Caring for the Caregiver: The Use of Music and Music Therapy in Grief and Trauma

Loewy, Joanne V. & Frisch Hara, Andrea (Eds.) (2007). Caring for the Caregiver: The Use of Music and Music Therapy in Grief and Trauma. Silver Spring MD: The American Music Therapy Association Inc.
Reviewed by Reviewed by Trygve Aasgaard PhD, Oslo University College and the Norwegian Academy of Music

Our awareness of the arts’ power to express and (sometimes) to heal loss, sorrow and intense misery may develop through theoretical studies, practice and even, through very personal experiences. I certainly did not reflect on these sides of musicking before music therapy had caught my interest for several years. In my life, music, dance and art had hitherto been surplus activities representing the best things in life. Mourning through the arts was – and still is – not my cup of tea. Music therapists usually become aquatinted with several new sides of music making throughout their professional career. My first music therapy textbook, Music Therapy, by Juliette Alvin (1966), was an eye-and-ear opener in many respects, but one does not find “loss”, “grief”, “crisis” or “trauma” in the index. This is, however, also the case with influential textbooks from the last two decenniums: Lesile Bunts’ Music Therapy – An Art Beyond Words (1994) and A Comprehensive Guide to Music Therapy (2001/2002) by Tony Wigram, Inge Nygaard Pedersen, and Lars Ole Bonde.

For some time now, music therapists have been involved in small or big aid projects after natural or manmade catastrophes of different kinds. From practice to written accounts and theory; during the last years, several new texts on music/the arts and trauma have eventually been published. Two of these have already been reviewed in NJMT: Music, Music Therapy and Trauma – International Perspectives by Julie Sutton (2002), and Expressive and Creative Arts Methods for Trauma Survivors, edited by Lois Carey (2006). In 2007 the German book Musiktherapie und Trauma was published with Hanns-Günter Wolf as editor/author. The web site www.voices.no contains many articles related to trauma and music therapy.

“Big disasters are, luckily, something going on far away from home”, many of us are calculating. What then, when one morning thousands of people are being killed in the centre of your home town? As several of the authors express in Caring for the caregiver: The shock when, all of a sudden, terror “happens” here! No one is safe! What’s next? . . . In fact, very soon after the 9/11 turmoil, New York based music therapists where using their skills and initiative in new ways, as this book amply testifies, through the American Music Therapy Association NYC Music Therapy Relief Project and the Caring for the Caregiver Program. 33 professional music therapists in the New York metropolitan area provided more than 7000 music therapy interventions over six months to children, adults, caregivers, and families affected by the attacks on the Twin Towers. This book was published in 2002 and a second printing, with a new preface, appeared in 2007. The editors, Joanne V. Loewy and Andrea Frisch Hara, quite realistically, state in their preface: “In many parts of the world, a life of trauma is, in fact, the norm. Unfortunately, this was as true before September 11th as it remains today”. The subtitle of the book is, The Use of Music and Music Therapy in Grief and Trauma. Differently from the aforementioned books on trauma, presenting rather international perspectives and examples, this book focuses various elements in the relief work during the first year after the “war” came to the US.

Caring for the Caregiver contains 19 chapters and is divided into one section on “Rationale and Theory” and one section named “Theory and Methods of Caregiving and Reflections”. In addition to several music therapists, the authors are professionally related to social work, pedagogies, medicine/psychiatry, and biological physics – some are experienced trauma and relief specialists. The different contributions present a variety of interrelated “methods” (such as) improvisation, song-writing and singing, stories, discussions, listening, relaxation, drawings, reading, imagery, and bodywork. It was Dr. Joanne V. Loewy, director of the Armstrong Music therapy program at Beth Israel Medical Center, who developed the Caring for the Caregiver program. Kirsten Stewart, the project coordinator, describes the program in this way:

[…] a 9-week series of trainings, each 90 minutes in length. These 90 minutes were divided into two 45-minute segments, one containing an experience of using music as a means of cope, and the other containing emotional and educational perspectives on how to move through the effects of anger, silence, depression, and fear associated with coping from the experience of traumatic events” (p. 15).

The concept of “caregiver” is being defined in this way by Loewy: “those who could benefit from experiencing, understanding, expressing, and educating themselves about trauma through music”(p.1). It had been interesting to know a little more about who the 90 participants were, some of whom were personally affected by the 9/11 events, some professionally affected, and some both ways. Throughout the book we are well presented for the core music therapy team of eight persons: Frank Bosco, Susan Feiner, Andrea Frisch Hara, Kate Richards Geller, Judi Rudin-Bosco, Kirsten Stewart, Bendikte Scheiby, and Alan Turry. Stewart discusses three different approaches to Caring for the Caregiver:

• behavioral” – focused on task-related intervention
• existential-humanistic” – focused on defining and supporting a foundational, internal center of self
• educational” – based on teaching stress-management skills that have been identified in stress-resistant persons

There is not one specific method of human self care and Stewart presents a rather comprehensive “categoric organization” with numerous examples of physical, psychological, social, spiritual, intellectual, recreational, and occupational (etc.) coping strategies (p.13).

This anthology may, to some extent, be useful as a handbook for practitioners who are interested to learn in some detail about specific approaches and “methods” when dealing with grief and trauma. It contains drawings, histories, and several new and old songs performed as part of the group sessions. Benedikte Scheiby convincingly presents Analytical Music Therapy as a model for attending to trauma related physical and psychosocial needs. This way of employing (mainly) musical improvisation is being discussed in the light of Community Music Therapy. The book contains many rather personal contributions, which, potentially, add value to the texts. The psychiatrist Craig L. Katz describes with humor his own uneasiness and how he felt like a “fish out of water” during a musical group session. I guess feedback and comments like these from a collaborating professional were quite useful to the core music therapy team. The majority of the fourteen authors tell, sometimes in detail, about where they were and what they thought and felt during “that” morning – whether in upstate New York, Michigan, or,”in a cute French bistro in my hometown in Denver, Colorado”. Here the more private and “local” features of this publication become significant. It is, however, quite moving to read about the music therapists’ own fears and uncertainty in relationship to this new task of caring for caregivers. Alan Turry states, “I rediscovered that, for me, improvising is intrinsically linked to a sense of trust in the unknown”. Now, this highly skilled and experienced therapist became preoccupied with his own fears of anticipating what will happen next, of not being prepared and of not doing a good enough job. He also gives a wonderful example of helping a client to be “empowered” through singing and quotes Dianne Austin’s (in my opinion) very wise statement: “Owing one’s voice is owning one’s authority and ending a cycle of victimization” (p. 49). Two words were consciously not included in the program description of the Caring for the Caregiver project: “therapy” and “victim”. Seemingly, this was a very sensible decision: at times it might be quite therapeutically not to name everything a music therapist does to enhance normality for “therapy”. And to put a “victim” tag to clients is perhaps not the best point of departure for fostering “empowerment”. . .

Some parts of the book not dealing specifically with music (therapy) are also interesting and informative, such as Joanne Loewy’s chapter, “Trauma and Posttraumatic Stress: Definition and Theory” and a list of terminology, Terry Altilio’s chapter, “Helping Children, Helping Ourselves: An Overview of Children’s Literature”, and Peter A. Levine’s chapter, “Trauma, Rhythm, Contact, and Flow”, where this well known psychologist reflects on themes like “Nature’s Lessons About Trauma” and “Why Do Humans Kill, Maim, and Torture One Another”?

Things have changed: when I was introduced to the psychology and psychiatry of crisis 35 years ago, descriptions and recommendations as to the correct therapy were far more mechanistic and less open ended than contemporary theory and practice. When Donna Gaffney writes about the challenges of helping children grow through loss, she claims that:

Trauma and grieving may not be categorized or staged. Phases or stages suggest there is there is a prescribed, optimum way to work through the process. […] Grief work, traumatic or otherwise, requires a holistic view of the world. There is not one starting point, nor is there a final endpoint (p. 57).

Caring for the Caregiver as a whole is a good example of this open attitude in addition to well reflected ethical considerations which mark the various contributions. 54 of the 90 participants involved returned questionnaires on what was more or less helpful. Persons who were either personally affected or both personally and professionally affected by the catastrophe when the two planes struck the World Trade Center (altogether 29 persons) answered that it was particularly important “to be part of a group”, “to identify my needs”, “to feel the impact of the music”, “hearing others’ stories”, and “sharing my stories” (p. 19). The idea of bringing together people affected in various ways was seemingly valuable. This book shows many examples of human suffering, but it also describes relief work second to nothing I have heard of. It is incredibly depressing to realize that many places in the world people are being bombed or persecuted for weeks or months at a time with very little medical or humanitarian aid. Music therapists cannot escape from (world) politics and from taking political priorities. However, in our fight for a better world to live in, music still is our most powerful tool. Scheiby quotes the composer and conductor Leonard Bernstein who, in 1965, said: “This will be our reply to violence: to make music more intensely, more beautifully, more devotedly than ever before” (p. 92).

References

Alvin, J. ( 1966). Music Therapy. London: John Baker.

Bunt, L. (1994). Music Therapy. An Art Beyond Words. London: Routledge.

Carey, Lois (Ed.)(2006). Expressive and Creative Arts Methods for Trauma Survivors. London: Jessica Kingsley Publishers.

Sutton, Julie P. (2002). Music, Music Therapy and Trauma – International Perspectives. London: Jessica Kingsley Publishers.

Wigram,T., Pedersen, I. N., & Bonde, L. O. (2002). A Comprehensive Guide to Music Therapy: Theory, Clinical Practice, Research and Training. London: Jessica Kingsley Publishers.

Wolf, H-G. (Ed.) (2007). Musiktherapie und Trauma: 15. Musiktherapietagung am Freien Musikzentrum München. Wiesbaden: Reichert Verlag.