Adolescents and Person-Centered Expressive Art Therapy: Using Music as a Therapeutic Tool

 This paper will explore the inherent connection between adolescents and music, and the ways in which music serves as a therapeutic tool for managing grief and loss. By reviewing the theoretical underpinnings of Natalie Rogers’ person-centered expressive art therapy and relating it to the psychosocial development of young adults, we can facilitate effective responses to grief and bereavement. Various therapeutic modalities exist within this regard, and music has been thought to be a highly effective method, in part due to the powerful relationship between teenagers and their music; as McFerran & Hunt (2008) point out, “statistics suggest that teenagers typically spend up to six hours a day listening to music.” It therefore makes practical sense to tap into this avenue of expression and develop a non-threatening and comfortable environment for these adolescents to express their emotions.

 This topic was chosen for a variety of reasons. Firstly, as someone who works with university students, many of whom are within the age range of 17-24 years of age, it is beneficial to my work to understand how grief processes develop. This cohort of young adults very often struggle with mental health issues and are known to “use music to relieve boredom, manipulate mood, ease tension, and fight loneliness.” (Duffey et al., 2001). As a university administrator who works in a counselling capacity, it is of great value for me to be aware of the various therapeutic options availed to these individuals. On a personal note, I have always felt a deep connection to music, whether it is the interpretation of the lyrical message, or simply using music to escape. Although I am not musically inclined, I appreciate the subtleties involved in musical writing and quite often, my mood can often be determined by the type of music I am listening to at any point throughout the day. I have never really thought about music as being a vehicle for therapy or counselling. Perhaps this is indicative of its effectiveness- it is seemingly effortless.

Overview of Person-Centered Expressive Art Therapy

 Person-centered expressive art therapy (PCEAT), particularly music therapy, is a good fit for youth, as it promotes self-expression and enables the client to feel a sense of control. This type of therapeutic relationship is collaborative and is highly dependent on mutual respect between the client and the caregiver. According to Tervo (2001), “Music therapy does not primarily depend on the music but on the co-operation and the interaction between the therapist and adolescent” (p.87), thus the essence of this modality is the establishment of trust, and freedom of expression, either positive or negative. Natalie Rogers, who pioneered the concept of PCEAT, placed great emphasis on the concept of trust, and like her father, Carl Rogers, “believed deeply in the client’s ability to know what hurts, what directions to go in, what problems are crucial” (Sommers-Flanagan, 2007, p.121). This approach is a welcome addition to a somewhat antiquated view of what “therapy” looks like, and fosters a sense of control for adolescents, who, at this developmental stage, can exhibit varied grief responses. A study conducted by McFerran and Hunt (2008) found that “young people needed to have fun and feel in control before they were able to address their own experience of grief” (p.51). For many youth, music is a way to bridge existing communication gaps and allows them to express their innermost feelings without having to speak their own words.

 PCEAT positions the clinician as a “collaborator” of the story the client wishes to tell. This relationship is built upon a foundation of understanding the client’s needs and boundaries; as Duffey et al. (2001) succinctly state, “it is not the counsellor who determines the meaning for the client” (p.404). Further, “people are engaged in a constant process of making sense of themselves, their relationships, and what happens to them” (Duffey et al., 2001, p. 400). The PCEAT approach passively facilitates this self-reflective process, enabling a self-directed response.

Complicated Grief

 In working with youth in particular, it is important to recognize the differences in the way in which the grieving process occurs. As McFerran & Hunt (2008) discuss, “the developmental stage of adolescence is defined as a period of identity formation” (p.45), and an ever-changing awareness of mortality- both their own, and that of others. Marty Slyter (2012) suggests there are two major features of adolescent grief. First, he believes that adolescent grief is “profoundly personal in nature. They grieve more intensely than adults do” (p.18). Second, he indicates that grief “may follow a lifelong developmental path. The loss may continue to be felt throughout the lifespan” (p.18). Slyter further emphasizes that fundamentally, responses to any kind of loss are amplified in the psyche of adolescents. Recognizing the developmental stage in which adolescents belong, is crucial to understanding how best to support their grief process.

 At this stage of development, the ability to problem-solve and rationalize is still forming, and Erikson’s psychosocial theory of development emphasizes the need for individuals to master each competency before advancing to the next stage (Cherry, 2018). Thus, it is imperative that adolescents effectively navigate loss and develop mechanisms to cope with subsequent challenges. Inherently, adolescents are “more likely to report a higher intensity and duration of anger…want to fix a problem as quickly as possible” (Slyter, 2012, p.19). By nature, many youth lack problem-solving abilities and become enveloped in the grief, unable to work through their emotions. As discussed in our lecture notes, complicated grief can be exhibited by various characteristics. Often, complicated grief presents itself by exuding “persistent feelings of intense yearning, difficulties with trust, and rumination about death or the deceased” (Arnold, 2018). Adolescents are at particular risk due to their stage of development, and many risk factors further increase the likelihood, or prevalence of, complicated grief in adolescents. Slyter further examines this by looking at five factors associated with complicated grief: (a) relational, (b) circumstantial, (c) historical, (d) personality, and (e) social (p.20). These factors interplay, interfering with the grieving and recovery process. By fully comprehending the extent of the loss and its impact, the adolescent can then seek ways to move forward.

Therapeutic Applications

 Music therapy serves to bolster the existing natural relationship between adolescents and music. As McFerran and Hunt (2008) point out, “for adolescents, music is non-threatening, accessible, familiar, and even attractive. Music therapy groups do not pose the threat of having to ‘talk’ about their grief” (p.46). An integral component of youth therapy is allowing the adolescents to feel a sense of freedom and control. Jukka Tervo, clinical psychologist, has worked with youth in PCEAT, specifically with music therapy, and has divided this therapeutic technique into three parts: (a) the stage of interest, (b) the stage of learning, and (c) the stage of improvisation (Tervo, 2001). Each stage of this therapeutic process builds upon the previous stage, first introducing music to the client, and working with him/her to learn how to play music. Tervo believes that this learning process is akin to learning how to cope with emotion and affords the client the opportunity to experiment with different modalities within the scope of music therapy. “During the interest and learning stages, the therapist guides and supports the adolescent to the gates of self-expression and creativity” (Tervo, 2001, p.82).  This is the very essence of Natalie Rogers’ PCEAT therapeutic approach; creating a safe space for the client to express emotion, at their own pace.

 Thelma Duffey, like Jukka Tervo, holds the belief that “listening to music often invokes in individuals cognitive and affective memories of important life events and significant losses” (Duffey et al., 2001, p.398). Duffey developed a process called “A Musical Chronology”; comprised of four stages, each of which “can be adapted to diverse client needs, including grief and loss” (Slyter, 2012, p.23). The client brings a selection of songs that have meaning for them to the counselling session, and the counsellor works with this music “to evoke memories, feelings, and thoughts about those who died and about the relationships the adolescent shared with the deceased” (Slyter, 2012, p.23). In collaboration, the adolescent and the counsellor work to make meaning of these thoughts and feelings, in an effort to invoke a forward-facing, positive view toward the future.

Personal Reflection: Experiential Workshop

 I was initially very apprehensive going into our experiential workshop. As someone who inherently does not like to talk about my feelings, or expose vulnerabilities, I was concerned about the expectations of both the workshop facilitator, and the other participants. While I would characterize myself as highly sensitive, and highly attuned to others’ feelings and circumstances, I have always been the type to keep my own emotions at bay- probably for fear of rejection or feeling misunderstood. It is amazing that within a few short hours, I felt comfortable within my assigned group; comfortable enough to talk about personal topics with complete strangers.

 Five modalities were explored throughout the course of the workshop: poem writing, story writing, collage-making, photography, and song/music therapy. As we discussed at the end of the workshop, the order in which we experimented with each therapeutic modality was intentional and purposeful. By following the person-centered expressive art therapy framework, beginning with a less intimidating, freeform type of expression allowed us to ease into the process. As someone who appreciates clear direction, art expression is not something that comes easily to me, so I appreciated that the first activity, story writing, provided us with six specific words or concepts that needed to be included in our stories: a closed door, a cabin in the woods, a wise woman, a mysterious stranger, a sun rising over a mountain, and a burning fire. What I found most interesting about this exercise was the different ways in which each participant interpreted those words and phrases. Each participant in the workshop created their own story, and while every story included the key components, the end result was wildly different for each of us. The poetry writing modality was challenging for me; I would like to think of myself as a fairly decent communicator, particularly in writing, however this exercise was one that I just could not grasp. I am a strong believer in structure, so perhaps this is why I found the exercise challenging; I have a certain image in my mind of what a “good poem” looks like, what it sounds like. So, I spent a good majority of my time trying to ensure the words flowed, that the message made sense.

 I found the collage-making exercise to be a turning point for me throughout this process (attached). There is great value in this modality, as it allowed me to control what elements were included, find symbolic meaning in the words and images chosen, and place these elements in the order in which I felt they belonged. The process itself felt therapeutic, as I carefully selected each piece of the story, as described in our course textbook, “I tore out words I dared not utter…I layered one image over another. Depth and multiple meanings emerged” (Thompson & Neimeyer, 2014, p.187). Much like the author of this chapter, I too, felt empowered. I also feel that the collage I produced does present a very clear picture, while incorporating the six elements presented in the story writing exercise, which speaks to the effectiveness of this modality.

 The photography modality was another form of expression that I struggled with. I am an avid photographer of my dog and my children; however, I do struggle to find the ‘hidden meaning’ behind images. I appreciated the freedom we had to complete this exercise, but really did not put much stock into its impact on my belief of “self-expression”. Until one photo that I took, struck a chord with me. I took a photo of a lone park bench in a park; unassuming, still, perhaps lonely. After a moment of looking at the photo, I envisioned my deceased grandfather siting on the bench. With that, came feeling of sadness, and regret about not spending much time with him in his final years. It is fascinating that one photograph can have such a profound impact, and how, once something just “clicks”, deeper meanings are uncovered.

 Unsurprisingly to me, the most impactful (for me) modality is music. As previously mentioned, music has always served as an unofficial form of self-therapy for me, and music really is a gauge for my mental state at any given point. We discussed in the workshop how many of the participants opted to share song lyrics that were sorrowful, and depressing, as opposed to upbeat and uplifting. From a therapeutic perspective, because music therapy is often viewed as a vehicle for working through a grief process, perhaps this is why these types of songs were selected. What I found interesting about the entire process was how, by starting with six simple words/concepts, I was able to tell a consistent story throughout most of the other modalities. When asked to select a song that holds meaning to us, I initially selected a song that really exemplified the feelings that this workshop brought out of me. Although I opted to share a different song with my group, the self-revelation was not lost.

Concluding Thoughts

 As we discussed in our workshop, creativity is comprised of four components: Person, Product, Process, and Press. In this theory of creativity, the ‘person’ is at the center of the therapeutic relationship, and in relation to the workshop, each person contributed to the success of the weekend as a whole. The environment, the “press”, was conducive to collaboration and I very much appreciated the option to “participate or pass”. Every modality was availed to each of us and we each have varied levels of comfort within each of those, so it was appreciated that there was no pressure. While we each created our own “products” that demonstrated our understanding of PCEAT concepts, I feel that the essence of this workshop was the “process”. As discussed throughout the literature cited in this paper, the success of PCEAT is highly dependent on the trusting relationship between the client and counsellor (in this case, the workshop participants and our facilitator). Allowing us to essentially forge our own paths throughout this process enabled the participants to fully immerse in person-centered expressive art therapy, which is the goal. For adolescents, activating this sense of self-control and self-expression is a powerful mechanism for healing. PCEAT is most effective when the client is able to fully immerse themselves into the process and make meaning of their experiences. As our experiential workshop uncovered, not every modality speaks to everyone, so it is key to find a relatable therapeutic method that will serve to facilitate the healing process.

References

• Arnold, C. (2018). Grief and Trauma [PowerPoint Slides]. Retrieved from https://owl.uwo.ca.
• Cherry, K. (2018, April 3). Erik Erikson’s Stages of Psychosocial Development. Retrieved from https://www.verywellmind.com/erik-eriksons-stages-of-psychosocial-development-2795740 https://www.verywellmind.com/erik-eriksons-stages-of-psychosocial-development-2795740
• Duffey, T., Lumadue, C., and Woods, S. A Musical Chronology and the Emerging Life Song. The Family Journal: Counseling and Therapy for Couples and Families, 9:4(2001), 398-406. 
• Kim, S. (2010). A Story of a Healing Relationship: The Person-Centered Approach in Expressive Arts Therapy. Journal of Creativity in Mental Health, 5:1(2010), 93-98.
• McFerran, K. and Hunt, M. Learning from Experiences in Action: Music in Schools to Promote Healthy Coping with Grief and Loss. Educational Action Research, 16:1(2008), 43-54.
• McFerran, K., Roberts, M., and O’Grady, L. Music Therapy with Bereaved Teenagers: A Mixed Methods Perspective. Death Studies, 34(2010), 541-565.
• Slyter, M. (2012). Creative Counselling Interventions for Grieving Adolescents. Journal of Creativity in Mental Health, 7(2012), 17-34.
• Sommers-Flanagan, J. The Development and Evolution of Person-Centered Expressive Art Therapy: A Conversation with Natalie Rogers. Journal of Counselling and Development, 85:1(2007), 120-125.
• Tervo, J. Music Therapy for Adolescents. Clinical Child Psychology and Psychiatry, 6:1(2001), 79-91.
• Thompson, B. (Ed.), Neimeyer, R. (Ed.). (2014). Grief and the Expressive Arts: Practices for Creating Meaning. New York, NY: Routledge.