By Molly Warren, MM, LPMT, MT-BC | Dec. 19, 2016
When I worked at a psychiatric hospital, I would wheel my cart full of instruments and musical gadgets down the hallway every morning. Patients lingering in the hall would smile and tap on a drum as I passed by. Some would ask me if I had their favorite band on my iPad. Some would peek their heads out of their rooms, and exclaim, “Molly’s here! It’s time for music therapy group!” Oftentimes, I would hear about patients who were asleep in their rooms when I arrived, but their friends would gently wake them with a reassurance: “You don’t want to miss this.”
Music to My Ears
I’ve been lucky to serve many children and adults in various mental health settings as a music therapist. I’ve heard stories of resilience, strength and adversity. I’ve worked with individuals who have experienced trauma, depression, grief, addiction and more. These individuals have not come to me in their finest hour, but despite feeling lost or broken, music provided them with the opportunity for expression and for experiencing safety, peace and comfort.
Research shows the benefits of music therapy for various mental health conditions, including depression, trauma, and schizophrenia(to name a few). Music acts as a medium for processing emotions, trauma, and grief—but music can also be utilized as a regulating or calming agent for anxiety or for dysregulation.
There are four major interventions involved with music therapy:
- Lyric Analysis
While talk therapy allows a person to speak about topics that may be difficult to discuss, lyric analysis introduces a novel and less-threatening approach to process emotions, thoughts and experiences. A person receiving music therapy is encouraged to offer insight, alternative lyrics and tangible tools or themes from lyrics that can apply to obstacles in their life and their treatment. We all have a song that we deeply connect to and appreciate—lyric analysis provides an opportunity for an individual to identify song lyrics that may correlate with their experience.
- Improvisation Music Playing
Playing instruments can encourage emotional expression, socialization and exploration of various therapeutic themes (i.e. conflict, communication, grief, etc.). For example, a group can create a “storm” by playing drums, rain sticks, thunder tubes and other percussive instruments. The group can note areas of escalation and de-escalation in the improvisation, and the group can correlate the “highs and lows” of the storm to particular feelings they may have. This creates an opportunity for the group to discuss their feelings further.
- Active Music Listening
Music can be utilized to regulate mood. Because of its rhythmic and repetitive aspects, music engages the neocortex of our brain, which calms us and reduces impulsivity. We often utilize music to match or alter our mood. While there are benefits to matching music to our mood, it can potentially keep us stuck in a depressive, angry or anxious state. To alter mood states, a music therapist can play music to match the current mood of the person and then slowly shift to a more positive or calm state.
Songwriting provides opportunities for expression in a positive and rewarding way. Anyone can create lyrics that reflect their own thoughts and experiences, and select instruments and sounds that best reflect the emotion behind the lyrics. This process can be very validating, and can aid in building self-worth. This intervention can also instill a sense of pride, as someone listens to their own creation.
On Another Note
When I worked at a residential treatment center, I was notified that a child refused to continue meeting with his usual therapist. Even though he was initially hesitant to meet with me, he soon became excited for our music therapy sessions.
In our first session, we decided to look at the lyrics of “Carry On” by FUN. I asked him to explain what it means to be a “shining star,” which is mentioned serval times in the song. I was expecting this 8-year-old to tell me something simple, like “it means you’re special.” But he surprised me when he stated, matter-of-factly: “It means that you are something others notice. It means you are something to look up to, and you are something that helps others navigate.”
And just like that: This lyric offered the opportunity to discuss self-worth, resilience, and strength. Music provided him with the structure and opportunity to process in an engaging way. Soon, his therapist began attending our sessions to help build a healthier therapeutic relationship. His family and teachers reported improved emotion regulation and social interaction skills. Music therapy had provided countless opportunities for building healthy relationships, just as it has for thousands of others.
Try it for yourself! Check out the American Music Therapy Association to find a board certified or licensed music therapist near you.
Molly Warren, MM, LPMT, MT-BC received her Master’s in Music Therapy with a focus in Psychology from Colorado State University. Warren specializes in working with individuals with trauma and neglect backgrounds and other behavioral disorders. She also has experience in working in an acute psychiatric facility in which she has worked with adult, adolescent, and pediatric general mental health populations. Her philosophy is to introduce novel and authentic modalities to best reach the needs of her clients to create a genuine and individualized experience. Warren currently works in her own private practice, Olive Branch Therapeutic Services. You can visit her website at www.olivebranchtherapeuticservices.com
Music therapy uses music to work with individuals or groups of people with dementia to enhance their quality of life.
A person’s ability to engage in music often remains intact far into the advanced stages of dementia. This is because music stimulates the motor center of the brain, which responds directly to auditory rhythmic sounds. This does not require active cognitive processes to work well.
Music can be a great opportunity to provide another layer of emotional and physical support when caring for your loved ones.
What Music Can Do
1. Enhance communication
As dementia progresses, it often becomes more difficult for a person to share their thoughts and feelings with other people in a meaningful, intimate way.
Listening to music together can allow those with dementia to relax and share experiences with others that does not require them to express themselves verbally. They may still be able to join you in singing along to favorite songs. Or simply holding hands while listening may provide a chance for deeper intimacy.
A person’s reduced ability to share with others can also feel very isolating. Music gives a space for those with dementia to interact socially, either with their loved ones, therapists or with a music therapy group.
Even if someone with dementia is not able to express these memories anymore, they are still able to be moved by the feelings and associations in their own way.
2. Provide emotional support
Music can be closely related to many of our unconscious emotions. A person may be able to connect with emotions they may not be consciously aware of anymore by listening to a piece of music.
Research has shown that music therapy can help those with dementia improve their memory recall, create a more positive mood and gain a greater sense of control over their lives.
In addition, most music will have either a stimulating or relaxing effect on a listener. This can be used in different therapeutic ways depending on your purpose.
If your loved one is fairly advanced in their dementia and does not respond easily, a stimulating piece of music may help to rouse them in a way simple conversation no longer can. Some people may start tapping their toes or look up attentively to listen to the music.
Stimulating music can also be played in the background at mealtime or other daily activities when it’s helpful to promote wakefulness.
In contrast, music can also help with individuals who become agitated or more aggressive due to their dementia. It’s helpful to identify if their disruptive behavior has a pattern. For instance, many people with dementia will become more upset around the time the sun sets, known as “sundowning.”
Times like these would be ideal to play relaxing music to see if it can help create a calming atmosphere and diffuse any tense situations.
3. Promote physical benefits
Music is an excellent way to promote exercise for those with dementia who are still physically active. Dancing together is a great way to interact if they are able to stand. Even in a wheelchair, many people with dementia are able to move their bodies to rhythm in various ways, from swinging their arms to moving their feet.
Many with dementia are also able to participate in physically making music. They may be able to use drums, bells, harps or other instruments. This can clearly improve their mood and enjoyment of interaction, but it will also help them build muscle strength.
Many studies have shown that familiar and well-like music can have more positive outcomes than medication for older adults with various types of dementia. Music has been able to reduce depression, lessen agitation, decrease problem behaviors and increase sociability, movement and cognitive function better than medications.
Music has also been found to act as an effective non-pharmacological way to manage physical pain.
How to Use Music With Your Loved Ones
A professional therapist can help you plan specific care for your loved one based on their history and personality. If you live in the United States, the American Music Therapy Association can help you find a therapist in your area. For other countries, there is often a similar local association you can contact.
If your loved one is in a care facility, they may already have a music therapy program in place. If they don’t, try discussing it with facility staff.
There are many general ways you can start using music to interact with those who have dementia, such as:
- Dance with them, either at home or go somewhere they feel comfortable. Make sure to play music they really love.
- Try a karaoke machine or use song sheets so you can sing along together.
- If they are farther along in their dementia and more interactive activities are unrealistic, at least spend time listening to music with them. Do your best to find what types of music they enjoyed earlier in their lives. Watch for their reactions to different music choices and stick to ones that seem to either calm them or make them happy. If they show signs of irritation, such as facial grimaces or tensing their muscles, stop the music and try something different.
- Sing to them, especially if they are unable to sing along themselves. And if you can sign to them in their first language, this often has the most positive effect.
- Find out if there are any local music therapy groups you can join with your loved one, or start your own.
By Susan Svrluga August 2
Friends draped arms across one another’s shoulders and swayed as they listened to Forrest Allen sing. Some joined in softly, not wanting to drown him out. Some blinked back tears.
They never expected him to survive the accident. They knew the effort it took that afternoon for Forrest to sing each note — just audible, even with a microphone — as his music therapist played keyboard next to him. His brother steadied Forrest with a hand to his back; with so much of his skull missing, a fall could be deadly.
Forrest stopped in the middle of “Lean on Me.” He grinned at the graduation-party guests gathered on the lawn of his family’s home in Virginia horse country. “You guys aren’t singing!” he teased. They laughed, and raised their voices along with his.
Forrest is 21. He was supposed to graduate from high school three years ago. Then he caught an edge snowboarding and fell, hard. For two years Forrest couldn’t say a word.
When he was finally able to type, he tapped out a message to his childhood music teacher: “Mr. Sweitzer, please help me get my voice back.”
Music therapist Tom Sweitzer and Forrest Stone Allen rehearse their songs at A Place to Be in Middleburg. (Nikki Kahn/The Washington Post)
Life changes in an instant for millions of people each year who, like Forrest, suffer traumatic brain injuries. Such injuries — whether from an IED in Afghanistan, a tackle on the football field, a fall off a ladder or a car accident — kill and disable more young people in the United States than anything else. More than 5 million people are trying to recover from them, at a staggering emotional and financial cost.
For Forrest, help came from places both expected — family, friends, teams of medical professionals — and unexpected. Tom Sweitzer used rhythm and melody to motivate him through the endless repetitions of neural recovery, coaxing out breathing and movement and laughter and, finally, Forrest’s own words. Cheering him on was a team of supporters — all of Middleburg, it seemed: old classmates, nurses and teachers, and thousands of strangers who followed online updates.
Those who came to the party in June had been waiting for this moment: graduation, celebration, a chance to hear Forrest sing. It was something to hold onto, a moment to savor before the next hit.
This month, Forrest will undergo the first of a groundbreaking series of surgeries to try, once again, to close up his skull.
It could save his life. It could wipe out everything he has so painfully earned back.
Ponies and dolphins
Forrest grew up riding ponies on his family’s farm in The Plains, Va., just outside Middleburg, and climbing in tree forts with his older brother, Austin. He spent summers scuba diving wherever his mom’s career as a marine mammal veterinarian took them, swimming with dolphins.
He was fun-loving, polite, silly, charismatic — and could talk his way out of anything, said Sweitzer, who has known him since kindergarten.
He spoke up for underdogs. There were tight cliques at the Hill School, but Forrest was always the one to bring everyone together, with sleepovers, parties and paintball fights. “He just had a lot of empathy for everyone,” said former classmate David Marshall.
He wanted to be a veterinarian, like his parents, and had been accepted into the president’s leadership program at Christopher Newport University in Newport News.
Soon after his 18th birthday and a family trip to Aspen, Colo., where he and Austin rode some of the toughest slopes, Forrest went snowboarding at a little ski area in Virginia.
This time, he didn’t wear his helmet.
He fell so hard that he shattered a wooden fence.
Doctors in Charlottesville, where Forrest was airlifted, told his family to prepare for the likelihood that he would never emerge from the coma, recalled his mother, Rae Stone. Surgeons cut out the front third of his skull to relieve pressure on his swelling brain.
But after 10 days, Forrest opened his eyes and squeezed Stone’s hand.
As Forrest began to recover, there were small signs that his personality, though silenced, wasn’t completely lost. On a medevac flight to a rehab hospital, a nurse handed him a stress ball. Forrest made his family laugh by playfully dropping the ball back in the nurse’s pocket.
After hours of a drill where a physical therapist asked him to hold up two of his fingers, he tired of doing it. So when she said, again, “Show me two fingers, Forrest,” he pointed at her fingers, and smiled.
But after doctors closed up his skull with a prosthetic plate, he went back into a coma. Racked with seizures and hallucinations, unable to breathe on his own, his 6-foot-3 frame dropped to 118 pounds.
Finding his voice
His condition was so precarious that Team 44 — as his loved ones called themselves, after his childhood nickname and lacrosse jersey number — didn’t look ahead very far. They focused on 12-hour plans. His family stayed with him in shifts around the clock, reading cards aloud and watching silly movies, despite his silence. Friends told funny stories over Skype.
Stone asked Sweitzer to come, hoping a familiar voice might trigger some response. Sweitzer played guitar and felt like a failure; Forrest seemed catatonic, he said. But Stone saw Forrest’s pinkie move to the music.
Over time, there were other glimpses of Forrest’s personality — a reassuring thumbs-up, a flash of his dimpled smile. When he came home from the hospital shortly before Christmas 2011, he required 24-hour nursing care and was still on oxygen and a feeding tube. But Sweitzer was able to visit more regularly.
They spent months working on breathing, or hitting a drum. Sweitzer used music, often the silliest of songs from cartoons, or pirate fights, to motivate his patient.
“I’m worried about the same thing the physical therapist is worried about,” Sweitzer said. “How many times can you cross the midline of your body to hit a drum?”
Forrest had both physical and cognitive gaps, typical of brain injuries. After two years of intensive therapy, he could understand a 12th-grade government class, but struggled with short-term memory. He was learning to use a keyboard, but was unable to speak and was unsteady on his feet.
As the 2012-2013 school year began, Forrest’s parents met with specialists at Fauquier County Public Schools, who laid out an education plan for a non-verbal person. Stone told them no — her son was going to talk again. They thought she was crazy.
In October, after months of effort, he was able to blow into a whistle enough to emit a tiny noise.
Later that fall, Forrest typed the message to Sweitzer asking for his voice back. After leaving the house, the music therapist broke down. “I knew Forrest was trapped in there,” he said.
The signs kept coming: same warmth, same playfulness. In his first typed message to a longtime aide, Forrest wrote, “You are a — ”
The aide waited breathlessly. What was it he wanted to say?
“ — nincompoop,” Forrest typed. They both cracked up.
Sweitzer kept trying to get Forrest to say words, to greet him when he arrived. In December 2012, he saw Forrest’s mouth forming, then heard the slightest sound, half an exhale, half a hum: “Good morning.”
It was afternoon but, Sweitzer said, they all laughed, elated. It was morning somewhere.
For the many months his son was silent, Kent Allen said, he kept thinking, “I’ll give anything in the world if you’ll just say yes or no.”
Once the words started to return, “you want more,” Allen said. “You want him to live a normal life.”
A starring role
“Eeeeeee,” Forrest said on a recent afternoon, trying to hold a note as long as he could at Sweitzer’s music therapy center in Middleburg. Sweitzer held up his phone to time the seconds.
“That was 21,” Sweitzer said. “Can you make it to 30?”
Forrest pounded out an ominous little crescendo on the piano keys with one hand. His mouth twitched into his ready smile. His “bucket,” a big white helmet signed by friends, and his service dog, Toliver, were at his side. He had tied a bandana around his head. It dropped starkly in front where his skull is missing.
“Eeeeeeeeeeeee,” he said.
For the past six months — since Forrest got out of the hospital after a third failed attempt to close his skull — he and Sweitzer have been working on a musical about Forrest’s life. It is by turns serious (information about brain injuries), goofy (“Dolphins, flying through the sky. Dolphins, eating pies.”) and heartfelt.
In the musical, titled “44,” Forrest thanks his brother for putting his life on hold for years to be there for him. He sings about the trapped feeling of wanting so badly to talk. He says he sure wishes he had worn a helmet that day.
His voice is weaker than it was last year, before the last, terrifying setback. But he can still talk trash during a ping-pong match, or sing along when friends play guitar.
Of all the many types of therapies he has to do, including speech therapy, music feels different, Forrest said. Sweitzer “makes it fun. I like going to it.”
At the beginning of summer, Forrest and several students read “44” to a packed auditorium at the Hill School. They plan to perform the play in October, but wanted to stage it early, just in case.
After three failed attempts, surgeons are trying a more extreme way to reconstruct Forrest’s skull and protect his brain. The protocol was designed by U.S. doctors serving in Iraq and Afghanistan to help brain-injured soldiers.
A team of doctors at Johns Hopkins will work to create a layer of living tissue on Forrest’s head by moving a flap of muscle there during an initial 10-hour surgery later this month. Eventually they plan to remove part of the healthy bone from the back of his skull, split it, and implant a piece on the front, behind his forehead.
“It kind of makes me sick to think about it,” Stone said. The risk. The hospital time. She’s most afraid of a return to silence.
Forrest says he’s ready. He told Sweitzer he would either wake up happy, “or, pfff.” He made a funny noise, like air coming out of a balloon.
When Kettle Run High School’s class of 2014 marched into the football stadium on graduation day, Forrest walked with it, mortarboard shimmied onto his helmet. He grinned and gave a thumbs-up when he saw Team 44 waving a giant photo of his head.
After the ceremony, his mom told him: You did it! You’re done!
No, Forrest said. I’m not done.
For a moment she thought he was confused. Her heart clenched. “ ‘Have we got a bleed?” she wondered. “Is there a setback situation here?’ ”
It was neither. Forrest wasn’t confused. He just had something to say. “There’s still college.”
Susan Svrluga is a Virginia rover for the Washington Post, covering anything and everything that’s happening in the Commonwealth.
By KATIE MOISSE (@katiemoisse) , BOB WOODRUFF (@bobwoodruff) , JAMES HILL (@jameshillABC) and LANA ZAK (@LanaZak)
Nov. 14, 2011
In the 10 months since a bullet to the brain left her in critical condition, Congresswoman Gabby Giffords has relearned how to talk — a feat partly credited to music therapy.