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S04 Episode 08: Connie Tomaino on Music Therapy and Trauma
1.1k Plays8 months ago
In a special series within season 4, Indre speaks with Connie Tomaino, executive director and co-founder of the Institute for Music and Neurological Function (IMNF). This episode, Connie talks about how music therapy can benefit patients who have experienced trauma both as an adult and in early childhood.
Cadence is the podcast where we talk about what music can tell us about the mind. Hosted by neuroscientist and musician, Dr. Indre Viskontas, the fourth season will bring you the stories of people who experience music outside the bounds of the average listener, and who use music as a tool to be heard in a society in which they are often ignored.
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Transcript
Introduction to Cadence and Music Perception
00:00:13
Speaker
Welcome back to Cadence. This season on Cadence, we're telling the stories of people who experience music differently than the rest of us.
Music as Expression for the Marginalized
00:00:21
Speaker
Those who use music as a form of not only expression, but of communication. Of a way to be heard by a society that ignores or outright silences them.
Healing Through Music Therapy
00:00:32
Speaker
But we also want to explore the healing power of music by diving into the nuts and bolts of music therapy. In four special episodes this season, I chat with the legendary Connie Tomano, executive director and co-founder of the Institute for Music and Neurologic Function in New York.
Music Therapy's Role in Trauma
00:00:50
Speaker
So far this season, Connie has covered several different use cases for music therapy, ranging from Parkinson's disease to dementia and aphasia. In this, our last talk with Connie this season, we'll be talking about trauma. Specifically, what is trauma, and how is music therapy useful in dealing with it?
00:01:13
Speaker
What is the trajectory of how music therapy deals with trauma? Dealing with the side effects of trauma. So somebody being emotionally repressed or not able to vocalize their self-needs, being very complacent in things that are done to them without being able to support themselves or defend themselves or to protect themselves.
00:01:38
Speaker
When your cognitive ability is somewhat impaired and you can't make sense of the world, there's this sense of a real strong fight-or-flight response that something's weird, something's dangerous. I don't know what it is. And so these people tend to be very agitated and hard to manage without
Uncovering Emotions with Improvisation
00:01:56
Speaker
medication. But yet at the bottom of all of this is the sense that they're not the same person. Something's very frightening. I don't know where I am. I don't feel safe.
00:02:06
Speaker
And I need help, but I don't know how to ask for it. And so in the context of music therapy, it's usually some kind of improvisational thing where the person is starting to evoke some of those deep feelings of agitation that could be like a
00:02:21
Speaker
very strong percussion drumming type thing or might be a vocal exercise of some sort where the person is able to sigh or to breathe or to make these sounds. And in the context of that, there's also the therapist tries to be comforting and supportive. So the person feels like they're being heard and being recognized. And sometimes that allows some of those fears that they can't express to come to the surface and then be realized and addressed and recognized. And that seems to help calm down the individuals.
Variability of Trauma Experiences
00:02:52
Speaker
So before delving into the practice of music therapy, it's worth taking a moment to consider what we mean when we say trauma. Because as Connie is very diligent to mention throughout our conversation, symptoms of trauma vary significantly from case to case in a variety of ways. For one, there's the idea of extent.
00:03:12
Speaker
It's interesting too because I won't say trauma is relative, but it is, and it's based on your perspective at the time of the experience. If it was something that put you in danger, or somebody that you really cared about in danger, then there's a huge neurologic response that then can get hardwired into the brain if you were really shocked by it.
00:03:36
Speaker
There are also major differences in a trauma that occurs during adulthood versus one that happened in early childhood, as Connie explains.
00:03:47
Speaker
I don't think anybody's ever really ready to see the atrocities of war. But to be in the battlefield, to see bombs and all this other stuff, of course there's a response to that. But it's going to be different from the kind of trauma, say, that an infant maybe had experience that they're not aware of that becomes almost a reflexive reaction to things in the environment.
00:04:08
Speaker
I think it's before they're even a year old when they're not able or even before two but mostly kids who've had either abuse or something traumatizing in their first year of life since they can't understand the concept of it or what's happening say their mother gets hurt or somebody hurts them and they don't understand why that's being done. They can't rationalize it the way an adult may and so it just becomes a sympathetic nervous system response to something.
00:04:34
Speaker
We also have to consider the difference between trauma that comes in the form of one acute event and then traumatic experiences that have been ongoing or have happened multiple times.
00:04:47
Speaker
This distinction between PTSD that develops from, say, one major traumatic event. Often this is what you think of veterans coming home, even though they might have had multiple traumas during that time. And they come home and they have a lot of the symptoms that they experience that are negative are things like being hypervigilant or a quick startle response, an overactive reaction to what's happening here or memories replaying.
Music Therapy for Veterans and Abuse Survivors
00:05:13
Speaker
as opposed to individuals who were, for example, victims of domestic abuse that happened over and over and over again. And for them, it's not that they feel too much, it's that they feel too little. And I wonder if you could talk about the different approaches that music therapists might have in these two different scenarios.
00:05:33
Speaker
Yeah, they're definitely different responses, but in both cases, there's a separation between what the person thinks and what they feel, and it's either somebody who was abused and experienced that time and time again.
00:05:49
Speaker
stop feeling their body. And I've heard similar things actually from veterans who say that they're taught, especially the Marines, people who were put into the really high risk type situations, they're taught from the beginning to not feel their body.
00:06:05
Speaker
so they can be very focused on what needs to be done and not be aware of what they're feeling. So when we've worked with veterans with PTSD, sometimes they say they feel fine. And after a music therapy session where we're really getting into emoting feelings through sound, after it, they'll say, I feel horrible, even though they came in feeling fine because they didn't realize that they had all this pent up feeling.
00:06:29
Speaker
This repression of deep physical and emotional responses, which Connie talks about as a unifying trait of trauma patients, is one of the things that music therapy is generally really good at addressing. So the music therapist is really going to explore these sounds and the sounds at the
00:06:48
Speaker
The client is able to make, and when I talk about sound, it's creating this environment for them. The therapist creates an environment for them where they can select some acoustic instruments, things that have different qualities with sound. Some can be very shrill, some can be very low in sound, some can be very bright, or some can be very warm in the sense of smooth acoustics.
00:07:07
Speaker
So when the client is playing around with these sounds, typically they'll pick a sound that's more reflective of what they're feeling at the time, even though they don't verbalize that. And it's almost like the instrument becomes an outward expression of what they want to project or share, but they can't verbally do that. And then the therapist very carefully draws more of that expression out of them through this improvisation. And the instruments are in something that you can make a mistake on.
00:07:34
Speaker
whatever you do is going to be fine. It's not supposed to be a traditional song composition type thing. Somehow music seems to have fast track to developing these kinds of attachments that lead to trust. So you want to talk a little bit about that? There are certain types of music. Stephen Porges talks about this a lot. He talks about vagal nerve responses, but he also talks about sound. And I think he wrote about the frequencies of sound in the mid-range
00:08:01
Speaker
You think of a lullaby as just three or four tone difference for a fourth, fifth, very small frame scope of sound, very lulling, mid range, not high, not low.
00:08:13
Speaker
That tends to be the safest sound that we subconsciously respond to. So songs and music, they have those qualities, even if we're feeling very anxious and restless, should put us into a calmer state because of these subconscious responses to those frequencies. So many times music therapists will use these sounds if they're starting from scratch to see if they can help the person self-soothe, relax, or ease their comfort a bit.
00:08:46
Speaker
And once a sense of comfort has been established, then some of the more difficult work can begin. People think of music therapy and they think that maybe music makes people feel good, that there's all these benefits, and they don't think about the challenges of music and the types of things and the emotions it can unfold.
00:09:03
Speaker
So when the veteran starts experiencing some of these feelings that they had repressed and it comes to the surface, that's the beginning of the
Addressing Chronic Conditions through Emotional Release
00:09:11
Speaker
therapy. That's a good thing because they're able to bring it to the surface, but the challenge is to be able to work with that client so you can help them resolve.
00:09:20
Speaker
what those issues are so then they can build up strategies to deal with the types of things that may be triggers. If you can't do one session, here comes the music therapist and we're going to do a music group and just leave the veteran with their own pain and whatever. So there needs to be some kind of plan if it's going to get that deep in the session. And if it's not going to have that kind of continuity and input of the therapist, then it shouldn't go to those places in that session.
00:09:46
Speaker
And at this juncture in the therapeutic process, some of the most crucial and effective work happens. Remember how we talked about how trauma can cause patients to repress their emotions? Well, bringing these difficult emotions to the surface can help prevent those feelings from persisting indefinitely and bring the person back to themselves so that they can fully experience life again with all of its ups and downs.
00:10:12
Speaker
When we hold onto certain emotions, that can lead to chronic conditions. The idea is you don't want to suppress the feeling because you don't want to suppress it so much so that it actually becomes a liability long-term because you'll start building up this anxious response to that situation over and over again. But if you have a sad situation or something that just happened that really makes you feel miserable, if you could deal with those emotions,
00:10:39
Speaker
immediately, either by crying or by laughing or screaming, whatever that is, it's to keep those feelings from becoming like a hardwired response. And that's when people get stuck in this, oh, it was me, the world is miserable, there's no hope. That becomes a chronic psychiatric condition because then you don't have the mental resilience to think of anything else but how horrible things are.
00:11:04
Speaker
And I think being able to really diffuse it in the moment is the most important thing. And sometimes you can't because of the situation, but as soon as you can, to be able to find a way to just get those feelings out, whatever's the best for you to do it.
00:11:18
Speaker
This effect of music therapy for trauma patients can be really profound. In fact, in some cases,
Case Study: Misdiagnosed Paralysis and Music Therapy
00:11:24
Speaker
music therapy has helped uncover trauma that a patient's medical team had been unaware of and that had been affecting the patient's treatment or their response to the treatment.
00:11:37
Speaker
I'll give you an example of a young person I worked with who was interesting because she was admitted to a long-term care facility because they thought she had multiple sclerosis, that she had actually a paralysis on one side of her body. She would scream and be really resistant to any kind of direct care and because of that was medicated so she could be more compliant for the aides and the nursing staff to take care of her.
00:12:03
Speaker
The social worker knew that this particular girl loved music, but they couldn't get her out of her room because she didn't want to be near anybody and was really fearful. Finally, she came to my studio at the facility. She was young. She was in her 20s. In fact, we were very close to the same age at the time. And really like Beatles songs and some of those things. And I had this electronic instrument that you could play chords on one hand.
00:12:28
Speaker
We would just improvise and maybe play some chords to some Beatles songs. And she started to trust me over time that we used to meet several times a week. And I had that luxury because she was an inpatient. But I noticed that her paralyzed side would sort of move and touch the soundboard on this electronic and make sounds. And I would stop her and I'd say, look,
00:12:49
Speaker
You moved your finger. She goes, no, I didn't. And she moved her back. Over time, as she started to trust me and as I supported her in expressing herself, she would open up and say things like, everybody loves their mother, right?
00:13:06
Speaker
And I'd say, well, yeah, but sometimes mothers could be challenging. And so little by little, I would take these open questions and direct it back to see what she would do. Then she said, you know, well, wonder if somebody did something bad.
00:13:24
Speaker
and you told on them and somebody else got hurt. And then I realized this is really severe. And I wondered if she really was paralyzed or whether this was a psychiatric regression type thing. So I spoke to the social worker and we got permission to discharge and send her to a more acute psych facility. What she had told me before we went, the reason why this came up was because either her mother had a boyfriend or she had a stepfather.
00:13:52
Speaker
who the mother was very protective of, and the mother, when she would get anxious, would hit the kid, both her and her sister. My patient told her counselor at school that they were getting her at home. The mother was called in, and then the sister's legs were broken. When she was admitted, they said she was in the fetal position, and her elbows and knees were all frozen stiff, and so she had surgery to release those tendinectomy or something like that.
00:14:21
Speaker
And we realized that that was all a response to the trauma, and somehow the doctors didn't pick it up. They thought it was this physical condition because she had all the manifestations, outward manifestations of the neurologic conditions, but it was all psychiatric.
00:14:36
Speaker
And once we were able to deal with that and got her to really understand that it's fine to leave home, it's fine to leave an abusive relationship, not only did she stop moving the arm again, it was able to use it, but we were able to discharge her into a group home. She started learning to play the guitar because she always wanted to. And the staff was actually so enthusiastic that they actually brought her a guitar as a going away present. And I think she ended up working like a handicap home or something like that too, besides.
Therapeutic Approaches for Trauma Recovery
00:15:06
Speaker
While this is a particularly striking example, there are many stories of music therapy helping trauma patients overcome their symptoms.
00:15:15
Speaker
Over her career, Connie has led group therapy sessions with veterans, individuals with PTSD, and in many situations in between. And one of the concepts that she talks about is how there are different therapeutic practices for different levels of trauma and for different points in the recovery process. And regardless of where the patient starts, the idea is to progress.
00:15:41
Speaker
It's almost like being graduated or progressing depending on your need and level. Yeah, it's like an evolution. Exactly. And that's how good therapy should happen. If therapists keep you stuck in the same place forever, that's really not a good therapist. So to end this episode and this season of Cadence, it's time for us to discuss some practical advice.
Finding Qualified Music Therapists
00:16:07
Speaker
If you've experienced trauma or a loved one has, how do you seek out music therapy? Most importantly, make sure that the person is a board certified music therapist and that they have master's level training and they should have training in psychotherapy, and most of them do. That's very important. And look at their experience with the issue that you're dealing with and their approach, because music therapists can also have additional training as a Jungian.
00:16:33
Speaker
psychotherapist or another type of psychotherapy. So maybe you may ought to do behavior type things, cognitive behavioral therapy on top of the music therapy. So like any specialist that you would go to, you want to be mindful of the person's background. But if you're able to seek out music therapy, do try that because it really helps get to some of those deep issues that you may not get to as quickly through verbal therapy.
Personal Use of Music for Mood Regulation
00:16:59
Speaker
And then in this case, because we've talked about some of these potential adverse effects, if a person just wants to use music themselves, what would you recommend? People should find music that helps them, when they listen to a song, especially if they have their playlist, start thinking about songs that help them feel a certain way, and they can actually categorize it like my chill music or things like that, or my go-to song for when I feel doubt, and just be mindful of what those songs are, because those are their go-to music.
00:17:29
Speaker
Same thing if they happen to love upbeat music when they're really feeling down, they need to scream when they're out in their room or something like that, shouting, listening to heavy metal or something. That's good too, because it helps get those frustrations and feelings out. So it's very individually based. If they don't know what to do, then the safe thing is to go to music that isn't too extreme, either low or high, the safe spots, and start exploring music in those ranges first.
Conclusion and Credits
00:18:00
Speaker
Thanks for listening, and if you've enjoyed the show, please subscribe wherever you get your podcasts and leave a review so that other people can find us. Season 4 was created by me, Dr. Indre Viscontis. It was produced by Ireland Meacham and Matthew Rubinstein at Audiation. It is mixed by Matt Noble with music by Rhian Sheehan from his album, Stories from Elsewhere.
00:18:23
Speaker
You can find us online at cadence.show. You can also get in touch with us at cadencemind.gmail.com. I'd love to hear from you. Cadence is generously supported by the Germanicos Foundation. Audiation.