Group Music Improvisation with Adolescents in Mental Health Facilities: Setting the Stage for Success

Young people today are born into society inundated with constant, short-term, passive stimulation, while often socially isolated. Music improvisation in music therapy gives them an opportunity to slow down, listen to one another, be present, be playful, be curious, be creative, be together, or just be.

“This is more engaged in anything than you’ve been all day,” an adolescent in a partial hospitalization psychiatric clinic remarked to their peer. When I entered the therapy room, this peer had been lying down, isolated and withdrawn. Yet once a wide array of instruments sat like an invitation in the center of the room, everything changed. Now this peer was leading the group in a music improvisation using a drum.

I studied music therapy at New York University, a Master’s program that emphasized the Nordoff-Robbins approach to music therapy. Thus, my music therapy education highlighted the benefits of clients taking an active role in music making in a therapeutic context. When I began providing music therapy groups for adolescents in mental health facilities, I soon realized that behavioral challenges, resistance and apathy were barriers I’d have to learn to work with when using this method. In this blog post, I will share some insights I have gathered along the way, which I will highlight anecdotally using this one particular session as an example, as well as potential benefits of group music exploration with adolescents in mental health facilities.  

To provide some context, I had been alerted by a staff member that morning that this group of adolescents was particularly “touchy,” in a physical sense. Despite other therapists’ repeated requests, they had a hard time sitting still and at an appropriate distance from one another. Fortunately, as a music therapist, I do not ask clients to sit still. On the contrary, movement is often encouraged in this mind-body integrated framework, and music therapy can provide a healthy way for clients to release pent-up energy. Of course, physical boundaries still always need to be respected.

Repeated observation of social trends in these groups has caused me to be sensitive to the issue this closeness could pose for other peers thereby feeling excluded. Considering that some of these adolescents had been playfully sitting on top of one another as I entered the room, when the group heeded my invitation to form a circle around the instruments, I knew we were off to a promising start. Not only does sitting in a circle set group members up for success in maintaining appropriate distance from their peers, but this organized formation of our bodies in space also helps to create a sense of belonging and inclusion.¹

Sometimes the first task I offer the group is to each select an instrument. Though it may seem simple, for those struggling with anxiety, depression, or people-pleasing, the act of making a choice and exercising their agency is undoubtedly an achievement to celebrate. Afterwards, I might offer, “Rumble on your drum/instrument if you felt _____ (anxious/excited/hesitant/etc.) about choosing an instrument today,” (a technique I learned in Simon Faulkner’s Rhythm2Recovery training workshop). Rumbling in this way increases participation and promotes connection while validating clients’ experiences as they observe that they were not alone in this feeling. Plus, the physical act of making noise on the drum allows clients to release tension, transforming nervous energy or excitement into a welcomed, shared experience of making sound.² Then, within minutes of the group starting, together we can honor their immediate accomplishment of selecting an instrument, despite feeling “anxious” or “embarrassed.” Cultivating the practice of self-compassion may play an important role in mental health and reducing self-harm, and music therapy provides ample opportunities for clients to do so, starting with when patients select, or even touch, an instrument.³

I always make time towards the beginning of each session for group members to check-in with the group. Providing individuals an opportunity to share their name and pronouns immediately creates a space for autonomy, inclusion, and respect. I also invite them to direct their focus inwards to share their current mood, either verbally or on their instrument. Every mood, from “annoyed” to “I don’t know,” is always a valid response that gives me and the rest of the group valuable information about what mental state a client is bringing with them to the group, while promoting self-awareness and empathy. 

I have found it advantageous to establish some ground rules together. Since some group members were more sensitive to sound than others that day, as is often the case, they even came up with a creative way to signal non-verbally when the music was too loud. By creating the rules together, the adolescent clients once again practiced both autonomy and boundary setting in a mindful and inclusive way. Through listening to and expressing one another’s needs, clients cultivate a safe space conducive to exploration and growth. (Note: The clinical site may also provide clients with ear plugs as an additional tool to cope with sound sensitivity).

Not long after I noticed one client continuing to play while I was speaking to the group, I invited them to take the lead in our musical improvisation. They expressed willingness, and the others then played with them in response. Organically, as a group and without speaking, they chose another group leader. This proceeded until each client had led the group. Afterwards, I explained that this had not been my plan and that they, as a group, had decided what to do and without any words! Then they processed what made them successful in their nonverbal communication.  Shared music-making with a flexible framework empowers clients to practice being present with one another and in real-time. Such experiences of group cohesion allow feelings of isolation to dissipate through meaningful social connection.⁴

While sometimes everyone is playing together, often at least one group member declines to participate or appears withdrawn. That day, I noticed that one patient was lying down in the circle, and yet still he engaged by hitting a tambourine with a mallet. Following the musical exploration, we might verbally process as a group the integral role of each sound, or of each person’s presence, to our group’s music as a whole, including that tambourine.

Simultaneously, one patient was in an anxious and elevated state and used the music as an outlet for creative self-expression and stimulation. They rolled the cabassa over their arms and legs. They put shakers inside bongos and shook them, seeming noticeably pleased with the sounds they discovered through their innovations. I often invite the group to lead with their curiosity; through exploring various sounds and textures with the instruments, there are infinite possibilities in the sounds that we can create together as a group.

I’ve observed expressions of anxiety softly fade as I remind them, “there are no wrong sounds.” It is from this space that we may bring to our awareness those judgmental inner voices concerned about lack of natural ability or prior music experience, and then quiet them by welcoming the free-flowing voice of creative self-expression in the music-making process. 

During the current youth mental health crisis, social connection, validation, and feelings of self-worth are more vital than ever for health and well-being. Whether you are a practicing music therapist or someone who is curious about clinical applications of music therapy, I hope this blog post illuminates a handful of seemingly simple and yet powerful mechanisms at play during group music making, beyond the healing potential of music in and of itself. Group music improvisation in mental health facilities with adolescents provides opportunities for releasing tension, cultivating self-compassion, exercising agency, setting boundaries, experiencing social cohesion and inclusivity, establishing autonomy, practicing nonverbal communication, being mindful, and engaging in creative self-expression, thereby setting the stage for future success both in and outside the music therapy room. 

Written by Missy Lees, MA, MT-BC

 

REFERENCES

1. Fallout, J. (2014). Circular seating arrangements: Approaching the social crux in language classrooms. Studies in Second Language Learning and Teaching, 4(2), 275-300. doi: 10.14746/ssllt.2014.4.2.6

2. Faulkner, Simon (2016). Rhythm to Recovery: A practical guide to using rhythmic music, voice, and movement for social and emotional development. Jessica Kingsley Publishers

3. Cleare, S, Gumley, A, O'Connor, RC. (2019). Self-compassion, self-forgiveness, suicidal ideation, and self-harm: A systematic review. Clinical Psychology and Psychotherapy. 26(5), 511–530. https://doi.org/10.1002/cpp.2372

4. Levitin, D. (2019). Medicine’s melodies: Music, health, and well-being. Music & Medicine. 11(4), 236-244.