Course Case Studies

Incorporating Musical Strategies into Clinical Practice

Course #76822 - $25 • 5 Hours/Credits

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  • Participation Instructions
    • Review the course material online or in print.
    • Complete the course evaluation.
    • Review your Transcript to view and print your Certificate of Completion. Your date of completion will be the date (Pacific Time) the course was electronically submitted for credit, with no exceptions. Partial credit is not available.
Learning Tools - Case Studies

CASE STUDY 1


Client A is a woman, 34 years of age, who is a survivor of extensive childhood sexual abuse. She presents for outpatient treatment, specifically to address unresolved issues that have affected her interpersonal functioning for years. Client A, a self-identified lesbian, recently got out of a manipulative relationship with a long-term partner, and she finds herself contemplating another equally dangerous relationship at the time that she presents for counseling. Client A has been recommended for eye movement desensitization and reprocessing (EMDR) therapy, a specialty treatment to address her post-traumatic stress disorder (PTSD). However, her therapist discovers that attempting EMDR immediately may be a bit of a problem because Client A has a difficult time visualizing, especially using visualization to develop safe coping resources. During the initial intake sessions, Client A reports that she is a lover of music, especially jazz music. She also indicates that although she struggled over the years with connecting with anything spiritual (primarily because her father was a member of a fundamentalist religious denomination and some of her sexual abuse occurred on the grounds of a school run by that denomination), listening to music is the closest she has come to meditating or "being spiritual."

In preparation for the more extensive therapy, her therapist asks if there are any specific songs that Client A feels are calming or empowering. After scanning her memory, she identifies one song that has both properties for her: "Ooh Child" by the Five Stairsteps. With an empowering melody and a positive, future-oriented message of hope and healing, Client A and her therapist decide that this is an excellent song for her to use as part of her stabilization plan. The therapist obtains a copy of the song, and they listen to the song together in the office. Client A's therapist invites her to close her eyes if she feels comfortable, and she elects to do so. As the song progresses, a smile washes over her face, and when the song is over, Client A verbalizes, as best she can, how much calmer her body felt by really focusing on the song.

Client A reports that she has a copy of the song on her portable music device, so she is able to access it on her own if needed. Client A and her therapist agree that they will have this song ready to use to calm Client A at the end of a session if their exploration of her traumatic stress issues using the EMDR process becomes too disturbing for her.

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CASE STUDY 2


Client B is a man, 42 years of age, presenting to a new therapist after spending most of his adult life in the community mental health system. Having received a variety of diagnoses over the years, Client B's previous therapist concurred that he needed to be seen by a counselor who was trauma-sensitive, as he is having trouble processing the various abuses and losses he experienced as a younger man. When he presents for therapy, knowing that hypnotherapy, EMDR, and several other specialty interventions for trauma are available, he cautions the therapist, "I can't relax. Other therapists have tried, but I just cannot relax." When the therapist asks him what other methods he has used, he reports that it was mostly guided imagery and breathing. During the first session, shortly after issuing this warning, Client B's cell phone rings, sounding out a popular country music song. This spawns a productive discussion about his musical tastes, and the therapist asks the client if he is willing to experiment with sound and musical strategies to help him relax. Client B is excited to try this approach.

Client B begins by identifying a series of Christian music songs that he finds inspirational and peaceful. The therapist is able to access these songs online and starts to play one over her computer's speakers. She invites him to stay focused only on the song and to let himself relax. It takes some practice, but soon Client B is able to bring his focus back to the song when his thoughts begin wandering. After each song-based meditation, Client B and his therapist are able to discuss the feelings and body sensations that the song elicited.

Upon witnessing how responsive Client B is to sound, the therapist decides to implement a Tibetan singing bowl as a form of mindfulness meditation. Client B is invited, upon hearing each long, echoing cling of the bowl, to be mindfully aware of the sound. He reports that he finds this process extremely relaxing. Several sessions later, when Client B and his therapist agree that he is ready to explore some of his past issues with hypnotherapy, the Tibetan singing bowl and Client B's mindfulness practice are incorporated to help induce a state of hypnosis.

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CASE STUDY 3


Client C is a young woman who recently entered recovery from alcohol and opioid addictions. Although she presents for treatment and begins attending 12-step meetings with a solid sense of awareness that she has a problem, she is still struggling to manage her cravings in an effective manner. Her sponsor and her counselor have told her that any craving, or any negative feeling, will eventually pass, but it is up to her to identify an effective coping mechanism to deal with the moments when these feelings are strongest. Always a fan of music, Client C finds that playing a song she finds to be comforting and inspirational on a steady loop seems to help the negativity pass. In some cases, she plays one particular song 20 times. Often, she sings along, but at other times, she simply listens and allows the words and melody to absorb her. Even after five years of sobriety, Client C finds this "musical looping" strategy to be incredibly effective to help her manage triggers and thoughts of acting impulsively.

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CASE STUDY 4


Client D is a man, 29 years of age, who enters outpatient counseling treatment. In his initial assessment, Client D reveals a series of traumas resulting from being bullied in school due to his visual learning disorders and maneuvering the household dynamics in his family of origin. Both of his parents were severe alcoholics and addicts. The client experienced a major loss at 12 years of age when his alcoholic father, who taught the client a love of music (specifically, the Beatles), died in the client's arms. These experiences have yielded problematic negative beliefs, including a need to hide emotions and a feeling of being intellectually inferior. These cognitions appear to be at the root of his depressive symptoms. Client D first manifested depressive symptoms (e.g., low motivation, hopelessness, poor energy, fleeting suicidal ideations) at 13 years of age, and they have intensified over the years as various life stressors were introduced.

Before presenting for treatment, Client D had been involved with five other counselors who were primarily cognitive-behavioral in their orientation. Client D found these treatments only minimally helpful; thus, he is willing to try alternative methods. Client D is determined to be a good candidate for EMDR, although he is unable to develop a traditional, visually based "safe place," a strategy that is often used as stabilization in EMDR treatment, which makes sense considering his history with visual learning problems. Client D responds very well to using a piece of music instead of an image.

When working through the trauma is commenced with EMDR, Client D begins blocking immediately, and his therapist is considering abandoning EMDR as an intervention. During his twelfth EMDR session, with the distress levels of his major traumas still very high, the therapist makes a decision to have a few musical tracks available (primarily music of the Beatles) that she has determined (based on her musical experience) could potentially unblock the client if he is stuck in an "unfeeling loop." During a major block in this session, the counselor chooses to play a Beatles song ("Let It Be") that was specifically meaningful to Client D's father. As he listens to the song, the client is able to cry and release feelings about his parents that he has been holding on to. At the next session, the distress levels connected to his major trauma memories (measured on Wolpe's 0–10 subjective units of distress scale) decreased by half.

Client D participates in three more traditional EMDR sessions with use of the musical interweave with no major shifts in distress levels but numerous reported improvements in depressive symptoms. Client D, who had been on extended leave from work due to his depression, is able to return to work, and he graduates from college, which he had previously thought would be impossible. Due to financial concerns, Client D elects to terminate treatment, but he feels that the treatment has helped him get to a "better, more manageable" place overall. Client D reports a general alleviation in his depressive symptoms through better expressing his feelings, with a definite improvement in self-awareness.

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CASE STUDY 5


Client E is a graduate student in psychology who presents for counseling services to fully resolve her issues of childhood sexual abuse. Although Client E has seen several counselors in the past and has engaged in a great deal of work on her own (e.g., self-help reading, journaling), she knows that there is still some material left to be resolved if she is going to help other people work on their traumatic issues. Client E admits that she is very intellectual but has difficulty expressing herself emotionally. An eclectic approach is taken to work with this client, with elements of hypnotherapy, EMDR, and trauma-focused cognitive-behavioral therapy incorporated, with the goal of helping Client E tap into the emotional states that she has long been repressing.

Client E has had no problem stabilizing and shows a good ability to intellectually process what happened to her at the time of her sexual abuse, but she acknowledges that she is blocked off from the feeling. Journaling, talking, and using EMDR with traditional visual elements does not seem to help. Then, one session, as Client E and her counselor walk through the experience of the sexual assaults again, Client E remembers that the 1980s song "Tainted Love," performed by Soft Cell, was always playing in the background on the stereo whenever her abuser molested her. Client E is willing to listen to the song during a counseling session, hoping that adding the element of sound will add another level of exposure that might help her tap into the emotions she needs to access in order for resolution to be achieved. As soon as the song is introduced, the client displays a higher level of affective connection with the memories of the abuse, which ultimately helps her to release many of the terror-based feelings that she had been repressing.

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CASE STUDY 6


Client F presents for counseling treatment to help her manage mental health symptoms. A woman in her 50s, Client F has been medically treated for mood management concerns over the years, but in talking to a clergy member, she realized that she needed to enter counseling to address the past traumas that she never seems to get over. Client F is certain that if she could resolve these issues, she would be better able to manage her mood.

Client F is treated using trauma-focused cognitive-behavioral therapy. This approach incorporates many of the standard principles of cognitive-behavioral therapy, but emphasizes the importance of examining the past or trauma-related etiologies of negative schema. Although she reports immediate relief from the distress and torture she typically experiences when thinking of her past, she seems to have difficulty integrating it into her present ability to deal with her emotions. Her therapist observes that there still seems to be a great incongruence between what she is feeling and what she is articulating. At one point about midway through the treatment sessions, the therapist asks Client F, "What do you think would help you to really connect with these feelings that you are still holding on to?" Client F pauses for a moment and then reports, "Probably the sound of children laughing. That sound has always brought me great comfort but has caused me great emotion at the same time…probably because when I was a kid I always wished I could laugh, but I couldn't."

At this point, the therapist obtains a sound sample of children laughing online. She encourages Client F to sit comfortably in the office recliner and notice. Client F does this, and upon hearing the laughter, there is an immediate release of emotion. The therapist allows Client F to experience the release, then they continue with their sessions, noticing a greater shift in Client F's ability to express her emotions after this simple, sonically assisted catharsis.

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CASE STUDY 7


Client G is a high school student of above-average intelligence who has always struggled with standardized testing. Though she likes music, she has never fully appreciated how it could help her cope with test anxiety. Having taken all of the courses she needs to prepare and working with her guidance counselor to address the mental blocks that she needs to overcome, she feels ready to retake the Scholastic Assessment Test (SAT) at the beginning of her senior year. A few days before the test, her friend hands her a CD that he created for her. He explains that he included the song "Eye of the Tiger" and that she should listen to it on a loop before going in to take the test. Not only does Client G find listening to this music energizing, but she also finds the meaning behind the song and the CD touching. The fact that her friend thought of her enough to send his motivation with her gives her an extra boost of confidence that helps her to perform as best as she can on the exam.

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CASE STUDY 8


Client H is a firefighter and emergency medical technician in a small town who has struggled with symptoms of PTSD for more than seven years. A perceived lack of understanding and compassion in his department is exacerbating his PTSD symptoms, and he finds going to work and dealing with others to be the most miserable part of his job, in some ways a more difficult task than fighting fires and rescuing people. Although Client H is not a musician, he enjoys music and is happy his therapist is willing to entertain his discussions about songs, no matter how dark they are. Client H completes a full course of stabilization (stage 1) and working through of the trauma (stage 2) using EMDR and some trauma-focused cognitive-behavioral therapy strategies. However, Client H's main concern continues to be returning to work now that he is feeling better. Together, Client H and his therapist develop a coping plan in order to deal with the drama in his work setting. Part of this plan includes listening to "angry" music in the car on the way to work. For Client H, getting his angst out by singing along with hardcore heavy metal music in the car on the way to work helps him to release his anticipatory anxiety about interacting with his fellow employees. Although Client H uses gentler techniques (e.g., breathing, grounding) while at the fire station, he finds that having the musical outlet in his car makes a difference for him in being able to return to work.

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CASE STUDY 9


Client I is a man, 58 years of age, who presents for PTSD treatment following a major robbery at his place of work. During the robbery, Client I was shot and barely escaped with his life. Client I initially struggled during his treatment, but he eventually experienced a great reduction in PTSD symptoms using a combination of pharmacotherapy (prescribed by a staff psychiatrist), trauma-focused cognitive-behavioral therapy, art therapy, and some somatic experiencing. Although Client I does not seem to connect with traditional EMDR therapy when his therapist attempts it, there is one element that he does like—the sound tones. (In EMDR, eye movements do not have to be used to generate the bilateral stimulation that defines the EMDR approach to psychotherapy. Alternating tapping/tactile sensations or beeps [typically generated by a specialized machine that can provide the alternation] are acceptable alternatives.) Client I indicates that simply putting the headphones on and focusing only on the beeps proves to be extremely relaxing. The therapist observes that drawing seems to help him with processing the trauma and listening to the tones serves as a form of soothing self-hypnosis.

As an experiment, Client I is sent home one day with a CD of just the beeping sounds on a loop to determine if it will have an effect even without the alternating capacity generated by the EMDR machine. At his next appointment, Client I reports that when he needed to relax, he simply put on his "beeping" CD and he was able to relax. He also noted a decrease in heart rate during listening sessions.

Upon termination of treatment, Client I indicates that using his "beeping" CD has become a regular part of his life whenever he feels panic or anxiety. Although Client I has done work in therapy to address the traumatic material, he continues to live in a dangerous neighborhood near the place of his shooting, so triggers are unavoidable. Client I indicates that the "beeps" are something he will call upon whenever he needs to relax and self-soothe.

  • Back to Course Home
  • Participation Instructions
    • Review the course material online or in print.
    • Complete the course evaluation.
    • Review your Transcript to view and print your Certificate of Completion. Your date of completion will be the date (Pacific Time) the course was electronically submitted for credit, with no exceptions. Partial credit is not available.