Ep. 024 | Music Therapy in Adolescent Mental Health

Today, we chat with guest, Addison Breier, a board-certified music therapist, about music therapy as a support for adolescent trauma healing.

RESOURCES

Guidelines for Music Therapy Practice in Mental Health Edited by Lillian Eyre | Book

Beautiful Boy Trailer Directed by Felix van Groeningen  | YouTube

American Music Therapy Association | Website

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 are talking about music therapy in adolescent mental health, with board certified music therapist, Addison Breier.

Addison is a board-certified music therapist with a background in adolescent trauma and mental health, as well as developmental disabilities. Following her clinical internship at Denver Children’s Home, where she worked collaboratively on a multi-disciplinary team, Addison worked as an in-home music therapist with individuals with varying diagnoses, as well as a classroom music therapist, and a music educator. Recently, Addison has moved back to Washington, where she plans to pursue developing a music therapy program within an adolescent mental health setting.

[Podcast intro music plays]

Erica: Welcome to the podcast, Adde, I’m so excited to have you with us today!

Addison: Hi, Erica! Thanks for having me!

Erica: So, today, we’re gonna talk about adolescent mental health. I know this is something that you’re really passionate about - I’m excited just to dive right in. For context for myself and for listeners, how did you originally decide to become a music therapist?

Addison: That’s a really funny story, to be honest. Um, when I was 14, I thought I made up music therapy.

[Erica and Addison laugh]

Addison: I had fully believed it was a thing I had come up with - was gonna have to build on my own. Basically, it all started with I was part of a nonprofit organization as a a vol - like a teen volunteer when I was in my - right as I became a teen honestly. And I was helping fundraise for a family that had 3 autistic boys who were all under the age of 4 - it was just a big handful of a family, but they were just such a fun, lighthearted, joyful group of people. And while I got to hang out with their little boys, I got to see how therapy played into their every day life -how it helped with their emotion regulation, and their sensory needs - and their mom had explained a lot of that to me while I sat their playing with them. And I thought, wow, I wanna do that - but I’m a musician - I had grown up dancing and playing instrument after instrument, starting at the age of 3. So music had always been part of my life, and I always knew I wanted to make it a career, but I also knew that I didn’t wanna go into performance - that I wanted to use it to help people in some way. So, little 13/14 year old Adde says, I’m gonna make up this thing called music therapy, and I’m gonna work with kids, people with disabilities, or people in mental health - just kind of like had this huge brainstorm. And then, when I was 15, my friend got me a book about a music therapist - it was a - I think it was just a novel that was about a music therapist —

Erica: Mmm —

Addison: But then I was like, oh, I have access to this thing called Google - I could look that up.

[Erica chuckles]

Addison: And so um - was really lucky to find out that Seattle Pacific was just a few hours away from where I grew up - I grew up in southern Oregon - and that they had a music therapy program. And it was kind of set in my heart probably from the age of like - of 15 that I was gonna go to SPU and study music therapy.

Erica: Wow!

Addison: So - did just that, and I’ve never regretted it once. Um, it just has been confirmed for me over time that this is what I wanna do. So…

Erica: That’s so cool! What a cool story. I love that you thought you made it up. [Chuckling] That’s - that’s really great. So, now that you’re a therapist, how do you describe your therapeutic philosophy?

Addison: I would say that I operate out of a primarily person-centered/humanistic philosophy, that I really value being able to take a lot of different philosophies - like cognitive, behavioral, psychodynamic - and combine them, and use them all for the sake of the pa - of the client - it’s clients, not patients. And, yeah, I think, just for my practice - and if we’re seeing the client as a whole - that a more humanistic combination of different philosophies feels right for me.

Erica: Absolutely. I really like the distinction you made between client and patient —

Addison: Mmm —

Erica: And how that relates to um a person-centered approach —

Addison: Mmm —

Erica: Because patient, to me, really pathologizes the person.

Addison: Yeah.

Erica: Versus client is just - it seems like a synonym, but it has the connotations for how you view the person you’re working with. And there’s always a power dynamic and hierarchy between therapist and client, but I feel like that power dynamic grows when you use the term patient.

Addison: Mmhmm.

Erica: Um, it’s just something I have noticed as I’ve been working in the music therapy community - it’s interesting to me the different ways that therapists reference the people or person they’re working with.

Addison: Totally. I totally agree. I think saying client helps, for me at least, and I think - just like you said, its connotation implies more of a therapeutic relationship more often than call - referring to somebody as a patient. But, I - not to say that therapists, or nurses or doctors, don’t have a relationship with their patient. But I think, when I think about being a patient, I do think, okay, you’re -you’re here to help me fix it and then move on.

Erica: Mmm.

Addison: Um, I think it also helps distinguish what setting you’re in as well. You know, I’m not in a hospital setting - I’m not in a clinic setting where somebody is coming as a patient, and receiving treatment outside of a therapeutic approach as well - whereas, when I was - I - I finished my internship about a year and a half ago now at Denver Children’s Home, which is a trauma facility, which I guess we’ll get into - but there, they are clients - because they’re seeing only therapists - they’re not seeing really anybody else. And so, for me, that’s how I kinda help approach it as well.

Erica: Sure. Absolutely, yeah. Yeah, so you mentioned your internship - can you tell us more about the work that you have done in adolescent mental health?

Addison: So mental health has  always been a field that I’ve been really interested in. I was really intrigued by the idea of music therapy and how it worked in a mental health field. For me, as a dancer growing up, it felt really easy to understand how music therapy could help on the physical side - um, that to me just seemed natural, because my whole life I’ve been moving my body to dance, and it’s been a healing practice for me - both emotionally physically, as I’ve experienced injuries. So I was really excited to learn more about the mental health side. I got a minor in psychology at SPU and that kind of helped, you know, push me in that direction.

So, I worked under Amy Sweetin over at Denver Children’s Home, um, which is an adolescent residential trauma facility. SO, I can’t remember the percentage quite, but it was somewhere between 85 and 90 percent of their clients that they see are living at the facility and acting as kind of inpatient clients - not to say that they can’t leave - a lot of them get to go on outings with their classes and with their dorms - everybody lives in a dorm, like a dorm group there - or with their family members, if they have any. Um, and then some come and just attend school and receive therapeutic treatment at the facility. So there is a school that’s operating within Denver Public School system inside Denver Children’s Home, and they kind of act as kinda both an independent and dependent facility because they are so unique.

But music therapy there looked like a pretty healthy combination of individual sessions and group sessions. Our group sessions focused primarily on the dorm life. So there are 5 dorms. Each hold up to 7 or 8 uh teens - most of them are teens - I was gonna say kids, but they’re really not anymore. And we - so there’s a - it’s a big team of music therapists, art therapists, occupational therapists, and traditional psychodynamic therapists -,. So we have - and then there’s a psychiatrist on a team, and uh many doctors in psychology - so it’s a big multi-disciplinary team. And each dorm has a weekly group within each of those therapeutic fields. So, our primary focus as music therapists was to provide a lot of like group emotion reg - regulation, a lot of group bonding time, because these are teens with some pretty significant mental health issues - a lot of trauma - um a lot of behavioral issues that they’re working through as a result of all that trauma. And putting them all in [chuckles] a little dorm and asking them all to live together is complicated - and the way they even decided for - how each person was placed in their dorm, and who they were placed with, is complicated - so having group therapy was really important.

But I, as an intern, right away was given my own case load that was supervised by Amy. Um, I had anywhere between like 6 or 7 and 10 or 11 clients of my own that I was seeing. And over the almost year that I I was there - I think I was there for a total of 10 months - it got more and more independent. SO I kinda started with like I built my case load - Amy supervised a lot, and then it slowly wained off, which was really nice actually. I’m definitely a person who learns with 2 feet I very quickly and prefers to jump fully in and learn as we go. But, in an individual session, which was my favorite, I very much prefer working on an individual level - in any given individual session, most often, we were focusing on emotion regulation - building different coping tools for when they were outside of therapy. And also, you know, kind of working our way into verbal processing what they had experienced in their life - because trauma puts us into a fight or flight freeze, which makes verbal processing so difficult for most of us. I will say, I’m a verbal processor so for me that tends to be my place. But a lot of adolescents are still building those skills.

And so, if we all - if any of us think about going back to being a teenager, music most often played a huge roll in how we coped with how we were feeling - how we identified how we were feeling - how we related to other people. I remember so often sitting in my room, blasting, you know, the saddest song I had that made me just feel all of the emotions I wanted to feel in that moment and getting it out that way - um, and a lot of the kids that I saw at DCH, that was the case for them as well - if they’re advocating for music therapy, or if we were, you know, approaching them and saying, hey, music therapy might be effective for you. So, we worked on a lot of those goals through a lot of lyric writing, lyric analysis - we used songwriting software, like Logic and GarageBand to practice taking emotions and experiences and putting them into nonverbal form. A lot of the conversations I had with my clients was about externalizing your experiences rather than internalizing it - whether that be verbal or not. But then, a lot of the time, those coping tools we were working on building um looked like um building resilience with an instrument, or practicing songwriting, or, you know, building a playlist for different experiences throughout the day. Most of the clients that I saw engaged or advocated to engage in lyric writing and learning an instrument - one client in particular - he was dealing with a pretty significant drug detox - a very very young man, but also had a lot of trauma in his life that lead to wear he was at - was - was experiencing some pretty significant depressive symptoms, and a lot of really intense anxiety and anger that came with that. And for him, learning the ukulele ended up being this amazing coping tool for him that he - instead of saying, hey, I feel blank - whatever he was feeling to his dorm staff, I need a break - he could say, hey, I need to go play my ukulele, and that became his way of stating I’m feeling unsafe - I’m feeling, you know, really upset right now and need my space - can I go sit - they had kind of like safe rooms - can I go sit in one of the rooms and play my ukulele right now. So having songs for him to practice and to focus on, and lyrics that he could work on continuing to write, and songs that he was building helped a lot to provide that emotion regulation that he needed, and in the end ended up being coping tools that he went home with - and continued. I mean, his - he was lucky enough - most of the kids at DCH that I saw were in the foster care system —

Erica: Mmm —

Addison: He was extremely lucky to still have family that was safe to live with. And so they bought him a ukulele and a songwriting notebook, and they were fully sup - prepared to support that - which, a lot of the kids that we see, that’s not the case - they have to learn how to support it themselves. But yeah, he’s a - he was a great example of finding healthy coping tools in music therapy, and music therapy was extremely successful for him. By the time we were done working together, which was probably 7 months? he was verbally processing what he had gone through with a lot more ease than when he had come in - when he had came to us, he was shut down - he was scared to talk - he was angry, and if he did speak, it was usually because he was melting down and, you know, crying and experiencing just kind of an overflow of emotions. So, he’s a great example of how adolescent mental health plus music therapy is a very successful combination.

Erica: That’s so cool! What a cool story. SO, I’m just curious - I don’t know if you mentioned this - ‘cause I was tracking, but sometimes I don’t catch everything you say - how do the - the clients get into the children’s home? Are they referred there? Is it mandated - etc?

Addison: That’s a good question. It’s a huge combination. DCH is technically a step down unit from in-patient psychiatric care, so often times, they are referred to DCH and - really, it’s kinda - kind of the recommended step down by their case manager. However, we did see a few who were admitted to the facility by their own parents, which was not a very common case. There were a few who it was court-mandated that they were there, and that if they weren’t successful, that was their last chance. Um, DCH, when I was there at least, saw a lot of those cases. And then sometimes, if they were teens in foster care who were struggling at a group home, this was their best step before reintegrating back into a group home. So, it’s a big combination, but I would say, the majority of them, it was their step down before either moving back home or into a group home, and to establish kind of a continuity of therapeutic care.

Erica: Absolutely. When I hear that DCH is directly or indirectly adjacent to the justice system, I’m now wondering about how do you - you specifically practice anti-racist therapy?

Addison: Mmhmm.

Erica: What does that look like for you?

Addison: I love that question. Because, that’s something I’ve been thinking about a lot over these past couple of weeks in more depth. That was something that Dr. Brown at SPU - before I was sent to my internship at Denver Children’s Home kinda asked me to think about a lot more too was how am I going to approach music therapy in a facility where the majority of the clients I was gonna work with don’t look like me? Because the system is  against - you know, is kind of working against them, I am a white woman, for listeners who don’t see me, and unfortunately our system sets up people of color and primar - primarily black individuals and - children to end up in their fo - in the foster care system, and end up in places like DCH. So, for me, I think it starts very much on a personal level - um and that’s a lifelong journey of self check-in, um of self education - I think for me, I started very much with understanding the term white privilege, and facing that, and asking why it made me uncomfortable - and choosing to read resources by black people who could explain their experience better, rather than, you know, continuing to read the perspective of white people. I think shifting the authors and the speakers that I was listening to and who I was learning from was important, but also having those conversations with other white women in particular about how -how do I cope with this, how do I come to terms with this, and then operating - instead of out of white guilt, but out of a place of kind of progress. Because I think for me, it looked - often times just feeling guilty, and being like, aww, I feel so bad about this thing that, honestly, I can’t change, you know, but I can change how I approach my clients - how I fight for - fight against and for the system - and yeah.

So that was a big - that was a big topic for me to look at and just think about in moving to Denver Children’s and working - er moving to Denver and working at Denver Children’s Home - and working on those biases and subconscious behaviors - you know, the language I use - things of that sort that is based in my functioning from a place of racial privilege. And then, at DCH, that also looked like just honestly and humbly asking questions. When, you know, I - different cultures breed different lingo, and I think, especially in music, we see that a lot in the lyrics. And so, when working with a client of color - asking questions - if I didn’t know what they were saying, just saying, hey, can you explain that to me - I - I don’t know what that means. You know, which - for a teenager, often times they would chuckle and be like, oh you’re so old, and then —

[Erica laughs]

Addison: All - all the teenagers know this - the fun way to say like, hey I acknowledge like you have a different experience, and I - I wanna learn, so if you are willing to say - like, to explain that to me, great. If not, I will look it up on my own, and that’s totally fine.

Erica: Mmhmm.

Addison: But I think setting up that kinda that basis with my clients is important. Something that I had to think about a lot when processing how to practice therapy in an anti-racist way was, how do I approach maybe fellow white clients who are saying things that might be racist.

Erica: Mmm.

Addison: …Don’t know that. I think often times we use language that we’re just used to, and we don’t know how that might hurt somebody. How do I gently provide not necessarily a correction, but ask questions to help them get to that answer - to help them reflect on why they’re using language like that. And something that helped me approach that a little bit better was thinking about how my experience as a white woman, you know - thinking  music exploits women often - and, if I’m hearing a client write lyrics that is - that are unsafe toward a woman, or derogatory about a woman, I’m gonna get fired up about that. Because that’s me. You know, that - that’s about people who look like me and function like me. So if I was black and I was hearing something similar coming from a - you know, a young white kid who doesn’t quite understand the lyrics most-likely, - it was the case often - I probably would have felt similarly -you know, kind of using my own experience to relate.

Um, I think in the populations that we see at DCH - whether there white kids, or black kids, or people of color, the music that they tend to listen to - that relates to them, often, I found, comes from a black perspective. Unfor - because unfor - again, unfortunately our system has set black people up for - or, I guess it’s just really working against them. You know - I’m not an expert on this at all, so I don’t wanna say things that - that make me sound like I am.

But… So, a lot of the music then, you know, uses the N word - but when a white boy is singing it and there’s a black boy walking by who looks offended, or flinches, when he hears that - how do I approach that in a gentle way of I identify - I recognize that this is the music that you identify with, and I don’t wanna censor what, you know, feels good to you and what has spoken to you, but can we talk about why maybe that - why somebody would flinch if they heard you, in particular, using that word? Or, you know, why does it feel okay to you - what - what makes it feel that that’s okay for you? I think those were conversations I had to have a lot. And, kinda back to that women piece that I was saying, that stemmed from me becoming bolder and saying, hey, why did you write that about a woman? I had multiple young, male clients you know write aggressive lyrics about a woman, and saying, hey why - why is that? Explain that to me - I would love to hear your perspective. And then, honestly, saying, hey, can I disclose something - or hey, can I - can I be really frank with you right now. As a woman, that doesn’t feel great to hear. I’m not saying that’s your fault, I’m saying that like, a lot of, you know - often times it was rap artists or trap artists write - write about that kind of stuff, and here’s how it makes me feel from a female perspective. Can we talk about that.

And so, I think being more bold as a therapist and saying, hey, if I were black, I don’t know how I would feel about that - can we talk about that? Can we learn together? Can we grow together in this? I think that’s kind of where i’ve come to terms with anti-racist therapy as it is.

Erica: Mmhmm.

Addison: Is that it’s my roll as a - it’s not my roll, as a therapist, to necessarily advise or correct, but it is my roll to help somebody reflect and process, and learn and grow. And I think asking those questions, and offering up maybe chunks of information that I’ve learned - or, again, me being willing to ask those questions without fear and without um defensiveness became an important piece. And also practicing. I mean, nobody’s perfect - you know, I had times where I asked a question and had a client look at me like, ugh, why would you ask me that - and, you know, being able to apologize as a therapist too, and model that -especially to teenagers. I’m so sorry - I - can I rephrase that? Will you let me rephrase that for you? Or should - can I just - we can just move on if that doesn’t feel like a safe topic for you right now. So I think trial and error and that boldness - that bravery to say - and that humility to say I’m ignorant about this topic, so I’m gonna ask - I might ask a question every once in a while - or misunderstand you every once in a while - so I just ask for grace, um, and I promise that I’m trying to learn.

You know, I think - again, it really always will come back to that personal growth piece. It will always look like changing the way that we act, the way we approach clients, what we understand, the way we educate ourselves so that our everyday practice reflects the changes that we’re working to make on a - an individual level, so that then our actions become anti-racist.

Erica: Yeah. I really like the point you made about being humble —

Addison: Mmm —

Erica: In your journey of developing and growth, and learning and unlearning, and… Um, so, in my roll at marketing for um the Music Project, I get to have a lot of community conversations about what is music therapy etc. And I hear um sometimes like the frequently asked questions list of like, what is music therapy? What do you exactly do - etc, etc, etc? What are some of the misconceptions that you hear about music therapy, particularly related to adolescent care?

Addison: That’s such a good question! [Chuckles] Um, gosh. Yeah, I think, in working at DCH, often times I heard - from not necessarily people inside, because I think Amy Sweetin, the music therapist there has done a great job of educating everybody within the building as to what music therapy is - why it is so important for these kids - but when saying like, yeah, I work in a trauma facility where there’s a lot of behavioral issues, I think a lot of times I heard like, oh you’re just affirming their obsession with quote unquote bad music. You know, like, by having them process it - by having them listen to it and living into it with them, you’re just affirming their bad music taste. And it was - I don’t think there’s a thing such as bad music. I mean, yes, there can be harmful in that - in how it plays into the individual ’s life, but… That was definitely one. Also, that all adolescents are subb - stubborn and unwilling to participate in therapy, and they are not going to open up - was a really common one. And that just wasn’t true. I think, like yes, a smaller child is going to naturally be more vulnerable and open - most often, but found that adolescents are super wiling to participate, once you’ve kind of hooked ‘em - once you got them to see that you genuinely care about them, and that you’re on their team - especially with these kids who, most of their life, people have not been on their team. Yeah, that just - it proved untrue.

Erica: When you were talking about um there is no bad music, I cannot agree with you more. I - one of the questions that I receive frequently - er, I receive kind of on behalf of the team is like what’s the best music to play - or like, what’s the best song to play or… Um, and so that - that’s - the there’s no bad music is kinda the flip side of it, that like there’s no like worst song ever or that kind of question. Um, a couple weeks ago, we did an episode um about censorship in music therapy with our therapist, Cassie, and so, listeners, like if this is have been an interest for you, I really encourage you to go back and listen to that particular episode, because uh we talked about all of these issues a little bit more in depth. And Cassie works in a variety of settings, but also in a juvenile detention center, which, much like DCH and some of the similarities of the types of clients that the therapists are seeing, um how you address different types of music and address it from anti-racist, anti-oppressive lens also - it really matters.

Addison: Absolutely. Yeah, I think that’s - that’s a great point too. Because I think that’s why it’s important that a music therapist is the one using music as a therapeutic tool. I don’t think we can ever stress enough, to people who don’t fully understand music therapy, that it is so individually based, and that that is like a huge highlight within the definition of music therapy - is that it is based on individual goals and individual taste - always. So that answer - I get that a lot too, especially when I talk to somebody on like a plane or, you know, in passing about what I do, they - there’s always that question, well what’s the best then? What should I be listening to? My question is always, well, what do you like? That’s what you should be listening to, the stuff that makes you feel good - the stuff that makes you feel relaxed - not this one particular song or this one particular genre, because you might hate it.

Erica: Yeah. Well, we’re coming to the end of our time. And so, for listeners that maybe want to explore more about the relationship between music therapy and adolescent mental health, do you have any resources that you can share with us?

Addison: Yeah. I think for those who are music therapists, Guidelines for Music Therapy Practice in Mental Health, by Lillian Eyre  - air, I think is how she pronounces her last name. It’s a massive textbook, but it’s broken up into really easy to find chunks - there’s a whole chapter on foster care youth, and a whole chapter on adolescent mental health that really goes into depth what music therapy practice looks like in those areas, and why it’s important. And then, I - I think I gave you a couple of articles as well for the resources, but also just musictherapy.org is a great place - if you go into the search bar and you type in adolescent mental health, they have a lot of pamphlets about what that looks like - or like online flyer type things. And then for somebody who, you know, wants to better understand the experience, I did include in my resources the movie Beautiful BOy - I don’t know if you’ve ever seen it, Erica. But basically it’s about - it’s with Steve Carell - it’s about a dad’s journey through his son’s pretty hard core drug addiction - that starts you - you know, just classic teen messing around and gets pretty intense, and he ends up on the streets. And it - it’s a really raw, honest, very much a rated R film, but if somebody is willing to cry and experience it and kind of live in the emotions -for me, it reminded me of so many of the clients I worked with at DCH - so many of the um, you know, the incarcerated youth, and the youth that I was working with who were detoxing. It gave a pretty like raw, real, unfiltered look into what that looked like. So, I would say, for somebody that just wants a movie to better understand that experience, that was a - that was a hard-hitter, but it was a good one. I cried for a long time afterward [chuckles].

Erica: Wow. Alright - yeah. Well, all of the resources that Adde has sent me will be in the episode notes attached to this podcast episode. And then on our website as well - which the URL is S as in Sam C as in cat music project dot org (scmusicproject.org). You can also find all kinds of information about the Snohomish County Music Project there. You’re also encouraged to follow us on all social media - Facebook, Instagram, Twitter - all the things @SCMusicProject. And if you are enjoying the podcast or enjoyed this episode, I really encourage you to subscribe so you get notifications when new episodes come out.

Thank you, Adde, so much for being here today and for sharing and chatting. And I really appreciate you being here, and I also just really appreciate the contributions you’re giving to the music therapy community, and I’m so glad you’re back in Washington State. Thank you, listeners, for listening. And we’ll talk to you next time.

Addison: Thanks for having me.

[Podcast outro music plays]