Ep. 015 | Music Therapy in Acute Psychiatric Care
Today, we chat with guest, Britta Erikson, a board-certified music therapist, about the necessity of trauma-informed care during involuntary hospitalization.
LEARN MORE
DBT Skills Training Manual by M. Linehan | Book
Building A Life Worth Living: A Memoir by M. Linehan | Book
Creative DBT Activities Using Music: Interventions for Enhancing Engagement and Effectiveness in Therapy by D. Spiegel, S. Makary, & L. Bonavitacola | Book
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, this week we are talking about Music Therapy in Acute Psychiatric Care, with board certified therapist, Britta Erikson, as the third episode in our four part series all about various topics within the field of mental health care.
Britta is a board-certified music therapist at a behavioral health hospital. Originally from Boston, she received her Bachelors in Music Therapy at Loyola University; Britta completed her clinical internship at the Snohomish County Music Project, and Music Works Northwest, in the greater Seattle area. Starting this fall, she is pursuing her Masters Degree in Music Therapy at Temple University.
[Podcast intro music plays]
Erica: Welcome, Britta. Thanks for being on the podcast with us!
Britta: Of course! I’m a - I’m a fan of the podcast - a friend of the podcast as they say [chuckles]
Erica: Oh yay! I’m excited. So, today, we’re gonna talk about what you do -we’re gonna talk about some of the trauma involved in involuntary hospitalization. Um, to help give us some context to what you do, can you um describe what your therapeutic approach is?
Britta: So, I’m primarily, like you said before, working in acute psychiatric care. Um, so a lot of kind of what I focus on is utilizing some aspects of DBT - dialectical behavioral therapy - um within my practice. I wouldn’t say that I’m like very strict, like all DBT all the time, but definitely taking some concepts of that, and kind of practicing mindfulness through that and in music. So that’s primarily my approach.
Erica: And, can you tell us more about the work that you are actually doing? What does it mean to do music therapy in the setting that you’re in?
Britta: Yeah, absolutely. Um, I find this - this setting really really interesting actually, because it’s not - I mean, previously, I’ve worked in places where, you know, we have a 12 week quarter, and I’m seeing you on a day to day basis, and I’m able to track your progress throughout that whole entire timeline. Um, but working in acute psychiatric care, it - it’s really different in that sense - there’s a lot of unpredictability - there are a lot of things that are outside of your control. Um, a lot of the legal side of what I do is we’re not able to really figure out how long a patient’s gonna be there for - that’s really up to the courts when it comes to involuntary um and discharge plans - all that stuff. SO, it - it kind of changes my frame - my lens when it comes to work, because I’m recognizing that I could have a patient for like 1 session - I could have a patient for like 40 sessions - there’s really no way to um really plan for that at the end of the day. I think that that kind of helps me intentionally say, okay, so I have this time frame - what’s something we can do - or we can do X, Y, Z, and we’re able to feel at least a little bit better by the end of that. Because I don’t know if I’m gonna see the same patient tomorrow too.
Erica: How does that - not knowing how long the client - the patient is going to be at the hospital - how does that impact how you like plan a session, or how you like determine what your goals and objectives are?
Britta: Totally. Yeah, and that’s actually something - one of the greatest challenges of working in this setting is behavioral health is such a big frame - like, I have folks coming in that are strictly working on like reality orientation - they might be in psychosis, but then I also have folks who are coming in maybe from having SI or - um - and being able to understand that we’re trying to reach the same goals, but it’s like all over the map, what people are dealing with. So being able to find interventions that are really rooted in somewhat reality orientation, but also focusing just on like self expression at the end of the day. So for me, knowing that I’m going int these sessions - and knowing that, a lot of times, this could be my only session with the person, or that they might be here long term - what I’m really focused on is just fostering this space, where we can have that healthy self expression, we’re able to figure out okay, what maybe could a coping skill be - or what maybe could a leisure skill I could use - with music - um, I find that music is accessible in that. So, a lot of times, when people are coming in like really guarded that sometimes we can just kind of reach them. For me, at the end of the day, if I can just reach a client and be able to have some of that self expression - be able to see them, you know, trying to figure out the workings of what a coping skill they might be able to use - or a leisure skill - outside of here, to me, that’s a win. Because we can’t always - I mean, we can’t always know —
Erica: Yeah —
Britta: What the next day’s gonna hold.
Erica: Yeah. How do uh patients come into the hospital? Do you work exclusively with involuntary hospitalization - is there a mix of that plus something else?
Britta: Yeah, it - it’s kind of a mix, um what I’m working with. And a lot of it - there’s some co-occurring sometimes substance abuse too, but we have some voluntary patients - we have some involuntary patients. I’d say, primarily, I work with involuntary patients, but there’s definitely a little bit of a mix you’ll see in the hospital.
Erica: Okay. And so, what happens - what is the process for being admitted - how does somebody end up —
Britta: Mmhmm —
Erica: Coming to music therapy?
Britta: Absolutely —
Erica: Yeah.
Britta: SO, um, a lot of times, these folks are - like they just say, a danger to themselves or others - and that’s why they’re really primarily coming into the hospital. So a lot of these are involuntary hospitalizations. I always say, no one really wants to be in a psych hospital, at the end of the day - no one’s like, today’s the day —
[Erica chuckles]
Britta: I really wanna do this. And — [chuckles]
Erica: Yeah.
Britta: So we have to kind of acknowledge that, the majority of the time, people are coming in under really difficult circumstances. And we always say, too, at the hospital like, we have to treat every single individual like they’re coming into the hospital on basically the worst day of their life. And I think that that’s something that you really have to take with a grain of salt - and being able to say this is the utmost importance of how we’re treating these folks. Um, but with that being said, I think that we have to recognize that each individual that steps into our hospital has faced trauma, and a lot of times, some of that trauma can be built upon the fact that that they’re being involuntarily detained.
Erica: Mmm.
Britta: Um, I think that that’s a trauma within yourself. You - you end up in this space that’s really unfamiliar, you’re on a unit with maybe 20-30 people who you don’t know, who are dealing with an array of different um psychiatric issues - and being able to recognize that it’s so unfamiliar to - to every single person that steps in - I think that’s the most important thing staff to be Able to recognize within that.
But then, when the music therapy process comes in, um, the cool thing about it is - people kinda come in as they want to, which can be a pro and a con [chuckles] - the cool thing is, a lot of times, the people who wanna be coming in are the folks who are coming in - so they hear music therapy and they’re kinda interested. Um, but the cool thing with that as well is being able just to kinda meet them where they’re at despite that. SO, it’s not so much as like a referral process - occasionally we’ll get a social worker whose like, hey, this person’s really into music, they should come - but, for the most part, it’s really kinda patient-oriented in having that autonomy to say today I’m gonna go to group and I’m gonna participate.
Erica: Okay. Last week, we talked with Alex Robinson, who you also know, about their work in emergency homeless shelter, and what trauma-informed care looks like there. Do you practice trauma-informed care within your setting, and then what does it look like if you do?
Britta: So, [chuckles] I’ll be the first to say - and maybe this is bold - but if you’re in music therapy - you’re a music therapist - and you’re not using trauma-informed care, we need to have a conversation. [Laughing] Because —
[Erica laughs]
Britta: No one knows all the traumas that we hold. And being able to just acknowledge that, I think, is one of the most important, crucial parts of being a music therapist - being an - any therapy - being a person basically [chuckles].
Erica: Yeah.
Britta: And I think, within, too - and this will kind of - I know we were gonna touch on just using um DBT in sessions - and I think um this is actually kind of a way that I find that - because, a lot of times, you come into a hospital and you hear all of those buzz words - you hear like CBT, DBT, um —
Erica: Yeah —
Britta: All these different things - and, I think that, with that, there comes a little bit of an unaccessibility by being able to say all of these buzz words. ‘Cause a lot of these patients are coming in saying, I have no idea what any of these things are —
Erica: Absolutely —
Britta: So, for me , using that trauma-informed care - it’s really trying to meet patients, first and foremost, where they’re at, but then also bringing in these ideas of DBT and making them accessible. And yeah, maybe at the end of the session, they’re not gonna be like, I know exactly what wise mind is, but they’re gonna be able to know the concepts of it - and they’re gonna be able to know how to actually practice it —
Erica: Mmm —
Britta: In a real and intentional way.
Erica: Yeah. Um, within the hospital setting, what kind of traumas are you encountering that folks are bringing in with them? Are there any traumas that are created out of the hospitalization? Can you just tell us more about what that is?
Britta: Yeah —
Erica: Yeah —
Britta: So, I mean, there’s such a spectrum, too, when you come in of folks - I always like - I always laugh at that just like typical, archetype of someone who’s admitted to a psych hospital. Because there is no one size fit all - everything is completely different. We have folks coming in on their first hospitalization - we have folks coming in on maybe their like 30th hospitalization —
Erica: Mmm —
Britta: It’s really really all over the map. Um, but with that, I think you also have to be aware of that - and being able to understand that some of these folks have been basically institutionalized for the majority of their life - that is reoccurring trauma. And kind of that sense of uncertainty - that sense of I’m not sure what it feels like to be outside the hospital and be within the community - and I think that that’s a really really important place to start with that, and being able to recognize some of the traumas that have occurred from frequent institutionalization. But, with that being said also, I think it’s important to note the folks who are coming in maybe on their first hospitalization, and everything seems so out of their control - and things seem really foreign too. So, there’s not exactly [chuckles] a one size fits all within that for sure.
Erica: Sure.
Britta: But, in itself, that’s a trauma - and there’s something that lead them to that space. And within the hospital, there’s also a lot of - I mean, we’re trying to protect people, so there might be a sense of kind of a loss of autonomy within that. You know, maybe you can’t have your favorite hoodie that has ligature risk, or maybe you can’t have access to these things you would at home. So I think, within that, there is - so that feeling of a loss of autonomy, but by being able to provide, you know, music therapy, rec therapy, um, we do a couple different things at the hospital, it brings back some of that sense of autonomy. And that’s something that I really focus on within group —
Erica: Mmm —
Britta: Of saying, okay, how can I put some of this decision back into your hands too?
Erica: Absolutely. What kinds of activities do you do around creating autonomy within a session?
Britta: Totally. Yeah, that’s a good question. Um, a lot of what I do is focusing on - I do do a lot of songwriting or lot - do a lot of improv too. I think improv is a really great example of how you can use autonomy, ‘cause it’s here’s all these instruments - pick something that is gonna apply to you in this circumstance - pick something that you can actively do - and be able to put the decision back in their hands. And sometimes, I honestly even come in being like, I have 3 session plans - what do we wanna do?
[Erica and Britta laugh]
Britta: And, I think it - really though - it brings some of that meaningfulness back into it. ‘Cause it’s not just, hey, I’m here and I have a worksheet, and this is what we’re doing - it’s saying, okay, here’s some of these options, what’s gonna serve you in the best way?
Erica: Absolutely. Um, how did you get into working in mental health - or what was your initial interest in mental health and kinda how did you evolve into this role you have now?
Britta: Totally. Yeah, I’ve been mental health the whole way. I’ve really really - that’s kinda been my primary focus ever since going into it. Um, I think - just personal and friendships, and even family - just seeing all the different ways that mental health can so deeply impact our day to day lives. Being able to say, I wanna bring music into that equation, - I think that that was pretty much the most important thing to me. I know, personally, being able to apply some of those concepts into music has helped me - practicing mindfulness and being able to kinda take a nonjudgemental stance —
[Erica and Britta chuckle]
Britta: It needs to work for you if it’s gonna work for everyone too.
Erica: Mmm.
Britta: Um, so I think being able to say, you know, this has helped me a lot - and I think that there’s this perfect little marriage between mental health and music - being able to utilize that has been really really inspiring [laughs]. I don’t know if that exactly answers that —
Erica: No —
Britta: I’m just like, mental health - music - they just fit together perfectly —
Erica: I’m just curious —
Britta: Yeah - totally —
Erica: Yeah. We - we’ve been friends for a while, and I don’t think that I’ve ever asked you like how did you get into this - I know that you’re really passionate about it —
Britta: Yeah —
Erica: Yeah.
Britta: I do really like the aspect of working in mental health, because you can go into a session and you can see a difference in affect by the end of a session.
Erica: Mmm.
Britta: So, I - I’ve worked in a lot of other populations - that I’ve really enjoyed - um, but that’s one thing that to me is just like… oof - it’s that sweet ice cream part [chuckles] of working in music therapy —
[Erica laughs]
Britta: It’s just like yes! Like, by the end of it you’re able to see that there is actually is a difference in mood - there actually is a difference in affect too.
Erica: Absolutely. Um, having worked in mental health and music therapy for a number of years now, what are some of the challenges in working in the mental health field as a music therapist? What’s like communication like with other types of health care professionals - particularly at the hospital you’re at now - is it super interdisciplinary - is it pretty separated?
Britta: Yeah, that’s a good question. And that’s hon - that’s honestly another reason why. I was really interested working in mental health, because it’s not just like just you as an island - you’re able to work with all of these different folks. Um, and the thing I really really appreciate about um the hospital I’m working at now is that there is that approach of people really taking your opinion too on client’s progress. Because, a lot of times, we’re seeing stuff that they’re not seeing - they’re seeing stuff that we’re not seeing - so it’s really really cool to kind of bridge that all together, and look at the client as a whole, and, you know, being able to say, okay, well I noticed this - but I noticed this - how can we kinda find a way to manage this - um, whether it’s through music therapy, whether it’s through social working meeting, or even just meeting with your psychiatrist. Um, it’s been really really cool working in that space and being able to work on treatment team - and treatment plans together, um, that is something I really deeply, deeply enjoy about working in mental health - that there is that int - interdisciplinary approach.
Erica: And so, what are the challenges involved in the work that you’re doing?
Britta: The biggest - and I will always say - this is like the forefront biggest issue - is back to that main idea that - people are coming in with so many different strengths and needs, and the thing is facilitating a session where someone - someone’s in active psychosis, and then also trying to facilitate the same session for an individual who is severely depressed. That’s probably the hardest part for me —
Erica: Mmhmm —
Britta: Is finding kind of a bridge to access um music therapy that can serve both of those folks. SO sometimes it’s really just adapting different activities as we go - ‘cause a lot of times too, I’m comin’ in and I don’t know the patients - there might be someone brand new - that can really change kinda the dynamic between the group as well. So that’s probably the biggest challenge - and [chuckling] something, though, in working here for a little bit longer - it’s kinda gotten a little bit more natural - just trying to find kind of that - that way to meld those together {laughs].
Erica: Absolutely, absolutely. Early, you had mentioned that the courts kinda determine the length of stay for a patient - do you have opportunity to form give input into court proceedings, or work with people from the justice system?
Britta: Um, in some ways - like, occasionally we’ll see them in a treatment team and we’re able to kind of um express some of the things that we’ve seen in group. But the biggest thing um is just within your notes.
Erica: Mmhmm —
Britta: Um, and that’s something - that’s something that’s honestly been kinda a cool and inspiring part of working in mental health - is knowing that the notes you’re writing, they really - I mean, they really serve to the patient’s progress as well. Sometimes - there’s a chance that they could pull out a note that you wrote for a patient and bring it in court - and that’s something that kinda helps - not that you should ever take documentation not - documentation not seriously, obviously —
Erica: Absolutely —
Britta: But it really holds that weight, where you realize like, wow! This could be used in a court - whenever they feel like it. So being able to write your notes so clearly - to be able to really express either that progress or either that need for staying for maybe a longer duration too.
Erica: Absolutely. Since starting this particular position, have you had any like new like revelations about the justice system —
Britta: Mmm —
Erica: Or like, learned things that you didn’t already know - or had an understanding deepened - or etc?
Britta: Yeah, I mean, in - in a couple different ways. There’s definitely been some realizations. I think I was always - I mean, it’s kind of a seeing is believing thing too I think - ‘cause, you know, I always know that there’s definitely some [chuckles] injustices —
Erica: Yeah —
Britta: Within the justice department. But being able to actively see it - and just realizing how relative mental health is to homelessness - how relative mental health is to addiction - and being able to really understand that if we don’t find a way to stop this cycle, there’s a chance that folks are just gonna be continuously in this cycle of addiction - continuously in this cycle of homelessness. And being able to recognize that, at this point in time, there aren’t completely enough resources to serve those folks - especially, you know, in - we live in Seattle, and that’s’ where there’s a huge homeless population. And just being able to recognize that [chuckles] a lot of this needs to start with mental health.
Erica: Mmm.
Britta: It doesn’t have to start with just providing housing - it doesn’t have to start with just providing addiction services - those are completely and utterly important - but we also have to just recognize the whole mental health side to things um, to move forward, I think.
Erica: Absolutely. Um, from the perspective of a music therapist, what recommendations do you have to the general community at large about how they can use music to help take care of their own mental health - or maybe support others in their family - really, immediate circle, that are struggling with a particular mental illness or significant mental health issue?
Britta: Mmhmm. Yeah, that’s a good question. I mean, a lot of what I like to do – personally, too, and in therapy - is really focusing on some of those DBT, but using music to kind of [chuckles] take that journey with it - so combining kind of those elements of it. One thing I do - this is kind of - it’s re - it’s related, I would - I would suggest it —
[Erica chuckles]
Britta: Is just looking into concepts of like uh wise mind, which is a DBT concept. So, wise mind is - basically, it’s identifying these 3 states of mind that we might have - which is your wise mind, your reasonable mind, and your emotional mind.
So, your reasonable mind is really - really just like pure logic. So it’s - I always say - musically, an example of this could be like the Hokey Pokey - there’s not a whole lot of emotion in that - put your left hand in, you put your left hand out. Um, and then, emotional mind is thinking about all those just like really - really like hot emotions we have, like anger, fear, frustration, sadness, depression, anxiety - my example I always use with clients is like, John McEnroe having like a melt down playing tennis - for all you tennis and music therapy fans out there, that’s an example of emotional mind. And then that re - that wise mind is kind of, again, that just like marriage between the 2, and finding a way to kinda use some of your reasonable, use some of your emotional to make really well-informed decisions and actions.
So this is something I always will say can really be applied during music. Whether it’s doing improv, or whether it’s coming up with playlists - and just kind of going through those and becoming more aware of it. Because, I think, a lot of times, we do experience our emotional mind, or our wise mind, but we’re not really being so intentional with it - we’re not really paying much attention to those reactions and those feelings we’re having. That’s one of the biggest things I think that I would recommend - is just getting an understanding of that, but making it accessible too. Because a lot of times - wise mind - it feels kind of rigid and just like, this is this and this is this —
Erica: Mmm —
Britta: But, applying it to music kind of allows us to have some more of that critical thinking and challenge ourselves to um look at it in a different way.
Erica: Absolutely, absolutely. Uh, next week - speaking of DBT and all this that you’re bringing up - next week, we’re talking to Marissa, from Seattle Children’s Hospital, and she’s gonna do a whole episode - specifically about DBT.
[Britta says something quietly off mic]
Erica: So, for listeners’ sake, we’re gonna get real deep into this —
[Britta laughs]
Erica: Next week. Just hold on - if you’re not like fully tracking with everything —
Britta: If you’re not already like into DBT, you will be —
Erica: Very soon —
Britta: By the end of these 2 episodes.
Erica: Yeah —
Britta: Oh my gosh!
Erica: Um, Is there anything that I haven’t asked you about that you would like to talk about?
Britta: No, I mean, I just - I’m excited for mental health month! I mean —
[Erica chuckles]
Britta: Take this - take this as a challenge, folks, to challenge yourself - think about ways you could um help your mental health - especially - especially during these unprecedented times.
Erica: Yes.
Britta: Thinking about ways we can kinda take care of ourselves is definitely important.
Erica: It is very important. So, as we wrap up - the thing I always ask, do you have any resources —
Britta: Yes! —
Erica: For listeners?
Britta: I came so prepared. [Chuckling] Um, so —
[Erica chuckles]
Britta: A lot of mine are just kind of DBT related too.
Erica: Sure.
Britta: So, I would recommend some Marsha Linehan - she’s kinda the queen of DBT as they say - she’s the founder. She’s also a um professor at U Dub, so there’s your Seattle —
Erica: Local —
Britta: Reference. Local. Um, then also uh Debrah Speigel, who does a lot of kind of music and DBT um in particular. She has some cool books out, and she has some resources.
Erica: Okay. Do you have any um advise - I guess for people that are coming in to helping professions —
Britta: Mmm —
Erica: Teachers, nurses, therapists, social workers - for if they’re wanting to enter a mental health specific field, what are some things that they can be doing to prepare - things that they should be thinking about…?
Britta: Totally. First and foremost, mental health has probably one of the highest turn over rates ever - which is very unfortunate. But I think it is something that’s really important to note when you are coming into this field, because you do kind of have to have a little bit of a thicker skin - you have to be especially taking care of yourself before taking care of others - because a lot of these folks are coming with some pretty significant stories and traumas - and being able to um - I mean, being able to take care of yourself for holding some of those stories - I think that that’s one of the most important things. It’s in - completely incredible field to work in, um but you definitely have to um be careful - and take care of yourself. That would be my biggest recommendation um for working in mental health. I mean, I a hundred percent recommend this field to anyone —
[Erica and Britta chuckle]
Britta: But you definitely have to be prepared, you know what I mean?
Erica: Yeah, absolutely. So Britta will send me the resources so I can get those up on our website. They’ll also be in the episode notes for the podcast. So, our website - if you wanna look up more information - is SCMusicProject.org. If you wanna know more about us, you can follow us on all major social media platforms @SCMusicProject. As I mentioned earlier, Marissa will be with us next week to talk about DBT in music therapy, and her work at Seattle Children’s Hospital. Thank you, Britta, so much for chatting with me today.
Britta: Thank you!
Erica: And then, thank you, listeners, for listening. And we will talk to you next time.
[Podcast outro music plays]