Synthesis Sunday: Thinking About Trauma Without Reading

I admit it, I didn't get my reading done this week, but I did spend time thinking about trauma-informed music therapy practice - spurred on by several situations that occurred in my music therapy sessions and structured by the reading and training that I have had in this particular topic. As this topic is something that challenges my way of thinking as well as my own interactions with the world, I am allowing myself to explore at a leisurely pace rather than keeping to a specific schedule.

My left arm was scratched by two separate clients on Monday. I have some wonderful bruises and small indentations on my forearm. This is just part of my job - there are times when I get scratched, bruised, kicked, pushed, hit up the side of the head - you name it. Part of my job is to help my clients learn that aggression is not the way to get what you need out of others, but there is a learning curve to that situation. When you've only been able to escape danger through fighting, you fight. If fighting works and allows you to escape danger, then you start to fight whenever you want to escape - even if things aren't dangerous.

My students are often aggressive when faced with threatening situations. They are exemplars of the "fight" when it comes to the "fight, flight, or freeze" responses to traumatic events.

Now, one of my students this week scratched me because he didn't want me to block access to the sock he was shredding all over my carpet. For the record, as far as I am concerned, he can shred a sock (if it isn't my sock), but not on the carpet because it makes a mess that cannot be easily cleaned. He doesn't clean after himself, so he just makes a mess. The carpet is not a good place for shredding socks. I'm fine with him shredding a sock over by the trash can, but he doesn't like being over by the trash can, he wants to be on the carpet. He grabbed my arm and scratched me - possibly (because I cannot know for sure) in order to get me to back away and leave him alone to shred his sock in peace. It did not work for him. He scratched me, and I continued to request that he not shred the sock on the carpet. I also told him that scratching me was not a way to get me to comply with his demands. He seemed to understand that and stopped shredding his sock.

The other student, however, did seem to attack due to a trauma response. This particular student was engaging in the music therapy session without difficulty until a peer walked in. At that moment, client 1 started to become aggressive towards me - the closest person. The second client is one who is very aggressive towards others (wasn't being aggressive at that particular moment, but strikes without warning), and I think that client 1 was fully engaged in a fight response when the second client arrived (again, I cannot know for sure what client 1 was thinking, but this is a typical pattern of increased distress when the second client is present).

During situations like these, I have to make interpretations and respond in the way I think most appropriate. With the first student, I remained consistent with my expectations and repeated the initial directive in a chant. With the second student, we had to engage in a physical assist to ensure safety of the client and the others in the room. Once the assist was over, we engaged in safety and coping skill review. In this instance, I decreased the musical stimulation in favor of rhythmic breathing to assist the client in calming rather than adding musical elements to the environment. I focused on breathing and rhythm without lyrics, melody, harmony, etc.

The most difficult part about working with clients in a trauma-informed practice is that you can never really know what the internal process is that the client is going through - if you work with clients who are verbal, they can choose what they share. If you work with clients who are nonverbal (like both of the students in the examples above), there is no real way to know what motivates the client to respond in any particular manner. 

I have to infer lots of things with my clients. I have to infer that the first student was frustrated by me and used scratching me as a way to get me to stop doing what I was doing - expecting him to follow directions. I've noticed a pattern in aggression for the second client's situation. Aggression or disruptive behavior always follows when a particular peer enters the room. I'm not sure if anyone else has seen this pattern or not. If I can interrupt the second client and acknowledge that we will keep the client safe by keeping the peer away from him, we have less aggression and disruptive behaviors. 

The problem? I do not always have the attention to give to that one client within the group of nine other clients. I do my best...and sometimes I get scratched, but I don't get scratched so much more than I do. I guess that's a good thing.

Synthesis time - I know that my clients have learned particular patterns of responses to situations. I also know that responses become automatic in persons who have significant trauma histories. I know that elements of music can help change those automatic responses, but I am not exactly sure how that happens (I know that there are brain patterns, neurological processes, and ways that music circumvents other patterns, but I cannot tell you the precise ways that music can change these trauma responses - yet!). As their therapist, it is my job to be consistent, to interpret responses, to use music to support them in the way they interact with me - whether that be through yelling, singing, making a beat, or scratching - without taking it personally (even though it is personal sometimes) and with views of acceptance and growth orientation.

I will continue to seek greater knowledge and understanding of the effect of trauma on the way my clients interact with the world around them. Thanks for joining me on this journey. See you next Sunday!

Sutton, J. (Ed.). (2002). Music, music therapy and trauma: International perspectives. London: Jessica Kingsley Publications.


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