On a beautiful sunny Saturday morning, I took the trolley from my apartment in Chula Vista to Seaport Village on the San Diego bay, and enjoyed a chai latte outside with a Music Therapist I went to college with. We engaged in conversation about our lives, our work, our visions and dreams. This young professional is so inspiring and insightful, and her optimistic and friendly demeanor is enjoyable as well as contagious. If you get the opportunity I would seriously advise knowing her. She gave me valuable insight into the specifics of Music Therapy with Military populations, which I am excited to share with you today!
Hannah Bronson, MT-BC, Trained in Neurologic Music Therapy Technique, is the Program Director of the Semper Sound Music Therapy program in San Diego, CA. She also does clinical work and intern supervision for Barbara Reuer at Musicworx Inc. Bronson works with active duty and limited duty military at the Balboa Naval Medical Hospital, and the Wounded Warrior Program at Camp Pendleton, as well as a residential VA facility, and Veteran members of the community. Her caseload includes Inpatient and Outpatient clients with Neurological Disorders, Psychological Disorders, and Physical Injuries. Although cases in this population are often served short term, Bronson is sometimes able to continue treatment when patients are transferred between facilities; the advantage of a spread out Music Therapy program like this one.
Due to the state of military duties, many of the personnel receiving treatment for combat injuries are in the veteran population. Current diagnoses are often related to stress caused by military life in general: Depression, Anxiety, Adjustment Disorders, Physical Injuries related to training or accidents, Sexual Trauma (prevalent in female service members), General Psychological Injuries, and Combat injuries that did not present symptoms immediately.
The first thing to do when working with this population is to take steps to understand their lifestyle. Military life is a culture, which presents unique stress and anxiety to service members as well as their families. It is important for clinicians to do all in their power to empathize with this lifestyle, which includes day to day life as well as the reality of changing locations frequently, and deployments. Bronson takes opportunities to educate herself on the military culture through reading anecdotal and descriptive books, articles, etc. One book in particular she recommended to me was Rule Number Two by Heidi Kraft, which contains first hand accounts of a combat deployed Psychologist’s experiences at a hospital in Iraq.
The next step to preparing for this population is understanding the neurological conditions on a clinical level. Neurologic Music Therapy training is extremely helpful for this population. “Being familiar with the research behind Cognitive Rehabilitation lets other therapists know what we do is valid.“ This gives the Music Therapist adequate ability to communicate with the Interdisciplinary team and understand (as well as compliment) their treatment plan. Bronson has been able to communicate effectively with Psychologists, Occupational Therapists, and the Rec Therapist with whom she co-treats. “They understand how Music Therapy benefits service members and how it compliments the other treatments. The Psychologists understand we can augment what they are doing in other groups.” This is an ideal relationship to establish with other health professionals, and can be achieved by keeping ourselves educated on what they are doing as well.
You can further familiarize yourself with the research by taking continuing education workshops on Military Mental Health as well as reading research that is not Music Therapy based. I recently purchased the Musicworx Inc Toolbox Self Study Course on Military populations, and I highly recommend it.
Music Therapy Methods
Breaking the Ice
Due to the short term nature of treatment with this population, it is important to build rapport and get comfortable as quick as possible. “Openness of the group varies. The people required to be there may be less eager to participate at first.” Here are a couple strategies Bronson uses to break the ice with a new group.
Music Listening – Original vs. Covers
– Listen to original and cover versions of songs, involving people in a conversation of which they like better and why, what part of the music is related their experience, etc.
Here is an example comparison:
Taylor Swift’s Blank Space vs. Punk Cover
The two styles of music elicit very different visualizations that can bring life to the lyrics in extreme contrast. We may talk more about this in our Song of the Week posts this month, or focus more on covering songs as a month theme at a later time.
Song Shout Out
– Take a word out of a hat and have the group shout out songs they can think of that contain the word in title or lyrics. This is one of the activities provided in the Toolbox Self-Study Course. “This sounds like a silly thing to do when you read it, but it’s actually really fun in a group, and encourages a lot of involvement.”
Bronson enthusiastically identified Songwriting as her favorite treatment method to use.. “I find it is easier and more satisfying to write with clients than by myself. Servicemen have written some of the most moving songs I have ever heard.” This method is extremely effective with trauma patients because often times they are involved in some other therapy that involves commentary, narratives, or journaling of some kind; allowing the music therapist to pull directly from other treatments for lyric material. Regardless of your approach, Bronson suggests starting with lyrics and finding thematic material from there to write the music. Another way to write lyrics is providing time to free write on a theme/topic individually or with a group, then discuss and organize together. “The more you put structure to it, the harder it is. Being open to the process is easier.” This is such a unique piece of advice that I think really captures the spontaneous nature of clinical songwriting. It is a therapeutically guided expression which not only releases feelings, but creates something new and valuable from them. You can meticulously plan your session but when it comes time for execution, you have to be open to where songwriting will lead you, trusting your therapeutic and musical instinct.
If you check out our resources page, I have listed an excellent book about clinical songwriting that offers a variety of approaches and applications.
Learning a new skill can be very frustrating at first, especially to those going through Cognitive Rehabilitation of some kind. The goal in this scenario is understanding what is happening to cause the frustration: motor deficit, spacial awareness, trouble with auditory/visual cueing, etc. Bronson actively adapts her approach to provide a successful experience. “This is a great opportunity for them to learn about themselves. I talk them through it and address the frustration right in the session.” Some ways she adapts the lesson includes: trying a different approach, adapting the chords to account for physical limitations, or introducing a different instrument.
Live recreation of repertoire is a great way to get a group actively involved in the music. For people taking instrument lessons as part of their treatment plan, this provides opportunities for practicing and building confidence. “Playing in a group setting creates really awesome opportunity for peer support and social connection in nonverbal ways. Especially in the military when they already have a sense of camaraderie, we can build on that in a therapeutic setting.”
Personal Music Inventory
– Have each person identify 5 songs that are significant to them
– Play in the group and discuss
In Bronson’s experience, there tends to be a lot of overlap in the repertoire that holds significance for service members. “It is mostly the themes in the lyrics that address common experiences among military patients.” Repertoire that shows up a lot include Metal, Metalica, Country Music, and Johnny Cash. Sharing experiences through music in a therapeutic group setting provides the opportunity to recreate cognitive associations to the song, making it positive to experience the song later rather than a reminder of deployment or traumatic events.
This brings me to our repertoire list for this month.
Repertoire For Military Populations
- Wagon Wheel – Old Crow Medicine Show – This is a great jam song. It is positive and easy to play in a group.
- Simple Man – Lynyrd Skynyrd – There is also a cover by Shinedown
- Hurt – Johnny Cash (this song is excellent to follow with Walk)
- Under the Bridge – Red Hot Chili Peppers
- Other Side
- The Unforgiven – Metallica
- Drive – Incubus
- Rooster – Alice in Chains
- Walk – Foo Fighters
Becky and I decided to create our own list as well. Here are some songs that we think portray/express specific emotions:
- Pharrell Williams – Happy
- Brett Dennen – Who Am I — (confusion/anxiety/doubt)
- Peter Bradley Adams – The Longer I Run — (grief/loss)
- Seryn – Our Love — (love & redemption)
- The Staves – Black&White — (anguish)
- First Aid Kit – I Met Up with The King — (pain)
- Painter Song – Norah Jones – (Longing)
Generalizing outside of the session:
The overarching goal of Music Therapy is always to generalize therapeutic outcomes to normal everyday life. In the case of people suffering from trauma or anxiety, this means giving them musical tools to utilize during those midnight hours when they are unable to sleep or when they are feeling loss of control due to the physiological symptoms related to anxiety. Bronson talks her clients through this when they are learning how to play an instrument, or when they are doing music listening exercises. Bronson teaches her clients how to use music to affect their mood, for relaxation and sleeping, how to use deep breathing, and how music is related to physiological responses. I asked if it takes a while to teach enough musical skill to accomplish this, but Bronson says her clients can use music therapeutically away from session with very basic skills. Furthermore, so many service members already use music to cope with stress in some way, especially during deployments. Bronson is able to build on that by providing more instrumental skills, repertoire, and knowledge about how music can affect their body and mind.
The future for Military Music Therapy
The Semper Sound program here in San Diego is well established at the facilities it serves and is respected within the Interdisciplinary team. However, strong presence of Music Therapists in military populations is tremendously lacking in most parts of the country. The programs that do exist are not funded by the Department of Defense (DoD), but rely on donations and grants. “I am very optimistic about the future of music therapy with the military. The #1 thing is to educate Music Therapists on what is effective, through providing research for what we do. Research is how the DoD will eventually fund us.” Despite the fact that Music Therapy was founded on work with World War II Veterans, the body of research is lacking. If you would like to read what the AMTA has on this topic, click HERE. Bronson strongly encourages music therapists, despite the funding hurdle, to approach the military and offer our services. She sees a great need in this population for what we do, and urges us to take initiative in finding grant money and donations and starting programs.
Bronson’s long-term professional goal is to go back to school for her PhD in Counseling or Clinical Psychology and conduct research in that medium from a Music Therapy perspective. “We need to connect with other disciplines and and provide our perspective in the lab.”
Bronson affirmed to me that she plans to keep working with this population long term.
“It fits me well and I love it.”