Claire Haglund dissertation

Institute for Clinical Social Work

Psychodynamic Music Therapy and Inner-City Young Adults

A Dissertation Submitted to the Faculty of the Institute for Clinical Social Work in Partial Fulfillment for the Degree of Doctor of Philosophy

By Claire Adeline Haglund

Chicago, Illinois

June 2023

Abstract

This mixed methods research study explored the role psychodynamic music therapy plays in resiliency and relationships in inner-city young adults. In the first phase of the study, the Resiliency Scale for Young Adults (RSYA) was given to participants to see how the resilience levels of young adults who have participated in psychodynamic music therapy (PMT) compare to those who have not. Of the 30 participants that completed the RSYA, the 10 that endorsed participating in PMT were interviewed to explore their experiences more in depth. The findings included PMT was a positive unexpected experience, trauma was a shared experience among PMT participants, PMT served as a psychological third space, and PMT served as a means of emotional regulation and development of ones sense of resilience.

For:

My parents, sisters, MRL, and my cohort partners Mary and Julie.

Thank you for showing me what unconditional love, intelligence, grit, grace, and perseverance look like.

Acknowledgements

I was unsure of where to start, or how to begin my dissertation. However, I was lucky enough to have interviewed, and interacted with 30 inner-city young adults who agreed to participate in my study. Their life stories are full of courage, survival, and resilience, this kept me focused and determined to make sure their stories were told. Even when their experiences were painful to recount, they remained honest, real, and above all hopeful throughout this process. It has been an honor to have been the recipient of your life experiences and music, you are incredible people, keep shinning bright.

My ICSW consultants Andrew Weaver LCSW, and Dr. Lynn McIntyre, gave me the courage to remain steadfast in studying a grossly underserved population in the psychodynamic community.

And lastly, my committee has been there with me throughout the entire process, and I am grateful for their expertise, time, and commitment they have given me and my study. Dr. Denise Duval Tsioles, Dr. Kerstin Blumhardt, and Karen Baker LMSW your insight, leadership, and willingness to champion my idea that operates far beyond the traditional 50 minute hour has meant the world to me.

Thank you all, so very much.

Significance of the Study of Clinical Social Work

Statement of the Problem and Specific Objectives to Be Achieved

Research Question to Be Explored

Theoretical and Operational Definitions of Major Concepts

Statement of Assumptions

Epistemological Foundation of the Project Foregrounding

Third Space as defined in literature

Conceptualization of Psychoynamic Music Therapy

Attachment

Prior Research Studies on Resilience and Inner City Young Adults

Prior Research Studies on Music Therapy and Young Adults

Research Questions to be Explored

Methodology.........................................................................................................41

Introduction

Rationale for Study Design

Rationale for Specific Methodology

Research Questions

Sample Selection

Research Plan or Process

Data Collection and Instrumentation

Plan for Data Analysis

Data Analysis

Ethical Considerations

Issues of Trustworthiness

Limitations and Delimitations

The Role and Background of the Researcher

Survey Results

Summary of PMT RSYA Results

Summary of Non PMT RSYA Results

Quantitative Conclusions

Qualitative Results-Introduction

Qualitative Second Phase

Introduction to Participants

Superordinate Themes, Subthemes and Respondent Experiences

Conclusion

Field Notes

Summary

Findings and Implications.................................................................................154

Findings

Field Note Reflections

Broader Implications for Social Work

Limitations

Suggestions for Future Research

Summary

Conclusions

PMT

Psychodynamic Music Therapy

RSYA

Resilience Scale for Young Adults

Chapter I

Introduction

a. General Statement of Purpose

The purpose of this mixed-methods study was to explore the role psychodynamic music therapy plays in resiliency and relationships in inner-city young adults. For the purposes of this study, inner city young adults was defined as someone between the ages of 18-26 who lived in a distressed urban or suburban area of concentrated poverty and low income. Psychodynamic music therapy (PMT) was defined as a creative process that utilizes music, words, or instruments within a client/therapist relationship to facilitate an ongoing dialogue between conscious and unconscious contents to integrate aspects of the client’s psyche and help the client develop their authentic self. A connection between music and words is established by “verbally processing the musical experience or musically processing the verbal experience” (Sementna, 2016, p. 111) which aids in the creation of intersubjective thirdness through the patient, therapist, and music. A psychodynamic music therapist will typically have a guitar, keyboard, percussion instrument trunk, and a wind instrument of some type as well as an iPod for music selection, and can be structured in a variety of ways, however typically follows the patients lead. Therapy can be structured in a variety of ways, but the PMT therapist typically follows the patient’s lead. This is different from traditional psychoanalytic therapy due to its use of musical instruments as a tool to access and observe as well as participate in the therapeutic content and transferential relationship.

Resilience was defined as the process and outcome of successfully adapting to difficult or challenging life experiences, especially through mental, emotional, and behavioral flexibility and adjustment to internal and external demands. This study aimed to see if there is a relationship

between experiencing PMT as a young adult and levels of resilience, as well as to examine the therapeutic relationship in PMT in connection with resilience.

b. Significance of the study for clinical social work

Social workers can play an essential role in the lives of inner-city young adults as they work to build resiliency and strengthen interpersonal relationships. Social workers understand that there is a myriad of bio-psycho-social influences on this population. Music, as a universal language, is one of them. If social workers have a deeper understanding of music and its ability to enhance the therapeutic relationship, this could be of tremendous value to the field of clinical social work.

Further, the study of music and its potential role in therapy is severely lacking in the field. Music is a tool that is accessible and a mode of communication that connects the inner-city community to a healing modality and potential therapeutic relationship and can break through long held community mistrust of the mental health/social work system. This distrust often lies in treatment ruptures that occur due to rapid turnover in mental health clinics right as trust is cultivated when therapists leave. In addition, there are unspoken power dynamics continually created and maintained between racial minority populations being treated by Caucasian clinicians. According to the APA’s Center for Workforce Studies “86% of psychologists are white, and other mental health professions are similarly homogeneous” (Calkins, 2020). The racial composition of psychodynamic music therapists is projected to be the same (approximately 88.4%), according to the 2018 American Music Therapy Membership Profile Survey. Additionally, it is estimated that urban inner-city health clinics (where many of these interviews will take place) “make up 85% of mental health care for young- adults, however, have a 40% annual clinician turnover rate” (Folies, 48). Folies urges that “for those of us who have played a

part in creating and sustaining the structures that make them miserable, though, we have to do more” (116). Therefore, a study focusing on psychodynamic music therapy (PMT), and the dynamics surfacing within the treatment relationship, is vitally significant as this work could offer insight into the therapeutic dyad, allowing therapeutic change through music and connection to occur.

Lastly, there is essential ethical significance to this study. The NASW Code of ethics states that licensed clinicians have a set of values and ethical principles that must be upheld when treating others. This study has the potential to shine a specific spotlight on the value of the dignity and worth of the person. For example, through the patient's exploration of their PMT experience, their right to self-determination and autonomy will be exercised as well as their right to share how their therapeutic relationship impacted their well-being. This value guides the ethical principle that social workers respect the inherent dignity and worth of the person. The code states:

“Social workers treat each person in a caring and respectful fashion, mindful of individual differences and cultural and ethnic diversity. Social workers promote clients' socially responsible self-determination. Social workers seek to enhance clients' capacity and opportunity to change and to address their own needs. Social workers are aware of their dual responsibility to clients and to the broader society. They seek to resolve conflicts between clients' interests and the broader society's interests in a socially responsible manner consistent with the values, ethical principles, and ethical standards of the profession” (National Association of Social Workers [NASW], 2017).

This study hoped to explore the role psychodynamic music therapy plays in resiliency and relationships in inner-city young adults. It should be noted that self-determination through PMT is thought to be a marker of resiliency which will also be assessed using the RSYA

Statement of the problem and specific objectives to be achieved

Psychodynamic music therapy (PMT) is very seldom provided to the inner-city population. . A 2017 study estimated that only 12% of inner-city youth were offered the service in their secondary school system (Porter, 591). Therefore, one of the key objectives of this study was to explore participants’ experiences with PMT and the impacts the therapeutic relationship, modality, and attachment has had on their overall sense of resiliency. For the purposes of this study psychodynamic music therapy was defined as a creative process that utilizes music and words within a client/therapist relationship to facilitate an ongoing dialogue between conscious and unconscious contents. A connection between music and words is established by verbally processing the musical experience and musically processing the verbal experience.

“Psychodynamic music therapy proposes that, with the assistance of music, human beings can become aware of their inner states, and can communicate these through the performed musical expression” (Metzner, 2016). Furthermore, from a psychodynamic perspective, music therapy is considered to portray meaning and give the individual the feeling of being mirrored, accompanied, and even personally understood.

It is important to note that when it comes to PMT, the focus of therapy is not only on the music being created but also “the therapeutic relationship, especially the dynamics of transference and countertransference between the client and music therapist (Kim, 2016). From a music therapist’s perspective, the unconscious process and its interaction with instruments/music is an element of research. Through the PMT therapeutic alliance, the intersection between the

“patients unconscious mental states, their conflicts, and defenses in which the therapist will be able to gain an in-depth insight into the client that might identify the contributing factors to the current problem the patient is facing” (Bruscia, 1987). The way a person picks up an instrument, which instruments they choose, the way they play with and interact with others all potentially reflect something deep within themselves, such as their relationship patterns, psychological state of mind, feelings, thoughts, and various aspects of oneself. Music is considered a medium that lies close to where trauma, repressed thoughts, or memories reside; therefore, it “reaches the deep archetypal material that we can only sometimes reach in our analytic work with patients” (Jung, 1982, p. 175). For this study PMT will serve as such a medium that participants are able to reflect upon as they explore their lived experiences.

Resilience was also explored in this study as it relates to the participant’s self-view both within the therapeutic relationship and independently. Most of the time, those who see themselves as the least resilient are, in fact, the most resilient. Therapists sense this. “Patients resist therapeutic attunement because of long-held conscious and unconscious beliefs” (Folies, 2021) that those outside one's family of origin cannot be trusted with psychological truths and innermost feelings. It also makes it understandable why there is less research and less advocacy for minority populations and psychotherapy. For example, Scrine found in a 2021 study that “that 54% of the participant population in a South African music therapy study reported that they resisted engaging in the therapy initially due to the researchers focus on their perceived resilience and failed to note the context of their trauma in the initial music therapy intervention” (15).

People are afraid to treat the most vulnerable, to serve the population in which the power differentials built our profession. The therapist-music-young adult triad is a complex relationship. “The source of our confusion and fear is also the source of our significance. If we

are going to live imaginatively and meaningfully, we must simultaneously embrace what is morally and politically given, contend with it, and shift it. And all this in a world that has no definite guarantees, certainties, or permanence” (Cushman, 1995, p.290). Therefore, it is argued that to foster healthy attachment and healing, the researcher must model both musically and figuratively the process of building, resculpting, and reconfiguring ourselves. “We must build bridges, not idols. Life is in the wandering” (Cushman, 1995, p. 330). This study hoped to highlight the complexity of an inner-city young adult experience and the way PMT can potentially provide a space to examine the role therapeutic attunement can have in addressing systemic oppression, power differentials, and healing through connection.

In the treatment of young adults, the patient experiences distress or displays distress and seeks help or is mandated to seek help from the social worker. While some young people respond well to treatment and their symptoms are resolved, there is a large majority that encounter obstacles or biases that challenge the work, prolong symptoms, and create treatment ruptures. This study aimed to examine the quality of the therapeutic relationship between the therapist-music-young adult triad and whether it plays an integral role in how the treatment progresses. The therapist-music-young adult triad is a complex relationship. One way to think about the connection of PMT in the young adult-music-therapist triad is to view it as a relationship where all three parties have the potential to meet the needs of others. It is the creation of that intersection that leads to the need for this study. The experience of needing to “overcome” something is personal and intimate, not to mention constant and indefinite for the inner-city young adult. The PMT relationship can serve as a gateway that resembles the dyadic relationship between a stable primary caregiver and an individual. In addition, the dependency of the inner-city, struggling young adult on the available therapist can resemble the earlier

dependence of a child on a parent. It can therefore evoke the attachment style that was established with their earlier caregivers or current caregivers. One’s attachment style has been shown to correlate to how one relays one needs to another being. John Bowlby, who pioneered attachment theory, defined attachment as “any form of behavior that results in a person attaining or maintaining proximity to some other clearly identified individual who is conceived as being better able to cope with the world. It is most obvious whenever the person is frightened, fatigued, or sick, and is assuaged by comforting and caregiving” (Bowlby, 1973, p. 27). Bowlby’s definition demonstrates how the PMT client relationship can evoke attachment behavior; the therapist is then impacted by that patient in a certain way.

Attachment theory, as well as relevant music therapy research, proposes that interpersonal experiences, sets of behaviors and responses from birth onward, create patterns that evolve into internal working modes (IWMs)” (Meredith, Strong, & Feeney, 2006, p. 150). These IWMs become a person’s expectations of the self, world, and others. This leads to predicting behavior, thoughts, feelings, and outcomes (Meredith, Strong, & Feeney, 2006). Attachment behaviors are the internal working model that is often summoned in the face of threat or adversity. The experience of living in an inner-city urban environment can be understood as a threat to the self. Thus, it can conjure avoidant or oppositional attachment behavior if they cannot place a language on their experience. For example, insecurely attached young people demonstrated less trust in and verbalization in music therapy sessions, and they have more general distress in multiple environments than a securely attached control group (Blauth, 2019). Another study found that insecurely attached patients have a more considerable number of relationship ruptures in multiple systems of care than secure patients, as well as the fact that it often results in family reunification failures within the juvenile justice system (Forslund, 2021).

While most of the studies regarding young adults focus on their attachment, trauma, and communication style, few explore the dynamic between a patient, therapist, and music nonverbally. The impact of both the music/therapist dynamic and non-verbal communication style is often overlooked. In this study, both of these components were taken into consideration.

D. Hypothesis or research questions to be explored

The purpose of this study was to capture the individual experiences of inner-city young adults who have been through PMT and explore their therapeutic relationship and level of resiliency. The primary research question was:

How does Psychodynamic Music Therapy (PMT) impact inner-city young adults?

Sub Questions were:

 What aspects of PMT, if any, do inner-city young adults identify as beneficial and why?

 How do inner-city young adults who have been through PMT view their relationship with their therapist?

 Does PMT help build resilience in inner-city young adults?

 Does PMT impact their relationships, and if so, in what ways?

 What challenges, if any, did participants identify when discussing their PMT experience?

The quantitative research question is: How do the resilience levels of young adults who have participated in PMT compared to those who have not?

E. Theoretical and operational definitions of central concepts

 For my study, ‘psychodynamic music therapy’ was defined as a creative process that utilizes music and words within a client/therapist relationship to facilitate an ongoing

dialogue between conscious and unconscious contents. A connection between music and words is established by verbally processing the musical experience or musically processing the verbal experience. PMT can be conducted through the utilization of not only songs and recordings but also instruments made available to the patient.

 Clinician/Therapist. For this study, ‘clinician/therapist’ was used interchangeably and was defined as a psychologist, social worker, physician, or counselor who is based in the United States, has a psychodynamic orientation, and is currently serving inner-city youth with music therapy.

 Young adult: A young person between the ages of 18-26.

 Inner-City: Someone who lives in a distressed urban or suburban area of concentrated poverty and low income.

 Psychodynamic orientation. For the purposes of this study, ‘psychodynamic orientation’ was defined as a self-reported general characterization of one’s practice as being grounded in psychoanalytic theory and practice traditions.

F. Statement of assumptions

It is assumed that PMT creates a space between the young adult patient and therapist and that the PMT space within the dyad can be used to work through the issues with which the young adult is coping. It is known that patients' needs are not always being met by just us (the clinician). However, we often get needs met by our patients. Patients affect the therapist by impacting the therapy’s overall success. Research suggests that “patient reduction in symptoms is correlated with time, listening, and music-patient- therapist encounter “(Blauth, 2019, p. 111).

Patient progress is crucial because it is found to be associated with indicators of success, including outcome, decreased regression, and more frequently kept appointments (Blauth, 2019).

I assume that clinicians hold a set of beliefs or principles that guide their way of conducting treatment.

Of PMT specifically, it is assumed that music may serve as a means of therapeutic communication and connection in the therapeutic relationship with inner-city young adults. This assumed connection between the young adults’ identity with the inner-city environment also helps create a sense of meaning, easily made through a modality such as music. when connecting with the therapeutic dyad. It is assumed that “we talk about shame, and we talk about rage, but we are never engaging interest and joy, and if we don’t, we’re not going to get anywhere...innercity youth would love for therapists who are so interested in dealing with, shame to reconnect people with inner-city. Interest motivates us to engage and have the bravery to connect” (Stopford, 2020).

Resilience is a broad concept that can be defined in a multitude of ways. Most commonly it is defined or understood as“ the capacity to recover quickly from difficulties, toughness”. “the ability to respond to change or adversity proactively and resourcefully”, “the process of adapting well”, or the “psychological quality that allows some people to be knocked down by the adversities of life and come back at least as strong as before” (APA , 2018). However, given my experiences working with inner city young adults, I know understand resilience as an individualized, deeply personal phenomenon most easily defined as the process and outcome of successfully adapting to difficult or challenging life experiences, especially through mental, emotional, and behavioral flexibility and adjustment to internal and external demands. In this study the definition of resilience was kept intentionally broad, as I hoped to hear how the study participants defined it for themselves.

G.

Epistemological foundation of the project

This study was rooted in pragmatism which accepts that “absolute truth can never be found” (Creswell, 2014, p. 7), but it maintains that objective truth exists out there, and that reality can be observed and measured. In addition, this study assumed that there were objective, observable, measurable factors (which may even be outside of a clinician’s awareness) that shape attitudes in the therapy space. These factors- resiliency and the therapeutic relationship in PMTwas explored quantitatively and qualitatively using a mixed-methods approach.

Further, as this study was rooted in a specific population's reality, experiences could be measured in unique and expanded dimensions. For this reason, a transformative worldview philosophical position was also used. This is a “philosophical position in which the researcher identifies one of the qualitative frameworks (Indigenous populations, females, racial and ethnic groups, disabled individuals, and so forth) and uses the framework to advocate for underrepresented populations and to help create a better, just society for them” (Creswell, 2018, p.9). Through the selected mixed methodology, the research also contained an action agenda for reform. More specifically “this research also assumes that the inquirer will proceed collaboratively not further to marginalize the participants as a result of the inquiry” (Cresswell, 2018, p. 9). The transformative research worldview then extends beyond the dissertation itself and provides a voice for the participants “raising their consciousness or advancing an agenda for change to improve their lives'' (Cresswell, 2018, p. 9). It becomes a united voice for reform and change.

H. Foregrounding

I am a licensed clinical social worker (LMSW) and music therapist with a psychodynamic orientation. This dissertation served as the final requirement for my doctoral degree at the Institute for Clinical Social work (ICSW) in Chicago, Illinois. I have been working

in inner-city Detroit clinically since 2014. I have always believed music therapy could serve my caseload of inner-city young adults; however, very few were given access to it due to biases and discrepancies in resources due to their race, age, and geographic location. “A child's time is not that of an adult, and we must respect this so that little by little, once they are alone with us, they can allow themselves to speak of their suffering, or even to declare that he is not suffering, without being reprimanded by a family more or less disappointment at being deprived of sessions with the analyst” (Mathelin, 1999, p. 103). I have previous experience doing music therapy research and felt pulled to this focus area due to the observed interest and receptiveness that many of her patients displayed when offered PMT.

Psychodynamic music therapy is seldom written about; however, it can be defined as “finding and using a particular musical object to help adolescents with severe affect and contact regulation disorders to manage the building of a therapeutic relationship” (Smetana, 2016, p. 105). For the purposes of this study, a musical object will be defined as a special song, instrument, sound pattern, rhythm, etc., that provides a safety-giving function, leading to eventual mentalization, internalization, and symbolization. Christopher Bollas suggests that the “choice of representational form or object is an important unconscious decision about the structuring and sharing of lived experience” (p.40), which then helps create thirdness (defined by Thomas Ogden (1994) as “a framework of ideas about the interdependence of subject and object, of transference–countertransference, that assists the analyst in his efforts to attend closely to, and think clearly about, the myriad of intersubjective clinical facts he encounters ) between the therapist and patient. I hoped that through my study and dissertation, I would be able to contribute to the concept of a third position within the therapeutic dyad. By using music, this incredibly powerful, creative, underserved population may be able to better access therapy and

attach to clinicians as the musical object would allow for the “development of exploration, contact regulation, mentalization, and symbolization” (Smetana, 2016, p. 105).

While my research experience is not as vast as I wish it was, in the past ten years, I have been part of several research grants, studying the intersection of music therapy, racial minorities, and attachment. In 2020, I completed a two-year grant in an infant mental health lab, looking at the connection between lullabies and ethnographic history between parents/infants and the transmission of intergenerational trauma. Through this research experience, the I was drawn to the resilience observed in my patients that were provided the opportunity to express themselves, make meaning, and process their experiences through PMT as compared to those limited to a more closed/traditional therapeutic frame. I was left wondering what the influence of PMT is not only on the patient but also on the therapeutic dyad

As I have been continually met with more confrontations about the lack of representative research and psychodynamic services within the inner-city community, I wonder what is being done to change this vast need. Why is psychodynamic music therapy not provided to this population? “Increased focus on mechanisms underlying treatment effectiveness and characteristics and circumstances of those likely to respond to treatment has the potential to inform the development of innovative approaches in psychodynamic child psychotherapy and the training of psychodynamic child psychotherapists in the future” (Midgely, 2017, p. 320). I know of other providers and families that have experienced similar healing encounters and imagine many others would like to aid in the training of practitioners of the future.

To conclude, today, more than ever, it is vitally important that the psychodynamic community continues to examine its therapeutic accessibility with vulnerable populations. On a more comprehensive, systemic level, the study of PMT and resilience is beneficial to the field as

this important intersection has the potential to contribute to a greater understanding of just how much healing can occur when we foster a young adult’s ability to have one's mind and body work together.

CH II

Literature Review

Introduction:

Research and literature on psychodynamic music therapy and inner-city young adults is sparse, and research detailing how their overall resilience is potentially impacted by this intervention is even more limited. Although research specific to the intersection of inner-city young adults, music therapy, and resilience is limited, several sources address key elements central to this study. The following review represents a selection of interrelated theories, topics, psychoanalytic and social research that is important to this discussion, emphasizing its contribution to PMT and enhancing the study of resilience.

To fulfill the criteria for a quality literature review, this discussion was delimited, comprehensive, coherent, synthesized, and well-referenced (Abbott, 2016). The method for reviewing the literature involved using electronic databases, such as ProQuest, EBSCO, PubMed, ResearchGate, Psych INFO, PEP, Google Scholar, and consulting handbooks and standard works in music therapy, psychodynamic theory, and resilience research. Pertinent journals such as the British Journal of Music Therapy, the Journal of Music Therapy, and Nordic Journal of Music Therapy, Contemporary Psychoanalysis, and the Journal of the American Psychoanalytic Association were searched. Further literature was obtained by manually searching the reference lists from articles and book chapters. This literature review includes references up until April 2021.

The following literature review was divided into six major parts:

1. Conceptualizations of resiliency

2. Conceptualization of third space and Psychodynamic Music Therapy

3. Attachment

4. Literature highlighting resilience in inner-city young adults

5. Prior research studies on resilience and inner-city young adults

6. Prior research studies on music therapy and young adults

Ultimately, this review of literature was aimed at examining pertinent areas of thought around psychodynamic music therapy, inner-city young adults, and resilience

Resiliency:

Several theorists, who examine notions of resiliency, link the concept to other phenomena such as trauma and neglect (Malagraim, 2018). Furthermore, resiliency is frequently conceptualized as having a relational component (Lacan 1956, Santana 2018). For example, one systemic review states “it is, in fact, an ability to survive, related to intra-psychic capabilities and early emotional experiences” (Malgarim, 2018). Additionally, the concept is explained in the psychology literature as a characteristic that emerges, closely related to the social context of the patient. Overarching themes to be reviewed in this section include, the role of relationships in resilience, historical functions of resilience, the function of resilience, and assessing for patient resilience in research. The proceeding discussion of how resiliency is conceptualized in literature was essential to this study as it helped readers broaden a patient's clinical picture beyond participants' potential suffering and pathologies. This study took into consideration the participants skills and strengths not only on a micro level but also on a macro level.

A recent 2018 systemic review (Malgarim, Santana, et al) investigating resilience and psychoanalysis indicates that resilience is "built fundamentally through relationships: among subjects, between subjects and their environments, and others” (p 210). Additionally, the analysis of the resiliency concept within the field of psychology in the review shared that the concept of resilience has not yet been accepted into the psychodynamic theoretical field. This was an important discovery for the purposes of this study as it suggested that the concept of resilience is more closely associated with different traditional concepts and consequently does not appear in the literature under the name of resiliency used in this literature review/study.

Barkai and Hauser (2008) engaged in systemic research with young adults through semistructured research interviews to explore through participant self-reflection how resilience could be defined from a psychodynamic perspective. They found that reflecting on mental states effects resilience in vital and far-reaching ways because it enables young adults to benefit most from accessing caretaking individuals , “ reflection is a critical component of autonomy, is crucial to the development of a coherent sense of identity, is an essential aspect of personal agency, engenders greater interpersonal awareness, and contributes to the development of empathy” according to Luthar and Brown (122). Relationships are a key aspect of resilience (Luthar and Brown, 2007); self-reflection functions reciprocally with reflection on others in enhancing relationships and fostering resilient outcome.

Margret Mahler (1952, 1963,1974, 1975) refers to “the sturdiness and potential adaptive capacity of the human species and demonstrates the importance of the catalyzing influence of the love object” (p, 321). Mahler's work on the adaptive capacities of the human species and the influence of the love object connects to this study due to its focus on exploring participant's lived

experiences, the ways the participants developmental histories intersect with their current histories, and the impact of their relationship with their PMT.

In describing the resilience factors, Southwick and Charney (2012) focused on the importance of addressing the realm of unconscious conflict or early internalizations. In their studies, they found it was useful to ask whether and how they might incorporate psychoanalytic notions such as defensive structure, character organization, and projective identifications into their understanding of what makes for resilience, that allows an individual to “bend but not break” in the face of adversity. Even when addressing the issues of emotional growth, personal meaning, and facing one's fears, they did not consider the underlying psychic topography of the internal landscape as it may affect core psychological strength and the capacity to endure trauma and deprivation. It was suggested that “ the nuances of one's early attachments, developmental trajectory, and those aspects of the mind that remain outside of awareness would surely shed light on individual differences in resilience and emotional endurance” (203). All of the aforementioned conceptualizations were relevant to this study, which partially used a psychodynamic lens in analyzing the lived experiences of young adults and their experiences with PMT.

Third Space as Defined in the Literature:

Music therapy creates a third space in treatment in which the musical communication jointly creates a new shared reality between patient and therapist. Thomas Ogden (1983, 1979,1994, 1997) first explored this notion of “thirdness” as the meeting of subjectivities between patient and therapist and the space that could be co-constructed. He proposes that “the analytic third is an asymmetrical construction because it is generated in the context of the analytic setting, which is powerfully defined by the relationship of roles of analyst and

analysand” (p. 16). The analyst's experience in and of the analytic third is, primarily, utilized as a vehicle for the understanding of the conscious and unconscious experience of the analysand (the analyst and analysand are not engaged in a democratic process of mutual analysis). Ultimately

Ogden’s notions of thirdness helps define the relationship between the PMT and patient as they are creating the music together. This phenomena, music as thirdness, transcends the relationship participants have when the music( such as in transitional therapy)is absent and will carry over into their relationship outside of the music. This triadic relationship between client, PMT therapist, and music in its variety of combinations, gives young adults another form of communication in which they can relate not only to themselves or the therapist, but to the outside world. Ogden’s notion of thirdness related to the purposes of this study, as it helped define what is created during a PMT experience in the interaction between participant and their therapist.

Jessica Benjamin (2007) defined the third space in literature as the “analytic position of compassionate witnessing, can only be reached through this experience of bearing pain and shame”. This notion of third space is relevant to the purposes of this study as it focuses on the importance of witnessing patients shared experiences. It is suggested that by accepting “third space” in the analytic interaction our therapeutic alignment will deepen.

Additionally, Winnicott's notion of transitional space (1971) can be defined as a space “that exists between internal and external reality. It is neither internal nor external but rather a potential space, or an intermediate area, in which to play” (13). For Winnicott transitionally/transitional space and play are the mechanisms of creativity that belong to the serious business of being authentic, ‘being alive’ (Winnicott, 1971 p. 67) and of being part of cultural life. It is the space between the internal and the external where subjectivity resides . For the purposes of this study it was this ability to suspend difference for sake of play and

understanding that allowed for the sharing of lived experience and PMT and research study outcomes.

Bruno Bettelheim (1977) addressed the in-between as the potential psychological problems that could occur when growing up and integrating their personalities. His literature used fairy-tales as the medium to create thirdness and understanding between the young person and analyst. He argued that creative modalities such as storytelling, music, dance etc. could help young people solve or resolve certain existential problems, as the medium makes it safer for the individual to express strong emotions and truths that they otherwise wouldn’t express. This directly related to the focus of this study and the role PMT potentially has on participant's concept of self-resilience once they are safely able to express their experiences that brought them to PMT.

Donald Stern’s (1985, 2004, 2008) work emphasized the importance of reciprocal communication between an infant and her caregiver emphasizing the developmental impact this has on an individual throughout the life span. His work is also highly relevant to this study. Throughout his career his research also highlights the way in which early interactions between a baby and their caregiver are of distinct musical quality. The intrinsic musicality of these early interactions makes music a fundamental part of our social experiences from an early age, which we carry into adulthood. “The striking similarities between early parent-infant-child-teen communication and musical interactions include the use of rhythm, melody, dynamics, intensity, structure, and timing as main elements of intersubjective exchange (p 221). For the purposes of this study the interactive experiences emerging from said PMT musical interplay could potentially be seen as a Sterns nonverbal analogy to “real life (1995),” where sharing of experiences belongs to intersubjective behavior. Following that interplay between bodily

memories and qualities of experiences begin to contribute to the activation of stored memories and the expectation of feeling, as in Stern’s concept of Representation of Interaction being Generalized (RIG) and Lived Story (Stern, 1995, p. 94). Therefore a musical relating experience, followed by verbal processing will provide a link between body and mind which will support a more coherent sense of self. This understanding of the intersubjective exchange between participants and those within their social worlds was pertinent to this study, not only throughout the interview process but also in the analysis off data in this study.as it helps provide a greater understanding of intersubjective behavior.

Conceptualizations of Psychodynamic Music Therapy:

There are three individuals acknowledged as the original conceptualizers/pioneers of psychodynamic music therapy: Juliet Alvin, Mary Preistley, and Florence Tyson. Juliet Alvin defined and developed her model of PMT (originally called Free Improvisation Therapy) based largely off of the psychoanalytic concepts of Freud. She directly associated musical process in music therapy with key concepts of psychoanalysis: music as a means of projection (Alvin, 1974); the musical object as an intermediary object (Alvin, 1977); and regressional techniques in music therapy (Alvin, 1981). Alvin stressed the importance of developing the clients musical relationship as the key to successful therapeutic process and outcomes. She also considered the therapists main instrument as the “primary means of communication and interaction” (Wigram, Pedersen, & Bonde, 2002, P. 132), and used a method of empathic improvisation in relation to the client’s way of 'being’ in music therapy (Alvin, 1974, 1977, 1981). Her method was integrally musical in that she used “every conceivable kind of musical activity”, both music listening and active music making, and including free improvisation. Alvin thought that music provided potential space for free expression and free improvisation was often likened to free

association in psychoanalysis. Ultimately Alvin’s conceptualization contributed to the purpose of this study as her concept of free improvisation in PMT was regarded as the original PMT model and revolutionary in how therapists and patients began to relate to one another.

Mary Priestly was trained by Alvin, and defined PMT as Analytical Music Therapy. While Alvin used both music listening and active music making methods to create PMT, Priestley focused mainly on using improvisation to explore unconscious issues that had detrimental effects on the clients present life (Priestley, 1975; 1994). She stressed the importance of verbal processing before and after improvisation to bring unconscious materials into conscious. She believed that joint improvisation between the client and therapist in PMT contained transference and counter transference responses (Eschen, 2002).

Florence Tyson, was the original American PMT therapist who focused on the psychodynamic orientation to music. She viewed music as “the only bridge from inner world to outer reality” (2010, p. 94) and felt that the music therapist should use music as means to explore and deal with the inner reality of the client (Tyson, 1981,2010). Like Alvin, her approach to PMT was eclectic, employing a vast range of therapies in her clinical practice and conceptualization. She viewed the role of the music therapist in relation to the client in terms of object relations, and saw regression as an essential process in PMT for patients with mental health problems. Therefore, all three of these conceptualizers related to the purposes of this study as they each recognized the importance of the triadic relationship-the music, therapist, and the client as the key components for successful therapy.

Sadly, few studies and papers discuss the experience of young adults in music therapy . All of which suggests that there are a variety of reasons why young adults specifically might respond to PMT (or not respond), with the most common reason being the interpersonal field and

social dynamics between patient and analyst (Malloch & Trevathen, 2009). Jinah Kim (2010, 2014, 2016) indicates that practitioners of psychodynamic approaches often strive to gain meaning and in-depth understandings from therapeutic experiences. Therefore their literature argues that PMT is suitable for individuals who are ready to work through their issues within a therapeutic relationship and suggests “through the use of PMT, a psychodynamic theoretical perspective will then inform the direction of the therapy and therapeutic processes” (p 79.). Lastly, in order to adequately demonstrate that PMT and resilience can be linked, Varvara’s 2013 study which connected how fostering child resilience and parental self-efficacy can be shaped through shared PMT musical experiences (2013) was reviewed. In all, this literature supports the value of the study at hand, which is to explore young adults' lived experiences of PMT.

Attachment:

For the purposes of this study, relevant psychodynamic literature pertaining to attachment within the PMT relationship was reviewed. John Bowlby was reviewed due to his focus on the impact self, others, and the relational world can have on attachment. Bowlby viewed the person as a social being, so much so that we work to establish and preserve connection and closeness across the course of life. Additionally, he challenged psychoanalytic perspectives that characterize “natural desires to be loved and cared for as regressive or pathological (Bowlby, 1940, 1969, 1979, 1988, ). “Bowlby hypothesizes that attachment behavior is made up of a number of component instinctive responses, which are at first relatively independent of each other, and serve the function of binding the child to another being” (Palombo, 296). He paid particular attention to the emotions that accompany a child’s behaviors and the empathy connected to distress. His work also demonstrated that there can be different types of attachment response: separation anxiety, grief and mourning, and defense . Ultimately suggesting that an

affectional bond develops between children and their caregivers, that will then become a powerful force in maintaining attachment patterns, and that these patterns will carry over to other relationships that will last throughout the lifespan.

Bowlby’s work is relevant to this study because in his efforts to explain patterns of behavior he was able to emphasize the ways in which the actual events and conditions of relational life “in early childhood shaped working models or representations of self and attachment figures that continue to guide functioning” (Borden, 114). It is an awareness of this functioning and potential attachment experiences (both positive and negative) that will create greater attunement in the PMT experience.

Margret Mahler was vitally important to this study as she was among the first psychoanalytic writers to study childhood psychotic disorders from a developmental perspective and make meaning of their lived experiences in early childhood. (1947,1968, 1975). Mahler viewed attachment as a process through which the child moves through as an orgasmic model, biogenetically preprogrammed to move through the various stages and her developmental organization model, much like the processes that occur in cell division. For Mahler, “growth reflects the formation of a self-representation and an object representation that result from the internalization of aspects of the person (s) with how the child forms a relationship” (Austrian, 2002). Representations of the self, object, other, and the relationship all evolve simultaneously. They are inextricably linked together.

For the purposes of this study, her attachment concept of developmental organization and object constancy were relevant as they are the processes through which the child internalizes a positively invested whole image of their caregiver, and then begins to tolerate delays and separations. Mahler felt that the “establishment of mental representations of the self as distinctly

separate from representations of the object, paves the way to self-identity formations” (1975).

This finding is important for the purposes of this study as self-identity and its emergence through the PMT relationship were specifically studied.

Prior Research Studies on Resilience and Inner City Young Adults:

Since the National Child Traumatic Stress Network was founded in 2000 (Craig & OzgaLawn, 2013), there has been more focus in literature encouraging researchers and clinicians to assess patient’s resilience despite stressors or comorbidities. However, there is limited literature on the specific experiences of inner-city young adults that highlights their resilience (e.g., Holbrook, Schmitt, Adam &Brooks, 2016). To explore that PMT as an intervention can foster changes in young adult resilience, it was essential to provide evidence and data obtained from scientifically sound assessment instruments. For that reason, a brief methodological review of existing resilience scales occurred in this literature review to showcase the use of the RSYA (Michael Ungar, 2013) in this study. (Table 1).

As mentioned in a previous section, there are very few studies focusing on the resilience of inner-city young adults. These studies primarily found educational resiliency factors, the importance of extracurricular outlets, and self-esteem within family systems were markers of inner city resilience. For example, Scorgie et al. (2017) developed a qualitative study that explored how inner-city violence is experienced differently between genders, how they conceptualize dangerous and safe places in the neighborhood, and what gaps exist in available services within the environment. Through analysis, the study found regardless of any violent experiences, the availability of recreational spaces for young adults helped foster overall resilience.

In a second study; Shirleyana, S., Hawken, S., and Sunindijo, R.Y (2021) sought to bring a new perspective on the meaning of resilience in Indonesia’s main inner-city settlement. Their work also focused on the importance of studying both risks and resilience of inner-city settlements so they can be further developed to address social, economic, and environmental vulnerabilities. Their research finds that there are many positive dimensions of the various project settlements and that this vital form of settlement is well suited to support the growth and sustainability of the individual and environment, specifically showcasing the importance of their collective feelings of security within the community, participants identified personal relationships, social programming, and educational empowerment options.

Miller and Bowen (2020) examined the resilience of inner-city homeless young adults. Asking the research question “How is resilience expressed in the lives of emerging adults who are also homeless?” and using interview data to create practice recommendations for area agencies. The analysis generated five themes highlighting attitudinal and behavioral dimensions of resilience: (1) perceptions of homelessness as a surmountable obstacle, (2) externalization of homelessness, (3) creation of support systems, (4) maintenance of personal health, and (5) use of music and creative expression as emotional outlets. Findings stress the optimism of emerging adults, the benefits of youth-only services, the relevance of harm reduction strategies, and the underutilized potential of music and creative expression as interventions.

Friedberg and Malefakis (2018) conceptualized resilience as a concept of the utmost importance to the field of psychodynamic psychiatry. This conceptualization was important for the purposes of this study and the historical understanding of this concept in the field as it directly addressed and demonstrated the importance of examining and assessing for resiliency on the neurobiological level, trauma treatment, and coping style levels. Holmes (2017) reviewed

developmental research using clinical cases and found that the self-reflection, relationships, and agency created by resiliency are crucial to surviving adversity. This finding is important for the purposes of this study and the understanding of resilience within the field of psychology due to the fact that clients often present for therapy when their resilience strategies have failed. It was the hope of this study that PMT will “foster mentalizing, stress inoculation, self-esteem, and agency, thus forming the basis for enduring and more flexible resilience” (372).

In another study, Xiang et al. (2020) aimed to test the association between perceived stress and problematic social networking site (SNS) usage, and to figure out whether psychological resilience moderated this relationship with young adults. The findings emphasize the importance of enhancing psychological resilience to decrease the likelihood of college students who experience higher levels of stress from using SNS problematically. Maginness (2007) and Stavrou (2018) demonstrated in their research that the field of mental health needs to be more open to understanding an individual’s capacity for resilience as coming from a dynamic system that is set in both the past and the present. As well as if there is a therapist or safe therapeutic medium present the patient will be able to “identify themselves with a new identificatory target and can therefore integrate the values or ways of being that the identificatory target manifests in his/her everyday life” (321). This finding was relevant to the purpose of this study due to its focus on the where the capacity for resilience comes from, and how it can manifest in patients’ everyday life on an ongoing basis.

Lastly, in a recent mixed methods study, Metel et al. (2021) sought to assess whether there is a connection between neurocognitive and personality underpinnings of resilience in young adults prone to psychosis. A correlational analysis was conducted to verify the relationships of resilience with neurocognitive and personality measures, and a hierarchical

multiple regression model was built to explain the predictors of resilience. Ultimately the study found that lower resilience predicted higher severity of the total CAARMS score but was not related to positive symptoms. Cognition, personality, and depressive symptoms affected resilience, and the strongest predictor of resilience was the severity of depressive symptoms. Metel et al's research relates to the focus of this study due to its examination of the impact resilience has on personality style and psychological functioning, In all, research focusing on resilience seems to be increasing; however, research assessing the resilience of inner-city young adults does not.

Prior research studies on music therapy and young adults:

In qualitative research literature, there is minimal research on the phenomenology or lived experiences of young adults who have experienced psychodynamic music therapy, as most studies focus primarily on the inpatient early childhood experience (Oli 2015). However, Hailday (2017) in particular was able to qualitatively demonstrate that for a patient “ PMT had addressed the angry, fearful, and omnipotent infant part of himself, and that it had helped to contain and manage it” (p.111) post PMT treatment experience.

In another study, Albers et al. (2017) developed an improvisational music therapy intervention based on insights from theory, evidence, and clinical practice for young adults with depressive symptoms. Their study findings demonstrate that using synchronization and emotional resonance might be a promising music therapy technique to improve emotion regulation and, in line with their expectation, reduce depressive symptoms.

In another study Gallego, et al. (2020) examined the experiences of nursing students within this study age group and their stress management outcomes after being provided music

therapy. Their intervention combined Progressive Muscle Relaxation (PMR) and music therapy to attempt to reduce before-exams stress, which would then result in an improvement of academic results. The study indicated that “the combination of PMR and music therapy was effective for the control and decrease of stress before exams, and also demonstrated improvements in academic results”(p. 113).

In addition, Singoroni et al. (2016) examined the way that creative spirit and art are used as part of the Youth Project in Milan, a program dedicated to adolescents and young adults (AYA) with cancer. This research study examined the “Summer is you” music project and involved 45 patients (15–26 years old). With professional help, the patients wrote music and lyrics, sang their songs, and recorded a video clip, sharing with researchers not only their hopes and fears but also their romantic encounters and their urge to travel. The study ultimately found that this project was able to access the “power of music to bring young people with cancer together in a novel form of support that can complement the more conventional psychological approaches” (234).

Lastly, Daykin, Mansfield et al. (2018) examined the role of arts and music in supporting subjective wellbeing (SWB). The study found that “there is reliable evidence for positive effects of music and singing on wellbeing in adults. There remains a need for research with sub-groups who are at greater risk of lower levels of wellbeing, and on the processes by which wellbeing outcomes are, or are not, achieved” (p, 40).

Concluding, in all, the research that concentrates on psychodynamic research and resiliency factors appears to be increasing, yet there has yet to be a qualitative or quantitative study that analyzes the data using psychodynamic theory, music therapy, and resiliency from an inner-city young adult lived perspective. The studies reviewed have highlighted the importance

of community, musical thirdness, psychodynamic historical views of young adult development, family systems, recreational outlets, strong therapeutic alignment, and social connection. Ultimately all of these findings were relevant to this study due to my hope to examine the lived experience of inner city young adults and their understanding of their PMT experience, and overall sense of resiliency.

Research Questions to be Explored:

1. The qualitative research question is: How does Psychodynamic Music Therapy (PMT) impact inner-city young adults?

2. What do inner-city young adults say about their experience of PMT?

Sub Questions are:

● What aspects of PMT, if any, do inner-city young adults identify as beneficial and why?

● How do inner-city young adults who have been through PMT view their relationship with their therapist?

● Does PMT help build resilience in inner-city young adults?

● Does PMT impact their relationships, and if so, in what ways?

● What challenges, if any, did participants identify when discussing their PMT experience?

2. The quantitative research question is: How do the resilience levels of young adults who have participated in PMT compare to those who have not?

Chapter III

Methodology

Introduction

Phenomenological theory was used in this mixed methods study with a focus on social constructivism as the epistemological framework. A phenomenological theory approach allowed for exploration of meanings the participants assign to their life experiences. Moreover, a social constructivist view provided a guide for understanding these complex meanings and experiences within specific contexts. Additionally, I planned to engage with the participants during the interview process to formulate an understanding of how meaning was constructed from life experiences within the participants’ historical, social, and cultural context. An interview was provided to participants, followed by thematic analysis, as well as a quantitative data collection assessment, utilizing the RSYA. Furthermore, it aimed to answer the qualitative research questions of: How does Psychodynamic Music Therapy (PMT) impact inner-city young adults? And what do young adults say about their PMT experience? The quantitative research question aims to answer: “How do the resilience levels of young adults who have participated in PMT compare to those who have not’? The research design will be outlined in this chapter and includes implementation, data collection, and analysis processes.

This chapter describes not only the methodology but also include “discussion around the rationale for research approach, description of the research sample, summary of the information needed, overview of the research design, methods of data collection, analysis and synthesis of

data, ethical considerations, issues of trustworthiness, and limitations of the study” (Bloomberg, Volpe, 2019, p.216).

A mixed-methods research approach was utilized as the dissertation topic required both qualitative and quantitative information regarding the young adults’ experience with PMT and their experiences with both their clinician and overall resilience. The five primary purposes of mixed methodology research are “triangulation, or seeking convergence of results, complementarity, or examining overlapping and different facets of a phenomenon, initiation, discovering paradoxes, contradictions, fresh perspectives, development, or using the methods sequentially, such that results from the first method inform the use of the second method, and expansion, or mixed methods adding breadth and scope to a project (Tashakkori & Teddlie, 2010, p. 111)”. The qualitative research genre of narrative content analysis was utilized due to its idiographic approach, which provided tremendous insight into how participants, in a particular context, make sense of a given phenomenon. In conclusion, this study aimed to see if there was a relationship between experiencing PMT as a young adult and their levels of resilience and examining the therapeutic relationship in PMT in connection with resilience.

The rationale for study design

This study used a mixed-method design that investigated the biopsychosocial elements in a coordinated fashion. Therefore, it was necessary to explore qualitative and quantitative information regarding the inner-city young adult’s experience with PMT and resiliency. For example, the PMT experience of the inner-city young adult and overall levels of resiliency (which was collected in both qualitative and quantitative forms through interviews and a resilience assessment tool) was analyzed to see if there are any trends in those who experienced PMT and their sense of self-resilience. Tashakkori and Teddlie defined mixed-method studies as

“studies that are products of the pragmatist paradigm and that combine the qualitative and quantitative approaches within different phases of the research process” (2010, p. 19). Their description of the mixed-method process highlighted both single and multiple applications within study phases. This specification helped further build the relationship between PMT and resilience. These aspects reflected the concept of triangulation that Tashakkori and Teddlie attributed to the rise of mixed methods (Tashakkori, Teddlie, 2010). Denzin’s identification of four basic types of triangulations suggested the power of combining data sources and forms with studying the social phenomenon. This study design was an example of theory triangulation (multiple perspectives to interpret the results of a study) and methodological triangulation (the use of numerous methods to study a research problem).

Mixed methods research has five primary purposes:

1. Triangulation or seeking convergence of results.

2. Complementarity, or examining overlapping and different facets of a phenomenon.

3. Initiation, discovering paradoxes, contradictions, and fresh perspectives.

4. Fourth, development, or using mixed methods sequentially, results from the first method inform the use of the second model.

5. Finally, expansion or mixed methods add breadth and scope to a project (Tashakkori, Teddlie).

These five purposes helped guide the design of this study. The study was reflective of the parallel/simultaneous mixed methods design, in which the quantitative and qualitative data was collected simultaneously and analyzed in a complementary manner (Tashakkori, Teddlie, 2010). This approach aided in generating both numerical and narrative data that helped answer comparable questions the data then helped collaborate.

The rationale for a specific methodology

Creswell identified the three components to methodological mixes as “design (naturalistic inquiry or experiential), measurement (qualitative or quantitative data), and analysis (content or statistical). The young adult’s reported experience with PMT was the qualitative data. Selfreported qualitative data was collected via semi-structured interviews to help understand the experiences of inner-city young adults, PMT, and how it impacts their relationships. The data analysis also used qualitative and quantitative methods such as narrative analysis to examine the interview themes to incorporate quantitative data obtained from the RSYA. Narrative Content Analysis was the most appropriate analysis for this study due to its ability to potentially further my personal or field of clinical social work’s understanding. This method will be described in further detail in the qualitative analysis section.

Research Questions

The primary qualitative research question is: How does Psychodynamic Music Therapy (PMT) impact inner-city young adults?

Sub Questions are:

1. What aspects of PMT, if any, do inner-city young adults identify as beneficial and why?

2. How do inner-city young adults who have been through PMT view their relationship with their therapist?

3. What do participants say about resilience? How do they describe their relationships?

4. What challenges, if any, did participants identify when discussing their PMT experience?

The quantitative research question is: How do the resilience levels of young adults who have participated in PMT compared to those who have not?

Sample Selection

This study used non-probability purposive and snowball sampling. These methods were appropriate as there was a limited number of people that met the criteria of the topic being researched (Marshall, 1996). The goal was to recruit ten inner-city young adults that had experienced PMT and twenty that have not experienced PMT (to be used as an RSYA comparison group). I kept the survey open until I had at least ten participants who had participated in PMT. Utilizing the ten participants who endorse participating in PMT the researcher then proceeded with conducting interviews with them. Twenty participants that had not experienced PMT were then recruited to complete the RSYA survey. It should be noted that 20 non PMT participants were selected to have more power in the survey portion of the data. The resiliency scale was used to purposely select subjects that score high on the resiliency scale to move forward into the interview process if eligible. Only young adults between the ages of 18-26 were eligible to participate in this study. This age group was selected due to their developmental ability to move into adult roles, fully understand abstract concepts, and be aware of personal experiences, goals, and struggles. Participants were recruited through community postings and emails addressed to various music therapy centers. I also spent a great deal of time at local community music centers to answer questions and get to know potential subjects. Beyond local fliering, both national and international listservs were going to be utilized if needed for additional recruitment.

Research plan or process

Preliminary literature review suggests that multidimensional biopsychosocial experiences of inner-city young adults, resiliency, and psychodynamic music therapy are unexamined areas and as such, this study required “openness, flexibility, versatility, curiosity, and receptivity”

beyond recruitment (Song, 2017). Potential participants responded to the study fliers stating that a study is being conducted on resilience and that participants are sought who have participated in PMT as well as those who have not participated in PMT. Both groups were asked to complete a survey that took 15 minutes (and some were then asked to stay for up to an hour-long interview) and to call or email the researcher if interested.

At the time of the initial email or phone call, a brief conversation took place to determine if they met the criteria for the study (either as a full study participant with survey/interview or a non-PMT comparison group/just survey) and their age. Those who endorsed previously participating in PMT were asked to participate in the interview portion of the study and could accept or decline the interview invitation after the survey was completed and still received a $25 gift card for their participation. If upon initial contact the individual did not meet the criteria, I thanked them for their time, and offered resources if requested. If the participant agreed to proceed with a full interview a time and location was arranged to meet (telehealth via zoom will be offered as an option as well). At the start of the interview, I covered the consent forms and requested that they read/share that they understand what the study is about as well as how their privacy will be protected. Additionally, subjects were offered snacks and beverages during the interview. For subjects that traveled to meet with me in person, they were provided with either bus tickets, Lyft/Uber credit, or a gas card.

After completing informed consent and providing information regarding incentives participants were provided with the RSYA and data collection sheet for completion. I provided an outline of how the instrument was completed and answered any administrative questions the participant may have had. Upon completion of the RSYA and data collection sheet, participants eligible who agreed to proceed with the interview regarding their PMT experience transitioned

into the interview questions being asked. At the end of each interview, subjects were asked if they knew of anyone interested in participating in the study. A request was made to pass along the project and interviewers’ contact information. I also kept a memo/journal detailing the experience immediately after the participant left using memo writing and the thematic analysis journaling outline.

The subjects were protected throughout the study process. First and foremost, only the primary researcher had access to the raw data. Secondly, the data and transcripts were password protected. Third, the data is being stored on a secure database and deleted after 5 years. There was also a potential power differential that was noted during the interview stage due to my identity as a Caucasian female researcher, primarily interviewing those of a racial minority, who historically have had been mistreated throughout the research process.

Data Collection and Instrumentation

Both quantitative and qualitative data was collected through interviews and the RSYA inventory. Participating young adults were asked to complete the Resilience Scale for Young Adults (RSYA). Participants were also asked to complete an hour-long interview session, through which qualitative data was collected through a semi-structured interview after completion of the RSYA.

The Resilience Scale for Young Adults (RSYA) was a revised version of the Resiliency Scales for Children and Adolescents (RSCA). The assessment was designed to assess individual differences concerning levels of personal resiliency, including mastery, relatedness, and emotional reactivity. The RSYA is a 50 item self-report measure with each item rated on a scale

from 0=never to 4=almost always. The creators of this instrument found that the scales were meaningfully related to various relational outcomes. These outcomes were:

 No matter what happens, I know I will be alright.

 People accept me for who I am.

 I can be myself around others.

 If people let me down, I can forgive them.

 I am in control of my life.

 I look for the “good in life.”

 Creativity gets me through.

 Communication with others is possible.

 My family or friends will help me if something terrible happens to me.

The scale was formatted so that participants were asked to answer the questions on a Likert scale ranging from 0=never to 4= almost always. The RSYA was developed to operationalize resiliency across the lifespan further. Individuals who have a higher level of personal resiliency will, in theory, be able to withstand the challenges in each area of life and thrive in these circumstances as well. “Individuals with more resiliencies would be expected to fulfill better adult roles, relationships, and academia “(Prince-Embury et al., 2016).

The purpose of this instrument in the context of this study was to establish a general resilience category for each person. These categories will include psychological, emotional, physical, and community. This category was not meant to be representative of the participant’s ability to engage in PMT. Participants were asked to complete a paper or virtual version of the RSYA. The form does not have any identifying information. However, the researcher assigned a

unique number to each document for tracking purposes. A comparison group of inner-city youth who have not been through PMT completed the RSYA and were used as a comparison group.

The interview consisted of primarily open-ended questions designed to capture the experience of the inner-city young adult and PMT. The following questions guided the discussion:

 Tell me about what aspects of PMT, if any, you found beneficial and why.

 Next, tell me about how inner-city young adults view their relationship with their PMT.

 Next, tell me about what your relationships looked like while participating in PMT.

Finally, tell me about any challenges you encountered while participating in PMT.

The interviews took place in a private office, in a secure community space, or via zoom. Only one researcher conducted the interviews. The discussions were audio-recorded with the participant’s consent. The recordings were transcribed and then analyzed.

Plan for data analysis

Using the software Atlas TI, the content of the interviews was analyzed using the method of categorical-content narrative analysis. Both attachment and relational theories were incorporated to interpret distinctive features that might become present through the PMT reflective experience. These combined narrative research methods helped organize the early phases of this investigative research as it helped to gather information and discover possible themes that could help guide future related research. This narrative research relies on “paradigm thinking to create the description of themes that hold across stories” (Creswell, 2006, p. 54). This collection of shared experiences is what eventually lead to the creation of themes across participants.

I processed every participant’s interview analytically, both descriptively and statistically.

Lieblich et al. summarized the process in the following steps: selecting subtext, defining the content categories, sorting the material into categories, and drawing conclusions into the results (1998). The interview portion of this study was considered directive because it asked participants to talk about their PMT experience specifically, rather than their entire life experience. It is important to note that formulating conclusions from the data obtained can be done in numerous ways. The content of the completed interviews in this study were also processed statistically by quantifying themes created in transcripts and transferring them into codes. I also used quantitative data to study any similarities between both types of data generated (qualitative and quantitative) in this study.

Once the transcripts were entered into the Atlas programming, phrases, words, and paragraphs were labeled to represent themes about PMT and resilience. These were then broken into more extensive participant codes and assigned a color for tracking purposes. Quantitatively speaking, I entered initial demographic information into SPSS. I used traditional statistical measures such as (mean, median, distributions, etc.) in conjunction with the narrative interpretations to create a more comprehensive picture of the inner-city young adult population under study. There was also the consideration of doing a t-test based on qualitative narratives for greater quantitative analysis. The analysis of the quantitative data collected from the standardized measure of resiliency from the RSYA was structured according to the pre-designed scoring protocol of the scale itself. The overall score and subscale scores were then calculated by averaging the ratings of each component. The overall resiliency score and sub score themes was then compared to the themes from the qualitative interviews to look for not only similarities/differences but also quantitative measures of resiliency/functioning.

Ethical considerations/protecting rights of human subjects

I obtained informed consent for each participant. This consent tool will be taken into consideration and include the following:

 Purpose of study.

 The name of the researcher, dissertation committee, and readers.

 Participant agrees to complete the interview with the researcher and have it recorded/transcribed.

 The limited risk of the study includes feeling vulnerable about exploring their past PMT experience. However, the researcher and subject will put a plan in place if that were to happen including stopping the interview, taking time to process, or utilizing breaks.

 Informing participants of the right to withdraw from the study at any time without consequence.

 Procedures for ensuring confidentiality.

Issues of trustworthiness

Credibility: In this study, it was essential that meaning categories that emerge from the data have value and are credible. To safeguard the process, the I engaged in member checking during the interviews. Member checking involved “sharing significant understandings of each participant’s relevant narrative material as the interviews were conducted, with the goal of greater data reliability” (Bloomberg, Volpe, p. 204). As necessary, the I also shared categories with my committee chair to receive another perspective regarding their understanding of the data and categories. I also offered follow-up contact with each participant to share the analysis of their data, and to see if it resonates with how they see their experience.

Dependability: Dependability is determined by the richness and descriptiveness of the data. This study utilized data analyses that are reasonable and believable. In addition, “hermeneutic dependability is informed by the degree to which each participant’s subjectivity was authentically represented through the strategic use of language” (Gadamer, 474). I used member checking to ensure that the subjects’ experiences were authentically represented.

Transferability: Transferability is established by demonstrating that the findings of this study would apply to other contexts, situations, times, and populations. However due to the small sample size and population, replication of any common shared PMT resilience themes in another sample geographic area was not easily transferable.

Limitations and delimitations

The primary limitation of this study was that it was confined to a small sample of eligible inner-city young adults. Participants were recruited from as many different sites as possible. This study also took place in Detroit, which further limited the sample. Secondly, data was collected through self-report. This relied on the subjects being open and wholehearted. Finally, this research was be conducted by an individual researcher who is a clinician and music therapist practicing psychodynamically with children, young adults, and families. My experience informed the data collection and analysis. It is possible that the findings might not be replicable in the same manner by a different person/researcher.

This study’s primary delimitation was its inclusion criteria of the sample. Therefore, any individual outside the ages of 18-26 were not eligible to participate. However, this enabled me to isolate key core study issues and provide boundaries within theoretical construction.

The Role and background of the researcher

I am a psychodynamically oriented, nationally TFCBT certified, CAADC, child, family, and individual adult psychotherapist/music therapist. I hold a master’s degree in social work, music therapy, women’s studies, and music performance. I have fully completed coursework for a Ph.D. in psychodynamically oriented clinical social work and have additional training in psychoanalysis. I currently work at a Special Victims Unit post-trauma post in Detroit, Michigan, public community health practice, private practice, and children’s hospital providing individual, family, and group therapy and consultation and classes to music therapists. In addition, I have previously worked at domestic/sexual violence shelters, psychiatric hospitals, eating disorder/addictions counseling facilities, and hospice programs. My role in this research process was to find participants, complete interviews, analyze data, organize, and present the findings.

CH IV Results

The purpose of the mixed methods phenomenological study was to explore the role psychodynamic music therapy plays in resilience and relationships in inner-city young adults in two phases. In the first phase, an online survey consisting of demographic information, if they had any previous PMT experience, and the RSYA was given to 30 young adults (aged 18-26). In the second phase of the research the 10 participants that endorsed receiving PMT were invited back to participate in a 1-hour semi-structured interview that was held in person, or via secure zoom telehealth platform exploring the research questions.

Part I: Survey Results

Table 1: Non PMT Participants Demographics

Of the 20 non-PMT participants 6 identified as male, 3 identified as transgender, and 11 identified as female. The average age of participants was 21.6 years of age. 6 participants identified as Hispanic, 4 identified as Middle Eastern, 4 identified as African American, 4 Identified as Biracial, 1 identified as Pacific Islander, and 1 identified as multi-racial. 19 of the participants endorsed currently living in an urban environment, and 1 reported living in the suburbs at present due to a housing placement, however their permanent address is within innercity Detroit. All 20 participants reported living in urban environments during their young adulthood. As for employment status 4 participants worked part time, 1 shared they were laid off, 3 identified as self-employed, 6 were identified as students, four identified as full time employees, and 2 shared they were unemployed. 13 of the survey participants shared that their annual household income was between $0-24,999 and 7 shared that their annual household

income was between $25,000 and $49,999. As for marital status, 13 participants identified as single, 3 identified as engaged, 1 identified as married, and 3 identified as divorced. Of the 20 participants 8 participants had children, and 12 did not. The average number of children for those who endorsed having children was 1.87. Lastly, of the 20 participants 0 endorsed having any PMT experience, or therapy experience. 1 endorsed participating in a probation check in group, and one shared limited experience with AA groups. The survey also consisted of the RSYA (Resilience Scale for Young Adults). The RSYA was a revised version of the Resiliency Scales for Children and Adolescents (RSCA). The assessment was designed to assess individual differences concerning levels of personal resiliency. This includes mastery, relatedness, and emotional reactivity. The RSYA is a 50 item self-report measure with each item rated on a scale from 0=never to 4=almost always. The creators of this instrument found that the scales were meaningfully related to various relational outcomes. These outcomes were:

● No matter what happens, I know I will be alright.

● People accept me for who I am.

● I can be myself around others.

● If people let me down, I can forgive them.

● I am in control of my life.

● I look for the “good in life.”

● Creativity gets me through.

● Communication with others is possible.

● My family or friends will help me if something terrible happens to me.

The scale was formatted so that participants were asked to answer the questions on a Likert scale ranging from 0=never to 4= almost always. The RSYA was developed to operationalize resiliency across the lifespan further. Individuals who have a higher level of personal resilience will, in theory, be able to withstand the challenges in each area of life and thrive in these circumstances as well. “Individuals with more resiliencies would be expected to fulfill better adult roles, relationships, and academia “(Prince-Embury et al., 2016). The purpose of this instrument in the context of this study was to establish a general resilience category for each person. These categories will include psychological, emotional, physical, and community. This category is not meant to be representative of the participant’s ability to engage in PMT.

Q 1: I always try to look on the bright side.

Q 2: People say I am easy to upset .

Table 2: Non PMT RSYA Question Results

Q

Q

Q

Q 6: My feelings are easily hurt.

Q 7: When I get upset, I stay upset for about a week.

Q 8: If I have a problem, I can solve it.

Q 9: People know who I really am.

Q 10: I like people.

Q 11: If something bad happens, I can ask my friends for help.

Q 12: I can get so upset that I can’t stand how I feel.

Q 13: I welcome changes in my life as opportunities to grow.

Q 14: There are people that will help me if something bad happens.

Q 15: I do things well.

Q 16: I find meaning in hardships that come my way.

Q 17: I can let others see my real feelings.

Q 18: When I get upset, I react without thinking.

Q 19: I can overcome life crises that come my way.

Q 20: I look for the ‘good’ in life.

Q 21: I view obstacles as challenges to overcome.

Q 22: I can meet new people easily.

Q 23: I welcome changes to my life.

Q 24: I can trust others.

Q 25: I can make up with friends after a fight.

Q 26: I can ask for help when I need to.

Q 27: When I am upset, I make mistakes.

Q 28: I feel I’m in control of my life.

Q 29: When I get upset, I stay upset the whole day.

Q 30: If people let me down, I can forgive them.

Q 31: If I get upset or angry, there is someone I can talk to.

Q 32: If I get so upset, I lose control.

Q 33: I can be myself around others.

Q 34: When I get upset, I don’t think clearly.

Q 35: I am good at figuring things out.

Q 36: When I am upset, I do things that I later feel bad about.

Q 37: I get very upset when things don’t go my way.

Q 38: I don’t hold grudges against those who upset or hurt me.

Q 39: When I get upset, I stay upset for about a month.

Q 40: I can make friends easily.

Q 41: My friends or family will help me if something bad happens to me.

Q 42: When I get upset, I stay upset for several days.

Q 43: People accept me for who I really am.

Q 44: I feel calm with people.

Q 45: When I am upset, it is hard for me to recover.

Q 46: No matter what happens, things will be alright.

Q 48: People like me.

Q 49: I am able to resolve conflicts with others.

Q 50: I try to be positive.

Table 2 depicts the RSYA individual questions answered, and the percentage of each response. Table 3 depicts the overall RSYA score for each non-PMT participant and their resilience category.

Table 5: PMT RSYA Question Results

Q 1: I always try to look on the bright side.

Q 2: People say I am easily upset .

Q 3: My life will be happy .

Q 4: I can forgive my family if they upset me .

Q 5: I can make major changes in my life when I need to.

Q 6: My feelings are easily hurt.

Q 7: When I get upset, I stay upset for about a week.

Q 8: If I have a problem, I can solve it.

Q 9: People know who I really am.

Q 10: I like people.

Q 11: If something bad happens, I can ask my friends for help.

Q 12: I can get so upset that I can’t stand how I feel.

Q 13: I welcome changes in my life as opportunities to grow.

Q 14: There are people that will help me if something bad happens.

Q 15: I do things well.

Almost Always-4 - -

Q 16: I find meaning in hardships that come my way.

Q 17: I can let others see my real feelings.

Q 18: When I get upset, I react without thinking.

Q 19: I can overcome life crises that come my way.

Q 20: I look for the ‘good’ in life.

Q 21: I view obstacles as challenges to overcome.

Q 22: I can meet new people easily.

Q 23: I welcome changes to my life.

Q 25: I can make up with friends after a fight.

Q 26: I can ask for help when I need to.

Q 27: When I am upset, I make mistakes.

Q 28: I feel I’m in control of my life.

Q 29: When I get upset, I stay upset the whole day.

Q 30: If people let me down, I can forgive them.

Q 31: If I get upset or angry, there is someone I can talk to.

Q 32: If I get so upset I lose control.

Q 33: I can be myself around others.

Q 34: When I get upset, I don’t think clearly.

Q 35: I am good at figuring things out.

Q 36: When I am upset, I do things that I later feel bad about.

Q 37: I get very upset when things don’t go my way.

Almost Always-4 - -

Q 38: I don’t hold grudges against those who upset or hurt me.

Q 39: When I get upset, I stay upset for about a month.

Q 40: I can make friends easily.

Q 41: My friends or family will help me if something bad happens to me.

Q 42: When I get upset, I stay upset for several days.

Q 43: People accept me for who I really am.

Q 44: I feel calm with people.

Q 45: When I am upset, it is hard for me to recover.

Q 46: No matter what happens, things will be alright.

Q 48: People like me.

Q 49: I am able to resolve conflicts with others.

Q 50: I try to be positive.

Table 5 depicts the RSYA individual questions answered, and the percentage of each response. Table 6 depicts the overall RSYA score for each PMT participant and their resilience category.

Table 6: RSYA Score for PMT Participants and their resilience category

Table 3: RSYA Comprehensive Score and Resilience Category of Non-PMT Comparison

The majority of the PMT participants (6) in this survey were considered to have a mastery resilience style. Those with a mastery resilience style can be described as having a “sense of optimism about his/her future, and how confident the individual is about his/her ability to adapt to the changing environment appropriately (Prince Embury, 2006, 2007, 2013, 2014)”. 2 participants were considered to have a relatedness resiliency style. A relatedness resilience style typically presents as an “individual’s sense of social support, ability to reach out to those supports, and trust in others (Prince-Embury, 2006, 2007, 2013, 2014)” in order to overcome. And lastly only 1 participant scored as having a reactive resilience style. A reactive resilience

style is defined as ”the threshold in which an individual can no longer regulate emotional reactions to external and internal stimuli (Prince Embury, 2006, 2007)”.

Summary of Non-PMT RSYA Survey Results

Most participants (11) in this survey were considered to have a reactive resilience style. A reactive resilience style is defined as “the threshold in which an individual can no longer regulate emotional reactions to external and internal stimuli (Prince Embury, 2006, 2007)”. 7 participants were considered to have a relatedness resiliency style. A relatedness resilience style is defined as an “individual’s sense of social support, ability to reach out to those supports, and trust in others (Prince-Embury, 2006, 2007, 2013, 2014)”. And lastly 2 participants scored as having a mastery resilience style. A mastery resilience style is defined as being able to have a “sense of optimism about his/her future, and how confident the individual is about his/her ability to adapt to the changing environment appropriately (Prince Embury, 2006, 2007, 2013, 2014)”.

Quantitative Conclusions:

The results suggest that these participants seemed to have higher levels of resiliency than the comparison group. Young adults who have not participated in PMT have not only lower resilience levels, but also a lower sense of relatedness to others around them. Of additional note, none of the non-PMT comparison group participants requested additional follow up or resources. Ultimately, the resilience levels of young adults who have participated in PMT were not only higher than the participants in the non-PMT comparison group, but also had a larger majority score in the mastery range.

Part Two: Qualitative Results

Introduction:

Ten participants who shared that they had previous PMT experience and lived in an inner-city environment agreed to complete a semi-structured interview. Participants identifying information was kept confidential, and each participant enjoyed selecting their own pseudonyms: Wally, Mel, Amy, Ethan, Elena, Sara, Alex, Max, Alexis, and Emily. After obtaining consents a brief demographic survey and the RSYA was completed by each participant. Once the surveys were complete the interviews took place. Throughout the course of the interviews, I was able to identify seven main superordinate themes which emerged from the material. The first theme, Experiences with PMT, represents the participants' individual experiences with PMT. Theme 2, External Treatment Systems examines what external treatment systems the participants were involved in and how they viewed said systems. Theme 3, Feeling States, sheds light on what feeling states the participants associated with their PMT experience. Theme 4, Musicianship, allowed participants to explore their identifications with music prior to, during, and post PMT experience. Theme 5, Relationships, focused on how patients define their relationships and the people important to them. Theme 6, Traumatic Loss, examines how participants' individual losses impacted their PMT experience. Finally, theme 7, view of self, focuses on how participants define themselves through their PMT experience. Direct quotes from interviews were used to further illustrate the subordinate themes as well.

In addition to these seven main themes, each of these superordinate themes is further broken into sub-themes which illustrate specific details of the overall theme. For example, some subthemes for the theme view of self are “less angsty” and “that was my truth,” which deals with how the participants' view of self-evolved through the PMT experience.

To assist with a greater understanding of how the themes emerged, I will describe the different phases of research, a description of the participants to assist in understanding their backgrounds, revising the themes and their meanings, and lastly, ending with a discussion of the participants' experiences using direct quotes from the interviews to assist with illustrating how the theme is represented. The initial demographic survey collected basic information with results presented below in Table 4 for the PMT participants:

Table 4: PMT Demographic Survey Responses

The general characteristics and qualities of the participants were as follows: The average age was 21.3 years of age. Two participants identified as male, two participants identified as trans-male, and six participants identified as female. Racially, four participants identified as African American, two identified as Hispanic, two identified as bi-racial, one identified as multiracial, and one participant identified as Asian. As for employment status, two of the participants endorsed working part-time, four identified as being full-time students, two identified as working full-time, one participant endorsed working part-time and going to school part-time, and one participant endorsed being unemployed. All of the participants have always lived in inner-city Detroit, which was verified by their zip code via survey monkey. All of the participants also endorsed being single and having an estimated yearly income of $0-24,999. While eight participants did not have children, one participant had a 2-month-old, and another was 35 weeks pregnant. Lastly, of note, all participants endorsed having PMT experience, with two also endorsing CBT-specific therapy, as well as two endorsing foster care treatment, as well as OT.

Qualitative Second Phase

The second phase of this research invited the participants to share their experiences in an intimate interview environment either in person or via zoom (selected by the participant). All participants were able to read, fluent in English, and were able to commit to a single interview time of at least one hour. 10 interviews were conducted, with each lasting between 45-90 minutes. Interviews attempted to explore several questions, including:

● What aspects of PMT, if any, do inner-city young adults identify as beneficial and why?

● How do inner-city young adults who have been through PMT view their relationship with their therapist?

● Does PMT help build resilience in inner-city young adults or impact their relationships, and if so, in what ways?

● What challenges, if any, did participants identify when discussing their PMT experience?

Superordinate Themes

Experiences with PMT’ “That shit broke me wide open.”

External Treatment Systems- “ You know the man’s got to have his paws all over us, even if that means treatment”.

Sub Themes

● Unexpected

● Confusing

● Release of Emotions

● Foster care

● Probation

● Juvenile Detention

● Hospital Systems

● School

● Shelter

Feeling States- “ I felt that shit, man”.

● Rage

● Loss

● Anxiety

● Fear

● Free

Musicianship- “I thought they were a damn hippie fool, but shoot, that music changed me, and now I be jammin”.

Relationships- “Heard I’m not salty no more, so I’m counting that as a win.”

● No previous experience

● Church

● Private Lessons

● Rapper/Writer

● Sibling

● Partner

● Child

● Abandonment

● Workers

Traumatic Loss- “Didn’t think I could ever get past losing him, still don’t think I can, just trying to stay on the outs.”

● Shooting

● Deployment

● OD

● Foster Care

● Kicked out due to coming out

Figure 7 below visually represents the themes and subthemes which emerged from the interviews.

Table 7: Qualitative Interview Themes

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●

●

●

●

●

Table seven illustrates the final themes and subordinate themes that were compiled through the coding process and present in the interviews of all 10 participants. To subordinate the choices, I made for themes and subthemes, Table 8 illustrates the frequency with which each participant was affected by the corresponding sub-theme and theme, as well as the total number of references made to each theme.

Table 8: Themes and References

Of note table 8 explored the number of participants that endorsed the specific theme as well as how frequently they referenced it. Of note, all ten participants described PMT as an intervention that was confusing, unexpected, and something that provided a release of emotions. Additionally, all the participants also endorsed the feeling states of loss, anxiety, and freedom during their PMT experience. Lastly, Table 9 represents the comparison results of findings broken down by themes and participants.

Table 9: Findings by Participant

Table nine demonstrates just how different the participant's experiences were, however, how unified they were in their emotive experience of PMT and the intervention overall. Participants were given the option of being mailed a copy of their transcript for member checking as well as a copy of the final dissertation if desired. Only one participant (Wally) chose to complete member checking.

Introduction to Participants

WALLY is a 21-year-old African American male, who has always lived in inner-city Detroit, works part-time at a gas station, and is single without children. He originally received PMT through a referral from his probation officer when he was 16 while he was being observed for drug-related charges and robbery. They found out about the study from a flier posted at the College of Creative Studies (CCS) He was open about PMT not being what he had expected therapeutically and that he thought it helped him process the loss of his close friend GP, who was the victim of gang violence.

During the interview process, which took place in a private room at the Wayne State University Library, he needed all the probes; however, once he shared about the loss of GP, he became very engaged and displayed a great sense of humor. I noticed that I often felt the urge to ask questions beyond the interview schedule because of how engaging he was and the details he still remembered about his PMT interventions.

MEL is a 21-year-old, multi-racial female who has always lived in inner-city Detroit. She is a full-time student and is single without any children. She originally received PMT and group therapy through a foster care agency. They found out about the study from a flier they saw at Affirmations (LGBTQIA+) Center during a poetry slam event. She was initially very

angry when starting the interview as her bus had been delayed. She was very excited to share her PMT experiences but was adamant that a lot had happened to her in foster care, and she did not wish to discuss that in the interview process (which took place in a private room at the Wayne State University Library. This could have been due to my previous clinical foster care experiences, but I felt very connected to Mel during the interview. She was very open about her desire to continue PMT but couldn’t due to a staffing shortage, and her insurance was not covering the service. Mel shared that she was studying criminal justice and hoped to be able to bring more PMT into the justice system in the future. However, towards the end of the interview, I began to experience a good deal of anxiety, due to the fear I had about her potential housing insecurity. These feelings persisted due to her discomfort and defensiveness about giving me her address, however upon further questioning about if she wanted housing support, she declined.

AMY is a 21-year-old Asian female who has always lived in inner-city Detroit and is a full-time student studying vocal performance. She is single without children and has previous PMT experience after going through the justice system as the victim of a sex crime. Amy found out about the study from a friend, who saw a flier they saw on an Instagram post at their own music therapy program. The interview took place in a private room at the Wayne State University Library. She provided limited detail about the circumstances of her sexual assault but acknowledged that it was violent, public, and incredibly traumatizing. Amy shared that her PMT experience was what helped her decide to study vocal performance.

Amy’s interview left me feeling incredibly sad. She was happy to be participating but was so guarded and emotionally blunted when describing her traumatic experience, which led to the PMT referral. More than anything, I wanted to offer support as she had not had any further

counseling after her court case despite wanting to continue her music therapy treatment. She did not require any of the interview guide probes but understandably was open about not trusting me yet. She declined to see the final product. It is my hope that she finds healing, and her interview only further motivates me to work toward PMT insurance and acceptance.

ETHAN is a 24-year-old African American male who has always lived in inner-city Detroit. He is currently unemployed and is single without any children. He was originally referred for music therapy by a teacher following a violent outburst in high school and was mandated to participate as part of a requirement for a diversion program. Ethan found out about the study through a flier he saw posted at the LGBTQIA+ Arts Center.

Ethan was the first participant who requested to meet through zoom. He was very animated however, at times, I felt like he was a bit guarded and carried a lot of anger about the end of his PMT and how his actions were perceived at his school after all of these years. Ethan was openly very angry about his life circumstances and stressors and the lack of available support in his area around anger management and musicians. After his interview concluded, I was struck by how strongly he still felt he was wronged by the system and the termination of his music therapy services. I was left feeling angry right along with him as well as curious about the potential differences in the musical expression of gender and anger.

ELENA is a 21-year-old biracial female who has always lived in inner-city Detroit. She is a full-time student who is single without any children. She first began to receive PMT service and CBT while hospitalized following a traumatic accident that left her with burns over 45% of her body. Elena found out about the study through a direct referral from the music therapy center at Eastern Michigan University, where she is currently studying music education. She chose to meet via zoom and was easy to engage. Elena openly shared that she had participated in

quite a few other research studies before about burn treatments and skin grafts and was used to the process.

As she shared all that she had been through, not only with her burn treatments but with the accident as well, I was blown away by her tenacity and ability to overcome. She was the first participant who had multiple music therapy experiences; however, she was also the first to report that, in some respects at times, PMT wasn’t always helpful because she was frustrated by the pain and what she was unable to do. Elena was an easy interview, and I was struck by her emotional vulnerability. I found it hard at times to stay in the role of investigator and not transition into more of an open therapeutic dialogue.

SARA is a 21-year-old African American female who has always lived in inner-city Detroit. She works part-time as a waitress and reports she is single with a 7-week-old son. She originally received PMT when she was in foster care, as well as general therapy. Sara found out about the study from a flier she saw posted at the Wayne State University Welcome Center. Our interview took place in person in a private room within the Wayne State University library. Sara was initially very hard to get in contact with. She shared early on that she was a new mom, had aged out of her foster care program, and was still learning to use transportation. I offered to use zoom; however, she was adamant that we do it in person. Sara arrived very tearful and shared that dropping her son off at daycare had been more difficult than expected. Despite starting off the interview emotionally raw, Sara was able to speak openly about her long time in foster care and her belief that PMT “broke her wide open” and allowed her to create more emotional safety for herself. I was blown away by how open she willingly participated in the interview. She required no probing, despite sharing how difficult her childhood traumas were, distrust of the system, and abandonment of her loved ones impacted

her. Sara spoke highly of PMT and her hopes to one day be able to study music or restart PMT. I was left feeling so frustrated that another promising young person was not able to access services that they felt helped them strictly because of insurance/financial access.

ALEX is a 21-year-old Hispanic male who has always lived in inner-city Detroit with the exception of three months when he was in a juvenile detention facility. He is currently unemployed but looking for a job, single, and without children. His therapy and PMT experience occurred while he was in the detention facility, and he saw the flier for my study at his former employer. Despite the fact that our interview occurred in person at a private room at the Wayne State Library, Alex was very guarded and required all of the probes. At times I was concerned that he would not complete the interview due to his initial distrust as to whether his interview would be shared with JDF, but with some clarification, he got more involved, which helped tremendously.

Alex was incredibly open about how PMT was not what he expected but felt it was essential to being able to get through his program. He attributed PMT with being able to figure out he was a good writer and enjoyed writing songs and raps about his traumatic experiences. Throughout Alex’s interview, I felt confused. He was simultaneously so angry and hurt by the justice system but also so appreciative of music and proud of the PMT work he had done. He was another participant who wished he could have continued PMT work after exiting the system; however, insurance and lack of access stopped him.

MAX is a 22-year-old African American trans male who has always lived in inner-city Detroit. He is a full-time student who also works part-time as an art teacher. He is single without any children and has done both PMT and therapy (and is currently doing so). He previously received PMT after entering a homeless shelter for LGBTIQA+ youth when he came

out to his parents. He found out about the study when I was at a creative arts event at the local youth shelter fliering for the study. Our interview took place face-to-face in a private room at the Wayne State Public Library.

Max, while very engaged, presented as VERY anxious, which by proxy generated anxiety within me. However, with time we settled into the interview, and Max required minimal probes. Max openly expressed that PMT and art therapy helped him learn to communicate his feelings better and that creative therapists aren’t as reactive to his “trauma.” Max loved participating in the study and shared that he is studying art therapy himself. He expressed anxiety as he is still in PMT; however, he will soon have to switch providers because he is switching housing programs, and he fears how that will impact his therapeutic process. I was blown away by his courage, openness, and determination to share their story.

ALEXIS is a 20-year-old biracial female who has always lived in inner-city Detroit. She is a full-time nursing student who is single and without children. Alexis originally received PMT and therapy during her long-term hospital stays for sickle cell disease. She found out about the study at a community event table at the LGBTQIA+ resource center. Our interview occurred online at zoom per her request due to her immunocompromised status. Alexis was a quick interview, and she was very open about her past participation in other research studies and dissertations at the hospital.

Alexis was open about her initial “angst” in participating in PMT because of her frustration about her long hospital stay. However, with time she shared that PMT kept her sane through her daily transfusions and that it helped her “deal with the feels” that came along with her diagnosis. It was clear that Alexis had participated in many studies, she received PMT frequently and was proud of the progress that she had made. She was a bit frustrated because the

hospital required her to meet with a general therapist, but she was optimistic about how her personal experiences will help deepen her advocacy skills as a research nurse. I ended this interview feeling appreciative of her honesty and again frustrated by the lack of access for PMT for Alexis outside of her hospital.

EMILY is a 20-year-old Hispanic female who has always lived in inner-city Detroit. She currently works full-time as a hairdresser, identifies as single and is 35 weeks pregnant. She originally received PMT at her arts high school following the loss of her brother while he was deployed. She found out about the study during a tabling event I was at in the area at the creative arts collaborative. Our interview took place on zoom due to her desire to stay close to the hospital. Emily engaged well during the interview however she often seemed concerned, as though she was saying the “wrong thing”. She shared many times how much she wished she would have liked to continue PMT if possible.

Emily acknowledged that at first, once she found out that her school had referred her, she wasn’t sure if she was going to participate because “it sounded cool but weird.” At points, she became tearful recalling some of the PMT interventions and how they helped her process her brother's death and not being able to say goodbye. She spoke in great detail about the relationship she had with the PMT therapist as being the thing that “set her grief fucking free” I felt incredibly thankful throughout her interview about how she was able to continue participating, despite still actively working through grief. She shared that she had hoped to provide PMT and music to her son once he was born.

Superordinate Themes, Sub Themes, and Respondent's Experiences

Theme I: Experiences with PMT- “That shit broke me wide open “!

This section highlights the participant's experiences with PMT and how it is explored

through their personal narratives. Each of these experiences set the foundation for how they viewed the PMT interventions and their relationship with the PMT therapists while receiving the service. Experiences with PMT describes how the individual participant experienced their initial referral into PMT and the interventions and therapeutic relationship. The underlying sub themes within the experiences with PMT theme in this category were unexpected, confusing, and a release of emotions, all of which looks at how emotional the nature of not only the referral but PMT as a modality was for the participants in this study.

Wally, who was 15 at the time of his referral to PMT when he was placed in a juvenile detention facility. He had no previous PMT experience at the time of his referral.

“I walk into this room, and they uncuff me because the fuckers had to; I was in the therapeutic pod. And I’m just sitting there chillin expecting some white dude to come out in a goddamn blazer and just like ask me about my feels or my charges. And then I look around and there are straight-up instruments. Like a guitar, and some drums, not a full drum kit, but like a drum, and a small keyboard. I wanted to say, uhh, hey man, I think you put me in the wrong room. Lock up don’t have stuff like this, but I waited it out. Didn’t see none of that coming”.

Wally then expresses insight into the fact that the unexpected nature of his placement into the PMT program allowed him to enter this service a bit differently because he did not know what to expect. Knowing that he was also participating in this program at a time in which he was already adjudicated also fostered a sense of freedom because he felt he could process and respond in whatever way he wanted because he was already “locked up.”

“You know, I was in lock-up because when my boy GP went down, I stayed with his body. So when the cops showed up, they started peppering me with all these questions, and I like I wasn’t no squealer. So, I took the fall for some charges. Didn’t think I would end up with

charges just because I stayed with my best friend’s body, but that’s how this shit works. Anyway, so I go into JDF (Juvenile Detention Facility), and I’m just pissed, and I’m angry, and I miss that fucker. GP was a cool dude man. I didn’t want to talk to no fucking therapist at that time, because they didn’t ever ask me about GP, they just asked me about my charges and my plans to get out. So when I saw those instruments, and then I met the PMT lady. And she just suggested maybe I might want to play how I feel, I first I thought that bitch was messed up in the head, but I tried it because like when else was I gonna get to go ham on some drums. And it just kind of felt good. And that led to me writing some songs about GP and that night and what it was like to see him die, and that shit I didn’t see coming but damn”.

The severe trauma and nature of what brought Wally into the detention facility set up a level of defensiveness, that often-made Wally reluctant to participate in programing in the facility. However, the unexpected musical component of PMT fostered curiosity in Wally, which led to an increasing willingness to participate in the service overtime. Wally was surprised by how much he enjoyed using rapping as an outlet supported by PMT.

Mel was 16 at the time of her referral to PMT, and much like Wally was not aware that the referral was being placed. She was in foster care at the time and going through the legal process of a sexual assault case. Mel recalls:

“ My worker was there to see me and says like get in the door. I remember thinking like fucking hell I’m not. The last time you picked me up was when I got dropped off at this sad shit hole. But then she tells me we are going to see the music lady. I’m sitting there thinking, this worker has lost her mind. But then we pulled up to this therapy center, and the lady in her weirdass cardigan sat down and tells me that she heard I was a pianist and just wanted to get to know me through the music. At first, I didn’t trust that shit, but it was the first time someone had

talked to me about music since the assault happened, so I was shocked and willing to go there”.

Mel then went on to describe how PMT and not knowing the intake was coming, or even the initial purpose helped her use the PMT sessions to process her court experience in more depth:

“You know to this day I don’t know why the hell they decided to send me to music therapy. I don’t know if you are with it or not, but foster care in Detroit don’t usually play out like that. But slowly I don’t know if it was some kind of music therapy voodoo or something, but I started writing these songs and poems and having the piano and her just there and not in the court building that helped. There was no doubting that she wasn’t connected to any of those court fuckers, and that made it ok and safe-ish”.

Mel had spent most of her life in and out of the foster care/community mental health system, which created a great distrust of the system. However, the unexpected nature of the referral and the fact that the PMT therapist was not associated or affiliated with the court system, combined with the use of music which Mel shared is a positive early childhood association, allowed her to engage and begin to successfully process her abuse in greater detail.

Amy was 14 at the time of her referral into a PMT program following a violent and public sexual assault that was publicized on her school campus. Due to her frequent panic attacks that would end up with her foster parent bringing her to the ER the referral was made, as they did not feel her court ordered counseling was sufficient to manage her symptoms. Amy knew that the referral was happening but was not sure how she would be impacted by it.

“When they first told me that I was going to be doing this whole music therapy thing, I didn’t trust that shit. I figured it would just be another appointment I was going to have to do and then the court would audit it, or steal it, whatever it's called when they read my records in

front of me. So because of that, I will admit that I went into those first few sessions a little edgy. She was legit about throwing down confidentiality and that my stuff would be protected. I believed that. At first, I didn’t want to do the songwriting thing she suggested because I thought it seemed lame and cringe. But once I started throwing down, I was able to just like put out what actually happened since the court didn’t believe me. Got that shit out”.

While Amy was aware of the PMT referral, she was not sure what to expect. However, having the confidentiality rules outlined and how the service would be different, supportive, and separate from the court system, helped not only build rapport and trust but foster greater therapeutic alignment.

Ethan was 16 at the time of his PMT referral through a diversion program following a violent outburst he had at his high school, following a violent outburst with another student when he was “outed” by another student before he was ready. He knew the referral was coming and enjoyed the music but was annoyed by the fact he was having to deal with another type of appointment.

“Part of me was excited; however, part of me was not. I just thought it was going to be yet another way for the man to get me in trouble. I pushed back hard, but the dude. He was fucking solid like a rock man. He was the first session that just straight up wouldn’t respond to me when I was acting up or a fool and just be chill. That threw me off. But once I saw that, I knew he was alright and that I could keep showing back up”.

For Ethan, the non-judgmental and affirming stance of the PMT allowed him to engage in PMT more openly. Based on his descriptions, it seems that his therapist's willingness to become othered by his anger, hurt, and trauma from systems of care, allowed Ethan to commit fully to his healing process.

Elena was 16 at the time of her PMT experience following presenting to the hospital with serious burns she acquired during a fire. In our interview, she shared that she felt prepared and had assumed that it would not be helpful after an initially bumpy start to PMT:

“So the lady just walks in and says I thought we could do some music therapy to help with the wound debriefing and she is holding a guitar. I just like flew off the handle with her. I still remember screaming BITCH CANT YOU SEE I CANT USE MY FUCKING HANDS. She was sweet about it and regrouped. When she came back the next day she was prepared, apologized, and had me teach HER how to play the piano and write a song about what the burn treatments sound like. That was wild”.

Elena was the first participant that openly expressed her initial PMT experience was negative. However, the PMT’s ability to maintain a relational frame, own the therapeutic rupture, and adapt the modality to reflect not only her physical by emotional abilities was unexpected and allowed Elena to feel safe enough to engage, despite the pain, unknown, and initially rocky start.

Sara was 14 when she was initially referred to her PMT experience by her foster care worker due to her difficulty engaging in the court-ordered therapy modalities. Sara openly shared that she did not think therapy would ever be for her, however after she engaged in more PMT sessions, she was surprised to notice that she was able to better engage in emotion-based conversations in individual sessions with her primary therapist:

“Like when I started, I hard core thought there wasn’t a chance in hell that I had a mental health problem. I felt like I was a walking fucking stereotype, cause like the only brown people that do therapy are the ones in foster care. And then there is this chick telling me not only do I need therapy, but I have trauma before she even knew my life. That was some bullshit. So I

went into PMT thinking that was how it would be, just another white lady telling me how I should feel. But shit, those sessions, we just jammed, and I practiced just saying and keeping it real, and that helped. Not only did it help me get through the court sessions, but now with my son, I’m gonna be fucking sure he knows those feeling words. That keeps you out of trouble man”.

Sara’s insightful reflection represents just how strong the attachment was that she was able to establish with her PMT. She attributes the reflective PMT relationship with providing her the mirroring and modeling of how to communicate emotion that up until that point she had never received.

Alex was 17 at the time of his referral into the PMT program while he was placed in a juvenile detention facility. The referral was placed after he disclosed a long history of ritualistic child abuse at the foster home he was living at when he was charged with armed robbery. The probation officer felt that PMT might provide him with an outlet but due to previous noncompliance made the service court mandated. Alex felt that the court mandate made him initially go into the service guarded and with the assumption that it would be connected to his court case, but was taken by how different the experience was sharing:

“I hated broskys guts for the first bit there, I felt like shoot there is another courtmandated service I don’t really want to do, that they are just going to share with everyone whenever I am on the stand. But he straight up told me how things were going to be, how PMT was formatted and different, and that ultimately it was for me. I’m not gonna lie, I was an asshole in school, so when he started throwing out all of these writing activities and shit like that I thought he was a damn fool. I remember doing my first poem about Bridge and how he went down by the points and thinking that there was no way in hell that it was going to be turned into

a song. But when he threw that out there, that shit slapped. And then he told me I was a good writer. After that, I felt like he helped me make things happen, and I didn’t view myself as smart until then. That was legit”.

Alex’s relationship with his PMT therapist allowed him to begin to challenge his sense of being a “bad object” and start to consider the idea that he was a successful young adult even though he was unsure what to expect with the referral initially.

Max was referred to PMT at the age of 16 when they moved into a homeless shelter for LGBTQIA teens after coming out as trans to their parents and getting kicked out. Max recalls being excited about the referral but anxious because he didn’t know what would be asked of him, and how vulnerable he would feel. Max recalls:

“ At first, I remember being real quiet, like not quite sure if these people were legit. But then, as we settled in and I learned what to expect, the format of the sessions, and stuff like that, it became a abso-fucking-lute part of my week. I still to this day have a copy of the song we wrote “OUT Song” which for real helped me stepped back from some very dark thoughts”.

Max describes his experience of PMT as something that provided him with much-needed containment of his anxiety-driven internal world as he attempted to control and recover from the trauma of his external world. What Max shared in his interview suggests that PMT assisted him in becoming more independent.

Alexis began PMT sessions at the age of 15 following a particularly intense sickle cell disease flared up when she was hospitalized for a long-term medical trial. She had previous PMT experience prior to this referral, but it was short-term and limited to procedural anxiety.

Alexis was open about her distrust of the medical system and familiarity with auxiliary therapies; however, she was not expecting to enjoy the interventions as much as she did because of how

tired she was during that particular flare up sharing:

“I went into this thing thinking great another fucking therapy to do. I was tired, it was one of those flares where just like everything ached. I didn’t feel like talking or doing any work. So she showed up and gave me the low down about how things were going to go. I still remember her asking me what I felt like doing, and I told her nothing, and she didn’t bat an eye; she just rolled with it. I liked that about her. And she just asked me about what songs I would be listening to at home and put together playlists for me. That really helped me open things up. She didn’t have an agenda, and I know everyone was concerned because I was not doing well, but she didn’t read into it. She just let me be, helped me communicate things and when I had the energy, and allowed me to feel. I’ve been doing music therapy ever since”.

Alexis demonstrated how important it is to meet the patient where they are in order to foster greater therapeutic alignment. She did not expect the PMT therapist to respect her needs or her desire to rest. However, having those needs met fostered not only a greater sense of safety but overall therapeutic engagement. Alexis attributed PMT with helping her cope with the painful transfusions and protecting her hope for the future outside of her medical trauma and complex series of diagnoses.

Emily was referred to PMT following a screening that took place at her school after she had submitted a paper in her AP English class discussing the traumatic death of her brother, who committed suicide while he was deployed with the US Army. Emily had disclosed passive suicidal ideations and felt overwhelmed with survivor's guilt. She shared that while she was relieved to have an outlet, she was concerned about getting lost in her feelings and was surprised when that was not the case stating:

“At first I was like well shit finally, but then I remember thinking well shit now I finally

have to feel this shit. She was cool about it though and kept things real slow. When she and I got to the point of writing that whole how dare you letter, that's when I started to get real worried, because I thought that writing and expressing all that would cause me to self-harm or do something reckless again. But it didn’t, I learned that it was ok to be angry with him for leaving me, but also that I still had a right to live my life, and I didn’t have to put my life on hold because of him and his hurt. I wouldn’t have been able to do that without her”. Emily’s example demonstrated the way that PMT can provide a containing function to the patient, becoming the receptacle for their internalized rage, grief and loss, and frustration. It was only once that containment occurred Emily was able to begin to engage in the healing process and separate from her survivors' guilt. .

Theme I Experiences with PMT (That shit broke me wide open) helps answer the first research question:

● What aspects of PMT, if any, do inner-city young adults identify as beneficial and why?

All of these participants endorsed their PMT experience as while unexpected and confusing, something that allowed for a healing experience and release of emotions. All ten of the qualitative participants attributed specific PMT interventions, the PMT relationship, or clinical approach on the part of their clinician as the reasons for their healing and internal regulation. One of which even went on to continue PMT into young adulthood and decided to study it personally in college! Ultimately all the participants identified PMT as beneficial, and that the relational frame and approach helped foster not only a greater sense of safety and security but also more confidence in coping with and managing themselves individually despite traumas, or lack of available support.

Theme

II: External Treatment Systems- “ You know the man’s got to have his paws all over us, even if that means treatment”.

This section highlights the participant's experiences with treatment systems external to PMT and how it is explored through their personal narratives. Each of these experiences set the foundation for how they viewed the PMT interventions and their relationship with the PMT therapists while receiving the service. External treatment systems describe how the individual participants received care in other treatment environments outside of PMT. The underlying subthemes in this theme category were foster care, probation, juvenile detention facility (JDF), hospital, school and shelter. These sub-themes all reflect the diversity found in the participants' external treatment experiences, prior to PMT.

Wally had previous treatment experience through the foster care system and probation system. He had been frustrated with the entire process and felt like post intake he walked around with a label, and an expectation as to how he would respond, and the focus of which his treatment should be.

“ I straight up remember coming in and them being like, so you are here to work on anger and sobriety, and I remember being so pissed. I wasn’t an addict, sure my charges were for possession but if they just would have read my file, they would have known about G being shot, and me having my stash. Sure I was angry, that part was true, but I was angry about still being in foster care and being labeled something I’m fucking not. That was my treatment experience”.

Wally’s sentiments represent the way manualized treatments work, and the overburdened community mental health system often stigmatizes patients before their treatment even begins, causing the patient to shut down and not engage in the therapeutic process.

Mel’s experience with external treatment systems was very similar to Wally’s. She was

referred into counseling once she was placed in foster care. Mel shared she was only referred into PMT after all other available court authorized modalities had failed.

“Not gonna lie, I fucking hated therapy. For over a year, they just kept referring me places, and making me repeat everything that happened with the rape. Over and over. They wanted me to do TFCBT and complete a trauma narrative or whatever the fuck that means. Anyways, I knew what they were up to. They just wanted my narrative because then they could use it in court. I don’t think any of those assholes cared at all about what I had to say, or what I had been through FOR FUCKING YEARS. They just wanted to check a fucking box and have their paws over everything”.

Mel’s reflections represent how often external treatment systems work so rigidly to complete the protocol in front of them, that they inadvertently forget to view the human being sitting in front of them and their emotional needs.

Amy’s previous external treatment system experiences were nonexistent until being referred for counseling following presenting for medical care in the ER following a violent stranger rape on campus. Amy initially expressed being excited about receiving support, however that emotional experience quickly changed.

“They started talking to me about doing counseling during the Sexual Assault Nurse Exam (SANE). The fucking SANE. I had a douchebag police officer interviewing me while another nurse person was scraping evidence out of my who ha, and they try to get me to complete a counseling intake. As you can imagine I did a shitty job, so when I came for my first session, the lady says “so I hear you aren’t happy about being here”, like no shit, I would have preferred to not be raped and forced in to counseling, but hey, it’s whatever”.

Amy’s experience demonstrates how traumatizing at times external treatment programs

can be. While in the moment she needed immediate medical care, the timing of the counseling referral could have been different. Following the rupture, she was reluctant to participate in any therapy due to the abrasive and aggressive start.

Ethan had limited previous individual treatment experience outside of the school system. He described a lengthy experience of being put in a variety of therapy groups during his early middle school experiences ranging from anger management, emotional communication, grief and loss, and stress management.

“I was so used to just seeing that pink slip come from the office and it meant I had to head to the counseling office. Half the time I didn’t even fucking know what I was walking in to. Not gonna lie, some of the time I was pissed too. Like they didn’t know the half of what was going on, and yet they were gonna label me as angry, or disorganized or whatever. Fuck I was just surviving man”.

Ethan’s experience represents another overburdened treatment system, trying to do the best they can with limited resources. Regardless, this haphazard therapeutic process fostered great reluctance for him initially in PMT.

Elena’s external treatment systems were primarily hospital system related. She shared that she had a complicated relationship with the social work department and how they viewed therapy.

“Like they would come in, usually after my grafts, and would almost read a script. By my third week in the hospital, I could almost predict what they were going to ask me. And they said that shit was counseling. They didn’t know shit about how I was feeling, they just knew that they needed to complete a session or whatever, that was legit what I thought was gonna happen once they told me the music lady was coming by”.

Elena’s experience was a prime example of how the hospital system demands can impact clinical therapeutic care. She had become so accustomed to care management, that she forgot what emotional communication, and therapeutic attunement could feel like.

Sara had the most external treatment experience of all of the participants. So much so, that it resulted in her PMT referral. Sara shared that due to spending a majority of her childhood in foster care she had had a variety of treatment experiences ranging from group homes, therapy groups, and individualized care. However, all of these things were court mandated and nothing was confidential.

“You know, I had so much fucking treatment, thats what kind of got me to PMT. My worker was fucking pissed that I wasn’t participating in the court module, that she thought PMT would help me open up more. Fuck that shit. PMT was great, I loved it. But the great part of it was that it was like scared or whatever. I knew I could share stuff and it wouldn’t be up on the stand during the next monthly review. That's what I hated about treatment. My feelings didn’t belong to me. They belonged to the goddamn system”.

Sara’s experience demonstrates the heartbreaking reality of mental health care for those within the foster care system. Oftentimes their “performance in services is used as a metric as to how well they are functioning” (Lee& Thompson., 2008), completely disregarding their emotional pain, or the importance of having a safe place to process.

Alex unlike other participants that had foster care experience, Alex had limited external treatment system exposure, outside of a few groups. Alex attributes his external treatment experiences (or lack thereof) due to the systems fear of him and his violent offense.

“ You know, I would be in these groups that my worker put me in, and I would share. Really, I would, and then I would see the other workers and kids cringe, and then I would be

thinking shit did I go too far, am I a bad person, no one else feels this way. So once that started happening, I would shut down. Because like what's the point. I already feel like a fucking failure, why let other people view me the same way. So I legit went into PMT thinking humm how long will this bitch last before I scare her away. Shit I was wrong haha”.

Alex’s emotional vulnerability throughout this interview process was impressive. Despite the multiple system failures, trauma, and loss he had suffered he was able to engage in the PMT process with time, therapeutic alignment, and emotional validation. This progression helps demonstrate how often the healing is in the relationship between the patient, music created, and therapist.

Max had external treatment experience once he moved into the LGBTQIA shelter ranging from individual to group therapy. However, prior to that his family of origin was against therapy or mental health treatment, which complicated his introduction to treatment.

“I went into it thinking I had made a horrible mistake. First I had come out, and that blew up my fucking family. And then I’m here and they tell me because of my anxiety they were seeing they were going to refer me to counseling? Like great now I’m trans, and I’m mentally ill. But you know what the therapist was alright, they changed a few times, but it was good practice. The groups made it hard. I felt judged and like everything I said was being studied. Made me go into PMT kind of on guard”.

Max’s external treatment experience highlighted how different treatment structures appeal and support people in a variety of ways. Furthermore, demonstrating that healing is not linear and that oftentimes treatment experiences need to be varied and affirming in order for recovery to occur.

Alexis came to the study with a great deal of external treatment experience due to her

chronic illness. She spoke in detail about how often these treatment experiences felt like home to her and were often some of the most affirming times of her life. She acknowledged that because of this familiarity, PMT was challenging to her.

“I knew what to expect with the therapies and stuff beside, they had known me for years. They were familiar with how I needed time, and how sickle cell brain is real. It was the PMT part that blew things up for me. It was creative and unexpected and vulnerable. Shit didn’t see those feels coming”!

Alexis’s experience is a prime example of how physical environments can often represent containment, safety, and security for the chronically ill.

Emily had no previous therapy experience before getting involved in her school counseling program. She shared that growing up in a military family that moved around a lot, she struggled to cope emotionally and open up when treatment opportunities were available. She expressed feeling initially concerned and betrayed when the school referred her to PMT.

“Like I had been through therapy and treatment and stuff like that before. I knew what to expect, and I just felt like they would judge me for how I was mourning, and my poems, that's what got me the referral in the first place. I felt like no one would understand my grief and didn’t feel like therapy was worth it. Seemed like just another situation where they would think I was another inner city army brat with a shitty family situation, and judge that. It took a hell of a long time for me to think otherwise”.

Emily is a good representation of how oftentimes treatment systems can create trauma and therapeutic wounds. It is only once there is an affirming therapeutic alliance that healing can take place.

Theme II External Treatment Systems- “ You know the man’s got to have his paws all

over us, even if that means treatment”. helps answer the second research question:

● How do inner-city young adults who have been through PMT view their relationship with their therapist?

All of these participants endorsed their prior external treatment experiences as complex, at times traumatizing and intense. All ten of the qualitative participants attributed specific components of their previous treatment experiences as barriers to their initial engagement in PMT, but also affirmed that their PMT therapist, helped them re-engage and participate in the therapeutic process again. Another participant shared that PMT changed the quality of her hospitalization in a positive way. Ultimately all of the participants identified the relationship with their PMT therapist as beneficial, and that the relational frame and approach helped heal previous ruptures and build hope and trust with others in the future.

Theme III Feeling States- “ I felt that shit, man”.

This section highlights the participant's individual feeling states throughout their PMT experiences and is explored through their personal narratives. Each of these experiences set the foundation for how they viewed the PMT interventions and their relationship with the PMT therapists while receiving the service. Feeling states describe the primary emotional experiences felt by the participants while going through the PMT process. The underlying subthemes in this theme category were loss, anxiety, fear, rage, and freedom. These sub-themes all reflect the wide emotive spectrum PMT was able to provide to the participants.

Wally was a participant that described his overall feeling state throughout his PMT experience was free. As he participated in the interview process, he became increasingly open about the way he was forced to suppress his feeling states, IF he wanted to be released quickly. It was during his PMT experience that Wally felt an emotional upheaval.

“I felt that shit man. A session kind of started off, you know it was going like a plain old boring session, and then the drums came out, and shit, stuff just started happening. I felt it. I felt like an asshole because the activity was just like an association thing. I think that's what he called it anyways, I’m just pounding away and then all of a sudden the tears come like I’m some kind of weakling or something. At first I remember thinking fuck this shit, I didn’t come here for that, but thats when the freedom feelings started. And I was cool with that”.

Wally’s experience with feeling states is representative of the thirdness that PMT can create in different clinical encounters. In this study thirdness can be understood as the shared space, aided by music, which allows both participants and therapists to explore emotional content. For example, in conjunction with the PMT therapist Wally reported that he was able to process his long-suppressed feelings, through the use of musical modalities.

Mel was a participant that reported the most intense emotional experience while participating in PMT. Mel expressed frustration initially about how intensely she experienced the rush of emotions, after a long period of suppression following abuse. She attributed this to the unexpected nature of her PMT referral and being used to manualized treatments.

“You know I heard that they were referring me to this. And I’m sorry if I’m repeating myself or whatever, but like I assumed that it would be like TFCBT, or the foster care groups. I’m used to doing the triangles and coping skills cards and then I walk into this room with a lady and she apologizes to me. At first I will admit that I got mad at her, like legit bitch you don’t know me. But then I realized that she meant it. I mean it took a few sessions, but damn, then the anxiety set in, like she apologized for the court stuff and trauma, and just wants to sit with me, that's when it got scary. I remember thinking fuck she’s gonna be chill about all this. Our first few sessions were rough after that, I’m not proud of it, but there were a lot of tears, but at the end

of it. I felt a little less connected to the label, and that, that was nice. And then fortunately and on fortunately for my peeps I was all up in my feels and would rage”.

Mel’s experience described how she used her previous therapy experience as a defensive structure that assisted her in continuing to suppress her emotions. By her PMT therapist being willing to be labeled as the “bad object” , Mel was able to courageously access her longsuppressed emotions utilizing the music modalities as the vehicle.

Amy’s PMT experience was unique in the way in which her emotive experience of rage initially scared her.

“Going through the shit I went through with the rapes and stuff, and let’s be real, the court doesn’t know about all of them. That douchebag had been doing stuff a whole hell of a lot longer than that exam showed. Anyways, if I got upset, he got upset, and the same goes for therapy, if like I got upset, the therapist would get upset, or not to sound like a creeper or anything they would get excited, like things were about to get juicy or whatever. Anyways, so I just decided that I was over feelings, and angry, or anger or whatever is the therapisty way of saying it, was the one to for real for real, not do. Anger got me nowhere. So I was going through PMT and some of those fucking sessions made me pissed like I remember being scared by what I wrote when we did a song writing thing, and then that made me anxious, like shit I went too far, will this get me in trouble, that kind of stuff. But then I realized that she wasn’t going anywhere and then I calmed down some, and things weren’t like a goddamn volcano , you get me”?

Amy’s experience with feeling states suggests that it was a combination of the relationship she was able to establish with the PMT therapist, and then the modalities themselves that allowed her the freedom to reconnect with a fuller emotive experience. Once Amy realized

that she no longer had to rely on her trauma response of emotional blunting to withstand the vulnerability of therapy she was able to fully engage in the therapeutic PMT process.

Ethan entered PMT very reluctant to acknowledge his emotions because his display of anger within his school system had not only gotten him placed in a diversion program, but also PMT. Ethan was told that the referral was being made to help him better address his anger, which only activated more anger, and fear that if he were to be emotionally up front, it would only result in further penalization.

“So going into this, I remember being pissed, like the principal made a judgment, and come on, he probably thought whelp here is another shitty black boy with an anger problem. He didn’t even know the whole story, like how the kid I came for had outed me. Like to the entire team. They didn’t know the first thing about my pops either, being out wasn’t an option. So yeah I got angry, and they didn’t factor that in. So then I find out about PMT and I figured nothing I said would be safe, because like duh I’m on probation, I’m not a fucking idiot. So that made me straight up anxious. I know I have a short fuse. I still do, I'm being honest, but I’m not like a rager kind of person. I don’t want to hurt people, I’m not a psycho. So it was this combination of being so anxious that I would say or feel too much and then get put on full probation, and then the freedom of being able to unfurl on the drums usually and know that it wasn’t going anywhere. That shit was nice”!

Ethan’s response highlights not only the systems racism, but also the impact that cultural outlooks on emotional expression can have on therapeutic presentation. Through the use of PMT and the role of the PMT therapist, the intervention served a containing function for his rage, and anxiety, which ultimately allowed for a therapeutic release, and an increase in overall emotional freedom.

Elena was one of the only participants that discussed an initially negative emotional state from her PMT experience early on. She attributed this to the hospital system not debriefing the PMT therapist about her injuries before the referral. However, upon emotional validation and adaptation, she experienced PMT as a freeing reflective experience.

“The PMT lady walks in right, and my hands were in those little cotton ball things, because of the wound debriefing, I think that was what it was called, but shit it’s been a few years so could be wrong. Anyway, so the lady walks in and says that she is here to help me play some music and just jam out. And I wanted to punch her in the face. I couldn’t play anything I couldn’t use my goddamn hands. Poor lady, I could tell she felt bad. She apologized over and over, and then she took a minute and said she would come back in a few. I thought, whelp, that's gotta be my record for how quickly I was able to scare someone away, but then she came back, and she had brought a keyboard and this tablet, and told me to teach her a song. I fucking sobbed like a punk, because I realized that I wouldn’t be playing again anytime soon. And that hurt, but here was this lady that was annoying and wouldn’t go away, but didn’t want me to give up and cared about what I had to say. That got me through''.

Elena’s experience demonstrates not only the containing function of PMT, but the way that the relationship built between herself and the PMT, served a corrective, and affirming function. Elena reports that in treatment it was the annoying PMT lady that wouldn’t go away and cared about what she had to say that helped her get through. This suggests that both the PMT model and relationship between Elena and her therapist were both contributing factors in her healing.

Sara spoke openly about the rage that her PMT experience unleashed for her, which she welcomed after years in court mandated manualized treatments.

“It was chill at first, I liked walked in and she explained how things were going to work. Maybe it was because of how pissed I was or something, but like once I knew this wouldn’t be coming into court, it’s like something came over me. And then I just started pounding. It’s like it all fucking exploded all over everything. And then I just got real sad because I started thinking about all the shitty things that had happened and everything I had lost”.

Sara’s experience represents the thirdness that can be created using PMT. The instruments not only served a containing function, but also became a receptacle for her rage and loss, which ultimately allowed her to engage more fully in the healing process.

Alex reported that it took quite a long time for him to engage in PMT because he didn’t trust it. Alex spoke openly about how in the past while in detention facilities, what he had shared in groups was used against him. He shared that the individual aspect of PMT initially generated a great deal of anxiety and fear about how his participation might impact his sentencing, but ultimately was able to find emotional freedom.

“ So the lady kept telling me that it would just be between us, and at first I was thinking well fuck no, I know how that goes. But she just kept reminding me. And didn’t push it and at first it might sound fucked up, but like that made me more anxious, like why isn’t she leaving. But after a while I just got used to us sitting there, talking music, and it wasn’t until she let me bring in some of the stuff I wrote, and she wanted me to rap it, that's when the shit got real.

BAM it came pouring out of me, shit made me real sad, but also it was nice to set those people free”.

Alex’s experience reflects how PMT provided a stabilizing function for him as he processed not only his JDF experiences, but also early childhood losses. His narrative suggests that his long-held view of himself as a bad object, was able to be challenged through the

constant presence of his PMT and allowed him to consider the reality, that despite traumas, violence, and treatment failures, he was good as is.

Max expressed the most appreciation for his PMT experience. He had entered the shelter with no previous therapy or music experience, in the midst of deep emotional turmoil. He attributes that to the reason why PMT was so freeing for him.

“ When I started PMT, I had literally nothing to lose. My so-called friends had outed me, my parents had kicked me out, and I had nothing left. And I was really fucking pissed and scared. It was really the song writing that did it, being able to get my words out like that, it really helped. And I realized it didn’t matter if a fucking spoke my truth because those homophobic assholes were out out of my life, and it was ok to say how I felt. Shit felt good”.

Max’s series of deep losses had resulted in a belief that everyone was going to leave him, therefore no one could be trusted with his emotions. It is possible that through the use of PMT he was able to safely process his emotional states, which he had been taught to suppress since childhood.

Alexis had entered PMT with a great deal of previous therapy experience, but also a great deal of anxiety. She attributed the additional service of PMT with a large amount of anxiety, given her pre-existing treatment burden due to her sickle cell trait. Alexis spoke openly about fearing PMT, because it wasn’t something she was typically used to, despite all her time in and out of the hospital.

“I was afraid at first. You know, I’m not scared of the hospital or treatments or whatever, being a sickle patient you get used to all of it. It was the therapy part of it, the talking, feelings and stuff, that made me real anxious, and kind of afraid of what was next. But once I started it was really cool and helped, cause like it didn’t take a lot of energy, I could do it from the bed,

and just get those feelings out. I liked that my mom didn’t hear the songs too, it was nice to tell the truth, like I was pissed, or angry, or scared, and not worry about worrying her ''.

Alexis described PMT as an opportunity to share her authentic emotional truth and have it mirrored back without fear of judgment, or concern on the part of her mother or medical team. She had spent a great deal of time in the hospital growing up and was used to a more traditional medical model of social work, where feelings were something to be resolved and treated, not necessarily felt. Alexis enjoyed describing just how healing how it was to have her feelings heard and recognized and wishes to continue PMT if it ever becomes a service that her insurance covers.

Emily acknowledged that when initially referred she had a great deal of distrust and fear about the referral, given how her school system had responded to her loss.

“At first I was really pissed off at them. Cause I had written what I had written about my brother in confidence, and then they just went and exposed it to everyone , and I was afraid that I would be locked up if I wrote more. Cause fuck the army. But the PMT lady. She was patient as hell. And like over time, it got easier and I realized that I could get angry and not get in trouble and that felt good. I could leave it there and move on”.

Emily’s PMT experience demonstrates the containing function the modality played in helping Emily process not only her rage, and loss, but also fear. Given how her referral to PMT was done without her knowledge, she entered the service with a lot of fear and anger over how her journaling exercise was perceived as a suicide note at school. Through the creation of music

Emily reports that PMT allowed her to safely express her emotions in a variety of ways, without negative repercussions, like she had experienced in previous forms of therapy.

Theme III Feeling States- “ I felt that shit man” helped answer two research questions:

● How do inner-city young adults who have been through PMT view their relationship with their therapist?

● What challenges, if any, did participants identify when discussing their PMT experience?

All the participants reported having a great deal of doubt or concern about the role of the PMT in their lives, and how their feelings states might impact how they are viewed by others. However, all of them later endorsed in a variety of ways being surprised by the stabilizing force and constant presence the PMT had in their lives. The largest challenge identified within the participants PMT experience, was distrust due to previous betrayals of the therapy community and how it impacted how quickly they were able to build rapport, in addition to being anxious and concerned about what all PMT will entail.

Theme IV: Musicianship- “I thought they were a damn hippie fool, but shoot, that music changed me, and now I be jammin”.

This section highlights any previous musical experience the participants had, as well as how they viewed the music they created, and the role the modality played in their overall PMT experience. The theme of musicianship was defined and described by the participants as: no previous experience, church, private lessons, and writer/rapper. The variety of ways the participants defined musicianship for themselves highlights the diversity and multitude of forms music can be communicated. Illustrating how music can be defined as a universal language. Wally, Mel, Elena, and Max had no previous musical experience. Because of that all of them had some understandable reluctance to initially engage with their PMT therapist. However, this lack of training also allowed all three participants to experiment with the interventions and therapeutic relationship more openly, due to no prior experience or training.

An illustration of this was Wally's report that “at first when I walked in, I thought that the PMT therapist was a damn hippie fool, but shoot, that music changed me, and now I be jammin, even now after all this”.

Amy and Alex had previous musical training through the church system, a system and environment where for both, a great deal of trauma occurred. Both Amy and Alex had previously associated musicianship and their training with a significant amount of rigidity around practicing and the sounds that they created. However, through the relationship they built with their PMT they were able access a level of freeness and creativity that they did not think was possible as musicians. Alex stated “it was like for me playing the piano was like something I had to do, I had to rise to the occasion, despite what those fuckers were doing to me. And then overtime, it was like I took back the fucking piano and instead of playing for them I was playing for me”.

Sara, Alexis, and Emily had the greatest sense of musicianship due to their long-time private lessons. These participants also were the most fearful about their referrals, due to concerns that the combination of music and therapy would ruin the outlet they all experienced from their lessons and instruments of choice. However, eventually all the participants found that their additional musical training allowed them access their emotional content with more ease. Emily shares “once I realized that this wouldn’t ruin flute for me, it was actually kind of nice because I could focus on what the PMT was asking me about how the trauma-impacted things, and I could write about it, and not have to worry about the music sounding like shit”.

Ethan was the only participant that identified as a rapper and writer prior to starting PMT. He shared that he started rapping to honor the death of a friend, then fell in love with the “rush”. Ethan felt it was this connection to the art form that allowed him to feel safe enough in

the PMT modality to engage in the therapeutic process. “You know, rapping for me always worked. It was how I kept it real and shared the truth about shit. PMT and songwriting wasn’t any different than the rhymes I wrote before, the only difference was that now I had someone to talk to and share things with, and that shit felt good”.

Theme IV: Musicianship- “I thought they were a damn hippie fool, but shoot, that music changed me, and now I be jammin”, helped answer two research questions:

● What aspects of PMT, if any, do inner-city young adults identify as beneficial and why?

● How do inner-city young adults who have been through PMT view their relationship with their therapist?

All of the participants had varying levels of musicianship, however the use of music as an artform itself allowed the participants to better engage in the PMT experience. By using music, all of the participants endorsed not only being able to break through their defensive structures about participating in therapy but also align with their therapists emotionally. Once this alignment was formed the participants report that they were able to begin to process therapeutic content and participate on a deeper therapeutic level.

Theme V: Relationships- “Heard I’m not salty no more, so I’m counting that as a win.”

This section explores the relationships that the participants endorsed as being important and explored during their PMT experience. Relationships describe the specific types of relationships that were endorsed as pivotal during the PMT experience. The underlying sub themes within the relationships theme in this category were: sibling, partner, child, abandonment, and workers. These sub themes all reflect the different types of relationships that can be identified as important to an individual, regardless of referral source.

Wally, Ethan, Sara reported that their relationships with their siblings were impacted

through their PMT experience. Both Wally and Ethan felt that through PMT they were better able to communicate and process the death of their siblings, which were both traumatic losses that occurred in front of them. Sara on the other hand felt that her relationships were negatively impacted but in a mature way sharing:

“I knew some of my relationships were fucked up. There wasn’t anyone where, that wasn’t the case. But like I don’t know, it might have been time, or maturity or whatever, but the more songs I wrote, the more I realized that if I didn’t step away from those asshats I was gonna become one and end up just like my momma. So, I guess PMT and the therapist lady she helped my relationship, because I realized I needed to change things. But also it made things worse because by the end of it, I didn’t have any of my OG’s and had to start over”.

Mel and Max reported that their relationships with their partners were impacted through their PMT experience. Mel reported that the PMT experience made her feel more vulnerable and pulled away from her partner, as she processed a series of traumas.

“It was like when I was with him, even though he did the fucked up shit, while I was doing all of the dealing with our feeling of everything that happened, when we would go and try to have sexy time if you know what I mean, it came rushing back. And like, don’t get me wrong I wanted sexy time but there was something about dealing with all that shit that made it bubble up or whatever. We ended up breaking up, but all in all, I think that was ok, because it’s not like he was going to be my forever and always or whatever”.

Max on the other hand shared that it was through his PMT experience that he was able to not only have an authentic relationship, but safely live their life “out” as a transgender man.

“You know I came into PMT or whatever when I was homeless because I came out and my parents couldn’t handle that. And at first when I started the therapy or whatever I just

assumed I would be one of those lame fuckers that would die alone, and that if I tried to date, I would ruin things and end up homeless again. But then, over time I dropped the shame shit and realized that I can date and be in a relationship. And you know what, I've been with my partner for four years now, and they are hot, smart, and don’t take no shit”.

Amy and Ethan felt that their relationship with children was most impacted. Ethan shared that through his PMT work he was able to come in contact with early childhood trauma which often made him become agitated and frustrated with children around him. This was particularly trying during his foster care experience.

“It was like when those foster nuggets came up to me I knew they just wanted to play. I knew that I was legit, safe or whatever. But their sounds and just the way that they were reminded me of all the fucked up shit that he did to me, and made me do to others. And that was why I went and did some of the shitty things that I did. Now don’t get me wrong, I know I have responsibility and all that. But it wasn’t until I did the PMT groups with that music lady that the rage and all that stuff started connecting together”.

Amy courageously shared that through PMT she was able to mourn the loss of the children she had to abort during the time she was sexually exploited. She attributes this to the relationship that she was able to cultivate with the PMT therapist. Amy shared that it was vitally important that her relationship with the PMT therapist was built independently of the court system, due to the traumatizing nature of the mandated therapy that she was subjected to previously.

“She started off by just telling me that the first activity would be to discuss things that we have lost. At first that was the last thing that I was thinking of. So I started real petty like, I’m talking about my keys, my weave, you know. But then I just like got to the point where I

wanted to talk about the two pregnancies I had to let go. I don’t know what it was, something about the music lady you know. She kept telling me I was courageous, fuck if I ever felt that way before, but she just kept telling me that and with time I started to believe it. I always be glad and thankful about that”.

Wally, Mel, Ethan, Sara, Max, and Emily all shared that through the PMT process they were able to realize their self-worth and the need for boundaries and closure in a variety of their relationships.

● Wally: “You know those fuckers, they left me, and I had to take the fall for those charges, but you know what that rap speaks the truth, I don’t need, and I haven’t needed them and their shit since being on the outs”.

● Mel: “I used to wish they weren’t assholes, and would care, but going through what I went through, and then seeing them not come around. I am not hurt by that anymore”.

● Ethan: “You know that my friends, they all dropped me like a goddamn potato after I did what I did at the school, and part of me gets that. But part of me was still holding out that they would understand why I busted up like that”.

● Sara: “My bio family came for my siblings, but they didn’t come for me. That shit hurt. And for a long time I took it personally, like was it because of how public the court case was? But then as I got my feet under me or whatever, it’s felt damn good to know that everything I have is because of the shit that I’ve done. I’m proud of that, I know I don’t take no shit from anyone”.

● Max: “ At first it was like shit, was it worth it, I don’t have a family anymore, but through the REC, I would much rather be orphaned but have any amazing chosen

family and live my authentic self, that a fake cis-gendered straight fool”.

● Emily: “I was fucking pissed at my brother because he was the one who went and enlisted. He left me, and then he got himself killed. But I get it now, he was living his life the way he wanted it to be”. Lastly Ethan, Elena and Sara reported as they participated in PMT that they felt abandoned by their foster care workers. This was often attributed to turnover at their community mental health agencies, and or foster care experiences. Interestingly all three participants shared that their workers had changed amid their PMT experience.

● Ethan: “During that whole time, my worker changed three times. That really pissed me off, because then I would have to keep repeating myself which was real stupid. But it made me glad for the PMT lady, cause girl that woman was a tank. She wasn’t put off by any of my bullshit”.

● Elena: “I had never been in the hospital like that before, but man the social worker person was different every week it seemed. The hard part was the way they looked like me. One time one really pissed me off and I ended up writing a song called “keep your eyes to your ever fucking self”.

● Sara: “Being in foster care, and at the group home it got to me. I think sometimes I used to believe that the worker turn over fucked up a lot of my court stuff. It makes it hard for a kid to be adopted if their counselor can’t stand up and tell their story right. That’s why I like the PMT lady. You know she even helped me write a song called “on the stand”.

Theme V: Relationships- “Heard I’m not salty no more, so I’m counting that as a win” answered three research questions:

● What aspects of PMT, if any, do inner-city young adults identify as beneficial and why?

● How do inner-city young adults who have been through PMT view their relationship with their therapist?

● Does PMT help build resilience in inner-city young adults or impact their relationships, and if so, in what ways?

All the participants endorsed that not only the PMT interventions, but the function of the PMT therapist was helpful in addressing aspects of their relationships while they were receiving PMT care. Additionally, they felt that their relationship with their PMT therapist made it easier to participate in therapy and made them feel better understood. Lastly, all of the participants felt that through the use of PMT they were able to identify areas of their lives where they felt resilience (relationships, work, living situation etc.) and that through their perceived increase in self-resilience they were able to further address problematic areas in their relationships, or build healthier connections and lay the groundwork for healthier relationships in the future.

Theme VI: Traumatic Loss- “Didn’t think I could ever get past losing him, still don’t think I can, just trying to stay on the outs.”

Theme Six- traumatic loss explores any traumatic losses the participants endorsed during their interview process. Traumatic loss refers to the loss of a loved one in the context of a major event that overwhelms one’s ability to cope. The underlying subthemes obtained from the participants were: shootings, deployment, overdose (OD), foster care, and being kicked out due to coming out.

Wally spoke openly about the shooting of his best friend, and how taking the fall for the gang violence related crime was what ultimately resulted in his referral to PMT.

“Didn’t think I could ever get past losing him, still don’t think I can, just trying to stay on outs. Cause like I didn’t want to take the fall for G, but otherwise they’d come after his family. And his Momma don’t need that they looked out for me. The PMT lady and I spent a lot of time just like pounding it out, cause I gave up my freedom for his family. But I’m not angry no more”.

Alexis surprisingly shared that it was a deployment that plagued her the most during her PMT referral experience.

“I was at the hospital and my auntie comes in and tells me Uncle Carlos died. He was in the Army. He was a chill dude. He wasn’t pushy, and he treated me like I was one of the rest of the kids. Not the sick one. I hated that. I’m not a fragile piece of shit. Because of my treatments and sickle cell treatment, I wasn’t going to the funeral. I was fucking pissed at the nurses, and shut down. That kind of what was lead to my PMT stuff starting. Might sound a little cringey but she helped me put on a funeral”.

Mel reported that her mother’s overdose (OD) was the reason for her entrance into foster care, which then exposed her to a lifetime of trauma.

“The really messed up part of this fucked up situation was that the court didn’t think I remembered the OD. I did. I walked in. I saw her there. It was me who waited until CeCe showed up. That changed my entire life. And you know the even shittier part? I didn’t realize that she abused drugs, until she was gone. My mom went above and beyond for us, and then she was gone. I was mad at myself about that. I feel like I missed out on girl time. And then, I was mad at her for choosing H over me, and then going through the fucked up shit that I did. That's when the PMT lady helped me we wrote a how dare you and miss you song. Sometimes when I get pissed off, or triggered. I still sing it”.

Amy, Ethan, Elena, Max, and Emily spoke openly about their foster care experience being the biggest source of loss for them. Throughout the process of their interviews they shared a way PMT contributed to the methods that they processed the traumatic losses associated with foster care.

● Amy: “For me it was being separated from my siblings. We had different dads. Think what you want to think. If we wouldn’t have been separated none of this fucked up shit never would have happened. I think that was what I think I lost the most of . Childhood . The system did that not a legit person. Don’t know if you think if that counts. Anyway, you know that song if I were a boy, by Beyonce? The PMT lady helped me write one called if I were a judge. Damn that thing slapped!”

● Ethan: “Foster care was fucked up for me, but the biggest part for me was the fact that my dad never came back or fought for me. I thought it was a sissy shit thing to do to cry about that but, not gonna lie, that's what I did in that instrument room. Helped that the lady didn’t judge or whatever”,

● Elena: “Foster care was kind of all I knew, and that's where things sucked. That's all that I knew. And I think I lost out on a lot because of that. I worried a lot. My foster mom always told me to get my head out of my ass. One time I just sat around in a circle with my PMT person and we just kept playing music and writing out worries until they ran out. The worries I was never able to say. Cause foster care didn’t care about my worries' '.

● Max: “I lost out on my family when I decided to come out, but I gained my freedom. I don’t regret nothin. For me, it’s that I miss out on being the real me

with my parents and that hurts. I think PMT when I first got to the shelter helped me learn how to say goodbye to the person that they knew, and learn how to say hello, I know cringey to like me. It was kinda like I had to grieve myself, even though I knew that I was going to have to say goodbye” .

● Emily: “Foster care failed me, like my brother died, my sister couldn’t step up. And like they just immediately put me in. So then like then I had to figure out foster care again, the fact that my family didn’t come from me, and that the army fucking killed my brother. Everything just got shitter and shitier from there. It was me and the PMT lady that did this whole thing about choosing me, and that was nice”.

Sara and Alex both openly shared their experiences of being kicked out and how they attributed that to their loss experiences.

Sara shared that she was kicked out by her foster mother after they overheard her talking about her sexual orientation with a friend.

“She was a fucking bitch. I was a good foster kid. I had a 4.0, I played sports. Was sober. Took care of their fucking kids. Kept things tidy around the house. Pretty much did whatever she told me to do. Anyways. So like she found out about me being out, and flipped. Then she kicks me out. And she tells me to go. All because of who I fucking love. And then she calls the worker and the worker tells me, and pretty much that like there isn’t a placement for me, and that because I was turning 18 in a few months, they most likely wouldn’t be able to find me a placement, I could go to the REC, and that they could give me stipend early. Then I did feel lost. The PMT lady spent a lot of time helping me be pissed and ok with that”.

Alex felt that the most traumatic loss that he faced was being outed at school which led to

his violent outburst that caused him to be kicked out, rejected, and entered into care.

“I don’t know if this counts at an answer to your question, but like fuck because of those homophobes I lost my family, and then the rest of the school just viewed me as another angry black fag. Of course, I was fucking pissed. The PMT dude though, he was just steady, He let me rage, you know I broke one of his guitars? And then it was like maybe I could think about things other than making people fucking pay. Because otherwise I was just gonna be in lock up indefinitely”.

Theme VI: Traumatic Loss- “Didn’t think I could ever get past losing him, still don’t think I can, just trying to stay on the outs.” Answered the following research questions:

● What aspects of PMT, if any, do inner-city young adults identify as beneficial and why?

● How do inner-city young adults who have been through PMT view their relationship with their therapist?

● Does PMT help build resilience in inner-city young adults or impact their relationships, and if so, in what ways?

● What challenges, if any, did participants identify when discussing their PMT experience?

Most of the participants were able to identify specific PMT interventions, as well as positive aspects of the PMT therapist relationship as contributing factors as to how and why they were able to cope with the nature of their traumatic loss. Additionally, they felt that their relationship with the PMT therapist was a stabilizing force in their lives, despite many previous systemic and therapeutic ruptures with previous relationships and systems of care. Participants also reported that while many of them were struggling with losses, abandonment, and relationship changes, their PMT experiences at the time were able to help them better regulate, remain present despite the turmoil, and begin to reevaluate how they would like their

relationships to look in the future. Lastly, the main challenge the participants identified pertaining to PMT was that it was often emotionally jarring and left them feeling raw or triggered. This emotional experience could at times be particularly trying due to the lack of available emotional support the participants had at the time.

Theme VII: View of Self- “Turns out I’m fucking smart”!

Theme Seven-View of self-explores how participants viewed themselves during their PMT experience. A view of self can be defined as a collection of beliefs about oneself such as failure, powerful, controlling, caring, smart, funny. The underlying subthemes obtained from the view of self-category were: Understanding, abandoned, independent, angsty, overwhelmed, and free.

Wally, Mel, and Amy expressed that during their time participating in PMT they began to view themselves as more understanding despite the circumstances they were processing and working to cope with.

● Wally: “It was like ok, shit I took the fall, now what do I do. Ya know? So I had to get my shit together. I think taking the fall or whatever, it made me get it, or understand where some of my other brothers were coming from when they locked up for crazy shit. I didn’t get it before, and was fucking pissed for a long time man”.

● Mel: “My son doesn’t stand a chance. He won’t be able to pull any shit cause I’ve done it all. And if he does fuck up. I’ll understand it. I used to be judgey before foster care. I’ll own it. I hate that I was an asshole. But sometime you have to go through some fucked up shit to get that. I think that's where the song stuff came in”.

● Amy: “I won’t ever understand why those fucktards did what they did to me. PMT wasn’t about that, at least I don’t think it was. The court wanted to get their answers, and

maybe they did. But for me, I guess through the songs and staff, and even the drumming, it helped me understand why I was fucked up the way I was. And that it was ok”.

Wally, Mel, Ethan, Elena, Sara, Alex and Alexis felt that during their PMT experience they began to view themselves as more independent.

● Wally: “The JDF place won’t be reading this, so I’m ok saying it, but those assholes don’t want no one to be independent. They strip us. They say the usual bullshit about JDF being more than just lock up, that it’s for our own good, blah fucking blah, that they want to rehab us so we can be successful in the future. But that is a load of SHIT. Sorry got off track there haha. So what I was trying to say, is that being able to get stuff out without a pencil or a stupid probation meeting, and just jam about it. Helped me kind of shift and figure out, ok took the fall, have the charge, I was held captive there, how can I still be independent and take care of my business if you know what I mean”.

● Mel: I always knew I was independent. Being in foster care for as long as I was, that wasn’t news. I think what was the news, straight up tea (laughs) was that me being independent was a good thing. I don’t think it was the songs or the activities. I think it was more so the lady. Like she listened as I cried and laid out why I was so pissed, and then would turn it around about how despite all of that I was still taking care of myself and was alive”.

Wally, Amy, Ethan, Elena and Sara all shared that in a variety of ways they felt abandoned at various points throughout their PMT experience.

● Wally: “The boys just fucking left me out there. Had to take the fall for them. Then when I called them up once I was in the lock up all them pussy’s just didn’t

answer and abandoned me, even though I took the fall for them so they could be free. Shit don’t make no sense. Some of that PMT shit, brought that up again. Got me salty sometimes”.

● Amy: “When I was going through the court part of it, I was suffocated. Until they realized that I wasn’t going to give them what they wanted. As soon as I wouldn’t do what they wanted on the stand. They abandoned me. I stand by the fact I think those legal assholes and that court system just used me for the cred. In PMT the lady let me rage about that ALOT”.

● Ethan: “Fuck man, the way the school responded when all that went down. Left me high and dry. They didn’t care that those asshats outed me and that's why I did what I did at school. Nope, my anger was too fucking big for that white bread school and they went and abandoned me. Spent a lot of time on that when I was doing the music stuff”.

● Elena: “That was a weird time in my life, lady. I’m in the hospital right, and I have burns all over the place. I felt like sometimes, they’d come in like some goddamn hurricanes, do the wound debriefing, rip my fucking skin off. And then leave me, like ok cool thanks for the pain, but it would be nice if they would have stayed instead of abandoning me there. That's when the PMT lady came in handy. I would refuse to see her, and save the times for when I knew I was getting those treatments”.

● Sara: “I spent a long ass time in foster care, only got out once I turned 18. And the day that happened, the system straight up abandoned me. Is that too strong a word? You know what, never mind, not like any of the family court people will

read this. They didn’t prepare me for nothin. Just held me captive and then once I was told old, said have a nice fucking life. Now I gotta figure out how to protect me and my son. That’s some messed up shit”.

Mel and Alex both described themselves as angsty at different points throughout the PMT experience, and attributed it to very different systems of care.

● Mel:' I mean I was in foster care my entire life so, as you can imagine. Made me a little angsty, or salty, or whatever. Cause like they were supposed to take care of me, or track down my bio family, or worst case find me a forever family and help with adoption or whatever, and none of that happened. That shit made me real angry for a long time. Maybe that's why I liked the anger drum circle with the PMT lady. I’m chillin now”.

● Alex: “Spending a good chunk of time in lock up will make a human angsty. You feel me? Like I was in foster care to start. And then things kept happening. I remember just hoping that one of the times, the worker might think, huh maybe there is something more going on here, this kid seems pretty upset. Spent a long time thinking I was just another angry foster kid, but the PMT dude, they taught me that the anger, or angstiness, or whatever was because I was hurt, and failed by the system. Those were some goodass sessions”.

Mel, Amy, Ethan, Alexis and Emily remembered feeling overwhelmed at various points throughout their PMT experience due to how raw and accessible their feelings were.

● Mel: “Yeah, I liked PMT, ALOT would have kept doing it. But shit, at times those sessions got REAL intense. I was used to therapy. Being in foster care as long as I was you get used to the usual CBT worksheet therapy. I didn’t see the

PMT feels coming and it was overwhelming at time. I felt bad for the PMT lady cause sometimes I’d go off on her because of that”.

● Amy: “ I mean started PMT overwhelmed. I was going through the sex crimes shit and was feeling shitty and like my feelings were the only way I was going to get justice. So, I shut down. I didn’t want to play the court's games anymore. So, they referred me to PMT. And, at first I thought it would be just like the other five million goddamn sessions they had put me through. So then when I realized not only were the sessions free from the court, and wouldn’t be recorded, and then to find out that music was involved. It all hit me like a goddamn tsunami. There were a lot of feelings to have to deal with, feel bad for the PMT lady, cause I was a mess”.

● Ethan: “The whole thing was overwhelming. It seemed like everything was happening so fast. And that was hard. Really hard. Like I was outed. The thing at school happened, and then FUCKING BAM (pounding noise) all these programs started, PMT was one of them, and my friends dropped me. It was all so much, and it was really hard. On top of it, the PMT stuff, and doing music made me a goddamn sap. Didn’t like that part at first, but I came around”.

● Alexis: “PMT started, right when my world was melting down. My sickle cell symptoms had gotten real bad. And the one treatment had just failed. I didn’t want any more appointments. I was kind of in my pity party mode. I know.

Bitchy place to be. But I was. I just wanted to be left alone. And then, here comes this PMT lady, who tells me to play how I feel, rather than talk about it. And I was really overwhelmed by how the feelings came on ``.

● Emily: “It just seemed like everything happened all at once and super fucking fast. I’m not proud of it, once I got the news about my brother I got overwhelmed and that's what led me to write the letter, and then that led to the PMT. Like I didn’t get to say goodbye. And I’m really fucking annoyed by Army for not protecting him, and then the PMT lady came and helped me sit with the feelings and explore why I was so overwhelmed, damn. That was some intense shit”. Wally, Mel, Ethan, Elena, Sara and Max expressed an emotional state of freeness or freedom during their PMT experience, that they had never felt before in therapy.

● Wally: “It was like once I started pounding on those drums man, I felt free as fuck, or I guess freeish because I was in lock up. That may have been why or how I broke that more music dudes flat drum one time. I remember the lock up monkeys come running up cause they heard all the commotion, and the PMT dude told them to back down cause I was just feeling it”.

● Mel: “ I had this moment where I realized, damn it turns out I’m fucking smart. And that was freeing. I think that's when I started opening up more song wise, because it felt like the PMT girl she saw me, she saw me as a smart person and not just my trauma”.

● Ethan: “It was when the PMT person and I were alone that like I just let it rip, cause like because of how it all went down, people were afraid of me. Like oh there goes the angry black kid, so when I realized that she wasn’t reporting to my probation man, I could rage and rage freely cause like damn I had some shit to get out”.

● Elena: “You know, when I started PMT, I was kind of like a captive. Couldn’t do

a whole lot because of the burns. And I was pissed. So when she came in and let me direct her and say what she sang. I felt free as fuck. I was in charge, saying what I wanted to say, and damn that felt good”.

● Sara: “I kind of remember that foster care time as being a captive. They put me in services, but like nothing I said was ever enough. And I don’t think it was ever safe. So, when the PMT referral happened, and I knew it wouldn’t be used in court, I could finally say the godamn truth about how fucked the system was. And damn that felt good. That was freedom”.

● Max: “When I started PMT from the outside it probably looked like I was free. Cause I was out. Living my truth or whatever. But it didn’t always feel that way. I spent my whole life at my house, and then had to enter the shelter, had lost my family and friends.. So when I started PMT, I felt a little salty. And it was that fight out song thing that really changed the game for me. That was freeing”.

Theme VII: View of self-”Turns out I’m fucking smart” answered the following research questions:

● What aspects of PMT, if any, do inner-city young adults identify as beneficial and why?

● How do inner-city young adults who have been through PMT view their relationship with their therapist?

● Does PMT help build resilience in inner-city young adults or impact their relationships, and if so, in what ways?

All the participants were able to identify various components of the PMT model that helped them not only build their sense of self, but also cope with intense emotional dysregulation. Additionally, all of the participants attributed their ability to explore how they

view themselves with the stabilizing presence of their PMT therapist. Lastly, during the use of PMT participants were able to not only identify negative aspects of their self-view, but become more aware of positive aspects of themselves (such as intelligence) which improved the quality of their relationships.

Conclusion:

Overall, the participants expressed various ways not only the PMT modality, but their relationship with their PMT therapist helped them process traumatic loss, chronic illness, detention facilities, and the foster care system. PMT served a protective function at the time of their participation in the service. The participants suggested that PMT as a model helped them address previous therapeutic ruptures and oppressive elements of other systems of care which resulted in a greater sense of self resiliency. Each participant seemed to identify at least one aspect of how PMT helped them cope more effectively and build healthier relationships.

Field Notes:

During the process of the interviews, memo writing was completed. Memo writing took place before each interview, and immediately after. Initially, I wondered if there would be enough interest in the topic, and if the chosen population would be receptive to participating in a research project. However, as the memo writing continued and I began to receive more and more responses, my anxiety and doubt about the study topic decreased. Much of memo writing also included questions and doubt around PMT and whether it would be supported enough by psychodynamic theory. Memo writing would occur additionally before and after each writing session. This allowed me to come back to areas of frustration at a later time, which helped me push through the times of writers block. Memo writing also took place throughout the coding process to help me keep track of patterns, and overarching emotional responses to the patterns

that were coming up throughout the process.

I also used memo writing to note things I observed as a listened to recordings and read over interview transcripts post interview. It was various obvious in most of the interviews how initially guarded most of the participants were at the start of their interviews, and then over time they become more open and engaged. It was apparent that most of the participants had some distrust of the healthcare and/or mental health system. Over time, in interviews various traumas inflicted by larger systems of care (foster care, previous therapists, law enforcement, shelters) came to light, which could be contributing to the guardedness present in the interviews.

Additional memos included reflections on musicianship, and previous therapy experience. Many of the participants had not only previous PMT experience, but court mandated therapy experience. Through memo writing, I noticed the impact of my own previous experiences as a court mandated therapist, contributed to my initial perception of the participants' court mandated therapy experiences being negative. When reviewing transcripts and recordings, it was clear that the participants weren’t as reactive as I originally thought they would be. Their responses to the surveys were also rechecked. Memo writing provided me with the opportunity to process my emotions that were present before, during and after each interview. Having this outlet helped me remain more objective, and also aware of how my own emotions intersected with the participants.

During the coding process, memo writing was used to help further develop codes and subthemes. Initially Atlas TI was used to help with the process. Other areas that were journaled included my thoughts and responses to the traumatic information shared, and reflections during recruitment, after consent, and after the interview, to explore emotional responses, triggers, and reflections pertaining to the interview questions asked.

Summary:

In this mixed methods phenomenological study the first part of the research included a survey of 30 young adults. The survey consisted of the RSYA and additional questions as to whether or not they had ever participated in PMT. The point of the RSYA was to help define whether or not those who participated in PMT had a higher resiliency scale.

10 participants from the initial survey portion were invited to participate in a semistructured interview about their PMT experience. These interviews lasted up to an hour and took place either in person at a secure location, or virtually via a HIPPA supported zoom platform. The major codes developed from the qualitative interviews and included the following. The first theme was experiences with PMT. This theme introduced the topic of PMT, and the variety of ways it can look to different patients., as well as how it was experienced by the participants. A participant example is “that shit broke me wide open”. The second theme was external treatment systems. This theme noted the various treatment experiences that the participants had prior to PMT. A participant example of this was “you know the policeman's got to have his paws all over us even if that means treatment”. The third theme was feeling states. This theme explored the relationship between feelings and the participants' experience of PMT. A participant example of this was “I felt that shit, man”. The fourth theme was around musicianship. In musicianship the participants explained whether or not they had any previous musical experience, and how that helped or hindered the PMT process. A participant shared “I thought they were a damn hippie fool, but shoot, that music changed me, and now I be jammin”. The fifth theme was relationships. This theme explored not only the relationship the participants had with their PMT therapist, but also other individuals in their lives. A participant example of this was “Heard I’m not salty no more, so I’m counting that as a win”. The sixth theme was traumatic

loss. Traumatic loss focused on how the various losses participants experienced manifested and impacted their PMT experience, as well as their connection and interactions with their PMT therapist. A participant example of this is “Didn’t think I could ever get past losing him, still don’t think I can, just trying to stay on the outs”. The seventh and last theme was view of self. In this theme the participants explored their view of themselves both during PMT and at present. A participant example of this was “turns out I’m fucking smart”. These themes provide a narrative around the lived experiences of inner city young adults and how they experienced PMT.

Findings and Implications

Psychodynamic music therapy was a vitally important treatment modality for the innercity young adults interviewed for this study. Based on the results of this phenomenological mixed methods study, the findings, and implications of this will be discussed below. The primary question this research aimed to explore was the relationship between experiencing PMT as a young adult and levels of resilience, as well as to examine the therapeutic relationship in PMT in connection with resilience. The focus was on inner-city young adults between the ages of 18-26. Specific questions to be answered included the following:

● What aspects of PMT, if any, do inner-city young adults identify as beneficial and why?

● How do inner-city young adults who have been through PMT view their relationship with their therapist?

● Does PMT help build resilience in inner-city young adults?

● Does PMT impact their relationships, and if so, in what ways?

● What challenges, if any, did participants identify when discussing their PMT experience?

Further, a quantitative research measure was used to see if there were any notable differences in resiliency levels of young adults who have participated in PMT compared to those

who have not.

Below is a list of four key findings that emerged from the narrative data themes and the research question (s) to which they relate.

● PMT was an unexpected, positive experience: All of the participants in the qualitative portion of this mixed-methods study had participated in PMT. The participants shared openly what they found beneficial about PMT. This finding directly relates to all five of the research questions.

● Trauma was a shared experience among the PMT Participants: Trauma emerged from two sources for the research participants -1) external treatment systems and 2) personal losses. The participants’ previous involvement in external treatment systems outside of PMT was a primary reason why the participants responded to PMT in the way that they did, as they endorsed their previous treatment experiences were traumatic. Further, participants differed in the nature of the traumatic losses that were processed during their time receiving PMT. However, all shared that PMT provided a supportive environment that allowed them to address their losses. Again, this relates to what aspects of PMT they found beneficial, the nature of their relationship with the PMT therapist, how PMT impacted their relationships, and if PMT helped them build resilience.

● PMT Served as a Psychological Third Space: The music and the relationships the participants had with their therapists created this “third” space where the clinical work of PMT was done. The participants differed in their experiences of either entering PMT with extensive musical experience, or none at all. They explored how “musicianship” impacted their ability to engage in PMT. In addition, relationships seemed to be impacted for participants not only during their time participating in PMT, but also on an ongoing

basis. This finding relates to the questions about whether their relationships were impacted by participating in PMT, as well as how they viewed their relationship with their PMT therapist at the time and aspects of PMT that were challenging or beneficial.

● PMT served as a means of emotional regulation and development of one's sense of self and resiliency: The participants identified a wide range of internal feeling states as well as feelings about the self while participating in PMT. Additionally, when comparing the results of the quantitative measure of resiliency between those who had participated in PMT and those who had not, the participants who had been involved in PMT appeared to have more developed levels of resiliency. This finding relates to the research questions pertaining to aspects of PMT they found beneficial, its impact on their relationships, and their relationship with their PMT therapist, as well as whether PMT helped build resilience.

Below, each finding will be discussed in relation to various psychodynamic theoretical concepts that help to interpret the findings.

PMT was an unexpected, positive experience.

The theme, PMT was an unexpected positive experience, presented in the participants’ narratives about the extenuating circumstances that led to their PMT involvement, their experiences as PMT patients, and their relationships with the therapist. All 10 participants highlighted aspects of the process they found challenging yet unexpectedly beneficial. Participants reported benefits tied to PMT, including cathartic emotional releases and opportunities to act in a spontaneous and free fashion. They each highlighted the crucial role the therapist played in creating a space conducive for improvisational and expressive experiences.

Therapists were described as using both musical and verbal interventions to facilitate a process participants believe enhanced their resiliency.

Wally explained that “the PMT lady man, I didn’t know what to think, they were solid, they let me just pound it out and it first I didn’t like that shit, seemed like it couldn’t be trusted, but over time, I realized that fool and his drums weren’t going no where, and that's when it got real”. Mel tried to make sense of her PMT referral by pushing the boundaries. She described her experience by saying “you know I just wasn’t used to it, the CMH people nothing I said was safe, and would show up in court, so I’d just shut down and get full of rage and freak the fuck out, but she was steady and would remind me that I was safe”. After Amy was referred in an attempt to get her to participate more in court ordered therapy she remembers “I went to it wanting to make the system pay, I didn’t want them to notice any kind of difference, but damn it was the music part that helped me chill the fuck out”. Ethan recalls the time that his PMT therapist comforted him as he processed his loss “I wasn’t expecting it. I was sharing some fucked up shit, and I thought, damn this will do it, I’m getting kicked out. But then he just said I’m sorry that happened to you. Shit that made me start feeling all the things man, all them”.

Elena describes how PMT was initially frustrating due to the nature of her injuries but eventually she experienced a sense of release] . She stated “she came into my room and I had all the burn bandages on my hands and offers PMT and I yelled at her like bitch can’t you see I can’t use my fucking hands. And then she regrouped, and when she started letting me tell HER what to sing. Shit, that was free as fuck”. After years of court ordered therapy in foster care, Sara found PMT an unexpected experience. She explained “it was like I knew what to expect CBT triangles, emoji sheets, and then here comes songwriting and instruments, and that was like nothin else”. Even though Alex was referred to PMT while incarcerated at a juvenile detention,

he still found the intervention freeing “I didn’t do no music shit before JDF, but those song writing jams, that's when I could write about the shit that had happened, and damn that was powerful”. Finally, Alexis describes her journey with PMT as freeing because “I was so used to treatment, you go through life with sickle cell, and you’re kinda forced to talk to people, but something about her was different. Connecting with music again, being able to speak my truth outside of my treatments, damn that was nice. I was free to be me, I won’t forget that''.

Freud's theories on free association offer a frame for Wally, Mel, Amy, Ethan, Elena’s, Sara, Alex, and Alexis’s experiences of spontaneity within the process. Free association, for the purposes of this discussion, is defined as the way in which “one passes spontaneously from one idea to another in the psychoanalytic setting and the connections between free association, psychic functioning, psychopathological disorders, and the therapeutic effects of the psychoanalytic treatment” (Frontiers, 2020). Freud also recommended that both the patient and therapist have a mindset of “free floating attention” in order to access unconscious material. In this way, analysts might use their own unconsciousness to decipher the unconscious of the patient. The participants described experiencing a sense of spontaneity in session, when they played music in a free-form manner. The findings of this study suggest that the improvisational nature of the musical component of PMT enhances both participants and therapists’ overall freedom in the clinical space

Emily’s testimony highlights how the unexpected nature and unknown aspect of PMT helped her engage therapeutically. “It was just different, everything happened so fast, and when they described it to me, PMT didn’t seem real. But shoot, that was my space, I could share my feelings without fear, and talk about him, and my self harm thoughts, and be ok, it was the music shit that did that, and the lady, and fucking me”. The lack of expectations and familiarity with

PMT, allowed the participants to approach their PMT experiences without bias or preconceived notions about the treatment protocol. Juliet Alvin, one of the founders of PMT stresses the importance of developing the client’s musical relationship as the key to successful therapeutic process and outcomes. This musical relationship is built through the gradual introduction of a variety of musical interventions over time. She also considers the therapist’s main instrument as the “primary means of communication and interaction” (Wigram, Pedersen, & Bonde, 2002, P. 132) and used a method of empathic improvisation in relation to the client’s way of 'being’ in music therapy (Alvin, 1974, 1977, 1981). Alvin believes that music provides potential space for free expression and musical improvisation, like free association in psychoanalysis . Alvin's notions highlight not only the pivotal role of the PMT therapist but also the way empathic improvisation and music helps create the therapeutic alliance and understanding between the patient and the PMT therapist. Her ideas illustrate how the musical element of the therapy helps the patient not only more openly speak to the therapist, but also acknowledge their emotions and traumas themselves . In summary, each participant expressed the freedom they felt in PMT in the following ways:

● Wally: “It was like all of a sudden I was going ham on some drums, and I knew I was free to say what ever the fuck I wanted”.

● Mel: “For the first time I didn’t have to deal with shitty court ordered therapy, and I had the right to do and say what I wanted, I was free from the judge. That shit was sweet”.

● Amy: “ Playing music like that made me feel free as fuck man”.

● Ethan: “I get that I was on probation and in lock up or whatever, but until the music lady came, whatever I said, could be used against me. But I was free to say whatever I wanted about the charges, probation, those racist assholes”.

● Elena: “Well being in the hospital like that, I was trapped. Couldn’t get out of the damn bed, just had to take the treatments. And even when I didn’t feel up to it, I was free to feel. She was just there”.

● Sara: “It seemed weird at first. To just pick up instruments. Didn’t expect it to come out of me like that. It was freaky, but once I got used to it, and knew I could trust that it was a safe place. I felt free to be me”.

● Alex: “Once I got used to the idea that like, my family wasn’t my family anymore, and that I was me, my PMT stuff got angsty, but I was free. I was out. I was Alex”.

● Max: “Well when I started I felt trapped and alone, I had been outed, and exploded at school. I didn’t know I could get that angry. But the more I just kind of leaned into the music or whatever and knew the PMT person wasn’t no snitch I could freely just release the rest of the rage”.

● Alexis: “I wasn’t new to therapy, having sickle cell, I grew up in the hospital at that time, and I was used to how they wanted me to do therapy. But when that lady just kept coming in there, and she knew I needed time. I realized that she wasn’t fucking around, she cared, and I could say what ever the fuck I wanted freely, and it wouldn’t come back to my treatment team”.

● Emily: “With how everything went down at school, it didn’t seem like anything was safe. She even called me out once, about wanting to hear my real voice. I realized that she wasn’t like the other btiches that were scared by my feelings, in her weird music room, I was free”

The role of the PMT therapist is very similar to the work of a traditional psychotherapist, except for their use of music. A PMT therapist has not only advanced psychoanalytic training, 160

but also advanced musical degrees. A PMT can use their knowledge of music and the psyche to help further support patients in therapy. Florence Tyson was the original American PMT therapist who focused on the psychodynamic orientation to music. She viewed music as “the only bridge from inner world to outer reality” (2010, p. 94) and felt that the music therapist should use music to explore and deal with the inner reality of the client (Tyson, 1981,2010). An example of this was when Alexis described how PMT allowed her to connect with split-off feelings about her illness.

Tyson additionally viewed the role of the music therapist in relation to the client in terms of how they cope with regression. In PMT, regression is viewed as a time of transition in the treatment when due to the presence of the music, the defenses are lessened, and the patient and therapist can process less conscious material. According to Tyson, regression was to be seen as an essential process in PMT for patients with mental health problems. She felt that not only does the improvisational nature of music help assist in fostering safe regression, but also in demonstrating the safety and security that can be found in the role of the therapist . Tyson shares that the role of the “music therapist is to not only be aware of the patient as a whole person and of the fact that each interpersonal contact may have immediate and crucial implications for the patient's total life situation, but that also at times might manifest as regression” (Tyson, 1968).

Tysons notions of regression coincide with Ethan’s emotional upheaval he experienced once he began to participate and display vulnerability in his relationship with his PMT therapist

Understanding the participants experiences with PMT helps answer all of the research questions:

● What aspects of PMT, if any, do inner-city young adults identify as beneficial and why?

● How do inner-city young adults who have been through PMT view their relationship with their therapist?

● Does PMT help build resilience in inner-city young adults?

● Does PMT impact their relationships, and if so, in what ways?

● What challenges, if any, did participants identify when discussing their PMT experience?

The participants all endorsed the unexpected combination of instrumentation, song writing, and the role of the PMT therapist within PMT as the aspects of the therapy model that were the most beneficial. These elements were reported by all 10 participants due to the way that it provided a sense of safety, helped build trust, and allowed them to be heard and validated. Every one of the interview participants viewed their relationship with their PMT therapist as a surprisingly safe, constant, consistent presence.

Trauma was a shared experience among PMT participants

The theme, trauma was a shared experience, surfaced in the narratives about the traumatic experiences participants went through in previous external treatment systems, as well as how important it was to the participants to have PMT as an alternative form of support. All 10 participants were unanimous in their opinion that their experience with other types of mental health treatment was traumatizing. In addition, all of the participants endorsed suffering a

variety of traumatic losses in their personal lives outside of treatment. The participants differed in the nature of the traumatic losses that were processed during their time receiving PMT. However, all shared that PMT and their relationship with their therapist provided a supportive environment that allowed them to address their losses.

The external treatment systems that created trauma identified by the participants were: foster care, probation, juvenile detention facilities, hospital systems, school counseling centers, and shelters. All 10 participants were unanimous in their opinion that their experience with external treatment systems was traumatizing. For the purposes of this study traumatizing is defined as an event or situation that overwhelmed their ability to cope emotionally. Ranging from Wally: “Those JDF fuckers didn’t care that I had taken the fall for someone else, I was just another fuck up”. To Max: “I had lost everything, came out, and my parents kicked me out. The shelter was great, but they didn’t give me time to feel or deal with my feelings, they just threw me in job training and called it a day, didn’t fix nothin”. To Elena within the hospital system:

“CBT triangles weren’t going to fix missing my uncle's funeral, or the fact that I was never going to be able to break dance again”.

This finding relates to the following research questions:

● What aspects of PMT, if any, do inner-city young adults identify as beneficial and why?

● Does PMT impact their relationships, and if so, in what ways?

Elena expressed: “I started PMT when I was dealing with a big fucking loss, I mean I lost the use of my hands, and like the PMT lady showed, up and helped me regroup and figure out that my life wasn’t fucking over”. Wally reflected that that: “Being in lock up was hard enough, but GP going down, I didn’t think I could ever get past losing him, still don’t think I

can, now I’m just trying to stay out the outs, I know I can do it now”. Emily shared: “My loss forced me into PMT, but she got my ass back into shape, it’s like over time I just kinda learned that I was gonna be alone, couldn’t bring him back, but I didn’t have to try and off myself to cope no more.”

Bowlby’s theories on attachment and human behavior offer a frame for the participants' experiences of loss and early childhood trauma within their relationships. He emphasizes the ways in which the actual events and conditions of relational life “in early childhood shape working models or representations of self and attachment figures that continue to guide functioning” (Borden, 114). The findings of this study suggest that the PMT’s awareness of the participants' early traumatic attachment experiences created greater attunement in the PMT experience, as evidenced in the participants willingness to continue to participate in sessions. PMT therapists are trained to think dynamically, in addition to their work as music therapists. Therefore, a major part of the initial treatment process entails assessment and consideration of how previous losses and traumas could impact the treatment relationship. With this awareness, the PMT is better able to examine the interactions of the patients past relational experiences, with how they relate to the PMT therapist in the present. The PMT therapists were able to address the losses more directly though the use of musical interventions, in a way that was not as emotionally overwhelming. Emily’s experience supports this as she shares “I wasn’t able to say good bye, talking about it just felt like punching me in the stomach, and that was a shitty feeling, but when I was singing about it, and using the drums in her drum circle it felt ok to go there, like I could go there and not go fucking postal afterwards”.

The findings suggest that PMT assisted the participants in coping with their traumatic experiences. It was reported by all of the participants that PMT provided a sense of safety and

trust as they processed their traumas. The elements of safety that were reported by participants included:

 Wally: “I was an asshole, but the PMT person, they didn’t flinch, that made me feel legit and solid”.

 Mel: “It helped knowing that she wasn’t going anywhere, and that what I was saying wasn’t too much”.

 Amy: “Sometimes it all felt like too much, but she’d remind me that what happened was shitty, that that even if I felt like I was drowning I’d make it”.

 Ethan: “I was fucking pissed, sometimes I’d go off, and she would just like keep me in line without being a bitch about it”.

 Elena: “The hospital I knew what to expect, but I didn’t expect her. I told her about some deep shit, and she reminded me that the urges would pass, that helped a lot”.

 Sara:”It was kinda like I was used to people fucking me over, it felt weird to have someone care like that, but knowing she wasn’t going no where, then I knew it was ok to share stuff.

 Alex: “The music was safe. I listed and wrote some douche bag stuff, but once it was out I was set”.

 Max: “I was me, I was out, I could sing my pronouns, it was safe to be me for the first time”.

 Alexis:” Having sickle cell, I don’t feel safe in my body, and in the hospital it isn’t always safe to say that, cause then they’ll psych you. But the PMT lady she let me say the shitty fucked up stuff and that felt good”.

 Emily: “She knew about the self harm, but yet it felt ok and safe to talk about it with the PMT person. With the school therapist she fucking judged me every time I mentioned it. It seemed safeish to talk about it there”.

Additionally, every one of the interview participants viewed their relationship with their PMT therapist as a surprisingly safe, constant, consistent presence, which was vastly different from their previous treatment experiences. This sense of safety was related to the fact that the PMT therapist was outside of the previous treatment environments they were a part of, the music served as a coping outlet, and that the PMT therapist remained stable, where as many of their other therapists changed due to staffing turn over.

PMT Served as a Psychological Third Space

The theme PMT Served as a Psychological Third Space surfaced in the participants' narratives about their levels of musical ability prior to entering PMT and how that contributed to their ability to engage in the model. Despite the varying levels of musical ability, all the participants found that the musical element of the model helped them therapeutically engage. Participants reported that they felt the music helped them connect with their therapist more intimately. This finding suggests that a psychological third space can be created between patient and PMT therapist.

This relates to the following research questions:

● What aspects of PMT, if any, do inner-city young adults identify as beneficial and why?

● How do inner-city young adults who have been through PMT view their

relationship with their therapist?

Amy noted “I thought I knew what to expect, I knew a few things about music, but that didn’t matter. It was music in a different way, and fuck it was powerful”. Ethan movingly verbalized that he had no prior music experience but by the end of it he considered himself a rapper and writer and is still pursuing that avenue to this day: “Ya know, we’ve been at this a while, so you won’t be surprised but like I don’t know, I thought music was just for the rich kids, I didn’t have a whole lot of hope. But shoot, the PMT peeps they taught me about beats and the shit just started pouring out, and then I was jammin man. Still rapping a bit. Don’t think I’m gonna be famous or nothin, but my music on tik tok, PMT did that”. Sara explained that it was her relationship with the PMT therapist that made the difference in her view of musicianship: “ I was tired of therapy, and knew what to expect, I was also pissed I had to be in another kind of therapy. I liked music and thought another therapist was just gonna ruin music for me. But she was steady, and repeatedly just kind of showed up, even though I was a bitch, there was something about her that made me feel safe, and that helped me share some of the fucked up shit I had been though when we were playing. I’m a mom now, but he’s gonna a play a fucking instrument, I’ll be sure of it”.

Music therapy creates a third space in treatment in which musical communication jointly creates a new shared reality between patient and therapist. Ogden (1983, 1979,1994, 1997) defines this notion of “thirdness” as the meeting of subjectivities between patient and therapist and the space that could be co-constructed. He proposed that the ” dialectical movement of individual subjectivity (of the analyst and analysand as separate individuals, each with his or her own unconscious life) and intersubjectivity (the jointly created unconscious life of the analytic pair)” (Ogden, 2004) creates the analytic third. Therefore, the analyst's experience in and of the

analytic third is, primarily utilized as a vehicle for the understanding of the conscious and unconscious experience of the analysand.

For the purposes of this study, Ogden’s notions of thirdness also helped define the relationship between the PMT and the patient as they are creating the music together. This phenomenon, music as thirdness, was carried over into their relationships outside of the music. This finding suggests that the triadic relationship between the client, PMT therapist, and music, in its variety of combinations, gave the young adults another form of communication in which they were able to relate not only to themselves or the therapist but to the outside world.

Participants also reported that following their PMT experiences, they were able to apply skills created in PMT to their relationships outside of the treatment room. Wally shared: “Just keeping it real man, the PMT person was my only relationship. I was getting the PMT because I had lost my relationship when they got their assess gunned down. I’m on the outs now, wouldn’t say that I’m rolling in the friends or whatever but I’ve got a few good ones”. Max reflected on their experience: “When I started PMT, I had lost everyone, my parents kicked me out, and I was outed at school. It was rough. I didn’t think I would have friends again. So safe to say my relationships were impacted. But the PMT lady, she helped me rebuild things. I sang some fucking ragers man, once I got my angst out, it took a while but I’m cooler with people now. Alex felt that “PMT was like my relationship, and kind of scrapped off my salt haha. My mama told me when I had a day pass that I wasn’t salty no more. I think it's cause I spent all that time drumming, I would just rage and scream and the PMT lady would take it. That got my relationships back I think”.

Jessica Benjamin (2007) definition of the third space in literature as the “analytic position

of compassionate witnessing, can only be reached through this experience of bearing pain and shame”, helps define Alex’s experience referenced above. Witnessing happens in the third space through the therapist emotionally “feeling the experience of the other as a separate yet connected being with whom we are acting reciprocally” (Benjamin, 2018). This notion of third space is relevant to the study theme of relationships as it focuses on the importance of witnessing patients' shared experiences. The findings of this study suggest that by the participants creating music together with their PMT therapist within the “third space” in the analytic interaction, their therapeutic alignment was able to deepen, leading to improved relationships overall.

PMT Served as a Means of Emotional Regulation and Development of one's sense of resilience.

The theme PMT Served as a Means of Emotional Regulation and Development of One’s Sense of Resilience surfaced in the participant's narratives about how PMT evoked a wide range of emotions and also a greater understanding of themselves. As noted in the previous finding, the participants' PMT experience was entirely different than any of their prior treatment experiences. The participants were unanimous in identifying a wide range of feeling states while participating in PMT. This finding relates to the following research questions:

● What aspects of PMT, if any, do inner-city young adults identify as beneficial and why?

● Does PMT impact their relationships, and if so, in what ways?

● How do inner-city young adults who have been through PMT view their relationship with their therapist?

● Does PMT help build resilience in inner-city young adults?

Mel shared “It was the music that did it, ya know. It wasn’t just another white lady staring at me, I mean she was still white, but the music it made things different. That spoke for me, and that was enough”. Alexis reflected on how PMT caused tension for her within her family at times during her treatments: “It was like the more I got my feelings out, the more pissed the fuck out I got with my folks because they thought they were protecting me from shit, but really they were just being petty, and thinking I was fragile or some weak shit like that”. Ethan attributed his relationship with his PMT therapist as the reason why he didn’t continue to get write ups for behavioral outbursts while locked up: “My dude just kept showing up, and letting me rage, and there was something about that guy and how he was just steady, that made me feel the feels. I felt that shit man!”. Lastly, Emily shared how PMT gave her the tools to process her loss and suicidal ideations, leading to her breaking the self-harm cycle: “You know it didn’t happen all at once. I was a goddamn mess, but the music let me kind of throw up the feels and dark thoughts, and then overtime between the PMT lady and the jams. It was like overtime I was able to get it out, and not be a hot mess express, still using the lame coping skills song to this day, but don’t tell my friends haha”.

PMT Researcher Kirsten Halliday (2017) in particular was able to qualitatively demonstrate that “ PMT had addressed the angry, fearful, and omnipotent infant part of himself, and that it had helped to contain and manage it” (p.111) post-PMT treatment experience. This is reflective of what the participants shared about their ability to use the music to contain “the feels' ' and learn to regulate more effectively. In another study, Albers et al. (2017) developed an improvisational music therapy intervention based on insights from theory, evidence, and clinical practice for young adults with depressive symptoms. Their study found that using synchronization and emotional resonance is a promising music therapy technique to improve

emotion regulation and, in line with their expectation, reduce depressive symptoms. Emily specifically was able to attribute the use of improvisation music therapy interventions with what allowed her to begin to regulate and discontinue self-harm behaviors, thus leading to a greater sense of resilience. The findings of this study suggest PMT as a therapeutic intervention in combination with established therapeutic rapport with a PMT therapist aided in not only greater emotional regulation but in also increasing overall emotional resilience.

The participants also reported that they began to think of themselves in a more positive light as they participated in PMT. Wally shared: “Shit by the end of it, rather than thinking that I had just fucked up and taken the fall for no reason, I remember thinking turns out I’m fucking smart, the jams and the raps and all that, it changed things”. Mel reflects on her PMT work and view of self: “So like for the longest time I was just foster care Mel, it was no use I was another number in the system. But I started to get that shit out, and kind of gave a fuck. I still question a lot, but like know I’m worth something, and I’m free of the shit hole foster care system”. Alexis shared “I know I’m always gonna be sick, I’m always gonna be another person of color with sickle trait, and I missed out on stuff, but ya know what, fuck society. It don’t have to be like that, I know better, I know who I am”.

Recent research about inner-city young adults can support the findings about why PMT was so supportive of the participants' exploration of their view of self. Holmes (2017) reviewed developmental research using clinical cases and found that the self-reflection, relationships, and agency created by resiliency are crucial to surviving adversity. This supports the findings of the theme as all of the participants shared that when they presented for PMT when their previous resilience/adaptive strategies had failed.

In another study, Maginness (2007) and Stavrou (2018) demonstrated in their research that the field of mental health needs to be more open to understanding an individual’s capacity for resilience as coming from a dynamic system that is set in both the past and the present. As well as if there is a therapist or safe therapeutic medium present the patient will be able to “identify themselves with a new identificatory target and can therefore integrate the values or ways of being that the identificatory target manifests in his/her everyday life” (321). The findings of this study suggest PMT has the capacity to contribute to participants' sense of resilience on an ongoing basis.

Lastly, in a recent mixed methods study, Metel et al. (2021) sought to assess whether or not there is a connection between neurocognitive and personality underpinnings of resilience in young adults prone to psychosis. A correlational analysis was conducted to verify the relationships of resilience with neurocognitive and personality measures, and a hierarchical multiple regression model was built to explain the predictors of resilience. Ultimately the study found that lower resilience predicted higher severity of the total CAARMS score but was not related to positive symptoms. Cognition, personality, and depressive symptoms affected resilience, and that the strongest predictor of resilience was the severity of depressive symptoms. Metel et al s research relates to the findings of this study due to its examination on the impact resilience has on personality style and psychological functioning.

Field Note Reflections

During the analysis of my findings, I realized that the field notes provided some additional interesting theoretical information. In review of my field notes there seemed to be a sense of deprivation from the participants both physically and relationally. Many participants

were very focused on the food stipend and made requests ranging from family sized pot pies with tin foil, to diapers and baby food as a way for me to demonstrate my trust and willingness to follow through on their voiced requests. The structuring of my interview process seemed to create a nurturing holding space (through the providing of food and necessities) that allowed the participants to speak openly and provided them with different corrective experiences then they had before with previous providers.

Broader Implications for Social Work

Due to not only the lack of PMT research, but also the lack of research focusing on the resilience of inner-city young adults, there are broader implications for social work and its practice. In particular, this study indicates how PMT provides inner-city young adults with a different way to communicate therapeutically, leading to positive relational outcomes. From a social justice standpoint, the mezzo or macro level activist or practitioner could begin to advocate for greater access to PMT in inner city environments, as well as to obtain greater insurance coverage for PMT related services.

At the current time, PMT and music therapy is not covered by private insurance, or Medicaid. Only in rare circumstances will the service be covered under an autism subsidy, but the sessions are very limited. Until there is widespread healthcare reform for the insurance coverage of creative therapies, this vital service will not be accessible to inner-city young adults. This is an opportunity for the social work field to advocate for further allocation of health insurance funding and increased reimbursement rates for the service.

From a practitioner level, inner-city young adults may be more comfortable communicating musically initially due to power differentials, and stigma associated with the

mental health system within their communities. While meeting the client where they are at and providing non-judgmental PMT services might take more time initially, it will decrease the chance of therapeutic resistance between patient and therapist. Additionally, having access to PMT would give patients the opportunity to engage in a psychological service that is not impersonal and manualized, typical of the community mental health system. Furthermore, it is recommended that therapists begin to research and acquaint themselves with PMT as a potential external referral, and work to network with PMT clinicians in the area, for more comprehensive, collaborative, and empathic care.

Limitations

One of the major limitations of this study was the lack of PMT services in inner-city Detroit where this study took place. It was incredibly difficult to find practices in the area that were able to connect me with PMT practitioners to begin the recruitment process. Second, due to the various power differentials (racial, academic, age, gender) and societal and socioeconomic stressors facing the study population not only directly but for generations prior, the recruitment process took a great deal of time, rapport building, and networking in inner-city Detroit within popular young adult spaces. Third, this research was limited to a small geographic area, of innercity Detroit, and therefore results depict only a small slice of a much larger society, making transferability limited. Lastly, these findings were solely analyzed from a psychoanalytic perspective, and could potentially also be looked at from different theories such as trauma and attachment.

Suggestions for Future Research

A larger mixed methods research study focusing on inner-city young adults during their

active participation in PMT would be indicated. This study could focus on RSYA scores pre, during, and post PMT treatment. It would also be interesting to explore how this would look differently based on what inner-city environment the study is taking place in. This multi-site addition would provide a richer data set. It would be recommended that multiple interviews take place not only with the PMT participant, but also the PMT clinician as well, to explore the progression of the therapeutic relationship between PMT participant and PMT clinician.

Research into how gender and racial differences are expressed in PMT interventions, and instrumentation of choice would also be indicated. There has been little research on how or if racial/gender differences could present differently musically, or in the selection of participants' instruments during PMT sessions. On that same note, further research into how the participants feel about being a PMT participant could be explored. Lastly, increased research focusing on psychodynamic therapy, is vitally important, as at the current time psychodynamic therapy is seldom provided to patients with Medicaid health insurance, residing in inner city environments.

There was conflict within the literature reviewed, as to who can benefit from PMT. A segment of the literature reviewed felt that PMT should not be provided to those acutely going through trauma, however most of the participants in this study found that PMT helped them not only cope with the trauma they were actively experiencing, but also cope with it more effectively in the long run. Therefore, there is an opportunity for future research to explore who can benefit from PMT, when, and why.

Additionally, as telehealth therapy becomes more normalized in this post COVID-19 reality a study comparing PMT modalities traditionally and adapted to telehealth would be indicated. If a similar creative therapy (such as art therapy) was explored as a control, it would

be easier to explore the specific strengths and worth of the PMT therapeutic relationship. It should be added that oftentimes manualized, short-term treatments are prioritized with inner city young adults over psychodynamic treatments, this treatment barrier should be further investigated in future research. Finally, research into how the introduction of PMT post traumatic incident, and how that impacts recovery is an opportunity for further research. As noted earlier in this chapter, despite the small sample size all the PMT participants in this study endorsed experiencing traumatic loss, and PMT assisting in their recovery around said losses. Which is indicative of a potential correlation between trauma recovery, and PMT as a treatment modality.

Summary

This research attempted to answer the broad-based question “How does psychodynamic music therapy (PMT) impact inner-city young adults? PMT impacts inner city young adults first and foremost through its use of music as therapeutic modality. Music is the only universal language, which allows for greater therapeutic attunement between therapist and patient within the treatment space. In closing, this study suggests that PMT impacts inner-city young adults positively by allowing them to explore, play, and recreate their view of self and inadvertently increasing their overall sense of resilience, as evidenced not only qualitatively but also quantitatively.

Concluding Thoughts

Sharing intimate, personal, at times traumatic experiences on the part of these incredible inner-city young adults required not only an element of risk given the confidential material they were sharing but also a willingness to be vulnerable, even though societally they have been taught not to display such tenderheartedness. I as a researcher was honored to bear witness to not

only their vulnerability, but also tremendous courage. This study has only further amplified my passion to not only continue to provide clinical services to this incredibly deserving yet underserved community, but also continue to conduct research reflective of the beauty, vulnerability, power, intelligence, strength, and resilience of inner-city young adults. My hope is that more and more participants begin to speak, play, and sing their truths on their path to empowerment. For the healing is not only in the song, but in the relationship as well.

Appendices

Approved by Institute for Clinical Social Work IRB

Research Participants Needed:

Ph.D. Candidate seeking participants for study being conducted on resilience

Participants will receive:

 $25 amazon gift card for survey or interview completion

 Snacks/refreshments

 Transportation stipend

Location/Format:

 All sessions will occur in Detroit, MI, or via telehealth based on participant preference.

 This study is a short survey and for select participants an interview.

Are you Eligible:

 Between the age of 18-26

 Lived or living in an urban/inner-city environment

 Have participated in psychodynamic music therapy (if yes, you will be asked to complete a survey and interview)

 Have not participated in psychodynamic music therapy (if yes, you will be asked to complete a survey only/no interview)

If you have any questions, would like to learn more, or enroll contact the primary investigator: Claire Haglund, LMSW, MMT (248)-635-3163, chaglund@icsw.edu

Demographic Collection Sheet: Circle Appropriate Answer

Gender  Male

 Female

 Gender Queer

 Trans 

Age:

Ethnicity:

 American Indian

 Caucasian

 Black/African American

 Middle Eastern or North African

 Hispanic, Latino(A), or Spanish Origin

 Native Hawaii or other Pacific islanders.

 Multi-Racial

 Other:_______

Current Location:

Childhood Location :

Type of Employment:

 Rural

 Urban

 Suburbs

 Zip Code:________

 Rural

 Urban

 Suburbs

 Zip Code: ______

 Student

 Unemployed (looking for a job)

 Unemployed (not looking for a job)

 Self Employed

 Full-Time

 Part-Time



Household Income:

Marital Status:

Furloughed/Laid Off

 $0-24,999

 $25,000-49,999

 $50,000-74,999

 $75,000-99,999

 $100,00-149,000

 $150,000-More

 Single

 Divorced

 Engaged

 Married

Number of Children:

Do you have previous therapy experience (social work, counselor, music therapy, group therapy)?

 Yes, the type was_____________

 No

Resiliency Scale for Young Adults (RSYA)

Here is a list of things that happen to people and that people think, feel, or do. Read each sentence carefully, and choose the one answer (Never, Rarely, Sometimes, Often, or Almost Always) that tells about you best. Please try to answer every question. There are no right or wrong answers.

1. I always try and look on the bright side

2. People say that I am easy to upset.

3. My life will be happy.

4. I can forgive my family if they upset me.

5. I can make major changes in my life when I need to.

Institute for Clinical Social Work

Research Information and Consent for Participation is Social Behavioral Research

Psychodynamic Music Therapy with Inner-City Young Adults

I,_____________________________________, acting for myself, agree to take part in the research entitled Psychodynamic Music Therapy with Inner-City Young Adults

This work will be carried out by Claire Haglund, LMSW under the supervision of Dr. Denise Duval Tisoles, PhD.

This work is being conducted under the auspices of the Institute for Clinical Social Work; At St. Augustine College, 1345 W. Argyle St., Chicago, IL 60640; (773)935-6500.

Purpose

The purpose of this study is to discover the critical factors of psychodynamic music therapy and its impact on inner-city young adult resilience. This study seeks to interview inner-city young adults who have experienced psychodynamic music therapy and assess and measure their overall sense of self-resilience using a measurement tool. The researcher will then review the information provided by participants to help create a theories that could be used to improve social work practice and/or social workers in the field.

Procedures used in the study and duration

Participants in this study will be assigned to 1 of 2 groups:

 Those who have participated in psychodynamic music therapy (if yes, will be asked to complete a survey and interview).

 Those who have not participated in psychodynamic music therapy ( if yes, will be asked to complete a survey no interview).

The survey completed is RSYA (Resilience Scale for Young Adults), and the interview will take up to one hour. During the interview participants will be asked to share their thoughts on their experience with psychodynamic music therapy by using a four-question interview guide. Participants of either group will be provided a $25 amazon gift card in gratitude for their participation.

Benefits

This study aims to add to the existing literature on working with young adults living in an innercity environment and using psychodynamic music therapy as an intervention. Participants will benefit by having an opportunity to contribute their thoughts and experience to the ongoing dialogue in the field about this area of practice. The interview will also provide a dedicated time to think critically about their PMT experiences and allow participants to reflect on their sense of self-resiliency.

Costs

The only cost associated with participation is the one-hour time commitment to undergo the interview. To the extent that it is possible, participants will be interviewed in a secure environment of their choice. The researcher will travel to the participant. If a participant is not able or interested in interviewing in their office, the researcher will offer to conduct the interview virtually in a secure setting. In this case, the cost will be of time in transit to the chosen interview site. Bus cards will be provided.

Possible Risks and/or Side Effects

Reviewing past experiences in therapy can be emotionally challenging. The nature of this discussion is an inquiry into the participant’s experience with PMT and their sense of self resiliency within their environments. Thus, participants revisiting past experiences can be strenuous, stressful, disheartening, or even confusing. This is unlikely to cause any significant distress. However, if discussing their thoughts and personal material significantly overwhelm a participant, the researcher will offer to terminate the interview and provide a referral for professional consultation or psychotherapy.

Privacy and Confidentiality

Each participant will be assigned a research code. The convention will be the research participant gender (M/F/O) number of participants in the study. For example, F1, M7, 09. A list of the corresponding participant’s names and contact information to this list will be held on an encrypted hard drive and deleted upon completion of the project. The reason for maintaining an identifiable list is that the researcher may need to contact the participant with a follow-up or clarifying question. Participants will be encouraged to share confidential information about their PMT experiences. Participants will be notified that their examples may be used in the final report of this study. Participants will be asked to conceal the identity of their family members/clinicians in a manner that is consistent with professional practices in writing about patients. These

methods may include: using an alias for the family member/clinician, changing the gender, age, and other identifying information in a manner that does not compromise the clinical utility of the communication. In situations where there is concern about patient confidentiality, this will be discussed directly with the participant. All transcripts and working documents will be stored on an protective hard drive. All personal notes of the researcher and printed documents will be held either on an protected computer hard drive or in a locked file cabinet. These records will be kept for 5 years and then destroyed through confidential shredding service.

Subject Assurances

By signing this consent form, you agree to take part in this study. You have not given up any of your rights or released this institution from responsibility for carelessness.

You may cancel my consent and refuse to continue in this study at any time without penalty or loss of benefits. Your relationship with the staff of ICSW will not be affected in any way, now or in the future, if you refuse to take part, or if you begin the study and then withdraw.

If you have any questions about the research methods, you can contact Claire Adeline Haglund, LMSW(Principal Researcher) at (248)-635-3163 or Denise Duval Tisoles, Ph.D. (Dissertation Chair/Sponsoring Faculty), at (773)880-1485 on weekdays (day), Between 9 am and 5 pm EST (evening).

If you have any questions about your rights as a research subject, you may contact Dr. John Ridings, Chair of Institutional Review Board; the Institute for Clinical Social Work; At St. Augustine College, 1345 W. Argyle St., Chicago, IL 60640; (773)935-6500.; irbchair@icsw.edu.

Signatures

For the Participant

I have read this consent form and I agree to take part in this study as it is explained in this consent form:

Participant Name (please print): ___________________________________

Participant Signature: Date: _____________

1. Would you like a summary of the results of this study?

Yes: ____

No: ____

For the Primary Researcher

I certify that I have explained the research to _________________________ and believe that they understand and that they have agreed to participate freely. I agree to answer any additional questions when they arise during the research or afterward.

Researcher Name (please print): ___________________________________

Researcher Signature: Date: _____________

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