually when people say, like I work in mental health, you know, you’re usually talking about people who deal with those illnesses. —

Erica: Mmm —

Amy: So, mental health is a very broad term - it’s not very even necessarily really a clinical term. It’s - it’s just applies to everyone. If you say somebody has a mental illness or a mental health condition, that’s something that - that is diagnosed by the Diagnostic and Statistical Manual for mental disorders - it is something that’s diagnosed under a standardized system for diagnosing and treating certain types of conditions.

Erica: Mmm.

Amy: That is more clinical and generally, it’s something pretty severe. If you have a mental health disorder, uh, especially a severe one, that’s something that really impacts your whole life.

Erica: Mmm. Can you tell me more about the setting - or settings that you are specifically working in, and in those settings, how is music therapy supporting people that your working with?

Amy: So, right now, one of the main things that I do is work at an acute psychiatric facility. So, those are people who have a - a sudden mental health crisis - might be drug related, might be suicide attempt, it - it’s a lot of things - um, it’s something that’s really affecting their life. And the average length of stay is usually just a few days, before they either -either transfer to another living situation or more long term care facility, or going back into the community or to their home. So it’s to basically help them work through their coping skills and some of the things that they deal with before sending them on to somewhere else.

Erica: Mmm.

Amy: Another thing that I do right now, that is somewhat related to mental health, is working at a residential facility for uh adults who were formerly homeless. So people who are transitioning out of homelessness and trying to have a more stable life, and uh at that facility, everybody has a mental health diagnosis as well. So that’s another type of setting you could do that type of work in.

Erica: Mmm. And so are you working with other professionals within those settings? What sort of interventions are you using? Um, how do you - you walk into the facility and like, what are you doing?

Amy: Mmhmm, yeah. Good question.

[Erica chuckles]

Amy: So, yes, there is a lot of uh - um at the homeless facility specifically, there’s not a whole lot of things, and so I’m kind of um - one of the main things that is being done there. But that’s pretty rare. Usually, yes, you are working with - a bunch of different types of people - are working on the - at the same facility to work on the treatment of an individual. So, um I’ve, you know, worked with some psychiatrists, psychologists, social workers, rec therapists, art therapists, dance therapists, other music therapists, and chaplains sometimes —

Erica: Mmm —

Amy: And all kinds of other types of people, the goal being to have a really comprehensive care for the individual and sort of treat the whole person with a bunch of different people working in different specialties. And so, because, right now I work for Snohomish County Music Project, I don’t work for a facility - it’s a little bit different —

Erica: Mmhmm —

Amy: So I’m not, like, on a team with other professionals - I’m not working with them as directly, I just kind of go to the place, and I’m like, hey! And have my instruments and kind of um just go do my thing while I’m there - do the music therapy while I’m there - and do my best to get a sense of what the culture is like there, what the treatment is like, and how music therapy can kind of fit in with that.

Erica: Mmm. And so can you tell me more about the specific types of interventions that you’re doing?

Amy: Yes. Music therapy is - is really broad, and it will depend on whatever I think the goals are for the people that I’m working with, and what types of needs they have - what they’re able to do - all those things. I use recorded music sometimes - like I’ll take a song in - or pieces of music and will do something with that - interact with that in some way. Or maybe I will bring my guitar - I will bring my keyboard - I’ll bring ukuleles or drums or things to do with people, and we will interact with it in a much more direct way. It always has something to do with music, and it’s always using the unique properties of music and people’s relationships with music to address some of those important needs that people are having when they’re in this time of - of transition.

And so, a few of the - to give you an example of some of the types of things I might do. Songwriting - I like songwriting a lot because you can do a lot of different types of things - work on different types of goals. Uh for people, for example, who may have schizophrenia or a disorder similar to schizophrenia - they may struggle with sort of cognitive challenges and not always be oriented to reality - not be, you know, out, dealing with things that are actually real. And so, songwriting can help with that - it can help with the higher level cognitive stuff, like decision making, thinking about things in a sequence, thinking about things in certain categories - organizing ideas - those types of things. You can also use songwriting to work on more social interaction type of stuff, which is also something that’s impacted by mental disorders.

And um, one thing I love to do with songwriting is just use it for kind of deeper processing as well. And that’s where you can kind of take some of the things that you - that they have been learning in like maybe they’re other types of treatments, or more verbal types of treatments - some of the things they’ve been thinking about and use music as a structured way - of - motivating and memorable way to think about their strengths, the challenges they’re going to face, what changes that they wanna make in their life - things like that. And - and use songwriting as a way to really delve into that —

Erica: Mmm —

Amy: In themes in sort of a more structured way. Other things that I like to do are things like learning a song, over the course of 1 or 2 sessions, or bringing in - like walking in and saying, okay, today, we’re going to all write something together - some piece of music - and by the end of today, it’ll be finished. And it’ll be what we want it to be. And so - and then, kind of through the process of working through that, you can kinda see what people’s strengths are - you can also see what some of their challenges might be – maybe because of their mental disorder, or because of the situation that they’re in, maybe they’re very withdrawn - maybe they’re, you know, narcissistic and playing louder than everybody else - maybe they’re aggressive, or they don’t have a tolerance built up for being able to keep trying at something, even through negative self talk, and through not being successful. You can kind of use the music to work through those things, workshop them, and give people ideas for different ways that they can approach them to address like social emotional things that are coming up through the process.

So, those are like a few of the things that I like to do.

Erica: Sure.

Amy: Mmhmm.

Erica: Can you tell me uh more about like what are the challenges in the work that you’re doing? What are things that you have to figure out and adapt to - especially - I’m curious, given everything that’s happening with the pandemic, what are some good things you’re seeing out of how other professionals are adapting, and what are some of the related challenges to that?

Amy: It’s definitely challenging to work - every - every type of person that you’re working with as a music therapist - there’s different challenges with working with different types of people and different settings. I would say, some of the - the biggest things that are difficult for me would be in acute psychiatric work specifically, is that I don’t really get the chance to get to know the patience that well - I don’t get to build up a relationship with them that much. And so that does affect things. I only work 2 days a week at - at the psychiatric hospital, and so, when I walk in, a lot of times they don’t know me - they don’t know who I.am - I’m like, hi, I’m here to do music, and they don’t like know anything. And so, like it can take a while to build up a rapport, and by then, maybe they’ve discharged and gone somewhere else.

So you’re always kind of rolling with the punches - you’re always kind of um working up - like finding new ways to um - to - you’re meeting new people a lot of the time, and you’re - you’re trying to find ways to adapt to that, and you don’t always know, because you don’t know the group, you don’t always know what goals t to work on - what they’re energy level’s gonna be like - what they’re stability level is going to be like. So you may walk in and have something planned and you may have to change it, or maybe you kind of go with it but it wasn’t the best thing, and then you have to like kind of keep changing and working as you go, instead of being able to build up a relationship with people that you see all the time and just working kind of steadily through that.

And so there’s a lot of challenges - there is a lot of um things that just happen with people becoming assaultive, or very emotional, or just a lot of things that arise that you kind of have to be a staff member there and present and ready to work through all of those sudden unexpected things that might happen within the course of the day. And uh, music can also be something that is sort of  t - triggering to people emotionally sometimes, and so sudden emotional changes can sometimes happen. And so I do feel like I have to be m - more careful and more aware - music therapists are always careful and aware of the music —

Erica: Mmm —

Amy: That they use, um, but it it - in this type of setting, even more so because there are - like there’s fragilities there, and there are things that can happen re - specifically related to the musical triggers or - or not —

Erica: Mmm —

Amy: Or other things as well. So, those are [chuckles] some of kind of things that um makes it a little bit challenging to work in that type of setting. As far as the pandemic goes, I think - I - I have not personally been, you know, to work there in person - or to work at some of my usual psychiatric settings - sites - um since it started. And um - and so, I’m kind of - in every - things are changing for me specifically - and just try to set up some more of that like individual one work - one on one work instead.

And, as far as kind of mental health in general, it is uh a hard time for people because they are experiencing increased isolation and being cut off from social support and from their coping skills, at the same time that people are experiencing increased fear and anxiety right now. And so yeah, this is something that we need to really be aware of right now is - how is this impacting your mental health, and what can you do within the limited resources that we have to - to - to address that - to address individual mental health. I think it’s going to really take its toll on - on people’s mental health and might have long term consequences for that, so…

Erica: Mmm. So, from the perspective of the clinician using music, um do you have any specific recommendations for listeners - the general community - about how they can be intentionally using music, both during the pandemic, but also just like in their non-pandemic related lives - to support their mental health? Because eventually, the pandemic will be over, um but that doesn’t mean that they can’t continue using music to support them and cope with other stressors that may come up in their lives.

Amy: Yeah. That’s super optimistic of you. We’re gonna get through this —

Erica: Mmhmm —

Amy: And this pandemic will be over at some point. Yeah. At the time of recording this, that is kind of the reality of what’s going on right now, and it is - it is affecting people - if you’re listening to this in the future then you’ve gone through it and that’s great.

[Erica and Amy chuckle]

Amy: Um, like I said, it is impacting mental health right now —

Erica: Yeah —

Amy: And people have little bit more time on their hands, so what better time to like become more aware of yourself and your own mental health. And using music to do that is something that - people are so used to thinking about music as like just an entertainment thing - like a throwaway entertainment thing - and hey, I don’t feel good or maybe I’m just bored, so I’m gonna listen to my favorite music and I’ll feel better. That is - that can be helpful to do that - listening to your own preferred music.

If you want to take it a step further, becoming more aware of specifically how the music interacts with you - your emotions - how it makes you feel, and how it interacts with your body - and one way to start doing that is to start thinking of the iso principle. I think we talked about that in past episodes as - as well, but basically, it’s the idea - it’s sort of a - a principle that’s talked about a lot in music therapy that has to do with matching the state that somebody is in, and then gradually moving that state towards a different state. So, to make that all a little bit less esoteric and like mumbo jumbo —

[Erica chuckles]

Amy: The - the way that you can think about that is - like maybe, what is your energy level like - are you in like a high arousal, negative state - like anxiety, or stress, or frustration, anger - are you in kind of uh a low like emotional state like boredom, or depression, or lethargy… And the way that you can kind of match the music to that is by the speed of the music - how fast or how slow it’s going. And so, if you kind of go by the iso principle, you might - if you’re in that high state of being really stressed out, you start to listen to really fast music, and maybe you listen to like 2 or 3 songs of really fast music, and what your body does is it will match up its rhythms - like breathing and heart rate - things like that - with what’s going on - rhythms in this - in this  external environment. So if you listen to something - if you’re in like a high arousal state and you listen to something that’s fast, your body can match up with that pretty easily, then what do you do, you just slow it down.

Erica: Mmm.

Amy: So maybe you listen to a couple of songs that are little less fast, and then a couple songs that are medium, and then a couple songs that are slower. Your emotions and your body are gonna go along for the ride. But if you’re really bored and you wake up and you’re like aaaah coronavirus! Then maybe you use that backwards, and work your way up to faster music. And so that’s one way to be more intentional about the type of music you listen to, rather than just I’m gonna listen to music.

And another thing that has been um shown - seems to be supported in a couple of uh really well known music therapy uh research studies, is that, when it comes to reducing your anxiety level, live music is more likely to work better with that than recorded music. And by live music, I mean somebody’s in the room with you playing an instrument, rather than listening on like a streaming app or YouTube or whatever.

Erica: Sure.

Amy: So, if you —

Erica: That’s interesting —

Amy: Yeah. So if you have access to an instrument that you can play, or an instrument that somebody else can play, take advantage of that, because there are a lot of - a lot of benefits to listening to music that’s being played by a person whose with you. And if you don’t have that type of access, get creative with pots, pans, body percussion - there’s lots of instruments online for making instruments.

And also, one instrument that almost everybody has access to is their voice. So, don’t worry if you don’t think you’re a good singer - if you don’t think people will wanna hear you - singing is healthy for everyone. And among other things, it forces you to take deep breaths and m - and measure - go for really long times - take long, slow breaths out. And so, it’s using music - it’s deepening your breath, and that can help you just in and of itself feel more stable and more grounded, because you can’t sing without doing that. So, experiment - find different things that work with you - both musically and non-musically, but be conscientious about it and consider using music —

Erica: Yeah —

Amy: Because music helps mental health.

Erica: Do lots of karaoke is what I’m hearing.

Amy: Yes. Absolutely.

Erica: Yes. [Chuckles] Um, we also - speaking - thinking of things people can do if they are at home and don’t feel particularly musically gifted - or shy about musically expressive - is the Snohomish County Music Project does have aYoutube channel, and we have just put up a bunch of new videos for kids, for adults, teenagers.

If you would like resources in addition to our Youtube channel, Amy’s gonna provide me some links. You can find those in the episode notes - they’ll also be on our website. The website is S as in Sam - C as in Cat - Music Project dot org (scmusicproject.org). If you are interested in learning more about the Snohomish County Music Project, you can follow us on all major social media platforms @SCMusicProject.

Um, please stay tuned for more episodes coming this month. In addition to Amy, we’re talking to other music therapists around the Puget Sound. Thank you so much, Amy, for chatting with us and sharing about all the things that you know. Thank you, listeners, for listening, and we will talk to you next time.

[Podcast outro music plays]