From Victims to Survivors

Music Therapy and Victims of Sexual Abuse

Music In Special Education Final Paper

By Kira Sarai Helper
Fall 2013
I sat on the bed, surrounded by a sea of Power Ranger sheets and stuffed animal toys. I hugged my knees to my chest and rocked slowly back and forth. I tried to ask myself what was happening and why, but my six-year-old mind could not quite

From Victims to Survivors comprehend the actions to come; so, I left. My spirit left my body and soared toward a bright blue sky. It did not matter that I left my body there on that twin-sized mattress, for it did not belong to me in that moment. I left and found my mom holding me and humming Rockabye Baby as she cradled me in her arms. I left and did my best to turn my nerves off so I would not remember the touch of what was occurring and how it felt. By the time I was forced back into my body, the babysitter had finished what he started. He finished, but it had just begun to affect the rest of my life. Child Sex Abuse (CSA) has many definitions and victims cope with their traumas in differing manners. CSA, by definition, can range from verbal proposition of a sexual act to actual physical contact (Bhandari, Winter, Messer & Metcalfe, 2011); however, definitions of sexual abuse and the diagnoses of such traumas can sometimes be difficult to outline. When trying to place sexual abuse, one must be aware of certain beliefs of one culture that may blur the lines of what constitutes sexual abuse in another culture. There are many other factors that must be considered when dealing with victims of sexual abuse, including but not limited to: family history, ability to cope with trauma, cultural perspective and background, mental health prior to incident, type of abuse, and support systems in place for the victim (Brooke, 2007). Children who are sexually abused generally cope with their trauma in one of two ways: like I did for ten years until I turned sixteen, CSA victims can repress their memories of the event so that the mind does not have to outwardly cope with the experience. Memories can be repressed in part or in full for a number of years if ones mind does not see itself fit for dealing with the trauma. The other coping mechanism that can occur in sexually abused children is Post Traumatic Stress Disorder (PTSD). The

From Victims to Survivors website for the National Center for PTSD (2013) defines the condition as a disorder that can manifest itself after someone experiences a traumatic event like abuse or assault. The website states that rates of PTSD are higher for certain types of abuse and the cases of the disorder are more prevalent in adolescent females than males. Those who experience traumas of a sexually abusive nature are also more likely to develop PTSD than other types of traumas. The severity of the trauma (which is difficult to measure because everyone is effected by trauma differently), parental reaction to the trauma and the proximity of the victim to the perpetrator of the abuse can also affect the childs chances of developing PTSD (National Center for PTSD, 2013). Common criteria for a professional therapist attempting to help any CSA victim, circumstances notwithstanding, comprise of implied threats of physical or verbal harm, fear, apprehension, and feelings of guilt (Brooke, 2007). Adolescent victims may also display issues with mistrusting others, feeling alone or apart, and having a low self-worth (National Center for PTSD, 2013). Childrens innocence, privacy, and even the essence of their identity can be robbed as a result of CSA, but victims do not have to suffer in silence. A lot of research has been conducted in the last twenty years that shows cases of CSA victims and how they rebuild their lives through music therapy. The research has shown that music therapy helps victims to repossess their voices and identity and helps make them stronger; they become survivors. Music therapy is the clinical use of music to help clients achieve goals in many areas including cognition, communication, socialization and social-emotional stability. The latter is particularly crucial for adolescents who are survivors of sexual abuse. Research on how music therapy affects different populations is done in order to develop

From Victims to Survivors evidence-based music therapy. Studies and observations are made using evidence in the research to display the positive effects of music therapy on clients (cause and effect); music therapy protocols reflect positive mental health. The main goals within music therapy settings for CSA survivors are focused in restrengthening the clients social-emotional stability. A big part of this stability occurs as the child-therapist relationship (Goodman, 2007) is established through the playing of music in the music therapy process. Music therapy sessions can eventually create a safe place for the client, where they may not feel safe in every day life (Robarts, 2006). The therapist, a stranger at first, also becomes a familiar figure that the client can learn to trust. One might argue that it would be more beneficial for a child to solely attend a psychotherapist as opposed to a music therapist; psychotherapists will get to the heart of the trauma through verbal conversation whereas music does not always present the issues so obviously. This is precisely why music therapy is so beneficial to CSA survivors. According to Faller and Nelson-Gardell (2009), therapies where the client is forced to verbally express their trauma can actually increase the levels of trauma experience in adolescents. Evaluation and assessment in psychotherapy or by forensic professionals often consists of an interview rather than observation of an individuals behavior. It is believed that multiple interviews can further traumatize a child of abuse. Being that music does not have to be a verbal activity, it allows space for the client to speak about his/her trauma when he or she feels ready to; sound through instrumentation becomes the source of communication between client and therapist. It can feel threatening and forceful (like

From Victims to Survivors sexual abuse) when a CSA survivor feels pressed to answer questions she does not wish to be asked. Music therapists use different techniques like the utilization of instrument songs to help CSA survivors reclaim their sense of self-expression and ownership of their choices and bodies (Robarts, 2006). As children, the only objects people can feel they have complete ownership of are their own bodies. Imagine having that stolen from you. Then imagine being in a music therapy session where an adult tells you that you can choose any instrument to play and you can play it however you would like. To an adult, that may not seem like an amazing feat, but to the abused child, it means she can begin to take back control over what she can do with her own body. This choice making helps the client to increase her trust in sensory exploration (Robarts, 2006) in terms of sensory awareness, what the client wants to touch (instruments), and how the client makes choices. The observation of such choice making can also help the music therapist to experience what a child may be feeling on a subconscious level in cases of memory repression (Faller & Nelson-Gardell, 2009). Musical interactions can be used as a way of recreating traumatic relationship patterns. One such case study was recorded by Strehlow (2009) at an agency in Germany called Dunkelziffer. The agency specializes in children who are survivors of sexual abuse. Strehlows client was an 8-year-old girl by the name of Kelly. Kelly was a victim of Type II manmade trauma: chronic cumulative (Strehlow, 2009), where her mothers boyfriend sexually molested her on more than one occasion. In a regular therapy setting, Kelly may not have talked about how the abuse took place, but her music therapist was able to observe her actions during sessions to put pieces together of what she experienced and

From Victims to Survivors how to help her. He describes a game Kelly likes to play during the sessions where she lies down on a monochord instrument and pretends to sleep. She asks her music therapist to wake her by playing loudly on the cymbals or drums. After some sessions, her therapist connects the game to Kellys fear that something might happen to her in the middle of the night. Kelly experienced her trauma while lying asleep between her mother and her mothers boyfriend. Her mother slept through the ordeal and did not initially believe Kellys story. Through the game in her sessions, Kelly demonstrated that sleeping is dangerous. Her therapist is able to play a double role in the scenario; he acts as the perpetrator of the loud crash that wakes her up and also as the person who is making sure she is safe. As is evident with Kelly, the concept of play is an important developmental tool for children (Payne, 1993). In music therapy, play toys are replaced usually with percussion instruments. The use of instruments helps the child to explore the making of sound, and provides an opportunity for interaction with the music therapist. The music therapist can follow the client in terms of patterns and dynamics. The instruments can in turn provide a bridge between client and therapist (Payne, 1993). Similarly to Strehlows experience with Kelly, the bridge can both bring the two together, and keep them at a safe distance; creating music together can help the client and therapist keep their separate voices. Most times, when children or adolescents are referred to music therapy, the sessions occur in group settings (Goodman, 2007). It is much more cost-effective to conduct music therapy sessions within a group than individually (Goodman, 2007), but, every case is different. The decision over whether group or individual music therapy is

From Victims to Survivors better suited for a child can be assessed in the initial observation. In special education settings, it is common to have music therapy settings with children of varying abilities and disabilities in the same group. This is less common for children in psychiatric settings; it is not generally seen as a good idea to have children with many different psychiatric diagnoses in the same music therapy session (Goodman, 2006). Looking at the research done on CSA survivors, I believe individual music therapy sessions would be the best placement. One must consider the attention a trauma survivor may need and the mistrust he or she has toward other people; it may be difficult enough to deal with the music therapist, but sharing the time with other children could be harder and less beneficial. Such individual music therapy was proven to be successful in a study done with 11 individuals, male and female, aged 14-19 over 12 weeks of individual music therapy sessions. The case study sited that there was a significant increase in indicators of self confidence (Finkelhor & Berliner, 1995, p. 1410). I do believe group music therapy can become an option once a trusting relationship has been established between the child and music therapist. It is when the child begins to cope and heal individually that they may feel safe enough to share their space and their session with other survivors. But how can we measure the healing process of the sexually abused child? The Florida Council Against Sexual Violence (2009) describes certain indicators that a survivor is beginning to heal: The survivor learns a new skill(s) that helps to make him feel empowered (e.g. music); the survivor becomes willing to access more support systems; she starts developing a tool box for positive healing strategies (activities in music such as songwriting, lyric substitution, vocalization,

From Victims to Survivors instrument choice making, etc.); giving him or herself permission to experience emotion (negation of numbness). The song The Dark I Know Well from the Broadway Musical Spring Awakening is what started my healing process from victim of sexual abuse to survivor of sexual abuse. I only wish I had heard the song sooner than ten years past my trauma date. It opened me up to talk about my experience in a way that psychotherapy never did. Music is categorized by its flexibility and that is why music therapy is so effective for CSA survivors; it gives us room to breathe.

References Bhandari, S., Winter, D., Messer, D., & Metcalfe, C. (2011). Family Characteristics and Long-Term Effects of Childhood Sexual Abuse. British Journal of Clinical

From Victims to Survivors

Psychology, 50, 435-451. Brooke, S. L. (2007). The Use of the Creative Therapies with Sexual Abuse Survivors. Springfield: Charles C Thomas Publisher, LTD. Faller, K. C., & Nelson-Gardell, D. (2010). Evaluation of Child Sexual Abuse; Extended Evaluations in Cases of Child Sexual Abuse: How Many Sessions are Sufficient?. Journal of Child Sexual Abuse, 22, 648-668. Finkelhor, D., & Berliner, L. (1995). Research On The Treatment Of Sexually Abused Children: A Review And Recommendations. Journal of the American Academy of Child & Adolescent Psychiatry, 34(10), 1408-1423. From Victim To Survivor. (n.d.). Florida Council Against Sexual Violence. Retrieved December 1, 2013, from http://www.fcasv.org/victim-survivor Goodman, K. D. (2007). Music Therapy Groupwork with Special Needs Children the Evolving Process.. Springfield: Charles C Thomas Publisher, LTD. PTSD: National Center for PTSD. (n.d.). Public. Retrieved December 10, 2013, from http://www.ptsd.va.gov/ Payne, H. (1993). Handbook of inquiry in the arts therapies: one river, many currents. London: Jessica Kingsley Publishers. Robarts, J. (2006). Music Therapy With Sexually Abused Children. Clinical Child Psychology and Psychiatry, 11(2), 249-269. Strehlow, G. (2009). The Use Of Music Therapy In Treating Sexually Abused Children. Nordic Journal of Music Therapy, 18(2), 167-183