Fortunately, music therapy is ideally suited to help fill this gap, and researchers are beginning to formally investigate its application. A common dynamic that child therapists encounter is the reluctance of traumatized children to engage in direct therapeutic work. Often, it is particularly difficult for children with low IQs to verbally express traumatic events, especially if the trauma occurred early in life when verbal skills were still emerging (Robb, 1999). Because of this, indirect and nonverbal forms of communication such as music can be highly effective avenues for treating victimized children.
Music has the potential to bypass the defensive operations of the higher cortical functions of the brain and move directly to the limbic system where emotions are processed. Music is also thought to stimulate right-brain functioning, which is associated with imagination and feelings, especially feelings of sadness (Montello, 1999). Research has found that early trauma affects the developing nervous system, causing chronic states of over-arousal in traumatized children. Music is an ideal way to help these children self-regulate and soothe as it creates a middle ground between over-arousal and numbness and helps the child to experience a state of stability (Montello, 1999). The immediate success that children experience in the music therapy setting can provide a boost to self-esteem and create a successful, nonthreatening environment in which the therapist can help the child to decrease symptoms of arousal or disinhibition.
The robust conceptual framework of music therapy affords tremendous flexibility and range of application. Music provides a curative mechanism for abused children to use symbols (e.g., sounds) to externalize their internal world and process overwhelming emotional material from a safer distance. This externalization process can serve as a vehicle of gradual exposure, whereby children naturally, and at their own pace, encounter, organize and better manage their dysregulated affects and anxieties.
Music therapy is also a powerful tool for helping children in foster care (Layman et al., 2002), particularly as they negotiate issues related to attachment and loss. While most of these children have been placed in foster care due to abuse or neglect, many have also experienced multiple early significant disruptions in their primary caregiver relationships. Such disruptions severely impair children's capacities to form trusting relationships and can lead to the development of a spectrum of attachment-disordered behaviors. Music therapy has been utilized to promote the establishment of trust and the development of reciprocal interactions (Hong et al., 1998). Music improvisation, for example, provides children with a nonverbal way to connect with the music therapist as a means of establishing a safe, therapeutic relationship.
Creativity is required by the music therapist in order to adapt the broad range of treatment techniques to the individualized needs and presentations of the child. As children practice and gradually acquire new relational and behavioral skills, they are helped to transfer these skills to other relationships, such as adoptive parents or foster caregivers, that are outside the music therapy context and into their natural environments.
"Sarah" was a 9-year-old African-American female with a history of sexual abuse, neglect and abandonment. The focus of her music therapy treatment addressed self-regulation and prosocial skill development. Music therapy sessions included improvisation, lyric analysis, live music production and songwriting. The structure of the sessions was activity-based and included use of visual aids to create a concrete and multisensory process.
The "Feelings Faces" improvisation activity used with Sarah explores musical expression of feeling states to encourage development of a feelings vocabulary. Pictures of actual people, each with a different affect (e.g., happy, sad, mad, scared), were first viewed and discussed. Then, Sarah and the music therapist took turns selecting a "feelings face" and improvising music on the piano that matched that feeling state. Each took turns guessing what feeling was being musically expressed. Sarah played loudly and aggressively to portray a mad feeling and softly to portray a sad feeling. The therapist encouraged Sarah to discuss and process circumstances and events in her life that contributed to these different feeling states.
"Helping Hands" is a more advanced lyric analysis activity that helped Sarah decrease her aggressive behavior and increase prosocial behavior. Printed lyric sheets of the song "Hands" by the recording artist Jewel were distributed, along with blank sheets of paper. Sarah was encouraged to follow the lyrics and actively listen to the meaning of the song. The recording was then played a second time (at a lower dynamic level), and Sarah was directed to trace around each of her hands on the blank sheets of paper. She was then asked to write or draw on each finger of her left hand one way in which she could use her hands to help others (e.g., handshake, kind touch, wave hello, help with chores). She was asked to write or draw on each finger of her right hand one way in which hands could be used to hurt others (e.g., hit, push, grab). Sarah and the therapist examined ways to use hands to help others and how to avoid using hands for hurtful behaviors. Sarah's foster mother used a sticker token economy to reinforce the times when Sarah used her hands in helpful ways.