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Marrakech powerpoint

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Presentation given at World Play Therapy Congress in Marrakech, May 2010

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Marrakech powerpoint

  1. 5. “ It’s not very nice is it, Henry” Music Therapy with a sexually abused boy Henry Dunn Music Psychotherapist Devon Partnership  NHS Trust 
  2. 6. Endless Cycle – Lou Reed <ul><li>The bias of the father runs on through the son leaving him bothered and bewildered The drugs in his veins only cause him to spit at the face staring back in the mirror How can he tell a good act from the bad he can't even remember his name How can he do what needs to be done when he's a follower and not a leader The sickness of the mother runs on through the girl leaving her small and helpless Liquor flies through her brain with the force of a gun leaving her running in circles How she can tell a good act from the bad when she's flat on her back in her room How can she do what needs to be done when she's a coward and a bleeder The man if he marries will batter his child and have endless excuses The woman sadly will do much the same thinking that it's right and it's proper Better than their mommy or their daddy did Better than the childhood they suffered The truth is they're happier when they're in pain In fact, that's why they got married </li></ul><ul><li>© Lou Reed 1989 </li></ul>
  3. 7. Introduction <ul><li>Case Study – young boy that had been sexually abused for first five years of his life. </li></ul><ul><li>How he was able to express his experience through music therapy. </li></ul><ul><li>Effect of abuse on brain development. </li></ul>
  4. 8. Case Study <ul><li>D was 10 when we started working together. </li></ul><ul><li>Weekly sessions, 30 minutes each. </li></ul><ul><li>Developing repertoire of games and interactions. </li></ul><ul><li>Powerful expression of abuse experience. </li></ul>
  5. 9. Affect Attunement – Stern (1985) <ul><li>“ The connection is read not simply as an imitation but as a real attempt to connect with the child’s feelings.” Bunt (1994:94) </li></ul><ul><li>Stern “describes this process as more sophisticated than imitation, giving the indication of a capacity for psychic intimacy, and allowing qualities of feeling or vitality affects to be shared.” Watson (2007:102) </li></ul>
  6. 10. The therapeutic relationship <ul><li>Needs to be “good enough” (Winnicott). </li></ul><ul><li>Therapist needs to survive. </li></ul>
  7. 11. Emotional Intelligence (Goleman) <ul><li>5 Keys </li></ul><ul><li>Knowing one’s emotions as they happen. </li></ul><ul><li>Managing emotions. </li></ul><ul><li>Self motivation and deferred gratification. </li></ul><ul><li>Recognizing and working with emotions in others. </li></ul><ul><li>Handling relationships. </li></ul>
  8. 12. The importance of play <ul><li>“ Psychotherapy takes place in the overlap of two areas of playing, that of the patient and that of the therapist. The corollary of this is that where playing is not possible then the work done by the therapist is directed towards bringing the patient from a state of not being able to play into a state of being able to play” (Winnicott 2005: 51). </li></ul>
  9. 13. <ul><li>“… playing facilitates growth and therefore health; playing leads into group relationships; playing can be a form of communication in psychotherapy; and lastly, psychoanalysis has been developed as a highly specialised form of playing in the service of communication with oneself and with others” (Winnicott 2005: 56). </li></ul>
  10. 14. The importance of survival <ul><li>“ (1) Subject relates to object. (2) Object is in process of being found instead of placed by the subject in the world. (3) Subject destroys object. (4) Object survives destruction. (5) Subject can use object. “ (2005:126) </li></ul>
  11. 15. Importance of a Secure Base Bowlby <ul><li>in childhood “the provision by both parents of a secure base from which a child or adolescent can make sorties into the outside world and to which he can return knowing for sure that he will be welcomed when he gets there, nourished physically and emotionally, comforted if distressed, reassured if frightened.” (1988:12) </li></ul>
  12. 16. Consequences of the lack of a secure base <ul><li>Attachment disorders </li></ul>“ anxious resistant attachment in which the individual is uncertain whether his parent will be available or responsive or helpful when called upon. Because of this uncertainty he is always prone to separation anxiety, tends to be clinging, and is anxious about exploring the world. This pattern, in which conflict is is evident is promoted by a parent being available and helpful on some occasions but not on others, and by separations and…by threats of abandonment used as a means of control.”(2005:140)
  13. 17. <ul><li>in therapy first task “is to provide the patient with a secure base from which he can explore the various unhappy and painful aspects of his life, past and present, many of which he finds it difficult or perhaps impossible to think about and reconsider without a trusted companion to provide support, encouragement, sympathy, and on occasion, guidance.” (ibid:156) </li></ul>
  14. 18. <ul><li>“ anxious avoidant attachment in which the individual has no confidence that, when he seeks care, he will be responded to helpfully but, on the contrary, expects to be rebuffed. When in marked degree such an individual attempts to live his life without the love and support of others, he tries to become emotionally self-sufficient and may later be diagnosed as narcissistic or as having a false self as described by Winnicott”. (2005:140) </li></ul>
  15. 19. <ul><li>Disorganised attachment – very unpredictable behaviour </li></ul><ul><li>D most like this. </li></ul>
  16. 20. Lack of secure base in therapy <ul><li>“ ..unless a therapist can enable his patient to feel some measure of security, therapy cannot even begin” (ibid:159) </li></ul>
  17. 21. Uncorrected Personality Traits Robyn Hitchcock <ul><li>Uncorrected personality traits that seem whimsical in a child may prove to be ugly in a fully grown adult. Lack of involvement with the father, or over-involvement with the mother, can result in lack of ability to relate to sexual fears, and in homosexual leanings, narcissism, transexuality (girls from the waist up/men from the waist down), attempts to be your own love object. Reconcile your parents to you by becoming both at once! Even Marilyn Monroe was a man, but this tends to get overlooked by our mother-fixated, overweight, sexist media. So: Uncorrected personality traits that seem whimsical in a child may prove to be ugly in a fully grown adult. If you give in to them Every time they cry They will become little tyrants But they won't remember why Then when they are thwarted By people in later life They will become psychotic And they won't make an ideal husband or wife The spoiled baby grows into the escapist teenager who's the adult alcoholic who's the middle-aged suicide. (Oy.) So: Uncorrected personality traits that seem whimsical in a child may prove to be ugly in a fully grown adult. </li></ul>
  18. 22. Containment - Bion <ul><li>“ It is the creation of a psychic space in which each and every communication, however confused and painful, is received by the therapist, retained and mentally digested with the aim of removing any unbearable qualities from the patient’s feelings. These feelings can then be given an acceptable form and place in the patient’s experience. The final aim is for this experience to enable the patient to accept his anxieties and learn to live with them; in other words, to understand and accept the containment function .” quoted in De Backer (1999) </li></ul>
  19. 23. Containment in Music Therapy Jos De Backer <ul><li>The therapist “will stretch a skin over the patient’s experience - an acoustic skin – which binds and shapes the expression of chaos. ……………… Music offers the advantage that the patient need not be alone in his/her chaotic expression and experience. The music therapist has the means of being with the patient without having to exclude him/her. S/he achieves this not only by his/her attitude but by his/her empathic accompaniment. This means that the patient can….feel that someone accepts his/her experience, someone who accompanies him/her without being swept along, who does not become alarmed, someone who gives him/her the feeling that his expression is not “destroying” anyone.” (1999:19) </li></ul>
  20. 24. <ul><li>“ In the psychic space created in the therapy the patient will be able to project his/her chaotic and confused feelings and experiences towards the therapist. This will enable him/her to bear these feelings (projective identification). (p19) </li></ul>
  21. 25. Say hello – Nitin Sawhney <ul><li>I knew you needed a friend. I knew you needed some blue skies. You need some laughter again, Til magic returns to your blue eyes. You're lost in the circle of pain. Where's it all going? Each day is the same, Where are you going? Say hello. Say hello. You're never alone. Something inside of yourself, When darkness approaches your silence. Freedom's forgotten her name. Nothing makes sense you don't complain. Everything started to fall. Where's it all going? Can't make any sense of it all. Where am I going? Say hello. Say hello. You're never alone. </li></ul><ul><li>© Nitin Sawhney 2003 </li></ul>
  22. 26. Abuse and neglect as causes of learning disability and autism <ul><li>Sinason and Stokes (1992) </li></ul>“ the link between sexual abuse and handicap. In several cases, mental handicap seemed to provide a screen against acknowledging the reality of sexual abuse…The “screen” of mental handicap provides a state of not knowing about, as a protection against the terrible feelings of abuse and rejection……..It is well established that learning difficulties…are a regular feature of sexual abuse and physical abuse. This is not surprising. If knowing and seeing involve knowing and seeing terrible things, it is not surprising that not-knowing, becoming stupid, becomes a defence…However, it is a mad defence as it takes away the possibility of communication and gaining help or understanding.”
  23. 27. Neurological implications <ul><li>“ There is some evidence to suggest that high levels of cortisol might be toxic to the developing brain over time. In particular, too much cortisol can affect the development of the orbito-frontal part of the prefrontal cortex….an area which…is responsible for reading social cues and adapting behaviour to social norms.” (2004:66) </li></ul>
  24. 28. <ul><li>Song by Risenga Makondo </li></ul>
  25. 29. Bibliography <ul><li>Goleman, D. (1995) Emotional Intelligence: Why It Can Matter More Than IQ for Character, Health and Lifelong Achievement. London: Bantam Press. </li></ul><ul><li>Winnicott, D.W. (2005) Playing and Reality. London and New York: Routledge Classics </li></ul><ul><li>Bowlby, J. (2003) A Secure Base, London: Brunner Routledge </li></ul><ul><li>Bion, W.R. (1962) “A theory of thinking.” International Journal of Psychoanalysis 43, 306-310. </li></ul><ul><li>De Backer, J. (1999) Specific aspects of the music therapy relationship to psychiatry, Clinical Applications of Music Therapy in Psychiatry. Ed. Wigram and De Backer. London and Philadelphia: Jessica Kingsley. </li></ul><ul><li>Stokes, J. & Sinason, V. (1992). Secondary mental handicap as a defence. In A. Waitman & S. Conboy-Hill (eds) Psychotherapy and Mental Handicap . London: Sage. pp. 46-58. </li></ul><ul><li>Sinason, V. (1992) Mental Handicap and the Human Condition. New Approaches from the Tavistock. London: Free Association Books. </li></ul><ul><li>Gerhardt, S. (2004) Why Love Matters. How Affection Shapes a Baby’s Brain. Hove, East Sussex and New York: Routledge. </li></ul><ul><li>Stern, D. (1985) The Interpersonal World of the Infant: A View from Psychoanalysis and Development. Basic Books, New York </li></ul><ul><li>Bunt, L. (1994) Music Therapy: An Art Beyond Words. Routledge, London. </li></ul><ul><li>Watson, T (ed) (2007) Music Therapy with Adults with Learning Disabilities. Routledge, London </li></ul>