Professional Documents
Culture Documents
SOCIAL-EMOTIONAL DEVELOPMENT
A Master’s Project
Presented to
In Partial Fulfillment
Master of Arts
By
Simone Miranda
Spring, 2022
© 2022 by Simone Miranda
committee and approved by members of the committee, has been presented to and accepted by
the faculty of the Kalmanovitz School of Education, in partial fulfillment of the requirements for
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By
Simone Miranda
The purpose of this project is to propose an eight-week, school-based music therapy group for
fourth and fifth grade children with emotional disturbance. Children with emotional disturbance
throughout their lifetime. The proposed intervention is a music therapy group grounded in
education-oriented music therapy. The use of this intervention will provide psychoeducation to
children around music, emotional expression and regulation, support peer and adult relationships,
while playing music. It will also introduce the concept of identity and the intersectionalities that
make it up. The group approach aims to support social-emotional growth and an understanding
I dedicate this master’s project to my Thompson and Miranda family. Everything I have
become and worked for is because of your unconditional love and support. Most importantly, I
dedicate this project to my parents Eddie and Kelley Miranda; from the bottom of my heart thank
you for everything you have instilled in me, being my backbone, and your sacrifices. I will
forever be grateful for your examples of hard-work and perseverance. I love you. To my siblings,
Chase, Natalie, and Tyce, thank you for being my forever cheerleaders and making dark days a
lot lighter. I’m grateful to have siblings that are there for me through everything. To my nieces
and nephews, thank you for being my motivation to further my education and give back to the
younger generation. Lastly, to my crew, thank you for being the best group of friends anyone
I would also like to acknowledge my professors and cohort; Thank you for your
inspiration and encouragement. It has been a privilege to learn from you all. Thank you to the
additional educators in my life who have pushed me to my fullest potential. Lastly, I would like
“I love music because it makes you feel. It makes you reminisce and appreciate things
from the past, present, and future. Helps face the vulnerabilities and what is being buried down.
Music gives you a voice when you don’t even know what it means to have one. I love music
because it’s a form of connection…through language and generations. It’s always there.”
Chapter Page
1. Introduction …………………………………………………………………….1
Summary ………………………………………………………………16
Summary ……………………………………………………………………..46
3. Application …………………………………………………………………..48
Summary ……………………………………………………………73
4. Discussion ………………………………………………………………….74
Strengths ……………………………………………………………74
Limitations …………………………………………………………75
Recommendations …………………………………………………77
Conclusion …………………………………………………………78
References …………………………………………………………………………80
Appendices ………………………………………………………………………..88
(Samuels, 2018). Layman et al. (2002) referred to emotional disturbance as a “diverse group of
depression), autism, and anxiety and attachment disorders'' (p. 164). Children with emotional
disturbance are unidentified and underserved in most spaces (e.g. schools, healthcare, criminal
justice system) (Kauffman, Mock, & Simpson, 2007, p. 44). According to Samuels (2018),
nationwide, 6% of children with any kind of disability (e.g. learning, speech impairment,
processing) are classified as having an emotional disturbance; however, the numbers do not
represent this specific population. Some children who present the features of an emotional
disturbance are not properly identified due to misdiagnosis, and as a result, are unidentified for
appropriate support (e.g. individual education plan, 504 plan, behavior plan, treatment plan)
(Samuels, 2018). Children with emotional disturbances represent a group that faces the most
challenges in spaces such as academia, and they are often unidentified until adolescence, when
acquire internalized and externalized behaviors that interrupt effective development to function
in prosocial environments (Malik & Marwaha, 2020). Internalized behaviors reflect a child’s
emotional or psychological state and can include anxiety (e.g., uncontrollable overthinking,
feeling irritable, trouble concentrating), depression (e.g., feelings of sadness or hopelessness, loss
of interest or pleasure in activities), withdrawal, or somatic complaints (Liu, Chen, & Lewis,
2011); while externalized behaviors are problem behaviors that are directed toward the external
environment (e.g., defiance, physical aggression, stealing, and destruction of property) (Liu,
1
2004). Social-emotional development involves “the ability to identify and understand one’s own
feelings, to comprehend emotional states in others, to manage strong emotions and their
expression, to regulate one’s own behavior, to develop empathy for others, and to establish and
maintain relationships” (National Scientific Council on the Developing Child, 2004, para. 2).
been associated with a significantly higher prognosis for serious mental disorders later in
pre-adolescence, adolescence, and adult stages (Bongers, Koot, Van Der Ende, & Verhulst, 2004;
Children with emotional disturbance (ED) are at high-risk to face challenges with their
with their peers and interpersonal relationships, self-esteem, and academic achievement (Sausser
& Waller, 2006). According to the American Association for Employment in Education (2001),
special education and emotional disorders are the areas with the highest demand for support in
the United States. Unfortunately, many children with emotional disturbance are stigmatized as
“troubled children” due to their internalized and externalized behaviors (Kauffman, Mock, &
Simpson, 2007, p. 45). As a result of interfering stimuli, such as impulsive reactions in minor
situations, there is a need to apply hands-on learning experiences to motivate and support the
Children who are emotionally disturbed confront intense emotions that can be
is complex and may be rooted in: attachment disruption, which refers to insecure attachment or
separation from primary attachment figure that negatively affects making emotional connections
2
with others (Bowlby, 1984); trauma, which is an emotional response to a terrible event such as
& Vandenberg, 2013); reactive classroom management, which is the way in which teachers (and
other adults) react to misbehavior (Chen, Lewis, & Liu, 2011); or improper support in place,
(i.e., lack of resources to provide specific services, untrained staff in place, lack of consistency)
(Kauffman, Mock, & Simpson, 2007). According to Lane, Gresham, and O’Shaghnessy (2002),
however, several challenges still exist that require prompt attention and support (pp. 507-521).
While there are treatment approaches in place, such as Cognitive Behavioral Therapy (CBT) and
behavior management, these approaches focus on shaping the behavior for the child to act in
accordance with what is considered “normal” in the environment, instead of focusing initially on
cognitive distortions, or how external factors impact the child’s social-emotional development
(Halder & Mahato, 2019). Children with emotional disturbance face various challenges and
consequences that might contribute to larger systemic issues like, the school-to-prison pipeline
later in adolescence and adulthood (Wagner et al., 2005); such issues will be discussed further in
the chapter. This section will address the following: Symptoms of Emotional Disturbance,
with children who are emotionally disturbed is the failure to identify symptoms of emotional
3
educational, and/or medical/neurological difficulties. Mclaughlin et. al. (2009) conducted a study
2 years post Hurricane Katrina, and the results indicated that in the first 3 to 6 months after the
hurricane, more than 50% of the children who had been exposed to the disaster exhibited
(IDEA, 2017) as, “a condition exhibiting one or more of the following characteristics over a long
period of time and to a marked degree that adversely affects a child’s educational performance”
(300.8 [c] [4]). There are five criteria that serve as characteristics of emotional disturbance.
According to the IDEA (2017) the five criteria are as follows: (a) an inability to learn that cannot
satisfactory interpersonal relationships with peers and teachers, (c) inappropriate types of
behavior or feelings under normal circumstances, (d) a general pervasive mood of unhappiness
or depression, and (e) a tendency to develop physical symptoms or fears associated with personal
or school problems. The characteristics described within the criteria are manifested through
experience, expression, and management of emotions and the ability to establish positive and
Children who have experienced one or more traumatic events are at high risk for
developing emotional disturbances (EDs). The National Survey of Children’s Health (NSCH,
2016) identified 46% of the nation’s youth ages 17 and under who had experienced at least one
trauma; the relationship between trauma and emotional disturbance will be further explained
4
within this section. Children who are emotionally disturbed are stigmatized in spaces such as
experiences, which is then expressed through internalized and externalized behaviors (Kauffman,
Mock, & Simpson, 2007, p. 45). Mclaughlin et al. (2009) identified that people in academia or in
places of power have high expectations in terms of “normative behavior” and a lack of
culturally sensitive approaches to understand the social-emotional needs of children who are
treatment plans, are a few of the factors that could contribute to the interruption of effective
Biologically, the emotional brain is frequently reactive in the emotionally disturbed child.
According to Van Der Kolk (2015), the reptilian brain and limbic system, also known as the
emotional brain, is activated when intense emotions activate the limbic system, specifically in an
area called the amygdala. The amygdala’s function is to warn the body of forthcoming danger
and activate the body’s stress response. When trauma occurs and influences emotional
disturbance in children through images, sounds, or thoughts related to their experience, the
amygdala automatically reacts with panic (Van Der Kolk, 2015). As a result, the panic triggers
intense stress hormones and nerve impulses that increase blood pressure, heart rate, and oxygen
intake, which eventually stimulates externalized or internalized behaviors (Van Der Kolk, 2015).
The effects of the stress hormones can affect memory, decrease attention, and increase irritability.
Additionally, when a child is unable to recover from a situation, the body is triggered to defend
itself, which causes dysregulation and makes them feel agitated and provoked (Van Der Kolk,
2015). When the emotional brain is triggered, it is more susceptible to impulsive thoughts and
feelings without warning, leaving rational capacities to be delayed long after the danger or threat
5
is gone.
Research has identified that attachment style is also an important contributing factor to
self-regulation depends on how secure early interactions with caregivers were (Van Der Kolk,
2015). If the adult is more responsive to the child, then the attachment is deeper, and the child is
more likely to develop healthy self-esteem and positive ways of responding to people around
them. Van Der Kolk (2015) explained that through secure attachment, children can learn how
other people have feelings and thoughts that are both similar to and different from theirs.
Therefore, both child and caregiver are emotionally attuned to one another, and the child
understands situations when they need help. On the other hand, if attachment is disorganized and
emotional communication is disrupted, children begin to feel unsafe and have trouble regulating
their moods and emotional responses as they get older (Van Der Kolk, 2015). As a result,
children tend to be more aggressive or disengaged, which creates a high reaction in stress
hormones. Caregivers who are still working through their own trauma or stresses might also be
too emotionally unstable to offer much comfort and protection, and to be attuned to their child’s
Furthermore, children from low socioeconomic status (SES) are associated with higher
levels of emotional and behavioral difficulties (Decarlo Santiago, Stump, & Wadsworth, 2011).
Sanchez et al. (2017) implied that economic stress and exposure to violence, alongside ongoing
discrimination have been associated with increased internalizing and externalizing symptoms,
further insinuating the need for “interventions to develop effective coping strategies” (pp. 15-24).
Being exposed to poverty during childhood appeared to have an impact that was detrimental on
childhood social and cognitive ability than experiencing poverty later in life (Duncan et al.,
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1998, as cited in Hosokawa & Katsura, 2018, p. 3). Compared to children from high SES
backgrounds, children with low SES were two to three times more likely to develop mental
health problems because of everyday stressors that impacted their development (Reiss et al.,
2019). Along with low SES, a shortage of appropriate support such as mental health
According to Shapiro et al. (1999), many adults reported a lack of training and access to
supportive resources to effectively educate and behaviorally manage children with emotional
disturbance. Many children who are emotionally disturbed and have undeveloped
other adults and, as a result, are treated as a “problem” in the environment, rather than the
environment being considered an issue for the child (Kauffman, Mock, & Simpson, 2007).
Environments that are overstimulating, or classrooms with poor classroom management might
(Kayıkçı, 2009). For example, poor classroom management portrays the temperament of the
teacher; if a teacher is dismissing certain “problem” behavior, or reacting negatively, rather than
using it as a teaching moment, then the child misses out on learning how to regulate their
emotions (Kayıkçı, 2009). Emotionally disturbed children who do not receive the necessary
support to encourage healthy development continue to face struggles throughout adolescence and
behaviors related to emotional disturbance, children may not achieve the social and cognitive
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breakthroughs typical to their chronological age (Paul, 1984). As a consequence,
social-emotional development, along with psychosocial development, are threatened and might
cause children to isolate and form unhealthy relationships with others (Choi, Lee, & Lee, 2010).
According to Yau and Fachner (2021), when children do not have the tools or skills to
self-regulate, they show much more behavioral/emotional problems in their social contexts and
According to Wagner, Cameto, and Newman (2003), about 58% of children with
emotional disturbance are arrested 3 to 5 years out of high school; as a consequence, the
school-to-prison pipeline increases and the population continues to be served unjustly. Lee et al.
influenced lower self-esteem, an increase in grade detainment, at risk drop-out rates, and a higher
likelihood of receiving school suspensions (Lee et al., 2013). Additionally, Forness et al. (2012)
explained that a critical consequence in the lack of provision of services to this population of
children is that the prevalence is underestimated or underreported; thus, so many children are not
getting services. For that reason, many children with emotional disturbance are underserved and
various environments (Forness et al., 2012). For example, according to Forness et al. (2012),
general education (K-12) administrators are likely to view a child’s lack of involvement in
depression and anxiety” (p. 14). As a result, there is a lack of referrals and/or limited access to
appropriate resources, as well as services (Bussing, Mason, Bell, Porter, & Garvan, 2010).
8
Treatment for Emotional Disturbance
“CBT is based, in part, on faulty or unhelpful ways of thinking” (para. 4). While CBT and
behavior management involve efforts to change behavioral patterns and have been shown to be
effective, according to Guadiano (2008), the approaches are determined by physical process
alone and fail to address the concerns of the “‘whole’” patient (p. 3). The sole focus is to change
behavior, rather than understanding the context of the behavior or focusing on social-emotional
development to better support the change in emotions or behavior (Guadiano, 2008). Approaches
such as cognitive behavioral therapy and behavioral management, while helpful, provide support
in behavioral problems; however, they do not consider cultural aspects or experiences within the
child’s realm that can be reintegrated to regulate effective social-emotional development (Levy
et. al., 2021). Additionally, there is rarely any consideration of familial and cultural influences
within the therapeutic formulation for a case (Levy et. al., 2021). Further research still needs to
be done specific to CBT and behavior management and children with emotional disturbances.
A child who meets one or more of the five characteristics of emotional disturbance is
considered emotionally disturbed according to the IDEA (2017). Emotional disturbance can be
disorders, anxiety, schizophrenia, attachment, depression, mania, and emotional issues associated
with autism. Children with emotional disturbance are one of the most underserved populations,
and they have challenges with social-emotional skills, which they express through externalized
9
and internalized behaviors. Factors that can contribute to emotional disturbance and unhealthy
children with emotional disturbance has consequences correlated with the school-to-prison
pipeline, an increase in emotional and behavioral challenges within their environment, low
self-image, an increase in being held back a grade, and limited access to appropriate resources or
services (Bussing, Mason, Bell, Porter, & Garvan, 2010; Lee et al., 2013). An inability to build
social-emotional skills in children with emotional disturbance. A few studies have been
conducted on the beneficial approaches and treatment of CBT and behavior management with
emotionally disturbed children and their social-emotional development; however, many of them
neutralize behavior in order for the child to conform to the expected environment. In other
words, the focus of such treatments is to make behavior ineffective or harmless by an opposite
force or effect, so the child aligns with the standards that are appropriate in institutionalized
spaces; rather than initially focusing on ways to make cognitive errors, or irrational thinking
The purpose of this project is to identify how music therapy can be utilized as an
disturbed, as well as how to integrate cultural values and experiences in their treatment.
Meaning, how can music therapy be used as an approach to form a new perception of
modality of Education-oriented Music Therapy (EoMT) (Chong & Kim, 2010) will be depicted
10
as a significant treatment technique for supporting social-emotional needs of children with
emotional disturbance. A hypothetical case study will be presented using music therapy to treat a
The significance of this project is to improve support for children with emotional
disturbance through the use of music therapy and provide more inclusive techniques, such as
active and passive music approaches, to strengthen social-emotional development. The project
will provide beneficial information to increase support and awareness for emotionally disturbed
children. Additionally, it will include information for music therapy approaches to encourage
approach to improve support for the social-emotional development of this vulnerable population.
While there are common techniques and coping strategies to assist children with
emotional disturbance, there are therapeutic interventions, such as music therapy, to help
children self-regulate, set and understand boundaries, and express themselves through the art of
music. Music therapy involves the use of music interventions to accomplish individualized goals
within the therapeutic relationship (American Music Therapy Association, 2005, para. 1). This
section will discuss the following: Influential People and Historical Context of Music Therapy,
Description of Music Therapy, How Music Therapy Works, and The Results of Using Music
Therapy.
Music therapy has been around for centuries and has a variety of influential people who
paved the way for music therapy to be used in clinical and educational settings (American Music
11
Therapy Association, 2005). During World Wars I and II, community musicians went to
Veterans’ (VA) hospitals around the country to play for veterans suffering both physical and
emotional trauma from the wars (American Music Therapy Association, 2005). The physical and
emotional responses to music from the patients led medical professionals to request musicians
for VA hospitals. As a result, music therapy became more recognized. Many of the earliest
innovators of music therapy understood that music was a significant method for healing affected
emotional and behavioral interactions, as well as increasing self-esteem. The earliest writings on
the therapeutic value of music were published by Edwin Atlee and Samuel Mathews in the
1800s, and they discussed the influence of music in the cure of diseases (American Music
Therapy Association, 2005). In the 1940s, music therapy began to move towards an
organizational and educational perspective (American Music Therapy Association, 2005). The
development of music therapy programs began with Michigan State College and the formation of
the National Association for Music Therapy (NAMT), because of the need for musicians to be
trained before working in hospital settings in the 1950s (American Music Therapy Association,
2005). The 1950s marked the start of music therapy as a profession with a focus on the
development of training programs and the establishment of the basic structures of the profession
(Beyers, 2016, p. 16). Clinical work focused on working with individuals with intellectual
disabilities, while theoretical developments were being discovered in the United Kingdom,
had a significant effect on the profession due to the early development of music therapy being
essentially for government paid positions in large residential facilities (Beyers, 2016, p. 21).
During the 1960s, clinical practice developed an interest in behavioral psychology, as well as a
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model that represented a culturally specific way of practice (Beyers, 2016, p. 21). In the 1970s,
clinicians desired ways to improve referrals to music therapy and encouraged other professions
to recognize music therapy as a form of therapy instead of recreation (Lord, 1971). The interest
in the development of music therapy assessments was also encouraged. The 1980s brought new
areas of development within music therapy that included advocacy work with the government
and growing attention on job creations, the concepts of ethics, and the integration of technology
into clinical work (Beyers, 2016, p. 43). Into the 1990s, music therapy as a profession had
become more established throughout the world. Music therapists expanded their services to
trauma survivors, the homeless, domestic violence survivors, and individuals with eating
disorders (Beyers, 2016, p. 62). In the United States, pressure increased to support services with
empirical evidence as music therapy became more recognized. In the beginning of the 21st
century, an explosion of diverse thought and clinical work dominated the music therapy
profession (Beyers, 2016, p. 81). Today, music therapy’s growth is shaped by society's needs and
In order to better support emotionally disturbed children, the study of how the brain
functions with music and exploring techniques and strategies involving music therapy can be
evidence have suggested that music therapy can assist children in reaching their Individual
Education Plan (IEP) goals (Yinger, 2018). Music therapy is an evidence-based practice with the
use of music interventions to meet goals within a therapeutic relationship to address physical,
emotional, cognitive, and social needs of individuals (American Music Therapy Association,
2005). The music therapists’ intention is to determine which music therapy approaches are
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effective in the reconstruction, maintenance, and improvement in mental and physical health
(American Music Therapy Association, 2005). Music therapy involves the use of active and
passive therapy, where instruments can be played during sessions (active) or music may be
listened to (passive) to reflect on tone, lyrics, or emotion in a musical piece (Montello & Coons,
1998). Sessions involve the client using instruments and their voice to explore the world of
sound, while the therapist supports the clients’ response through improvised music (American
The various types of music therapy include: Guided Imagery and Music (Beyers, 2016, p.
39); Nordoff-Robbins Music Therapy (Beyers, 2016, p.40); Free Improvisation Therapy (Beyers,
2016, p. 19); Neurological Music Therapy (Thaut, 2005, p. 126); Resource-Oriented Music
Therapy (Schwabe, 2005, p. 50); Education-Oriented Music Therapy (Chong & Kim, 2010, p.
Jansen, Scherder, and Uhlig (2018) reported that music induces complex
cognitive-emotional processes; interacts with brain areas that modulate mood and stress; and
enhances contact, coordination, and cooperation with others. According to Sharkey (2019),
during sessions, the music therapist attempts to form a bond with their client in order to enhance
well-being and improve confidence, communication skills, awareness, and attention (para. 3).
The goal of the music therapist is to reach a “‘moment of change’” where the therapist can
strengthen their connection with their client to influence positive development (Sharkey, 2019,
para. 9). Music interventions are utilized to attain either individual or group goals; particularly,
the music alone and the way the music is used are customized to meet distinct nonmusical
objectives (Yinger, 2018, p. 2). Yinger (2018) expressed that in music therapy, both the music
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and the therapeutic relationship with the music therapist are essential to attaining treatment goals
(p. 2). According to Nilsson (2008), with more activation, music acts as a distractor, focusing the
clients’ attention away from negative stimuli to something pleasant and encouraging (p. 781).
From a neurological perspective, listening to music that is pleasurable activates neural areas
associated with the release of dopamine (Blood & Zatorre, 2001, as cited in Yinger, 2018, p. 17).
This implies that music not only leads to feelings of gratification, but also supports human
behavior that is motivating and involved in the function of learning and memory, as a result of its
Musical engagement provides various opportunities for children to explore interests, react
to numerous stimuli, and demonstrate developmental skills that adults can model (Yang, 2016).
In other words, according to Yang (2016), music supports the concept of “matching,” which
involves adult-child interactions where adults adjust their behaviors according to children’s
developmental levels, interests, and behavior styles (p. 34). By acting out songs expressively,
singing with expression, or playing instruments with rhythmic or dynamic changes, parents,
children, and other adults can adapt to one another in a positive way. According to Levitin
(2006), the emotions experienced in response to music involve structures rooted in the primitive,
reptilian regions of the cerebellum and the amygdala, which is the core of emotional processing
in the cortex (p. 87). Through music, children can process their own emotions and understand
Music, whether played or listened to, can influence emotional expression through the
frontal cortex and language development through the cerebral cortex, by use of tone, sound, or
repetition of songs (Levitin, 2006, p. 109). The memory pathways in the brain begin to improve
15
and enhance the pathways for melodic memory, where the brain then translates it into language
(Collins, 2014, p. 5). Rhythm, which is a strong, regular, repeated pattern of sound or movement,
supports the synchronization of physiological functions such as heart rate, blood pressure, and
breathing, so that individuals learn how to be in harmony with themselves (Coons & Montello,
Review Questions
3. What are the negative outcomes for children with emotional disturbance?
emotional disturbance?
Summary
internalized and externalized behaviors. There are children who display the symptoms of
emotional disturbance, but are misidentified for appropriate support, increasing risk for further
challenges with development (Samuels, 2018). Children who present at least one or more of the
five characteristics within the IDEA’s criteria are considered to be emotionally disturbed. This
leaves a large percentage of children who are either overdiagnosed or misdiagnosed. Children
with emotional disturbance face challenges with self-regulation and have a difficult time
16
managing uncontrollable emotions. As a result, emotionally disturbed children might not
progress towards the social and cognitive development appropriate for their consecutive age. Not
might cause children to isolate, or form unhealthy coping habits. Music therapy was described,
and it was posited that it could serve as a valuable approach for improving emotionally disturbed
Chapter II will review the research that has been conducted on emotionally disturbed
children’s social-emotional development. Treatment and treatment plans that have been used
with this population will be reviewed, and music therapy will be further described. Additionally,
Chapter II will analyze research studies conducted with music therapy and the
acknowledge the benefits music therapy could provide for this population. Chapter III will
provide a creative and intricate description of music therapy treatment for emotionally disturbed
children. Chapter IV will examine the strengths and limitations of this project utilizing music
therapy as an approach, considerations for therapists and adults who support this population, and
Definition of Terms
Active Music Therapy: Participating in singing, music composition, and instrument playing
Emotional Disturbance: “An inability to learn that cannot be explained by intellectual, sensory,
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personal or school problems” (IDEA, 2017, 300.8 [c] [4]).
Externalized Behaviors: Problem behaviors that are directed toward the external environment
(e.g., physical aggression, disobeying rules, cheating, stealing, and destruction of property) (Liu,
2004).
depressive disorders, anxiety disorders, withdrawal, or somatic complaints (Liu, Chen, & Lewis,
2011).
Music Therapy: “Music Therapy is an established health profession in which music is used
within a therapeutic relationship to address physical, emotional, cognitive, and social needs of
Passive Music Therapy: Listening to live or recorded music (Coons & Montello, 1998).
Social-Emotional Development: “The ability to identify and understand one’s own feelings, to
comprehend emotional states in others, to manage strong emotions and their expression, to
regulate one’s own behavior, to develop empathy for others, and to establish and maintain
relationships” (National Scientific Council on the Developing Child, 2004, para. 2).
Trauma: An emotional response to a terrible event like physical, emotional, or sexual abuse,
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Chapter II
Children with emotional disturbance (ED) are challenged with complex disruptions in
their development that continue into adolescence and adulthood. Theoretical orientations
commonly used with this population include CBT and behavior management; while such
techniques have been shown useful, they lack a holistic perspective of the child (Halder &
Mahato, 2019). Therefore, further therapeutic interventions implemented with this population
will be discussed in this chapter. Music Therapy provides a creative medium that captures the
whole client while integrating essential treatment approaches for the client to practice
self-regulation skills and healthy forms of expression, as well as to set fundamental foundations
to support social-emotional development. Researchers have studied children with ED and the use
of music therapy and have found that music therapy is an evidence-based practice that addresses
emotional and social needs of individuals (American Music Therapy Association, 2005) .
Chapter II will cover the following topics: The characteristics/behaviors of children with
With Children with Emotional Disturbance, Music Therapy, and Ways Music Therapy Supports
critical to serving them well (Wagner et al., 2005). Findings on this topic, both past and current,
generally confirm that children with ED exhibit maladaptive characteristics to a greater extent
than children without ED (Cullinan et al., 2003). In a study conducted by Cullinan et al. (2003),
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the characteristics of children with ED and without ED were compared (pp. 99-101). Participants
were 884 elementary school-aged students in U.S. public schools; there were 336 students with
ED and 548 students without ED [or any other education disability]. Of the students with ED, 62
identified as girls and 274 identified as boys; of the students without ED, 260 identified as girls
and 288 identified as boys. Students involved in the study were African-American and
European-American. The procedure involved educators rating children with ED and without ED
using the Scales for Assessing Emotional Disturbance (SAED), which was designed to
operationalize the five quality characteristics of ED (Cullinan et al., 2003). Results indicated that
children with ED were higher in the following categories: inability to learn, relationship
or fears (Cullinan et al., 2003). European American students with ED demonstrated relationship
African-Americans, while girls with ED exhibited more physical characteristics or fears than
boys (Cullinan et al., 2003). Cullinan et al. (2003) specified that social maladjustment in
preadolescent children with ED tends to present at high levels of antisocial behaviors (p. 101).
A significant limitation of this research is the need for more research on the ED
characteristics of more ethnicities (Cullinan et al., 2003). According to the authors, the U.S.
Department of Education collected data on a variety of variables about children with disabilities;
however, the agency needed to take action to obtain and present more detailed information
involving cross-tabulations of age, gender, race or ethnicity, and other important descriptive
variables about U.S. children with ED (Cullinan et al., 2003). Additionally, considering the
measurement limitations, variables could have been measured by other methods, such as
interviewing, target behavior recording, and objective personality testing (Cullinan, 2002).
20
Additional forms of rating scales and other raters, such as parents and children, could have also
been included in the study (Cullinan et al., 2003). Furthermore, in comparing studies involving
participants identified as children with ED, there is often ambiguity with how similar the
with ED and their households, along with their functional characteristics that provided context
for their ongoing school experiences (p. 79). The purpose of the article was to describe the
complex factors that assist in explaining the academic and social challenges children with ED
encounter in the school environment (Wagner et al., 2005). According to Wagner et al. (2005),
the education system is the only child-serving institution mandated to serve children (and youth)
with ED (p. 79). Considering children and household characteristics of ED, children with ED are
more likely than the general population to have several demographic characteristics that are
correlated with poor outcomes (Wagner et al., 2005). The Special Education Elementary
Longitudinal Study (SEELS) and the National Longitudinal Transition Study-2 (NLTS2) were
drawn to generalize all children with disabilities, including ED, who were in particular age
ranges and receiving special education services when the study began (Wagner et al., 2005).
SEELS consisted of children receiving special education who were 6 through 12 years of
age, and NLTS2 consisted of youth ages 13 through 16 years who were receiving special
education services (Wagner et al., 2005). Most of the measurement items that generated the data
reported were surveys or interview questions; parents responded to 11 items regarding their
children’s social interactions, 9 of which were drawn from the Social Skills Rating System
(SSRS) (Wagner et al., 2005). A second scale, measuring functional cognitive skills, was
composed of responses that provided an overall assessment by parents of the abilities of their
21
children with ED to manage everyday functions that require the cognitive ability to read, count,
Results of the study indicated that across the school-age range, more than three-fourths of
children and youth classified with ED were boys; in both SEELS (ages 6-12) and NLTS2 (ages
with ED than was found in the general population; and children and youth classified with ED
were significantly more likely to live in households with several risk factors for poor outcomes
(Wagner et al., 2005). Furthermore, results specified that one-third of elementary and middle
school children classified with ED lived in a single-parent household; one-fourth of both age
groups classified with ED lived in households whose head was unemployed; and both age groups
of children with ED were more likely than their peers to live in a household that had the added
stress of another member who has a disability (Wagner et al., 2005). In regards to Functional
Characteristics of Children with ED in the research article (e.g., the life domains: the cognitive,
social, and communication skills of children and youth), the wide range of problems that
contribute disabling conditions as reported by parents of children with ED, included anxiety,
oppositional behaviors, and psychosis (Wagner et al., 2005). Almost two-thirds of both
elementary and middle school children classified with ED were reported by parents to have
elementary and middle school children with ED had consistent and significantly lower social
skills, as well as in the subareas of self-control, assertion, and cooperation skills, on all measures
than their peers with other disabilities (Wagner et al., 2005). Furthermore, Wagner et al. (2005)
22
stipulated that 10.6% of elementary and middle school children with ED were reported by their
Considering factors that contribute to emotional disturbance, it has been documented that
children from low-income families were more likely to suffer from chronic illnesses, mental
health problems, and disabilities than their privileged counterparts (Brooks-Gunn & Duncan,
1998; Brooks-Gunn, Duncan, & Klebanov, 1994). Studies have examined the effects of
neighborhood and family poverty on the home environment and discovered that neighborhood
poverty was associated with a poorer physical home environment and less maternal/(paternal)
warmth, factors that adversely affect children’s mental health (Klebanov et al., 1994). Gyamfi
(2004) conducted a study that examined the associations between poverty status, receipt of
public assistance, service use, and children’s mental health (p. 1129). She reviewed important
factors such as, the impact of welfare reform on children’s mental health and the effects of
low-income status on service use (Gyamfi, 2004). In regard to the impact of welfare reform on
children’s mental health, the federal welfare legislation, recognized as the Personal
Responsibility and Work Opportunity Reconciliation Act of 1996 (PRWORA), was the most
significant change in welfare policy the United States had initiated in decades, attributable to the
fact that it ended the federal guarantee of cash assistance to needy families (Gyamfi, 2004). The
PRWORA of 1996 was a comprehensive bipartisan welfare reform plan that dramatically
changed the nation’s welfare system into one that required work in exchange for time-limited
assistance (U.S. Department of Health and Human Services, 1996). According to Gyamfi (2004)
the federal entitlement to childcare assistance was no longer available, meaning placements such
as daycare or after-school programs for children with emotional and behavioral problems became
23
more difficult to access (p. 1131). Additionally, the eligibility requirements to participate in
Supplemental Security Income (SSI) had changed in legislation and significantly reduced
eligibility for children with mental-health needs, as children must present a higher level of
severity to qualify (p. 1131). Meaning, families with children with emotional disturbance may
not receive the assistance put in place, because the severity of their child’s emotional disturbance
was not serious enough to qualify for extra support such as child care subsidy. For example,
according to the Social Security Administration (SSA) (2021), symptoms/diagnosis must have
lasted, or be expected to last, at least 1 year or result in death. Additionally, a state agency makes
the disability decision; they will also ask for information from medical and school sources, and
other people familiar with the child’s conditions (Social Security Administration, 2021).
In regard to the effects of low-income status on service use, Gyamfi (2004) stated that
despite poorer health, children from low-income families were less likely to receive health care
services than children from more affluent families (p. 1131). The lack of consistency may be due
to less access to primary care or Medicaid, or the severity of the condition (Gyamfi, 2004). In
other words, resources put in place for children with mental health needs such as emotional
disturbance, could be hard to access for families because of the lack of acknowledgement by
health insurance in regard to the severity of mental health needs. As stated previously, the
purpose of Gyamfi’s (2004) study was to determine the effects of poverty level and receipt of
public assistance on child emotional/behavioral factors and service use among children with
mental-health needs (p. 1132). Data was obtained from the child and family outcome study
Services for Children and their Families Program; the total sample of 9493 children was
primarily male (68%) around the age of 12, and 55% Caucasian (Gyamfi, 2004). About 65%
24
reported annual incomes at or below the poverty level (U.S. Department of Health and Human
Services, 2004). To examine the impact of low-income status and receipt of public assistance for
were the two clinical variables that were examined (Gyamfi, 2004).
poverty status, receipt of public assistance, and child behavioral problems, while four separate
analyses were run to determine the effect of poverty status on children’s social and emotional
problems (Gyamfi, 2004). The results indicated that there were no significant associations
between poverty status and internalizing, externalizing, or total behavior problems, along with
child functioning (Gyamfi, 2004). However, according to Gyamfi (2004), significant associations
were found in the child’s age, race/ethnicity, caregiver education, Medicaid receipt, child and
family risk factors, and number of services received (p. 1134). Families with income below the
poverty threshold tended to have older children, to be non-white, to have caregivers with fewer
years of education, to receive Medicaid and Temporary Assitance for Needy Families (TANF)
benefits, to have fewer child risk factors, but more family risk factors, such as history of
domestic violence, mental illness, and substance abuse in the family (Gyamfi, 2004). Such
factors can play a role in contributing to emotional disturbance and affect the development of
Copeland et al. (2007) examined the developmental epidemiology of potential trauma and
western North Carolina. A sample population of 1,420 children ages 9, 11, and 13 years at intake
were followed up annually through the age of 16 years old (Copeland et al., 2007). The authors
based their analyses on (a) psychiatric disorders, (b) potentially traumatic events and associated
25
PTS symptoms, and (c) risk factors (Copeland et al., 2007). Copeland et al. (2007) assessed the
areas using the Child and Adolescent Psychiatric Assessment (CAPA) (p. 578). Children were
interviewed as close as possible to their 9th, 11th, and 13th birthday, as well as annually until 16
years old, either at home or in a location convenient for them (Copeland et al., 2007). Parent(s)
and child were interviewed separately by the Department of Social Services staff (Copeland et
al., 2007).
According to Copeland et al. (2007), about 40% of children with any trauma history had
at least one other mood, anxiety, or disruptive behavioral/emotional diagnosis (p. 580). To test
the predictors of PTS symptoms in the presence of a traumatic event, the authors set four sets of
variables, which were entered into a model: (a) sex and current developmental period (ages 9-13
[childhood] versus 14-16 years [adolescence]); (b) previous emotional and behavioral disorders
(e.g., anxiety disorders, depressive disorders, and disruptive behavior disorders); (c) previous
negative events; and (d) previous environmental, family, and parental risk factors (Copeland et
al., 2007). Results indicated that previous environmental adversity, such as coming from an
impoverished or neglectful home, predicted further symptoms for internalized and externalized
behaviors between ages 14-16 years old (Copeland et al., 2007). The model suggested that age,
prior anxiety, and previous trauma were important considerations of trauma response and
emotional disturbance in the next year (Copeland et al., 2007). Copeland et al. (2007) indicated
that children exposed to trauma had almost double the rates of psychiatric disorders (e.g., any
anxiety, depression, and behavioral diagnosis) of those not exposed (p. 581). Additionally, higher
levels of PTS-related symptoms were associated with higher levels of psychiatric disorders with
rates of 52.6% and 59.5% for painful recall and subclinical PTSD (i.e., no recognizable clinical
findings) (Copeland et al., 2007). Co-occurrence was highest for affective disorders and lower
26
for substance use and disruptive behavior disorders (Copeland et al., 2007). Risk factors that
were speculated to influence trauma exposure were previous environmental adversity, parenting
problems, and history of depressive disorders. The authors identified that children displaying
PTS symptoms in response to trauma exposure were more likely to be older, to have a history of
exposure to trauma, as well as anxiety, and to come from an adverse family environment
(Copeland et al., 2007). Furthermore, higher levels of trauma were related to higher levels of
Graves et al. (2007) examined factors associated with mental health and the juvenile
justice involvement among children with severe emotional disturbance. Previous research using
community samples had indicated that almost 46%-88% of children involved with the juvenile
system were diagnosed with a severe emotional disturbance (Lyons et al., 2001). Within Graves
et al. (2007) research, they examined the following factors: demographics (i.e., age, ethnicity);
person-level (i.e., anxious and/or depressed); family-level (i.e., number of transitions in living
situations); and school-level factors associated with being involved in the mental health and
juvenile justice systems (i.e., dual involvement). A total of 1,168 children participated in the
study. The study focused on European American and African American clinically-referred
children between the ages of 11 to 17 years; all children had at least one clinical diagnosis
(Graves et al., 2007). Graves et al. (2007) reported that children were referred to their local
community mental health program from a variety of sources (i.e., caregivers, child-serving
agencies), and trained evaluators conducted in-home interviews lasting 2 hours for caregivers
27
The measures utilized for this study included: a Demographic Information Questionnaire
(DIQ) that consisted of a 37-item caregiver reported questionnaire that measured child and
family characteristics (e.g., age, race, ethnicity, risk factors, family structure); The Child
Behavior Checklist (CBCL) and Youth Self Report (YSR), which measured person-level factors;
the Caregiver Strain Questionnaire (CGSQ) to assess family-level factors; and the Child and
al., 2007). The results indicated that among the 1,168 participants, 545 disclosed that, in addition
to being involved in the mental health system, they also were involved with the juvenile justice
system, while 623 were not involved. According to Graves et al. (2007), tests indicated that
among these children, girls had significantly higher levels of impairment compared to boys,
suggesting that the mental health status among girls involved in the juvenile system is more
severe than the mental health status of boys in the system. The findings also illuminated that,
children who were older and had had more transitions in their living situations were more likely
to face challenges with their mental health due to instability and lack of caregiving (Graves et al.,
2007). In regard to person-level factors, the results indicated more peer rejection and isolation
rather than social problems, which were more related to deviant peer association (Graves et al.,
2007). Lastly, levels of school functioning were not related to an increased likelihood of
becoming dually involved in both systems. Graves et al. (2007) suggested that future research
would benefit from looking into the possible influences of ethnicity, SES, and system policies in
relation to the mental health of children and the juvenile justice system (p. 163).
Siperstein et al. (2011) conducted a study over a 2-year period where 86 children were
drawn from the following three subgroups: children with ED receiving special education in
28
low-income schools, children with ED receiving special education services in high-income
schools, and children not receiving special education services but who were considered high risk
for ED (p. 172). Participants with ED were from elementary schools in the Boston area (public
schools were not included in the study) and consisted of 61 elementary-age students receiving
special education services for ED (35 students with ED from 8 low-income elementary schools,
and 26 students with ED from 12 high-income schools), along with 25 students at risk for ED not
receiving special education services, from one of the 8 low-income schools (Siperstein et al.,
2011). According to Siperstein et al. (2011), general education teachers in participating schools
were asked to identify at-risk students in their classrooms by distinguishing the most externalized
and internalized behaviors in the classroom (p. 175). Outcome measures included reading and
consisted of two math subtests and two reading subtests of the Woodcock Johnson III; teachers
rated students behavior using the Social Skills Rating System-Teacher Version and the Critical
Events Index to indicate the frequency of problem behaviors (Siperstein et al., 2011).
The results of the study indicated that children in the low-income schools receiving
special education for ED were significantly behind children from the other two sub-groups in
academics and pro-social behavior, and the scores did not significantly change over the year
(Siperstein et al., 2011). Children at risk for ED in low-income schools were to some degree
below children with ED in high-income schools for academic achievement; these children also
did not make any statistically significant gains in academic achievement over the course of the
year (Siperstein et al., 2011). Ultimately, children with, or at risk for, emotional disturbance did
not appear to show any noticeable progress over a year’s time (not including the high-income
schools) (Siperstein et al., 2011). Furthermore, for students with ED receiving special education,
29
Siperstein et al. (2011) found substantial differences by school income in placement patterns and
related services; students with ED in low-income schools were served in separate settings (e.g.,
special day class instead of included in the mainstream classroom), while students with ED in
high-income schools were mostly served in full or limited inclusion programs (p. 180).
Siperstein et al. (2011) also established a relationship between school context and related
services in that students with ED in low-income schools received less counseling, social skills
training, speech therapy, and occupational therapy than students with ED in high-income schools
(p. 180). Lastly, students with ED in low-income schools also received more discipline in regard
with emotional and behavioral disorders (EBDs). The article discusses services that children with
EBD receive and their outcomes (Bradley et al., 2008). The authors examined the Special
(NLTS2), and the National Adolescent and Child Treatment Study (NACTS) by Wagner et al.
(2005), Blackorby et al. (2003), and Walker and Tullis (2004). The literature review presented a
comprehensive picture of issues relevant to students with emotional and behavioral disorders
(EBD) (Bradley et al., 2008). The SEELS study focused on students with EBD as they moved
from elementary to middle school, while the NLTS and NLTS2 studies focused on high school
students with EBD as they transitioned into early adulthood (Bradley et al., 2008). Bradley et al.
(2008) stated that the review attempted to highlight the need for a comprehensive and focused
effort tailored toward improving outcomes for children with EBD (p. 5). Data from the NLTS2
and the SEELS showed that students with EBD experienced negative disciplinary and behavioral
outcomes twice as often as other students (Bradley et al., 2008). The SEELS data also showed
30
that children with emotional disturbances had a dramatic increase overtime (33%) in disciplinary
trouble at school (i.e., suspension, expulsion), being fired from a job, or being arrested
(Blackorby et al., 2003; Wagner et al., 2005). According to Bradley et al. (2008), data from the
NLST-2 and NACTS indicated that post-school outcomes for students with EBD have been
concerning; many students have challenges developing the behavioral and social skills to adjust
to adult life (p. 13). Such difficulties to develop social-emotional skills were suggested to
relationships, and their high rate of involvement with the justice system (Bradley et al., 2008).
Socially, the NACTS study found sizable deficits in social and adaptive behavior in its
sample, specifically low levels of social interaction and disconnection from the community
among students with EBD (Wagner et al., 2005). The NACTS study by Wagner et al. (2005) also
found that two-thirds of the sample had some type of contact with law enforcement, and 43%
had been arrested at least once. Additionally, research by Walker and Tullis (2004) identified that
the consequences of these outcomes had a widespread impact that posed significant costs both
personally and economically (Walker & Tullis, 2004, as cited in Bradley et al., 2008). Bradley et
al. (2008) suggested that there is a continued need for data that will further support the
emotionally disturbed population (p. 19). The results of the longitudinal studies demonstrated a
limitation in the services that have been provided to students with EBD and indicated a
continued need to improve such services (e.g., mental health services, financial support) (Bradley
et al., 2008).
Wagner and Newman (2012) considered the changes in the longitudinal transition
outcomes of youth with emotional disturbances, which they conducted in 1990, 2005, and 2009
(p. 199). The authors provided two perspectives on the transition outcomes using data from the
31
National Longitudinal Transition Study (NLTS) and the National Longitudinal Transition
Study-2 (NLTS2) (Wagner & Newman, 2012). The first perspective compared two cohorts of
youth ages 18-21 who had been out of high school up to 4 years (1990 and 2005) and their rates
living, and criminal justice involvement (Wagner & Newman, 2012). The second perspective
provided similar information from the final wave of NLTS2 data collection (2009), when the
same participants were ages 21-25 (Wagner & Newman, 2012). Results indicated that a higher
increase of students with ED had serious academic deficiencies, and one-third of high school
completers did not receive a regular diploma, but a certificate of completion, GED, or “other
nonstandard school-leaving document” (Wagner & Newman, 2012). By 2009, 53% of young
adults with ED had been enrolled in postsecondary education at some time and still represented a
significantly lower rate of enrollment than in the general population of same-age youth (Wagner
& Newman, 2012). In regard to independent living there was no significant difference for youth
in 1990 and 2005; the rate of independent living was higher among adults with ED who had been
out of high school up to 8 years in 2009 (Wagner & Newman, 2012). However, there was a large
increase in the percentage of youth with ED who were reported to have been arrested between
1990 and 2005 from about 36% to 60.7% (Wagner & Newman, 2012). Furthermore, Wagner and
Newman (2012) indicated that among young adults with ED in 2009, 60.5% had been arrested,
and 44.2% had been on probation or parole (p. 205). Lastly, employment rates had declined in
2005 since 1990, falling significantly below the general population rate, while young adults with
ED out of high school up to 8 years showed employment instability (Wagner & Newman, 2012).
32
Therapeutic Interventions Implemented with Children with Emotional Disturbance
expressed internalized and externalized behaviors that impaired social functioning (p. 19).
Twelve children ages 13-16 years (7 male and 5 female), living with HIV positive parents, were
the participants of a 12-week intervention (Sinha & Kumar, 2010). At baseline and
post-treatment, assessments were conducted with the help of self-report and teacher-report
measures (Sinha & Kumar, 2010). In order to demonstrate the efficacy of MCBT, Sinha and
Kumar (2010) focused on: Internalizing problems, measured by Youth Self-Report (YSR);
Competence Scale (ICS-T); and Perceived academic stress, measured by Scale for Assessing
The procedure of the study included a baseline assessment, completed in two sessions,
where all 12 subjects were assessed individually by clinical psychologists (Sinha & Kumar,
2010). Participants were kept in two groups according to gender, and 12 sessions of Mindfulness
Cognitive Behavior Therapy (MCBT) were held in group settings once a week, each session
lasting for 85 minutes (Sinha & Kumar, 2010). According to Sinha and Kumar (2010), the first
20 minutes were for mindfulness practice, and the remaining time was used for CBT intervention
with 5--minute breaks between each intervention (p. 23). Mindfulness practice included
discussion on the power of mind and awareness of how powerful the mind can be, the practice of
33
meditation guided by the trainer, and mindfulness exercises for self-awareness and self-control.
The CBT intervention followed Beck's model (Sinha & Kumar, 2010). Post therapy assessment
was completed after the termination of therapy (Sinha & Kumar, 2010).
The results indicated that more than 80% experienced a clinically significant decrease in
their emotional problems after therapy (91% to 83% ), as well as a significant reduction in the
‘T’ scores: Pre-therapy T scores of 64.80, to post-therapy T scores of 58.0, of the Children’s
Depression Inventory (CDI) scales (Sinha & Kumar, 2010). At the beginning of the study,
participants reported more social and psychological symptom profiles of anxiety as compared to
symptoms (Sinha & Kumar, 2010). In each of the remaining categories that were assessed in the
there were significant differences between pre- and post- scores in that participants indicated
hopelessness and internalization of emotional feelings (Sinha & Kumar, 2010). There was no
Benner et al. (2010) conducted research on the impact of intensive positive behavioral
supports on the behavioral functioning of students with emotional disturbance. The two purposes
of the pre-post naturalistic research design were the following: (a) Investigate the impact of
Positive Behavioral Intervention and Supports (PBIS) on the behavioral functioning of students
with ED served in classroom settings (b) and to examine the extent to which teacher fidelity of
PBIS implementation influenced student changes in behavioral functioning over the school year
(Benner et al., 2010). Measures used in this research included the Child Behavior Checklist-
Teacher’s Report Form (CBC-TRF) to measure the behavioral functioning (e.g., difficulty
34
following direction, disturbing other pupils, and disrupting class discipline) of participants, and a
modified version of the Teacher Knowledge and Skills Survey (TKSS) to ascertain fidelity of
PBIS implementation (Benner et al., 2010). Participants included 37 public school students (29
males and 8 females) receiving special education services for ED in an urban northwestern city,
between the ages of 7 to 16 years, as well as eight teachers (Benner et al., 2010). Benner et al.
(2010) reported that at the beginning of the study, all participating teachers had been
In regard to the study’s procedure, all eight ED teachers (e.g., Special Education teachers
responsible for the instruction of all subjects) received 20 2-hour training sessions in Positive
Behavioral Intervention and Support (Benner et al., 2010). Training began with positive
replacement behaviors (Benner et al., 2010). Training also included assessing functions of
behavior, developing positive behavior intervention plans precisely linked to the functions of
behavior, identifying and implementing research-based practices in the area of PBIS, and
designing data collection procedures to inform instructional decisions (Benner et al., 2010).
Results of the first finding stipulated that PBIS was correlated with the behavioral functioning of
students with ED in that statistically significant reductions were found in the pre- and post-test
scores of students on the Teacher Report Form (TRF) symptom scores of thought problems,
attention problems, and aggression (Benner et al., 2010). Furthermore, there were significant
reductions in the number of students who met the standard for clinically notable internalizing and
externalizing behavior problems, and total behavior problems were found in acting, thinking,
feeling (Benner et al., 2010). Benner et al. (2010) reported that such data indicated that PBIS
appeared to play an essential role in improving the behavioral functioning of students with ED
35
(p. 94). Results of the second finding suggested that teacher fidelity to the structure and process
of PBIS played a significant role in reducing problem behaviors (Benner et al., 2010). Such
findings demonstrated that the professional development activities were able to successfully
build the capacity of teachers, which resulted in improved children behavior outcomes (Benner et
al., 2010). However, Benner et al. (2010) reported that shortages of well-prepared teachers made
professional development crucial (U.S. Department of Education, 2002, as cited in Brenner et al.,
2010).
Benner et al. (2010) reported that the study had several limitations beginning with the
research design (p. 95). It was suggested that future researchers should use higher quality designs
that include regression, discontinuity, or randomized experimental designs (Benner et al., 2010).
Additionally, the participants in the study did not demographically represent the general
population, along with the mean participant age (13.2 years), which was an overrepresentation of
older students (Benner et al., 2010). Furthermore, the study should have incorporated other
(Benner et al., 2010). Benner et al. (2010) also reported implications for the challenge of moving
PBIS to practice (p. 95). The authors referenced Cook et al. (2003) in regard to the services, that
if not used with adequate amounts of treatment (e.g., amount to achieve a desired therapeutic
In a wait-list control study conducted by Swain et al. (2019), they examined the response
to group CBT in terms of individual-level change in young children with Autism Spectrum
Disorder (ASD) (p. 1). The study measured ASD characteristics using the Social Responsiveness
Scale second edition (SRS-2); Negative affect measures where parents reported on their child’s
36
negative affect using the Liability/Negativity (LN) subscale of the Emotion Regulation Checklist
10-point Likert scale to assess confidence in their ability to manage their child’s anger/anxiety;
Cognitive functioning using the Kaufman Brief Intelligence Test second edition (KBIT-2); and
and usefulness of the treatment and its components after participating in the Stress and Anger
Management Program (STAMP) (Swain et al., 2019). Participants included 18 children (16 boys;
2 girls) between the ages of 5 and 7 years with high functioning ASD, and at least one parent of
each child. The children were not language impaired and were able to tolerate a group setting
Parents completed the SRS-2 prior to treatment and the ERC, confidence scales, and
Behavioral Monitoring Sheets before and after treatment (Swain et al., 2019). Both children and
parents participated in nine hour-long, separate, weekly group sessions led by trained master’s or
doctoral level clinicians (Swain et al., 2019). Swain et al. (2019) reported that each child group
session included stories, interactive lessons, and singing, with session components focusing on a
specific topic that offered strategies to understand and better manage anger/anxiety (p. 6). Parent
group sessions consisted of clinicians holding discussions on session material (e.g., treatment
goals, coping skills, behavior management), home assignments (e.g., behavior chart, personal
goals, journal writing) and issues around applying treatment strategies to other settings (e.g.,
school, supermarket, group settings) (Swain et al., 2019). A child was classified as a “treatment
responder” if they met at least two of the following four criteria: (a) statistically significant
post-treatment decrease in Liability/Negativity (LN) applying the RCI (Reliable Change Index);
(b) greater than 20% decrease in average intensity of outbursts; (c) greater than 20% decrease in
37
frequency of outbursts; or (d) greater than 20% decrease in average duration of outbursts (Swain
et al., 2019).
Results indicated that 12 child participants were classified as treatment responders; nine
of the treatment responders were classified based on a reliable change in RCI and significant
decreases in at least one behavioral monitoring measure (Swain et al., 2019). However, three
treatment responders did not show a significant change in LN but demonstrated a 20% or greater
decrease in at least two behavioral monitoring measures (Swain et al., 2019). Swain et al. (2019)
expressed that within the group of eight parents who endorsed significant decreases in intensity
of their child’s emotional outbursts, five also reported a reduction in episode duration (p. 7).
Parents in the study also observed an increase in changes in their own emotional regulation and
patience, and they identified ways to bridge the gap between the therapy room and the classroom
(Swain et al., 2019). There were specific difficulties with generalization of skills, little indication
of occasional use of the coping strategies by the child, and responses that the program should
have been more tailored to each child’s individual needs (Swain et al., 2019). While almost 70%
of the children responded to treatment, the authors also observed substantial room for
improvement (Swain et al., 2019). Results relied solely on parent-reported information, which
again limited generalizability outcomes (Swain et al., 2019). Swain et al. (2019) concluded that a
better understanding of the parents and children who responded best to treatment would increase
the knowledge of who could benefit from this treatment in a clinical setting, and how it could be
38
Music Therapy
Research and clinical evidence have suggested that music therapy can assist children in
reaching their Individualized Education Plan (IEP) goals (Yinger, 2018). In order to better
support emotionally disturbed children, the study of how the brain functions with music and
exploring techniques and strategies involving music therapy can be used as a therapeutic strategy
practice with the use of music interventions to meet goals within a therapeutic relationship to
address physical, emotional, cognitive, and social needs of individuals (American Music Therapy
Association, 2005). The music therapists’ intention is to determine which music therapy
approaches are effective in the reconstruction, maintenance, and improvement in mental and
physical health (American Music Therapy Association, 2005). Music therapy involves the use of
active and passive therapy, where instruments can be played during sessions (active) or music
may be listened to (passive) to reflect on tone, lyrics, or emotion in a musical piece (Coons &
Montello, 1998). Sessions involve the client using instruments and their voice to explore the
world of sound, while the therapist supports the clients’ response through improvised music
The various types of music therapy include: Guided Imagery and Music: the purposeful
use of prepared music by a therapist to evoke sensory and emotional responses in the listener
(Beyers, 2016, p. 39); Nordoff-Robbins Music Therapy: based on the belief that everyone
possesses a sensitivity to music that can be implemented for personal growth (Beyers, 2016,
p.40); Free Improvisation Therapy: free use of music, using instruments and voice to
maintain/improve health (Beyers, 2016, p. 19); Neurological Music Therapy: based on the
scientific knowledge of music perception and the effects of the treatment on nonmusical brain
39
and behavior functions (Thaut, 2005, p. 126); Resource-Oriented Music Therapy: emphasizes the
development and stimulation of individual’s strengths rather than the reduction of symptoms
(Schwabe, 2005, p. 50); Education-Oriented Music Therapy: the use of music activities to foster
the development of motor, communication, cognitive, and social abilities (Chong & Kim, 2010,
p. 193) ; and Community Music Therapy: an approach to working musically with people in
context (e.g., acknowledging the social and cultural factors of their health) (Pavlicevic, 2012;
Stige, 2010).
Disturbance
Chong and Kim (2010) examined how an after-school Education-oriented Music Therapy
(EoMT) program can impact children’s emotional and behavioral problems as well as academic
competency. A 16-week music therapy program using music activities and interventions to
promote academic, social, and emotional skills was implemented with this study (Chong & Kim,
2010). Gresham and Elliott's (1990) Social Skills Rating System (SSRS) was also utilized to
measure social skills, academic competency, and problem behavior (Chong & Kim, 2010). To
identify change in such areas, the SSRS was administered before and after the EoMT program to
assess students’ problem behaviors and interpersonal skills (Chong & Kim, 2010). The study
took place over 6 months (16 weeks), with sessions occurring twice a week and lasting 50
minutes each (Chong & Kim, 2010). A total of 89 elementary students who were identified as
having social and emotional problem behaviors by the SSRS and from 13 different schools, who
did not have any prior music instruction were selected to participate in the study (Chong & Kim,
2010). According to Chong and Kim (2010) participants were placed into three groups of four to
six students by grade: grades 1 and 2 were combined into one group, as well as grades 3 and 4,
40
and grades 5 and 6 were in one group (p. 191). Eight music therapists provided sessions for all of
the participants and met on a weekly basis to discuss the appropriateness of music interventions
for meeting the established therapeutic and educational goals (Chong & Kim, 2010).
social and emotional problems, and then to reinforce learning skills essential in musical tasks and
transfer such skills to non-musical or academic subject matter (Chong & Kim, 2010). Each
session plan articulated educational goals and therapeutic goals with a rationale of why the
presented intervention and musical material would meet such goals (Chong & Kim, 2010). The
structure of each session included an opening activity that invited participants to the musical
experience and established a common ground for the main activity, a main activity where music
therapists and students engaged in sequenced musical activities targeting non-musical goals; and
a closing activity that included participants sharing musical challenges and a sense of
achievement in the activity that could be transferred to other non-musical tasks (Chong & Kim,
2010). Chong & Kim (2010) reported that the main activities of sessions were formulated to
utilize cognitive skills to understand the musical process and playing, and at the same time get in
touch with the emotional and social aspects of the intervention (p.193). With each session plan,
Results indicated that EoMT was effective in enhancing social skills and bringing about
appropriate behavioral changes (Chong & Kim, 2010). There were also increased changes in the
students’ assertiveness, self-control, and level of cooperation, due to the various roles and
interactions facilitated by the music activities, which supported positive changes in the ways
students worked together to achieve common goals related to music-making (Chong & Kim,
41
2010). Furthermore, results suggested that students who exhibited externalized behavior
problems were able to reduce acting-out behaviors through musical experience, and students
with internalized behavior problems were able to express themselves more outwardly (Chong &
Kim, 2010). Music therapists also indicated that students who had externalized behaviors had an
increase in musical participation, proposing that their impulsive energy was channeled into
purposeful musical behavior, such as percussive playing and singing, while students who had
internalized behaviors learned to be more expressive (Chong & Kim, 2010). On the other hand,
results indicated that there was no visible positive change in academic competence, perhaps due
to the possibility of the implementation period being too short (Chong & Kim, 2010). Therapists
also reported that assisting with academic support was out of their scope and implementing
educational support would have supported academic competency for the students (Chong &
Kim, 2010).
Porter et al. (2017) examined the efficacy of Free Improvisation in clinical practice. Two
hundred and fifty-one child and parent dyads from six Child and Adolescent Mental Health
Service community care facilities in Northern Ireland were randomized to 12 weekly sessions of
community music therapy plus regular therapy (Porter et al., 2017). Follow-up occurred at 13
weeks and 26 weeks (Porter et al., 2017). Child participants were between 8-16 years old with
from single-parent families, and 32% were from families where neither parent was employed
(Porter et al., 2017). Measures implemented in this study were communicative and interactional
skills, as measured by parental and self-reporting of the Social Skills Improvement System
Rating Scales (SSIS) at week 13 (Porter et al., 2017). The secondary outcomes included
communicative and interactional skills at week 26, self-esteem, and depressive symptoms were
42
measured using the Center for Epidemiological Studies Depression Scale for Children
(CES-DC), social functioning measured using the Child Behavior Checklist (CBC), and family
functioning assessed using the Family Assessment Device completed by the parent (Porter et al.,
2017).
Participants were randomly assigned to the control group, which received regular therapy
only (“usual care” group), and consisted of psychiatric counseling and/or medication (the dose
and frequency deemed as appropriate). In addition to usual care, patients assigned to the
experimental group received the Alvin model of Free Improvisation (Porter et al., 2017). Porter
et al. (2017) explained that improvisation encourages individuals to create music and sound
freely through voice, instrument, or movement, while receiving support and encouragement
specifically to suit their needs as assessed by their therapist (p. 587). Instruments used in this
study consisted of the guitar, xylophone, keyboard, and drums, and patients had the opportunity
to make personalized CDs (Porter et al., 2017). Sessions were delivered individually,
face-to-face, in a private room for 12 weeks and lasted 30 minutes (Porter et al., 2017).
Participants also received three assessment sessions before treatment objectives were discussed
and established with the music therapist (Porter et al., 2017). After discussion, all music therapy
sessions were led by the participant who was invited to choose an instrument to express how they
were feeling that day and the previous week; each session ended with a verbal or musical
reflection on the session and a plan made for the following week (Porter et al., 2017).
Results indicated a small but clinically significant effect for improved communication
and interaction skills for participants aged 13 and over in the intervention group as compared to
the control group (Porter et al, 2017). At week 13, self-esteem was significantly improved, and
depression scores were significantly lower in the intervention group when compared to the usual
43
care group therapy only group (Porter et al., 2017). At week 26, social functioning was also
significantly improved in the intervention group and a slight improvement in family functioning
Limitations of this study included short session times. Porter et al. (2017) reported that if
session times were longer there might have been a higher increase in both primary and secondary
outcomes (p. 591). Additionally, results indicated a need for further studies targeted at specific
disorders (Porter et al., 2017). Lastly, outcome measures were all based solely on parent and
patient reports, while other outcomes such as behavioral observations were by a clinician. More
observations would have helped strengthen the study (Porter et al., 2017).
a hip hop framework with youth who had experienced trauma. Hip hop interventions have been
skills (Travis & Deepak, 2011, as cited in Levy et al., 2021). This research brought about hip hop
and spoken word therapy (HHSWT), an approach to counseling where students engage in
previously validated counseling interventions through the process of writing, recording, and
performing hip hop music (Levy, 2012). Interviews were conducted with willing participants and
used to measure and collect data for the study (Levy at al., 2021). According to Levy et al.
(2021), the interview guide was developed by the first author to prompt discussion around
participant experiences, including perceptions of what they learned in the program, as well as
what they identified as important to them (p. 7). Interviews ranged from 10-30 minutes and were
conducted by the first and second authors, and then transcribed verbatim (Levy et al., 2021).
Participants were youth at the Boys & Girls Club who displayed internalized and externalized
44
behaviors. However, there was no further information regarding geographic location or age of
participants, but the number of participants ranged from 6 to 12 in each session (Levy et al.,
2021).
Once a week, for 10 weeks, participants engaged in one, 90-minute session that explored
one of the topics suggested by the participants (e.g., the struggles in life) (Levy et al., 2021).
Discussions between participants lead to the development or realization of experiences that they
perceived as difficult or needing to get through (Levy et al., 2021). The topics chosen and the
songs implemented to represent them were utilized to guide choreography and lyric writing in
sessions (Levy et al., 2021). Every week the session began with 5-minute check-ins, where
participants discussed likes and dislikes from the prior sessions and what they wanted to discuss
that day (Levy et al., 2021). In the first part of the session, participants were given 15-20 minutes
to watch a music video that group facilitators selected based on the comparison between the
video content and the identified session topic (Levy et al., 2021). Afterward, participants were
given the space for reflection on the weekly theme and their own lives (Levy et al., 2021).
Participants were then divided into a lyric writing group and a dance group with the same
instrumentals, then asked to create specific dance movements and/or lyrics that represented the
weekly topic (Levy et al., 2021). Within the lyric group, participants worked closely with the
principal investigator (PI), while the dance group worked with two graduate assistants (GA);
both asked their group follow-up questions regarding underlying thoughts and emotions that
included further exploration (Levy et al., 2021). The last 5-10 minutes of each group were
brought together for a group close-out and provided the space for participants to process their
group experiences by discussing the process with other group members or participating in
self-reflection through writing in journals (Levy et al., 2021). Levy et al. (2021) left space for
45
each group to share their work with the rest of the group and tell their peers what the verse or
Results identified that participants developed social or emotional skills with the HHSWT
program, and the authors suggested that participants experienced improved confidence, stepped
outside of their comfort zone, and had the ability to process difficult emotions verbally with
others (Levy et al., 2021). Additionally, results indicated that participants were able to share and
learn from others and value that the space was safe and judgment free, while feeling pride in
their community (Levy et al., 2021). Participants expressed learning new skills they did not
challenging tasks within a group (Levy et al., 2021). Furthermore, participants expressed the
ability to process difficult topics in a verbal way, as well as forming healthy relationships with
others and managing conflict-ridden situations (Levy et la., 2021). In general, the study indicated
that hip hop elements supported participants in disclosing emotions, and identifying deeper
Summary
with emotional disturbance. Understanding the characteristics and behaviors of children with ED
is critical to serving them well (Wagner et al., 2005). Furthermore, factors that contribute to
emotional disturbance included poverty and trauma in childhood ( Copeland et al., 2007;
Gyamfi, 2004). As a result, the negative outcomes of children with emotional disturbance are at
high-risk for academic challenges, negative disciplinary and behavioral outcomes, as well as
involvement with law enforcement (Wagner & Newman, 2012). Common therapeutic
46
CBT and Positive Behavioral Intervention and Supports (PBIS) (Benner et al., 2010; Sinha &
Kumar, 2010). The chapter also described the theoretical orientation of music therapy. The
American Music Therapy Association (2005) was referenced to identify how music therapy is an
evidence-based practice with the use of music interventions to meet goals within a therapeutic
relationship to address physical, emotional, cognitive, and social needs of individuals. The use of
Education-oriented Music Therapy (EoMT) was implemented to describe the ways in which
disturbances (Chong & Kim, 2010). Porter et al. (2017) also implemented free improvisation, the
use of instruments and voice, to examine the efficacy of music therapy in clinical practice with
emotionally disturbed children. Lastly, the use of Hip-Hop and Spoken Word Therapy (HHSWT)
was examined to identify the effects of a community-based intervention with youth who had
experienced trauma, and results indicated that participants developed deeper social-emotional
Chapter III will describe a hypothetical case study of a group of four to six children in
upper elementary grades, with emotional disturbance undergoing Music Therapy treatment.
Chapter IV will identify the strengths and limitations of this project, further therapeutic
considerations for treating clients with ED, and recommendations for future research.
47
Chapter III
Application
associated with children with emotional disturbance. Included was the treatment commonly used
Furthermore, it provided information on the use of music therapy and how it has been
Chapter II reviewed the literature on the characteristics and behaviors, as well as the
negative outcomes, of children with emotional disturbance. Researchers found that children with
emotional disturbance have greater challenges with peer interactions, an inability to learn,
display inappropriate behavior, and have feelings of depression (Cullinan et al., 2003). Research
outcomes for this population have identified that they are at high risk for incarceration (Wagner
& Newman, 2012). Children with emotional disturbance are more likely to have higher
disciplinary trouble in school than their peers (i.e., suspension, expulsion) (Blackorby et al.,
2003; Wagner et al., 2005). Chapter II also described the implementation of music therapy and
Emotion”, for fourth and fifth grade students with emotional disturbance who either have an
Individual Education Plan (IEP) or students without an IEP who have serious externalized and
internalized behaviors. The intervention is grounded in active and passive music therapy and will
be guided by Education-oriented Music Therapy (EoMT) (Chong & Kim, 2010). Incorporated in
this chapter are the setting and structure of the group, the selection of group members, the
48
Setting and Structure
This therapy group will take place in a school setting such as a classroom or enclosed
space necessary for the group. The classroom will need a projector and a whiteboard. There will
also need sufficient space for movement. In the classroom, there will be a circular rug with
musical designs and bean bag chairs for group members to sit in. Around the rug, bean bag
chairs will be spaced between members to keep from physical distraction from one another (e.g.,
touching, kicking). To avoid altercations, bean bag chairs will be the same color.
Boys and girls ages 9-11, or in the 4th and 5th grades, will be piloted for this counseling
project. A credentialed music therapist will facilitate the group. There will be no more than eight
students in a group. The group will be 8 weeks long with 50-minute sessions each week, along
with individual check-ins once a week prior to group sessions. Each session will begin with a
group check-in and review of group agreements; a lesson to encourage thinking and expression;
an activity to support relational skills; and a debrief of the group session. Following the initial
session, there will be two sessions on each theme. Session one will provide psychoeducation
regarding the overall theme to familiarize students with the appropriate language to express
themselves, and the second session will continue to implement what was learned the week prior
support consistency and trust, the group will be closed, and no new members will be admitted
The selection process of the group members will first involve a consultation between the
counselor and teachers who have students with emotional disturbance on an IEP, as well as
emotionally disturbed students who do not qualify for an IEP, but display a high level of
49
externalized and internalized behaviors. Prior to the consent form being sent home for the
selected students, the counselor will call the parent(s)/guardian(s) to inform them that a consent
form will be sent home to sign (Appendix A). After obtaining parental consent, the counselor
will hold a brief meeting with recommended students and present what the group is about. The
counselor will explain that the group is for 4th and 5th graders to understand their emotions and
experiences, gain a better understanding of themselves, and form healthy relationships through
the art of music. The counselor will also explain the benefits of music. Following the
presentation, students can express interest in the group by completing a 3-question survey
(Appendix B). The survey will establish students' awareness of what the group is about, their
interest in the group, and their reasons for wanting to participate. Surveys will be collected and
reviewed with the teachers of the students who completed the survey. Teachers will be included
in the screening process with the counselor in order to identify which students would most
benefit from the group. Once students have been chosen, the counselor will meet individually
with chosen students and review their survey together to establish rapport and gain further
understanding of their interest in the group. Informed consent will be reviewed for the student to
understand the important information of the group. The names of the students who were not
Program Approach
This “Sweet Emotion” music therapy group is designed for children (4th and 5th graders)
with emotional disturbance to help them understand their emotions and experiences, gain a better
understanding of themselves, and form healthy relationships through the art of music. The
environment of the group and selected interventions are utilized to promote rapport building and
trust within the group, as well as to promote pro-social skills. Students will also learn how to use
50
music for healthy coping strategies and taking better control of their emotions, as the emotional
brain, specifically in the amygdala and cerebellum, become activated when music is played
(Levy, 2005). The activation leads to the connection to emotions and physical movement in the
body that can move with the sound of the music. Furthermore, the group will include cultural
considerations for the use of music and ways in which indigenous people have used music for
In the initial group session, students will have the opportunity to create a sense of
community through establishing group norms and rapport building activities. Additionally, the
initial session will set the tone for building trust and empathy between the students and
counselor. Every week at the beginning of each session, the students will be given an agenda
regarding the overall structure of how the group session will be held. At check-ins the counselor
can assess students’ feelings and discuss if a “cool down” choice may be needed during the
session. To assess, the counselor will have students check-in by answering the check-in question
of the day at the beginning of each session. The counselor will give students a post-it note sized
paper at the beginning of the session that says “Cool Down” with two blank spaces at the bottom
for students to write their number choice for their break, the post-it note can be seen as a “ticket”
for students (Appendix C). As the group is starting, soft instrumental relaxation music will be
● INTRODUCTION (10 minutes): The counselor will introduce herself and introduce the
norms, check-in, lesson, rapport building activity, and close-out. This will be the overall
structure for the duration of the 8 weeks that this group will meet. The counselor will
51
then ask students to share their name and what grade they are in. After each student shares their
name, the counselor will introduce the check-in process at the beginning of the following
sessions.
● RAPPORT BUILDING ACTIVITY (5-8 minutes): The counselor will then follow up with a
rapport building activity and will invite the students to engage with one another. Each student
will have the opportunity to take turns sharing with their partner.
● The counselor will encourage students to pair up. During this activity, the soft
instrumental relaxation music will play lightly in the background to create the ambiance.
● Students will be prompted to build rapport by answering the following question that will
be written on the whiteboard, “What would your walk-up song be today and why?”
● The counselor will ask students to share one another’s name and their walk-up song. The
student who is being shared on will have the opportunity to elaborate on their walk-up
● ESTABLISHING GROUP NORMS (10 minutes): The counselor will then engage the group
to begin establishing group norms, which will create boundaries surrounding the overall function
of the group and create a sense of community. Group norms will be written on poster sized paper
and displayed at the beginning of each session. After creating group norms, students will sign the
bottom of the poster to acknowledge the norms that were created. The counselor will explain that
at the beginning of each session one group norm will be chosen to focus on during the session.
● To provide structure for establishing group norms, the counselor will give two-three
examples of group norms (e.g., Treat others how you would want to be treated, One voice
at a time, Respect your neighbors) and explain that group norms are important in shaping
52
the way we interact with each other as well as, supporting the group in creating a safe
space.
● The counselor will explain that the group will have space to share a group norm and will
prompt students to raise their hand if they choose to share. The counselor will discuss the
group norms that are shared by the group and write them on the poster.
● The counselor will then discuss the concept and use of a “safe word”. A “safe word” will
be defined to the group as a discreet way to notify or confirm with the counselor that the
student is beginning to feel dysregulated, and, therefore, needs to access and utilize a
“cool down” card. The “safe word” will remain the same word throughout the 8 weeks of
group therapy. The counselor will then prompt the group to identify a word they all agree
● LESSON (20 minutes): The counselor will provide the group psychoeducation regarding
emotional dysregulation and strategies to self-regulate. The counselor will play a short YouTube
video about losing control of emotions (Appendix D). The counselor will then discuss 3-6
pre-selected “cool down” options students can choose from. The counselor will provide options
on a poster (Appendix E). The counselor will then refer to the protocol in how students can
access a cool down break and provide visuals through a powerpoint slide (Appendix F).
● If students choose to pick a “cool down” choice, they can choose a number from the
poster that will have a strategy to use (e.g., hug/squeeze a pillow, sit with a weighted
blanket on lap, trace a shape and take a breath, 10 jumping jacks with the group, if others
want to join in) . Students can give counselor “cool down” paper when they feel the break
is needed.
53
● Students will be asked to check-in with the counselor throughout the group if a “cool
down” is needed.
● CLOSE OUT (5-10 minutes): This activity is intended to regulate students before their
● Before explaining the close out activity, the counselor will play the soft instrumental
acoustic beats/music to set a relaxing tone for the end of the group session. The counselor
will ask students to draw/color with provided arts and crafts, on an 8x11 blank piece of
paper and draw an abstract art on what they learned or felt from this initial session, which
will then be placed on a bigger poster board and stored by the counselor once the session
has concluded. The poster will be implemented throughout sessions and used at the very
The purpose of this session will be for students to learn how to be aware of their
emotions and identify where emotions are felt in their bodies. A video will be implemented for
visuals, and students will have the opportunity to practice identifying emotions by completing a
worksheet to assist in visualizing where emotions are felt and experienced throughout the body.
Soft instrumental music will be quietly played as background music during the activity to set a
calm ambiance within the setting. The session will continue to support rapport building and
group cohesion. Therapeutic space will then be provided and held in the event students choose to
share their experiences with their peers. Lastly, as the session comes to a close, students will be
encouraged to be mindful throughout the week of their newfound awareness of any emotions that
54
● INTRODUCTION (5 minutes): As the group comes in the room, the counselor will be
playing the students playlist based on the activity in the initial session to make the space
inviting. The counselor will stop the music, welcome the students to the second session,
and reintroduce herself and the purpose of the group. The counselor will also ask students
to share their name again before transitioning to the structure of the session. The structure
will be as followed: Review of group norms, check-in, lesson, activity, and wrap-up of
the session.
● GROUP NORMS (5 minutes): Before transitioning to the check-in, the counselor will
display the group norms that the group collaboratively created in the previous session.
The counselor will briefly review the importance of group norms and highlight how the
group worked as a community to form them. The counselor will remind the group that
they will go over the group norms each session before the group begins. Furthermore, the
counselor will prompt the group to think of a group norm they want to focus on for this
○ To highlight which norm the group wants to focus on for the session, the
○ The counselor will make sure the group is in agreement with the chosen group
norm and remind the group about the use of the “safe word” before transitioning.
● CHECK-IN (10 minutes): At the beginning of the check-in, the counselor will briefly
review the structure of a cool down break if students need one and show the powerpoint
slide(s) of how to access a break before students share (Appendix F). The cool down
poster will be displayed for students to refer to throughout the group (Appendix E). The
counselor will then follow up with the check-in for the session: “Rose and Thorn”. The
55
counselor will give an example and ask students to share their positive moments of the
week (rose) and parts of their week the students felt did not go well (thorn). For example,
the rose of the week is having an extra recess, and the thorn is forgetting to do a
homework assignment.
● LESSON (15 minutes) : The counselor will provide the group psychoeducation regarding
where in our bodies we feel strong emotions. The counselor will review psychoeducation
of the brain and emotions from the video in the previous session. The counselor will
emotions and then use the video to teach the group where the emotions can be felt in their
○ The counselor will use the video as an interactive way to teach the students how
○ The counselor will pause the video and provide structure for the group in
identifying their emotions in their bodies. For example, the counselor will give an
example of how happiness is felt in their cheeks, or anger is felt in their chest, and
○ The counselor will prompt the students to point to where named emotions are felt.
The counselor will also use the video to assist students in identifying and giving
examples of feeling sad, happy, or angry. The counselor will encourage discussion
● ACTIVITY (10-15 minutes): The counselor will provide students with a body template
worksheet and coloring supplies (Appendix H). The counselor will display a powerpoint
56
with 4-5 pictures of emotions and ask students to color where on their template they feel
○ While students are coloring, soft instrumental music will be played in the
background.
○ Debrief: The counselor will leave 10 to 15 minutes open for students, if they
choose, to openly process with the group if they identify with the theme of the
session, “Emotions”.
● CLOSE-OUT (5 minutes): The counselor will provide students their own folders to use
during sessions to keep their papers in and collect them as students are leaving the group.
To close the session, the counselor will do one final check in with the group. The
emotions. And lastly, the counselor will encourage students to be mindful of any
emotions they experience within their bodies, throughout the coming week.
The purpose of this session will be to form a feelings circle where students will have the
opportunity to discuss their feelings and express their emotions. The counselor will implement
57
music therapy interventions such as, reflective listening and free improvisation with instruments.
Visuals such as powerpoint slide(s) and videos will also be implemented throughout the session.
Students will learn how emotions sound by listening to the loud and soft volume of instrumental
music and be able to express emotions through playing instruments. The session will continue to
support rapport building and group cohesion, therapeutic space will then be provided and held in
the event students choose to share their experiences with their peers. To close, the students will
have the opportunity to reflect on the lesson through art and draw what they felt was important to
● INTRODUCTION (5 minutes): As the group is entering the room, the counselor will play
a song from the group playlist. The counselor will pause the music when the group is
situated and welcome the group to the third session. The counselor will remind the group
that there are five sessions left. The counselor will briefly summarize the previous session
of identifying emotions to remind the group of what was covered in the previous session
● GROUP NORMS (5 minutes): The counselor will remind the group that they will go over
the group norms each session before the group begins. Furthermore, the counselor will
prompt the group to think of a group norm they want to focus on for this session and
facilitate discussion if necessary. Refer to session two for structure of group norms.
● CHECK-IN (5 minutes): The counselor will continue to review the structure of a cool
down break before students check-in (Appendix F). The cool down poster will be
displayed for students to refer to throughout the group (Appendix E). The counselor will
begin the check-in by asking how the group did with being mindful of their emotions
within their bodies during the week. The counselor will prompt the students to name
58
feelings and identify where in their bodies they experienced the feeling. The counselor
will follow-up with a check-in regarding how students feel in the current session by
displaying the body template on the projector (Appendix H). The counselor will ask
students how they are feeling in the present moment and prompt students to identify
where they feel the feeling in their body. The students will write their name on a sticky
note and either draw the face of their feeling, or write a feeling word to stick on the body
template.
expression and facilitate discussion between the group regarding what it is like to express
their feelings. The counselor will introduce the lesson by providing psychoeducation
about the volume of music, known as forte and piano, and how it relates to how our
emotions are expressed. The counselor will introduce the musical terms forte and piano
on a powerpoint slide to provide visuals as well as define them (Appendix J). The
counselor will explain that just like volume controls how loud or soft music is played, our
emotions control how big or small we express them. The counselor will prompt students
to observe the sounds of an instrumental music clip from youtube (Appendix J) with loud
and soft volumes of sound for 50 seconds. Additionally, the counselor will prompt
students to observe their feelings while listening to the music. The counselor will begin
the discussion after the music clip and encourage students to share what sounds they
Questions for discussion will also be provided on the powerpoint slides for
students to visually see and then answer within the group (Appendix J):
59
○ What feelings did you notice in your body when you listened to the music get
○ When was the last time you noticed your emotions get “loud”? Was there
○ What is it like to share your feelings? Are there times where you don’t feel like
● ACTIVITY (10 minutes): The counselor will put 8 folded pieces of paper in the middle
of the circle for students to pick from. On these strips of paper will be different emotions
(e.g., happy, sad, angry, surprised, scared, excited, annoyed, and worried) that the
students will either act out or draw on the white board when they are called on to show
what the emotion looks like and where they feel it (Appendix K). The counselor will
prompt students to think about the sound the emotion makes and allow them the choice to
○ The counselor will implement active music therapy with the intervention of free
improvisation and students will have the choice of picking between three
instruments to play (small drum, xylophone, mini keyboard piano) to express the
○ The counselor will model by naming an emotion (e.g., silly) and draw a picture of
what the emotion “silly” looks like on the white board. The counselor will give
one example of where she feels silly in her body. Following, the counselor will
pick the xylophone and say, “This is what silly sounds like to me” and play the
sound. *The counselor would play a jumpy beat to represent the emotion. The
60
(Appendix J). The counselor will also provide structure by calling on students for
them to share their emotions and the instrument/music to demonstrate the sound
of the feeling.
■ Structure of activity:
■ Students will choose an emotion from the center of the circle and name it,
and either act out or draw the emotion on the white board.
■ Students will point to where they feel the emotion in their body, and then
■ Students will use the prompt, “This is what __________ sounds like to
me”.
○ Debrief: The counselor will leave 5 to 10 minutes open for students, if they
choose, to openly process with the group if they identify with the theme of the
● CLOSE-OUT (5 minutes): To close the session, the counselor will briefly review
psychoeducation on emotional expression. The counselor will express that we can use our
cool down choices to help with our emotions. The Counselor will end by asking students
The purpose of this session will be to learn about the meaning of identity and the qualities
of our identity. A video will be shown (Pike, n.d.) to break-down the characteristics of identity
for the students to understand. Furthermore, the counselor will introduce an “Identity Flower”
(Appendix L) and display it for students to visualize. Students will listen to and watch a story
about a boy with different identities (Diggs, 2015) and work collectively as a group to describe
61
his qualities on the “Identity Flower” displayed. Lastly, the students will have the opportunity to
complete their own “Identity Flowers” and share an aspect of their identity that is of importance
to them. Songs from the students’ playlist will be quietly played as background music during the
activity to create an enjoyable ambiance within the setting. The music played softly in the
background is a music therapy intervention called passive music therapy implemented to assist
● INTRODUCTION (5 minutes): The counselor will play the group’s playlist as students
are coming into the room. Before sitting down the counselor will pause the music and
join the circle to welcome the group. The counselor will remind and express that there are
4 sessions left of the group. The counselor will briefly explain what was covered in the
previous session and introduce that the topic of this session will be about their own
identity (5 minutes).
● GROUP NORMS (5 minutes): Before transitioning to the check-in, the counselor will
display the group norms that the group collaboratively created in the initial session. The
counselor will briefly review the importance of group norms and highlight how the group
worked as a community to form them. Refer to session two for further structure of group
norms.
● CHECK-IN (5 minutes): The counselor will continue to review the structure for a cool
down break and bring attention to the poster (Appendix E). The counselor will transition
(Appendix M), with 1 being happy and 5 being out of control. The counselor will ask
students to show a number with their fingers to express how they are feeling at the
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● LESSON (10 minutes): The lesson for this session will be interactive. The counselor will
introduce the word “Identity” and write its definition on the white board for students to
see. The counselor will define identity as the qualities, beliefs, expressions, appearance
and values that make us who we are. The counselor will ask students to discuss what they
think the word means. The counselor will write the students’ meanings and definitions on
the white board. After a brief discussion about the word identity, the counselor will play a
2 minute and 58 second Youtube video, referred to above, about what makes up our
identity (Pike, n.d.) (Appendix N). The counselor will then explain that understanding our
identity helps us recognize our strengths and makes us unique. The counselor will use the
video to introduce an identity flower (Appendix L) and go over the identities on each
petal. The counselor will ask students if they have any questions about the identities on
the flower.
● ACTIVITY (15 minutes): To transition, students will listen to and watch a story on
Youtube called “Mixed Me” (Diggs, 2015) (Appendix O). Students will be prompted to
observe the character's identity throughout the story. The counselor will project the
identity flower and facilitate discussion between the group in identifying the character's
identity based on what they observed in the video. The counselor will again inquire about
the students' identities and provide an identity flower to each student. Students can draw
or write their qualities on the petals. Music from the students’ playlist will be quietly
played in the background as students decorate their flowers. The students will have the
opportunity to share their flower and share a part of their identity flower that is special to
them.
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● CLOSE-OUT (10 minutes): To transition to the end of the session the counselor will
briefly review the theme of identity that was covered in the session. The counselor will
ask the students to name a song that relates to their identity at the close of the group.
Lastly, the counselor will hand out the students’ folders for them to put their identity
flowers in and hand it back to the counselor as they transition back to class.
The purpose of this session is to continue exploring the meaning of identity. The students
will have the opportunity to further discuss what identity means to them. The counselor will
provide the group psychoeducation regarding how music shapes our identities through a brief
powerpoint. Passive music therapy will be implemented, where music will be played before the
session begins and during the activity portion of the session. Students will be able to write down
their own personal playlists with soundtracks of their songs they connect to and decorate an
individual CD case. While CDs are no longer used, the activity is implemented for students to
visually create an “album cover” (that can fit into the CD case) that they feel connects with their
identities. Additionally, the songs the students include on their soundtrack list are implemented
as a representation of who they are and also as a reference for students to utilize when the group
is over. Lastly, the counselor will facilitate an “I am” affirmation and have students share a
● INTRODUCTION (5 minutes): To welcome students into the session, the counselor will
continue to play a song from the students playlist to begin the group. The counselor will
be transparent and share that there are three more sessions of the group left. The
counselor will review the topic of identity from the prior session and have the students
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● GROUP NORMS (5 minutes): Before transitioning to the check-in, the counselor will
display the group norms that the group collaboratively created in the previous session.
The counselor will prompt the group to think of a group norm they want to focus on for
● CHECK-IN (5 minutes): The counselor will review the option for a cool down break
(Appendix C) and bring attention to the cool down poster, reminding students of the
structure in case they need a break (Appendix E). The check-in question will be written
on the white board, asking students how they felt when they listened to the song being
● LESSON (15 minutes): To begin the lesson, the counselor will place cut out letters from
the word “Identity” that are mixed up in the center of the circle. The counselor will
facilitate the group in working with one another to unscramble the word and identify
what the word is. When the group unscrambles the word, the counselor will bring the
group back together and provide psychoeducation on the way music influences our
identities. The counselor will display a powerpoint with 3 brief slides for students to refer
○ Music is an important way to present our identities. When music is listened to, it
brings up memories which helps us create and make sense of who we are.
○ Music is a way for us to express how we feel, where we come from, and allows
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● ACTIVITY (15 minutes): The counselor will hand out a worksheet titled “The
Soundtracks of My Life” (Appendix Q) where students will get to create their own
personal playlist of songs that they feel connected to. The worksheet will have five
spaces for students to write down their songs. To assist students in spelling and writing,
the counselor will write the names of students' songs on the white board for them to copy.
After students have filled out their hand-out, the counselor will give each student their
own CD case that they can slide their soundtrack into. The students will be able to
decorate the front of the CD case with provided arts and crafts. To wrap-up the activity,
students will be able to share the songs they added onto their soundtrack. While the
students are completing the activity, the counselor will play the group playlist to create a
fun ambiance. The students will be able to take home their CD cases.
● CLOSE-OUT (5 minutes): The counselor will summarize what was done in the session to
transition to the close of the session. . To close the session, the counselor will ask each
The purpose of this session will be to identify the qualities of a good and bad friend.
Group cohesion and discussion will be encouraged. Music from the students playlist will play at
the beginning of the session and lightly during the activity of the session to create an engaging
environment. A video from YouTube about a llama and a penguin will be implemented for
students to later reflect on in the discussion (Appendix R). Students will work with one another
in a supportive peer building activity. Lastly, students will engage in positive talk with one
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● INTRODUCTION (5 minutes): The counselor will continue to play the students’ playlist
of songs as they come to the group. At the start of the session, the counselor will
welcome the group to the sixth session and express that there are two more sessions left.
Furthermore, the counselor will briefly review the topics the group has covered thus far.
The counselor will then introduce the topic of the session- Friendship.
● GROUP NORMS (5 minutes): Before transitioning to the check-in, the counselor will
display the group norms that the group collaboratively created in the initial session. The
counselor will prompt the group to think of a group norm they want to focus on for this
● CHECK-IN (5 minutes): The counselor will be consistent in showing the procedures for a
cool down break if students feel the need (Appendix F), as well as display the cool down
choices for students to refer to (Appendix E). To get an idea of how the group is feeling
about the termination session, the counselor will briefly check-in about how the group is
feeling by using the feelings thermometer (Appendix M). The counselor will leave space
● LESSON (15 minutes): The counselor will begin the lesson by reviewing the previous
session on identity. The counselor will express to the group that when they recognize and
accept their unique qualities of their identity, it can make it easier for them to recognize
qualities in others. The counselor will prompt students to think of someone they consider
a friend and ask students to share what qualities make this person a friend. As students
are responding, the counselor will write them down on the white board. On the other side
of the board, the counselor will ask students what makes someone a “bad” friend and
write down those qualities. The counselor will then show a humorous two minute and
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thirty-five second video for students to observe regarding friendship (Appendix R). The
counselor will prompt students to look for the qualities of a good friend and a bad friend
in the video.
The counselor will hold a small discussion on what the students recognized about
friendship in the video. The counselor can use the following questions to prompt
further discussion:
○ What is a song that you and your friend enjoy listening to and why?
○ Have you had a disagreement with your friend? How did you handle it?
● ACTIVITY (15 minutes): “Friendship Soup” - The counselor will review the qualities
that the students shared of what makes a good friend. The counselor will prompt students
to find a partner and create a recipe for friendship. The counselor will show an example
to the group to refer to if needed (Appendix S). Supplies for coloring will be provided as
well as small poster sized paper for the pairs. During the activity, the counselor will softly
play songs that involve friendship (i.e., “Count on Me” by Bruno Mars, “You've got a
Friend in Me” by Randy Newman, “You’re my Best Friend” by Queen, etc.). When
students are done with their poster, the group can do a brief “Friendship Walk-Around” to
look at other pairs' recipes that they came up with. If time permits, then the counselor will
leave space open for students, if they choose, to openly process with the group.
● CLOSE-OUT (5 minutes): To close this session, the counselor will have a small ball that
the students will pass to one another. The counselor will prompt students to name one
68
person in the group and give them a compliment, passing the ball to the named student
afterwards, and continuing the pattern until each person has had a turn.
In a theory called the music marker, it is suggested that music is relevant to the structure
of peer groups and plays a role in friendship formation (Franken et al., 2017). The purpose of this
session will be for students to be in community with one another while listening and playing
music to support and strengthen peer relationships. The theme of friendship will be incorporated
and students will engage in passive (receptive listening) and active (singing, dancing, playing
instruments) music therapy. The counselor will provide visualizations for the group to refer to
and play a reggae pop song for students to listen to, as well as play or sing along with.
● INTRODUCTION (5 minutes): The counselor will welcome the group and remind them
that this is the second to last group. The counselor will name the topics of emotions and
emotional expression, identity, and friendship that have been covered thus far.
● GROUP NORMS (5 minutes): The counselor will display the group norms that the group
collaboratively created in the initial session. Refer to session two for further structure.
● CHECK-IN (5 minutes): The counselor will briefly refer to the “Cool Down” poster
(Appendix E). For the check-in the counselor will ask students how they are feeling about
the end of the group. The counselor will leave space for students to express themselves.
● LESSON (15 minutes): To transition, the counselor will reintroduce the topic of
friendship and briefly assess what the group recalls about the prior session. As the
counselor is validating the students' responses, they will write it down on the whiteboard.
The counselor will explain that music is a way for us to connect with people around us
whether it is played or listened to. The counselor will hand out the lyrics to the song Lean
69
on Me (Appendix T) and ask the students to follow along as the music plays. The
counselor will play the song Lean on Me by UB40 as it is an upbeat tempo and more
engaging for the students to move along with.When the song is done, the counselor will
write a few questions on the board (refer further down for questions), and ask students to
pair and share with one another. As students are in their pairs, the counselor will play soft
instrumental music quietly in the background to create a calm ambiance. The counselor
will bring the group back together for a bigger group discussion and encourage students
○ Reflect on the lyrics: e.g. What do you think it means to “swallow your pride”?
○ What is one way you help your friends when they are sad or hurt?
● ACTIVITY (10-12 minutes): After the discussion, the counselor will briefly demonstrate
how to play a beat on a floor tom drum and then give each pair of students one children’s
style floor tom drum and one drumstick to play with one another as a group. The
counselor will briefly go over the proper way to use a drum stick (i.e., appropriate ways
to play a drum with a drumstick). The counselor will play a beat that will go with the
song and play with the students so the group can match the rhythm of the song. When the
music starts, students will be encouraged to sing along with the song as they play. The
counselor will project the lyrics of the song on the projector for students to look at while
70
The counselor will write the following prompts on the board for the students to be
○ How does your body feel, when the beat of the drum is played as a group?
● CLOSE-OUT (5 minutes): To close the session, the counselor will hand out an 8 x 11
piece of paper for students to draw/write their experience on. The counselor will refer to
the prompts on the board and ask students to draw or write what came up for them.
Coloring and writing supplies will be provided for students. Students will also share their
Week 8: Termination
The final session is focused on closing the group and reflecting on the experiences of
being in the group. The counselor will review the topics that were covered during sessions and
recognize the work the students have done in the group. Students will have the chance to express
what the group meant to them and what they learned about music. Students will also be able to
decorate a wooden musical note to take home with them and be in community with another while
listening to their preferred music. Lastly, the counselor will hand out a brief “End of Group”
questionnaire (Appendix V) for students to fill-out and close the group with a prompt for
● INTRODUCTION (5 minutes): The counselor will welcome the group to the final
session of the group. The counselor will also acknowledge the growth the students have
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● GROUP NORMS (5 minutes): To keep consistency in the final session, the counselor
will continue to include students in choosing the group norms and recognizing the
● CHECK-IN (5 minutes): The counselor will still review the choices for a cool down
break (Appendix E) in the final session and review the structure of how to access a break
(Appendix F). For the check-in, the counselor will ask students to name a song that
represents how they are feeling. Students will have space to give one reason they chose
● REVIEW OF LESSONS (15 minutes): The counselor will briefly review the topics of
emotions, identity, and friendship and the way music influences these areas in our lives.
The counselor will hand out the students folders for them to take as resources to refer to
while at school or at home. The counselor will also provide a handout of the main points
of the group and include it in the students folders (Appendix U). The counselor will hold
a small discussion with the students about their experience in the group and any
● ACTIVITY (15 minutes): For the activity, the counselor will give each student a
keychain sized, wooden musical note for students to decorate with empowering words. A
rectangle table will be placed in the middle of the rug for students to gather around and
arts and crafts will be placed in the middle of the table. The students will be able to
request appropriate songs they would like to be played as they decorate. The counselor
will provide snacks and encourage students to mingle with one another.
● CLOSE-OUT (5 minutes): Before closing the group, students will fill out a brief “End of
Group” questionnaire form (Appendix V) which the counselor will read to them. The
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counselor will collect the evaluations and close the last session by asking students to
Summary
Sweet Emotion is an intervention to be used at the fourth and fifth grade level with
students who are emotionally disturbed. It encourages healthy expression and understanding of
relationships. Children with emotional disturbance struggle in various areas that affect their
interactions with themselves and others. Music is a medium that connects individuals to their
feelings and fosters an understanding of how to express their emotions. Music in the group
environment is fitting for children with emotional disturbance to understand their emotions in a
fun integrative way as well as form relationships by creating music with one another. Throughout
the 8-week group the participants have the opportunity to create community, understand their
sense of self, and acknowledge how music can be used as a tool for self-regulation.
Chapter IV will include the strengths and limitations of this intervention, and the
implications for educators and counselors will be discussed. Lastly, suggestions for additional
73
Chapter IV
Discussion
Chapter I introduced the symptoms, factors, consequences, and common treatment for
children with emotional disturbance, as well as the overview of music therapy. Chapter II
emotional disturbance; the factors that contribute to emotional disturbance; the negative
outcomes for children with emotional disturbance; therapeutic interventions implemented with
children with emotional disturbance; music therapy; and ways music therapy supports
8-week, school based psychoeducational music therapy group called Sweet Emotion for 4th and
5th grade boys and girls with emotional disturbance. Chapter IV proposes the strengths and
limitations of Sweet Emotion. Lastly, it discusses the considerations for counselors and
This project is suggested to further support the social-emotional development for children
with emotional disturbance. A significant strength is that the early intervention involving music
therapy activities are interactive and hands-on. In Chapter II, research presented that musical
engagement contributes a variety of opportunities for children to explore interests, connect with
their emotions, and demonstrate positive interactions with others (Yang, 2016). The music
therapy interventions implemented in this project give children with emotional disturbance the
opportunity to feel and hear their experiences, as well as the experiences of their peers, through
playing instruments and receptively listening to music. Music gives individuals the opportunity
to freely express themselves and gives a voice to those who may not have one. By providing
74
psychoeducation around emotions/emotional expression, identity, and peer relationships with the
intervention of music, children with emotional disturbance may learn more awareness of
Another strength of this project is the information from chapters I and II that was
provided in regarding the factors that contribute to emotional disturbance. This project gives
context to the way trauma and attachment contribute to emotional disturbance, as well as how the
psychoeducation on why our bodies lose control and gives children the language to understand
what they are experiencing. Furthermore, a strength of this project is that children can be in
community with one another in a school-based intervention. By holding the group in a school
setting, more students have access to counseling services and children are still able to see one
The last significant strength is that parents are involved and aware of the purpose of the
group to support their child. Parents are given the counselors contact information on the consent
form and can communicate if needed. At the end of the 8 weeks, the students will also be able to
keep their folder of the work they accomplished in the group which parents can keep if they feel
the need to implement what was focused on at home. The resource hand-out provided on the last
session of the group is also a strength for families to refer to after the music therapy group.
A notable limitation of this project is the duration of the group. It would be more
impactful to have additional sessions on emotions, identity, and peer relationships than just two
sessions for each topic that is implemented. Furthermore, the duration of the session time, 50
minutes, seemed limited with the different avenues of social-emotional interventions that can be
75
applied for children with emotional disturbance. Research presented by Porter et al. (2017)
suggested that longer session times with music therapy groups could have increased the
outcomes in areas such as prosocial peer interactions, communication, and emotional expression.
With this group being in a school setting, there is a limitation in prolonging the session time.
There is also a limitation in scheduling an appropriate time where all 8 students can come
to the group. With some students being in different grades, as well as classes, there can be a
challenge in scheduling which part of the school day the group can be held. Teachers schedules
would also have to be considered, along with considering the work students may have to
An additional limitation of this project is the process of receiving consent. Children in 4th
and 5th grade are required to receive consent from their parent(s)/guardian(s) to participate in a
therapeutic group. Receiving consent and getting in contact with some parents can pose a
challenge if parents are working or do not communicate with the school, slowing down the
screening process for selected students. For some cultures, therapy and mental health are
stigmatized and, therefore, poses a limitation on parents giving consent for their children to
participate.
The counselor will be working with children with emotional disturbance and will need to
be aware of sociocultural context to support further growth in the therapeutic group environment.
The way in which individual behaviors of children with emotional disturbance present
needs of the child and how to appropriately support them in their development. As mentioned in
previous chapters, in spaces of power such as academia, adults hold high expectations in terms of
76
“normative behavior” and lack culturally sensitive approaches to understanding the
necessary for counselors to acknowledge the developmental stage that group members are at and
the challenges facing this population. It is important to understand how group members perceive
themselves in the world they live in and for the counselor to acknowledge their own privilege
The counselor who will facilitate the group will also need to be aware of musical terms
and the way in which music supports social-emotional growth. When implemented appropriately,
music therapy is beneficial for pain control; reducing anxiety; stress; anger, and agitation; and
improving mood states (Choi, Lee, & Lee, 2010). Furthermore, the counselor must be aware of
the intersectionalities of the members of the group to effectively build rapport and create a safe
space. There is the likelihood that the group would need to be adjusted to accommodate different
This intervention is directed towards the needs of a population that often is dismissed or
emotional disturbance have the potential to make connections with others with the appropriate
support. Furthermore, children with emotional disturbance struggle with expressing themselves
and do not seek help easily. Therefore, it is essential for counselors to hold unconditional
music therapy. However, there is not much research on using music therapy with children with
77
emotional disturbance. Future research is needed on the influence and advantages of a music
with emotional disturbance and the impact Covid has on their social-emotional development.
The pandemic affected many children and created a social-emotional gap when children returned
to school. Further research would support closing the gap and implementing additional resources
Furthermore, there is a need for research to be more inclusive of children with emotional
disturbance who are from multicultural backgrounds. Additional research on various ethnic
backgrounds and the norms within these cultures would involve cultural competence in how
symptoms and behaviors present themselves in different cultures. Understanding the cultural
norms would be supportive in holding mental health conversations with multicultural families
Conclusion
This counseling intervention presented an 8-week music therapy group for 4th and 5th
grade children with emotional disturbance. Children with emotional disturbance experience
several challenges within their social-emotional development that affects the way they express
themselves and interact with others. The group, Sweet Emotion, is a counseling group rooted in
emotions and emotional expression, identity, and peer relationships. A safe space will be
provided for children to explore their experiences and build community with others in the group.
It will also address the way behavior is expressed and provide space for the children to reflect on
how their emotions serve them and how they do not. Through music, Sweet Emotion will help
78
children with emotional disturbance connect with themselves and externalize the meaning of
their experiences through music to support healthy understanding and expression of the self.
79
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Appendix A
Consent Form
88
Appendix B
Survey Questionnaire
89
Appendix C
90
Appendix D
https://www.youtube.com/watch?v=3bKuoH8CkFc
91
Appendix E
92
Appendix F
93
Appendix G
Emotions for Kids - Happiness, Sadness, Fear, Anger, Disgust and Surprise Video
Emotions for Kids - Happiness, Sadness, Fear, Anger, Disgust and Surprise Video
https://www.youtube.com/results?search_query=Emotions+for+Kids+-+Happiness%2C+Sadness
%2C+Fear%2C+Anger%2C+Disgust+and+Surprise
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Appendix H
Body Template
Body Template
https://www.templateroller.com/template/1493322/human-body-template.html
95
Appendix I
96
Appendix J
97
98
99
Appendix K
100
Appendix L
https://www.glsen.org/sites/default/files/Identity-Flowers-Lesson-Plan.pdf
101
Appendix M
Feelings Thermometer
https://www.teacherspayteachers.com/Product/5-point-feelings-scale-3620536?gclid=CjwKCAj
wyryUBhBSEiwAGN5OCDGa0SOhNE5BAEvlBETG-F1X-_gDUeZYX0rGR4elfkt3KzmSP--P
AhoCtwAQAvD_BwE
102
Appendix N
https://www.youtube.com/watch?v=eRzRAh2M2Ao&t=110s
103
Appendix O
https://www.youtube.com/watch?v=rhwAQ3OHZpw
104
Appendix P
105
106
Appendix Q
107
Appendix R
Video on Friendship
Video on Friendship
https://www.youtube.com/watch?v=t4Q_B0fIrJE
108
Appendix S
https://pin.it/2L1cFx0
109
Appendix T
Lyrics to Lean on Me
110
Appendix U
111
Appendix V
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