Critical points and levels of depth in the therapeutic process

In humanistic and positive psychology songwriting practices, the therapeutic relationship is regarded as a key component in the songwriting process. The songwriting process has the potential for maximum therapeutic benefit when rapport has been established. At what point this therapeutic relationship is established, however, is somewhat difficult to articulate with certainty, as it will be depend upon numerous factors, including the setting, the diagnosis (if relevant), the therapist's characteristics, sociocultural factors, and length of the proposed treatment

Example of sung imaginal dialogue

Figure 13.5 Example of sung imaginal dialogue

plan (see Chapters 3-6). For example, one clinician reported that building a trusting relationship sufficient for songwriting takes longer when she works in mental health when compared with her work in palliative care. Therefore, the initial stages are a very important part of the songwriting process, where the therapist is establishing this safe space for the songwriter to express himself in song when he is ready and able. Some clinicians begin the therapy process by asking songwriters to create a 'lighter', less personal or emotional song as a way of introducing songwriting as a possible journey in their recovery.

Being empowered to have a voice is a fundamental principle of humanistic thinking. When a therapist is sitting next to the songwriter and acting as a scribe, the songwriter has the freedom, support, and safety to create lyrics and/or music. The songwriter experiences this therapist attention as a form of unconditional positive regard, of being heard, acknowledged, and validated. These feelings of validation might prompt the songwriter to take more risks with disclosure and uncensored material, and share, process, and potentially release tension associated with internal or external conflict. The songwriter may experience similar feelings of empowerment and validation when his song is being performed or shared (Baker, 2013d).

Performing to and sharing the song with significant others can be a critical step in the songwriters' therapeutic journey, affording greater transformative power than the creation process itself. For example, for children grieving the loss of a family member, sharing the song creation with others can lead to additional grief processing. One clinician stated:

The kids were great creating songs for or about their lost family member and we would record them on a CD. Sometimes the child wanted to share it with the rest of the family, often mum and dad, sometimes the whole family, aunts, uncles, grandparents will all come along. There'd be tears and there'd be hugging; it was really powerful. Then they would all start processing what had happened to them, and doing it as a family.

For those working on identity issues with adolescents, a critical point in the songwriting process occurs when the adolescents start to replace the imitation of their idols with their own voices and sculpting the music into their own creative sound. One clinician suggests it is this authenticity in sound that signals the entry into a new phase of 'identifying myself; who I am, what my voice is'.

Some clinicians assert that self-growth is associated with self-disclosure. As the songwriter works through therapeutic issues, he may feel vulnerable, exposed. There are moments of baring oneself in front of other people, having to own what has been created, and risking being exposed to whatever feedback or reactions might follow. It is through the therapist's support that songwriters courageously share themselves through lyrics and music, and become catalysts for self-actualization.

Experienced humanistic and positive psychology-oriented clinicians differed in their views of the level of depth achieved through therapeutic songwriting. Levels of depth depended upon time available, therapeutic needs being addressed, and the age and abilities of the songwriters and context. Songwriting at the supportive level is practiced when its purpose is to support the songwriter in whatever is prevalent in his life at that moment, whether the focus is on accepting the past, being content with the present, or looking toward the future. In the medical setting, for example, songwriting would be supportive when a person is about to undergo a medical procedure or is in pain. Supportive levels are appropriate when the songwriters are preparing for discharge and exploring feelings and concerns about the future. In the palliative care setting, songwriting is supportive when children or adults feel a need to express their here-and-now feelings - feelings that may be transitory and not necessarily ongoing issues.

A humanistic-oriented clinician working with an eight-year-old boy from the Dominican Republic recounted an example of songwriting at the supportive level. The young boy had received a burns injury and had travelled to the United States to receive reconstructive surgeries. He had large keloid scars and limited movement in his hands due to scarring, and his disfigured appearance led to social isolation at home. During one of his first music therapy sessions, his nurse interrupted the session to undertake a procedure involving a needle. The music therapist noticed the boy presented with symptoms of post-traumatic stress disorder during the needle part of the procedure. The mother reported that ever since he had been a baby, he had had a needle phobia (and these procedures were to occur weekly during his treatment period). The music therapist offered to support the boy and addressed his phobia in various ways, including offering the boy a space to express how he felt about needles. Using songwriting, the child wrote a song called 'La Aguja Mala' (The Bad Needle). The music to accompany it was created to support the negative emotions he expressed about the needle, thereby acknowledging his negative feelings. The boy and the music therapist sang together when recording the song, with the boy playing percussion and the music therapist on guitar. The song (Figure 13.6), composed in Spanish, included repeated lyrics to highlight certain thoughts and feelings.

In this case, the use of songwriting during distressing procedures illustrates its effectiveness in addressing the here-and-now feelings.

People who have experienced trauma or who have a mental illness may experience catharsis as songwriting releases stress and tension, and insight may result as they move toward a new realization about their lives. For example, a songwriter's lyrics might express 'I may have lost the house, I may have lost some books, I may have lost some photos, but I haven't lost my life'. As children with disability or people in palliative care tell their story through the lyrics and music, they concretize their abstract feelings, and this verbalization process contributes to increased insight into themselves and their contexts.

Example of song composed at the supportive activities-oriented level Source

Figure 13.6 Example of song composed at the supportive activities-oriented level Source: Permission to transcribe and print song 'La Aguja Mala' (The Bad Needle) given by Annette Whitehead-Pleaux.

Songwriting at the reconstructive or transformative level was less frequently reported for those practicing within the humanistic traditions. Transformations occurred during the processing of some form of loss - for example, loss of a loved one through death, loss of a relationship, or loss of a physical self - and also led to the capacity for some people to genuinely forgive others. As one clinician reported: 'I think so many transformative things can happen during songwriting. You know you can forgive others, you can forgive yourself and you can express emotions that you never knew existed. You can say things like I love you, thank you, you can assess regrets, pathways that you've chosen in life.'

One clinician recounted her experiences of working with a 16-year-old girl from the Dominican Republic who received significant burns and relocated to the United States for treatment. She described the girl as having a significantly altered appearance due to the severe burns on her face, upper limbs and hands, chest, and feet. Her family tried to protect her by not giving her an opportunity to see herself in the mirror during her initial hospitalization. Internalizing the message that she was hideous to behold, she hid in her room in the dark, afraid of her appearance and afraid of having others see her. Additionally, her eyelids contracted, limiting her ability to blink, which resulted in cataracts that blinded her. Upon admission she was referred to music therapy to focus on her pain management, anxiety management, and coping. During one of her sessions, the music therapist introduced the idea of songwriting. The adolescent girl wrote many songs, starting with song parody and then moving to writing lyrics and original music. Her songs were a way to bridge her 'three lives': life before the accident, life since the accident, and her life when she returned home. She saw the third life as a joining of the two first lives. Outside of her music therapy sessions she created the song 'Chica Diferente' (Different Girl), which explored her feelings of being different, and she brought it to her therapy session. It was a significant step for her in the integration of her two 'lives'. In this sense, the songwriting process was transformative.

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