Ep. 004 | Trauma-Informed Music Therapy

Today, we chat with guest, Colby Cumine, a board-certified music therapist, about how he practices music therapy while taking into account the past trauma(s) of a client.

LEARN MORE

The Trauma Therapist by Guy McPherson | Podcast

The Body Keeps the Score by B. van der Kolk

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: Trauma-Informed Music Therapy, with board certified music therapist, Colby Cumine. Colby works primarily with elementary children experiencing trauma. With over 2 years of experience, his clinical practice includes over 500 kids, ranging from infancy through middle school, in both group and individual settings at 8 different schools. He uses a social justice orientation and a trauma-informed lens while working with clients from a range of different backgrounds and abilities, always focusing on client strengths, and providing them with as much power and agency as possible in therapeutic settings.

Also listeners, please note that this episode includes brief mention of suicide, military combat, abandonment, and sexual abuse. Please protect your mental health, and listen with caution.

[Podcast intro music plays]

Erica: Thank you, Colby for joining us.

Colby: Hi! My pleasure.

Erica: Is this your first podcast?

Colby: It is!

Erica: Oh, welcome to podcasting!

Colby: Thanks!

Erica: So, you do a lot of trauma-informed work —

Colby: Uh huh —

Erica: Yes.

Colby: Yes, I do that.

Erica: Can you give us a brief, um, orientation to what the phrase, like trauma-informed care - trauma-informed approach means?

Colby: Yeah, I think the trauma-informed phrase has become, like, a pretty like hot catch phrase - kinda thrown in onto certain things. At At its core, I mean, like taking into account the effects trauma can have on individuals… and then working around that when you are treating or working with them in any sort of capacity.

Erica: Mmhmm.

Colby: And then, especially, you know, in the therapeutic lens, it’s important that we take those considerations into effect - and how they would kind of show up and maybe… disrupt elements of care that we’re used to seeing.

Erica: Okay! And so then how do you… define trauma, or how do you characterize trauma - what are the characteristics of that you’re like, oh that person is experiencing or has experienced trauma?

Colby: Yeah… It can be really difficult ‘cause it’s so subjective —

Erica: Mmhmm —

Colby: It really comes down to, like how the person perceives it —

Erica: Mmm —

Colby: So it’s different for every person.

Erica: Is it then that the client is vocalizing to you - I have experienced trauma - and you’re just taking it on face value, or are there additional questions that you’re asking?

Colby: Well, a lot of times, um folks might not even be aware —

Erica: Mmm —

Colby: That a trauma - traumatic event has happened —

Erica: True, true —

Colby: Or that they are experiencing trauma. Uh, they can be, like small things that build up over time - um, I think the fancy term for that is like micro traumas?

Erica: Mmhmm.

Colby: Um… as things build - just being in high stress situations consistently - um will raise like, your cortisol - your stress hormone levels. And to a certain point when those are staying in there is when we see some of those effects of trauma. They can also be, like more acute things - like being in a car accident, or coming back from war, or… all sorts of different things… that can… uh end up… affecting a person? So, I think, like… the general definition for trauma be just like a past event or series of past events that build up to disrupt current… functioning in everyday life.

Erica: Absolutely. Trauma can look like so many different things. So there are micro ways of looking at trauma, and there are more acute —

Colby: Mmhmm —

Erica: Traumatic experiences. What are you doing as a therapist - what are you recognizing in the therapeutic relationship to say like, oh I think this person has a trauma history —

Colby: Mmhmm —

Erica: Or is experiencing a trauma. What is happening… biologically that —

Colby: Yeah —

Erica: That gives you more information - and then how are you working with that information?

Colby: Yeah —

Erica: Those are a lot of questions.

Colby: Mmhmm. Yeah, that’s it. Um…

Erica: So let’s start with maybe like, biologically like what’s happening during trauma.

Colby: Yeah, so, I mentioned like stress hormones - cortisol —

Erica: Yeah —

Colby: Um… essentially, when - whenever… people in acute or… like, micro situations end up in sort of a place where they might feel the need to… run for their lives or fight for their lives - there’s also freeze, um, which happens when… there’s a situation happening when we don’t think we can get out of it? You’re, you know, trapped in a burning building… or in a war zone, uh like, under fire from enemies - and you’re kind of stuck - not being able to move - and - in those fight or flight situations your body’s like shooting out adrenaline and  other hormones - and things like that that will help us like run - do things… But they’re actually kinda toxic to the body when they’re not being used, so as we sit there and we freeze, our bodies go, okay, well I can’t do either of these 2 options - I’m going to die. The least I can do is make dying not painful. And so that’s where like dissociation can happen, where people will describe pretty traumatic events as like they floated out of their body, and like saw someone else experiencing it and being so thankful that it wasn’t actually them. Um, but then, when you actually survive and move past that - that creates like this - kinda disjunction, and like the - uh a break - in possibly like psyche - or just like activities and behaviors - break in memory - um, and the - those stress hormones not knowing that it’s okay to, like come back down… That level of toxicity can affect like our immune systems, um, as well as continuing to interrupt with like - the way our brains function, and sometimes even the way they’re shaped - it can actually, like reshape your brain in certain ways.

Erica: Mmm, really?

Colby: Yeah. Um… which also, like treating that can also… help kinda reshape things. Um, the  fun word for that is neuroplasticity - our brains are always malleable - even if we’re not kids growing up anymore, we can still… find ways to like change the brain and to alter pathways, so that… we know how to… understand when things are actually safe —

Erica: Mmm —

Colby: ‘Cause we’re in the present - no longer in that past circumstance - or circumstances. Um —

Erica: Sure. I’m sure we’ll talk about neuroplastis - neuroplasticity - I can’t say the word —

Colby: [Chuckles] It’s a big word.

Erica: That word. We’ll talk about that word more —

Colby: Mmhmm —

Erica: When we - next week uh you’re gonna talk - come back and we’re gonna talk about music and the brain —

Colby: Yeah —

Erica: So, I’m sure we’ll talk about that more - later. So, given all of these… things that’s happening in the body —

Colby: Mmhmm —

Erica:  with trauma - people don’t know that they’ve had traumatic experience —

Colby: Mmhmm —

Erica: Or maybe don’t identify it as a traumatic experience —

Colby: Yeah.

Erica: How does that inform your clinical practice - what are some things you maybe do differently, compared to, like a quote unquote non-trauma-informed —

Colby: Yeah —

Erica: Approach?

Colby: Truthfully, I’ve never practiced non-trauma-informed, so it’d be tough to compare, but the things I do that…really make sure to take into account the possible effects of trauma is like… first and foremost is trying to come from a place of like understanding - instead of judgement.

Erica: Mmm.

Colby: It’s much less about - oh I see these problems like - oh they’re really angry and… they burst out - or they become violent - like, those are ways that… probably would help them survive, given the situations they’ve been in in the past and are no longer in and are no longer helpful. And so, as opposed to being like, oh we need to… shut those things down, it’s important to understand, uh, like what is happening with all of that.

Erica: Mmm.

Colby: I think that’s number 1 - is coming from a place of understanding and… not judging.

Erica: What does that - not judging and understanding - what does that practically look like… in a session… I think, obviously at least to me, it would change your in the moment response —

Colby: Yeah —

Erica: To what a child is telling you… What does that response look like - or how - do you understand what I’m asking?

Colby: Yeah, I think so. It’s um - it’s - if a kid doesn’t, like, stop singing or stop playing an instrument exactly when I tell them to, that doesn’t get them like in trouble - there’s no… doing bad [chuckles] in therapy —

Erica: Mmm —

Colby: Um - with me. Sometimes teachers ask like, oh how’d they do? I’m like - great. [Chuckles] They were there the whole time - um, it can look like - it can look like kids needing to leave - um, not feeling - taking a lot longer to build that like therapeutic… trust and bond… that’s so vital to therapeutic relationships. That can take a lot longer - and that means sometimes therapy initially starts out like… just listening to their favorite songs and, like, having coloring papers - and even if they don’t color, if they’re there, there’s that base level of forming trust and safety that can be really difficult - um, especially with… younger kids who experience things like neglect, or abandonment, or… abuse or sexual abuse, where, the people they’re supposed to trust… can’t actually be trusted - and it leads to, like, this super confusing roles for them of like—

Erica: Mmm —

Colby: Do I give up… my caretaker by like admitting all these feelings of like anger and frustration towards them? Or do I like… separate that and then release it in other places. And then - if they get out of that situation, like, who - who- who is an adult I can trust? ‘Cause… the adults I was supposed to trust in the past prove to be really harmful. Um, and so… I guess that’s - to circle back around to the actual question - that is one way in which… um, that trauma-informed lens comes into play - is that therapy with those kids all - with all my folks - is not really based around, like, meeting a specific objective —

Erica: Mmm —

Colby: Or like doing the thing that the song tells people to do - it’s  more about… are they participating and finding their own way to be in the space - and, if they can’t be in the space, there might be something on my end that’s - like, I’m doing something that’s triggering to them, or… doing something that is just not engaging to them - or make them feel safe and unable to… engage in the same way.

Erica: That all makes a lot of sense, in terms of like your practical response —

Colby: Mmhmm —

Erica: With the children in a session. And I really like what you had said about - if someone asks you like, how is the child doing? How was the session? —

Colby: Yeah —

Erica: That, like, your level of what is success is accepting and embracing like —

Colby: Yeah —

Erica: Where that child really is - like, they can’t - you’re not expecting them to meet like unrealistic expectations —

Colby: No —

Erica: Your expectation is that they’re a child.

Colby: Yeah. Or even like - beyond that, they’re a person - and people have different levels at different days —

Erica: Yeah —

Colby: And like, one day they might be doing, you know, seemingly really well as to what we’re expecting - like, oh yeah, they’re paying attention in class, they’re not getting into fights, yada yada yada… And, you know, the next day or next week, they might be, uh, returning to some of those behaviors - or just places that - or they might have found new ways to uh present things - and, um, you know, it’s just - it’s a… long cycle and journey.

Erica: Sure. So, how does your trauma-informed approach transfer then also to, the - um, the more administrative side of you - your job —

Colby: Mmhmm —

Erica: Um, you have to do assessments —

Colby: Yeah —

Erica: You take data —

Colby: Yeah, mmhmm —

Erica: When you talk to school administrators - educators - what does that look like for you?

Colby: Yeah… So it - it ends up being, like not - I guess kind of, like, altering certain assessments that are standardizing - or creating our own - for different kids or groups. Like, there are certain bylines and - I use personally the Individual Music Therapy Assessment Protocol - the IMTAP - or… some of my kids, for just some of the bylines in there that ask, you know, did they meet the goals for session. I just end up not rating anything on that, because… unless we have both said okay, here are the goals we wanna work on - how are we gonna try and meet them - and,… the kid is also aware of this whole process that’s going on - then it feels almost unfair to be like, uh, well, today they couldn’t, you know, do this thing… And so, it’s just like an odd thing to judge a person on —

Erica: Absolutely —

Colby: And… then - then reporting on that too is… you know, trying to make sure you find ways that still present as numbers but also providing like a narrative, um, written part that can help kind of explain what the numbers are showing.

Erica: Mmm.

Colby: Um, so, if I’m doing like reports for grants or school admin… I’ll have the like percentages and numbers up - plan - presented on a graph, then also, like, have an… paragraph or couple sentences explaining - okay, this trend is showing possibly because of these things - maybe there were transitions in the classroom - new kids came in - transitions could be really difficult for anyone, but especially for folks who have a hard time adapting because of trauma, um, and then… that could explain like why there was a drop or if - there can be like a large increase because they started receiving services, of any kind - or there’s like… at home, they ended up being able to be in, like, one home for the entire school year, and could be a big reason why we see so much growth.

Erica: Mmhmm.

Colby: So, there’s like - there’s so much more than just like the numbers we’ll give you… um, at the same time though, there’s a bit of like a numbers game, in regards to… funding and maintaining services, because that is kind of like the world we live in - is that everyone wants to see… the hard numbers —

Erica: Mmhmm —

Colby: Um… Yeah - showing progress is showing like - this works! And —

Erica: Yes. Yeah.

Colby: Yeah.

Erica: Yeah. So if you live in an area where there’s music therapy nonprofit —

[Colby laughs]

Erica: Donate to that nonprofit, because then we can do trauma-informed work, and not have to rely so much on quantitative data. Side note —

Colby: Side note, yeah —

Erica: Just FYI.

[Colby laughs and says something quietly]

Erica: Um… because you work in schools —

Colby: Mmhmm —

Erica: Uh, just a little bit extra background on me is that  I come from a family of educators —

Colby: Yeah —

Erica: I grew up hearing about the ACEs study.

Colby: ACEs —

Erica: Do you wanna touch on the ACEs study - does that inform your work —

Colby: Yeah, absolutely —

Erica: How does that inform what’s happening?

Colby: Um, yeah… ACEs was like - I think back in the 90’s - a pretty big break through  uh  study done. The ACEs stands - the all - A, C, and E are all capital. - stands for adverse childhood experiences. And the study, um, was done with Kaiser, I think, as a - as a partner… and they looked at medical records - and um - of a whole bunch of different clientele - um, and they gave them like a little questionnaire sheet to fill out.

Basically was like, in the past - like when you were below 18 years old - did any of these things happen - and they talk about, you know, witnessing abuse, being sexually assaulted or abused, um, having family members in prison, going through a divorce - all these other just pretty… um broad possible identifiers of trauma. And they found correlation between folks that scored higher - they had more adverse childhood experiences - and all sorts of physical health… problems, like, um, lower immune systems, increases and chances of like depression, and risk of suicide - increases in like liver and heart problems too, so like, the lasting effects - it’s like - those toxic chemicals stay in your body and effect more than just the psyche, they can spill out into every facet of your being.

Um… and so, that was a really good… thing that kinda kickstarted this whole trauma-informed… movement. Um, and of course today, it kind of echos out.

And - if you look at that study, it was done with, you know, folks who had access to Kaiser’s insurance - and so, they were um predominantly white middle class folks. Um, and we also know that marginalized communities uh have a lot more obstacles to kinda overcome —

Erica: Mmhmm —

Colby: Um, including access to healthcare at all. So, we’re also disregarding, like, systemic pressures - um, increased poverty - social economic standing is known to have impacts on, you know, traumatic experiences and, uh, just like continual low level micro traumas… so, we also kinda pull back layers… the study was important - showed something like 1 in 12 kids scored 3 or more, and that was correlated with higher chances of all these kind - negative side effects we saw.

Erica: What was the scale - you said 3 or more - was it like a 1 to 10 scale?

Colby: Yeah. A 1 to 10 scale —

Erica: Okay.

Colby: Um… Yeah. So, getting, you know, 3 or 4 out of 10 was correlated with pretty high risks a lot more than folks who scored 1 or 0 - and I think it was something like - 1 in 4 had at least 1… something —

Erica: Yeah —

Colby: Pretty remarkable like that, where, even a quarter of the kids we would kind of consider the most protected by their environment still face some sort of —

Erica: Mmm —

Colby: Traumatic experience. So if we pull back all the layers —

Erica: Yeah —

Colby: And… try and apply it much more broadly to the type of folks we end up being able to work with… um, there’s a lot more chances that every kid - or almost every kid - that you know, you or I encounter - have something that still kind of shapes them. Yeah —

Erica: Yeah. Absolutely. And listeners, if you are interested in learning more about the ACEs study we will put a reliable —

Colby: Yeah —

Erica: Resource available on the episode notes that go with this episode specifically —

Colby: Mmhmm —

Erica: Um, uh - feel free to check it out. We talked a couple days with Vee about social justice in music therapy —

Colby: Yeah —

Erica: And talked a lot about ableism, and I think, as you look more into the ACEs study, you’ll find more ways that the study is helpful —

Colby: Mmhmm —

Erica: To launch the trauma-informed movement, but also incorporates —

Colby: Yeah, there’s a lot of crossover with that —

Erica: Dismissive and erasure behavior for marginalized identities.

Colby: Yeah, yup.

Erica: Yeah, it’s unfortunate. But - but we’re glad to have trauma-informed care!

Colby: Mmhmm.

Erica: And… So, okay - so we spent a lot of time talking about trauma - trauma-informed care - what that looks like. What are the impacts of a non-trauma-informed approach? I know you said you don’t practice that way —

Colby: Yeah —

Erica: But are you aware —

Colby: Yeah, I’ve seen some things —

Erica: Of… what those impacts might be?

Colby: Yes. So, if we’re disregarding some of the longer standing effects of trauma, they can - other treatments that, you know, disregard that or don’t take that same into account - can actually be pretty harmful. I’m thinking of, like, when there are really severe or harsh consequences provided to like not following a certain instruction - usually peoples or kids - or not all usually - always people’s behaviors are geared towards getting them the things that they need to survive. And so, if we start counteracting those without doing the deeper work… people are just gonna find new and more potentially problematic ways of finding those needs, because they haven’t learned that it’s okay to adapt to the current safe situation - they’re still worried about, you know, am I going to sleep here - like, they’re still worried about much broader pictures than - I’m thinking very specifically of like school examples —

Erica: Sure —

Colby: Because that’s where I’ve been mostly.

Erica: Absolutely.

Colby: Um, it’s like - knowing kids that like worry about where they’re going to be sleeping or eating that night - they’re not going to be able to focus on the math problem you’re having them work on. And so, if you, you know, get mad at them and judge them and give them some sort of harsh consequence  for not doing the math homework - or not doing this certain problem the way you told them to - or not following instructions right away - then it’s going to kinda like continue this punishment cycle, and teach the kid that they aren’t smart, or aren’t, you know, worth helping out - they aren’t lovable - they’re going to be alone —

Erica: Mmm —

Colby: And this com - could just c - compound upon things that they’ve already experienced and learned from adults in their life, um, who have… taken advantage - or completely ignored them.

Erica: Yeah.

Colby: Um… So… just thinking of a kid whose, like, not sure where they’re going to sleep because their parents are too busy, you know - ‘cause they’re involved with drugs or in prison or… just aren’t there —

Erica: A multitude of circumstances that makes them absent —

Colby: Yeah - have passed away - like, there are so many different things.

Erica: Yeah.

Colby: And then we’re telling them again, like, hey, you didn’t do this math problem or you didn’t sit down this right way - go be alone - go sit in time out - or, I’ve seen a quiet room, a QR, place where kids if they get really - kinda disregulated end u end up getting kinda just shoved in there and left by themselves. Like, it’s just reenforcing that once you act a certain way, you will be alone.

Erica: Mmm —

Colby: Um, and you… aren’t worthy of, like, that care. So… —

Erica: That’s so sad… those poor children. Aww…

Colby: Yeah [chuckles uncomfortably]

Erica: Okay, so… if - um, I’m sure we have a wide variety of listeners listening - uh, different professions —

Colby: [Asks a question far from the microphone] Mmm.

Erica: Oh we do. Don’t you worry.

[Colby chuckles]

Erica: Um… what sorta resources can you offer - what do - what have you found to be good resources for investigating this further —

Colby: Mmhmm —

Erica: For learning more what they can do…

Colby: Yeah. I would super duper recommend um a book called The Body Keeps the Score, by Bessel van der Kolk.

Erica: He just happens to have it right next to him.

Colby: Okay - managed to get the name right. It’s a very important name. Bessel van der Kolk.

Erica: How do you spell that?

Colby: B-E-S-S-E-L space V-A-N space D-E-R space K-O-L-K. I read it during internship and it really changed a lot for me. And I’ve been rereading it recently —

Erica: Mmm —

Colby: And it’s really been a great eye re-opener. Just to… continue to remind myself what all the things are going on - it breaks down, like, the neurobiology of it, the like physiology of it, um, mental parts, some history things - some history as in how it’s like been neglected by the mainstream, um, including, like, the APA… and, um, the DSM, and, um, how there’s a lot of problems with  the current system of diagnosis - as opposed to looking at people’s histories.

Erica: Mmm —

Colby: Um - and then another good source - resource would be - there’s a podcast called the Trauma Therapist —

Erica: Okay!

Colby: Um —

Erica: Do you know who that’s by maybe?

Colby: Guy McPherson I think? I was tryna look it up.

Erica: We’ll have the link - we’ll make a link available. If you would like to look at these resources, the website is S, as in Sam, C, as in Cat, Music Project dot org. (SCMusicproject.org) Go to the podcast page and you can find, um, notes from this episode - resources - and we also make available a transcript of every podcast episode, so if you are hard of hearing or part of the Deaf community, you are also welcome to read and join with us in these conversations about music therapy - different philosophies, concepts, and what it means to be a music therapist in the 21st century.

Thank you so much for talking to us —

Colby: Yeah! It’s my pleasure —

Erica: About trauma-informed care. Colby’s gonna be back next week —

Colby: Yeah! —

Erica: Um, with Vee, to talk about music in the brain. We’re doing a 2-part series talking about the… um theoretics —

Colby: Mmhmm —

Erica: About what’s happening in the brain, and then talking - the next part will be about the actual applications and how a music therapist applies —

Colby: Yeah —

Erica: The information to their work. If you would like to learn more about the Snohomish County Music Project, you can follow us on social media. Uh, we’re on all platforms at SCMusicProject. Uh, thank you so much for listening. Talk to you next time.

Colby: Bye!

[Podcast outro music plays.]