Using Music In Therapy To Help Heal Attachment Trauma

Introduction

In the article “The Effect of Integrating Music Listening With an Attachment- And Affective-Focused Short-Term Psychotherapy in an Individual With Relational Trauma: The Case of ‘James.’”[1], G. Paul Blimling describes a hybridized case study using music chosen by a client nicknamed “James” within psychotherapy to help them heal their early life attachment trauma. By facilitating trust in the relationship with the therapist, collaborative music listening helped the client access and express strong emotions which would otherwise overwhelm and incapacitate them, and as a result healed their core attachment wound[2].

Karen Riggs Skean responds in her article “Integrating Client-Chosen Music in Relational Trauma Treatment: Pathways to the Heart”[3], noting that Blimling is a talented cellist, and adding that integrating his musicianship into his role as a therapist “helped him be more fully present with the client, which in turn helped the client be more present as well”[4]. Bringing his musical background to the therapy setting helped to bridge the gap with a client who was initially extremely reticent, untrusting and hostile.[5]

Ben G. Adams continues the conversation in his article “Self-Selected Music for Relational Trauma: Commentary on the Psychotherapy Case of ‘James’”[6] by pointing out that while integrating music listening into mainstream therapy sessions may at first seem novel, it actually represents a return to our hunter-gatherer ancestors, when music was integral to the shamanic healing process. By combining the music and psychotherapy, Blimling has in fact reconciled what was originally a unified societal role.[7]

In this essay I summarise the use of music for healing attachment trauma in Blimling’s case study and Skean & Adams’s responses, and discuss how it informs and impacts my own current musical practice and future projects.

Using music in psychotherapy can help heal attachment trauma

Music Facilitates Emotional Connection

Blimling begins by noting the research into music’s ability to facilitate both social bonding and self-expression.[8] Music is universally present in the highly intonated “motherese” which mothers across all cultures instinctively use to facilitate attachment with their infants.[9] This makes it a powerful tool in establishing the kind of safe emotional connection necessary to heal relational trauma caused by early life parental attachment issues.[10] Accelerated Experiential Dynamic Psychotherapy (AEDP), which Blimling chose to use with James, is grounded in attachment theory and well suited healing relational trauma.[11]

However, the therapy for attachment trauma is difficult because the relational nature of the attachment wound frustrates the very process of connecting to an emotionally safe therapist that could heal it[12]. Clients typically have strong defences erected during early infancy to help them survive, which prevent the safe emotional connection required to heal trauma. James had spent his infancy in a household filled with violence and his parents separated when he was only three or four years of age. His father was violent and abandoned James to his mother, who he suspected was a prostitute.[13] He developed a deep distrust of other people and was highly antagonistic towards his therapist, who had to be extremely cautious just to keep him attending.[14]

Other therapists have previously used “verbal psychotherapy with music”[15], but what is novel about Blimling’s case study is the application of collaborative client-chosen music listening in the context of AEDP to help James access and express the feelings that didn’t feel safe to express towards his parents as a child.[16] Music chosen by James included:

• Bill Withers song “Lean on me”, his first hint of vulnerability with his therapist.
• “The Death of Fallstaff” from Henry V by Sir William Walton, which shifted him from a state of intense anger deep into his grief.
• Don McLean’s “American Pie”, a gift from the one person he trusted, his late sister, along with a note saying she hoped it would “save his mortal soul”.
• “Papaoutai”, a French song which translates roughly to “Where are you, Dad?”, which expressed his grief at having been abandoned by his alcoholic father.
• “Pushin’ On” by The Quantic Soul Orchestra, chosen at James’s request by the therapist towards the end of their time working together and reflecting his belief that James was ready to move on and handle life by himself.

Traumatised individuals typically have strong defences erected around their emotional pain, which need to be dismantled safely[17]. James was initially extremely hostile towards his therapist. Collaborative music listening was the key to accessing his vulnerable core feelings and providing the safety necessary for him to share them in relationship with his therapist.[18] Feeling and express strong emotions while maintaining an empathic relational connection to another human being is the key to healing attachment trauma.[19]

The Authentic Presence Of The Therapist

Skean had worked as an instructor teaching Blimling Short-Term Dynamic Psychotherapy and was a member of his dissertation committee, so she was very familiar with the process that led to his article. She noted that Blimling is a talented cellist who is well suited to integrate music into the therapy process.[20] Skean compares Blimling’s combination of AEDP and client chosen collaborative music listening with other therapists’ work combining AEDP with other modalities of creative expression including a multicultural framework, and an expressive writing intervention.[21]

While Skean is enthusiastic in her support for the use of client chosen music in Blimling’s sessions and agrees that it was powerful for the client, she believes that the importance of the therapist has been downplayed in research into the effectiveness of psychotherapy generally. Integrating music with therapy not only impacted James directly, but also had a powerful effect on bringing Blimling’s full sense of presence to his role as therapist, and this was hugely significant in facilitating the successful therapy with James.[22]

Skean suggests that clients would benefit from having therapists integrate something core about themselves into the therapy process in a way that makes both the therapist and client come more alive. In Blimling’s case, this was music. Music is an activity of both mind and body, and singing in particular has been described as an evolutionary means of bonding social groups.[23] It provides a channel directly into the physical body that can bypass the defences that clients erect to protect themselves from their fear and pain.[24] It wasn’t just the inclusion of music in therapy that worked so well with James, it was the fact that Blimling’s own passion for music connected with James’s innate interest in the arts to help bridge the trust gap between them.

The lesson in Blimling’s case study is not necessarily that every therapist should use music in their therapy sessions, but that they should have the flexibility to do whatever is necessary to bring their full selves to the relationship in service of the client. It is the unique authentic presence of the therapist that helps create the safe emotional attachment needed to access painful emotions and transform old memories to heal the client’s attachment trauma.[25]

Music And Therapy’s Shamanic Origins

Adams reiterates support for Blimling’s use of music with individuals who have experienced relational trauma in early life. He highlights the challenge in working with them because they typically experience other people as being unsafe, and generally develop strong defenses against even feeling their own overwhelming emotions[26]. Music has powerful potential to disarm these defenses and collaborative listening helps facilitate an emotionally safe connection between client and therapist, which is a key ingredient of AEDP.[27]

However, the combination of music and psychotherapy is not as novel as it might first appear. There is perhaps an evolutionary reason why Blimling has been drawn to combine his two passions in this way, and why it was so effective in working with his hybridized client James.

In Adam’s view, using music in therapy is “a reconciliation in the sense that both music and psychotherapy have their historical origins in the ancient forms of psychological healing carried out by shamans in the societies of our hunter-gatherer ancestors.”[28] In ancient cultures there was no distinction between the musician and the therapist. Using music and dance to induce a trance-like state, the shaman would lead their tribe members on a metaphysical/metaphorical inner journey of transformation to help heal their physical and psychological ailments. Shamans were the first music makers among humans and all music ever created can be considered to be derived from shamanic practice. Like contemporary musicians, shamans operated in somewhat eccentric ways compared to the rest of the culture. They both employ elaborate costumes, utilise rich symbolism and imagery, and function as storytellers who express emotions and articulate narratives as representatives of their culture.[29]

Adams notes that virtually every worthy topic has been addressed somewhere in a rock song, and that many of these songs contain great wisdom. Traditional shamans were the purveyors of wisdom to their tribe. Using self-selected music in therapy can help a relationally traumatised patient to support their sense of self and connect with feelings that would otherwise be overwhelming. By expressing emotions in their music that listeners can connect with, contemporary musicians facilitate healing and transformation by acting as a modern-day incarnation of the traditional tribal shaman.[30]

Implications For My Practice

My own interest in using music to help heal attachment trauma is not merely academic., but stems from my own lived experience growing up with emotionally unavailable parents and struggling to both regulate and find a safe way to express my emotions. My childhood wasn’t anywhere near as abusive as James’s, but nevertheless I related strongly to his childhood story of “extreme interpersonal dysfunction that he encountered on a daily basis at home.”[31] While he acted out destructively by dumping his rage on other people, I dumped mine on myself in the form of a harsh inner critic, a crippling fear of exposing my emotions to other people, intense feelings of anxiety and panic attacks.

I came to music relatively late in life, only first picking up a guitar at age 40. Sure, I had piano lessons briefly as a child, but found the instrument frustrating and quickly abandoned it. I was a restless kid and just didn’t have the patience. What I didn’t understand at the time was how good it could feel to play music and how effective it could be at helping me deal with the emotions I was struggling with. I also never understood just how cool it is to play in a band until I learned to play an instrument and actually joined one in my mid 40’s.

I’ve had a lot of therapy to help heal my own attachment wounds, and while the process was necessary, it took a long, long time. I often wonder how the healing process could be accelerated, and I have long thought that music could be part of the answer. The conversation between Blimling, Skean and Adams has helped fill in some of the gaps.

I now understand music’s ability to facilitate an emotional connection with other people that would otherwise be too threatening. As a relatively latecomer to music, my musicality needs work, so I find myself at Sydney University studying music and psychology with the aim of combining the two. These articles demonstrate that there is clear potential for integrating music listening in a therapy session. I am also interested in creative approaches such as collaborative songwriting with clients, which will require me to continue working on my music theory, musicality, and songwriting skill. I am also working on my first album tentatively titled “Music Therapy” and aspire to becoming a musician who acts as Adam’s shaman to help heal other people vicariously through listening to my own musical works.

I feel a strong resonance with all my fellow students discovering who we are as musicians through formal study, working out where we fit in and what the future of music means for us. I’m also committed to practicing every day: I really want to be able to play piano well.

I’m highly motivated to keep improving my own basic skills on my instruments, writing songs that express the emotions that I still sometimes find challenging, and using music as a way to connect more deeply to other human beings in a way that is fun, engaging and transformative for everyone.

Bibliography

Adams, Ben G. “Self-Selected Music for Relational Trauma: Commentary on the Psychotherapy Case of ‘James’.” Pragmatic Case Studies in Psychotherapy 15, no. 2 (2019): 198-205. http://dx.doi.org/10.14713/pcsp.v15i2.2054 

Blimling, G. Paul. “The Effect of Integrating Music Listening With an Attachment- And Affective-Focused Short-Term Psychotherapy in an Individual With Relational Trauma: The Case of ‘James’”. Pragmatic Case Studies in Psychotherapy 15, no. 2 (2019): 116-166. http://dx.doi.org/10.14713/pcsp.v15i2.2051

Boer, D., Fischer, R., Strack, M., Bond, M. H., Lo, E., Lam, J. “How shared preferences in music create bonds between people: values as the missing link.” Personality and Social Psychology Bulletin, 37 no. 9 (2011): 1159-1171.

Bowlby, J. Attachment and loss: Vol. 1. Attachment (2d ed.) New York: Basic Books, 1982.

Bruscia, K. E. The dynamics of music psychotherapy. Gilsum, NH: Barcelona Publishers, 1998.

Fosha, D. The transforming power of affect: A model for accelerated change. New York: Basic Books, 2000.

McGilchrist, I. The master and his emissary: The divided brain and the making of the western world. New Haven, CT: Yale University Press, 2009.

Norcross, J.C., & Wampold, B.E. “Relationship and responsiveness in the
psychological treatment of trauma: The tragedy of the APA Clinical Practice Guidelines.” Psychotherapy, 56 (2019): 391-399.

Skean, Karen Riggs. “Integrating Client-Chosen Music in Relational Trauma Treatment: Pathways to the Heart.” Pragmatic Case Studies in Psychotherapy 15, no. 2 (2019). http://dx.doi.org/10.14713/pcsp.v15i2.2052

Trevarthen, C. & Malloch, S. “The musical lives of babies and families.” Journal of Zero to Three, 23 no. 1 (2002): 35-40.

Footnotes

[1] G. Paul Blimling, “The Effect of Integrating Music Listening With an Attachment- And Affective-Focused Short-Term Psychotherapy in an Individual With Relational Trauma: The Case of ‘James’”, Pragmatic Case Studies in Psychotherapy 15, no. 2 (2019), 116-166.

[2] Blimling, “The Case of ‘James’,” 116.

[3] Karen Riggs Skean, “Integrating Client-Chosen Music in Relational Trauma Treatment: Pathways to the Heart”, Pragmatic Case Studies in Psychotherapy 15, no. 2 (2019), 168-274.

[4] Skean, “Pathways to the Heart,” 168.

[5] Ibid, 173.

[6] Ben G. Adams, “Self-Selected Music for Relational Trauma: Commentary on the Psychotherapy Case of ‘James’”, Pragmatic Case Studies in Psychotherapy 15, no. 2 (2019): 198-205.

[7] Ibid, 198.

[8] D. Boer, R. Fischer, M. Strack, M.H. Bond, E. Lo, J. Lam, “How shared preferences in music create bonds between people: values as the missing link,” Personality and Social Psychology Bulletin, 37 no. 9 (2011), 1159-1171, cited in Blimling, 119.

[9] C. Trevarthen & S. Malloch, “The musical lives of babies and families”, Journal of Zero to Three, 23, no 1 (2002): 35-40, cited in Blimling “The Case of ‘James’,” 119.

[10] J. Bowlby, Attachment and loss: Vol. 1. Attachment (2d ed.), New York: Basic Books, 1982, cited in Blimling, “The Case of ‘James’,” 122.

[11] D. Fosha, The transforming power of affect: A model for accelerated change. New York: Basic Books, 2000,  cited in Blimling, “The Case of ‘James’,” 122.

[12] J. Bowlby, Attachment and loss, cited in Blimling, “The Case of ‘James’,” 122.

[13] Blimling, “The Case of ‘James’,” 125.

[14] Ibid, 126.

[15] K. E. Bruscia, The dynamics of music psychotherapy. Gilsum, NH: Barcelona Publishers, 1998, cited in Blimling, “The Case of ‘James’,” 120.

[16] Blimling, “The Case of ‘James’,” 128.

[17] Fosha, The transforming power of affect, cited in Blimling, “The Case of ‘James’,” 122.

[18] Blimling, “The Case of ‘James’,” 145.

[19] Fosha, The transforming power of affect, cited in Blimling, “The Case of ‘James’,” 122.

[20] Karen Riggs Skean, “Integrating Client-Chosen Music in Relational Trauma Treatment: Pathways to the Heart,” Pragmatic Case Studies in Psychotherapy 15, no. 2 (2019), 167.

[21] Skean, “Pathways to the Heart,” 168.

[22] J.C. Norcross & B.E. Wampold, “Relationship and responsiveness in the psychological treatment of trauma: The tragedy of the APA Clinical Practice Guidelines.” Psychotherapy, 56 (2019): 391-399, cited in Skean, 173.

[23] I. McGilchrist, The master and his emissary: The divided brain and the making of the western world. New Haven, CT: Yale University Press, 2009, cited in Skean, 172.

[24] Skean, “Pathways to the Heart,” 168.

[25] Ibid, 173.

[26] Ben G. Adams, “Self-Selected Music for Relational Trauma: Commentary on the Psychotherapy Case of ‘James’,” Pragmatic Case Studies in Psychotherapy 15, no. 2 (2019), 199.

[27] Fosha, The transforming power of affect, cited in Blimling, “The Case of ‘James’,” 122.

[28] Adams, “Self-Selected Music for Relational Trauma,” 200.

[29] Ibid.

[30] Ibid.

[31] Blimling, “The Case of ‘James’,” 135.