Music Therapy Practices and Processes with Foster-
Care Youth: Formulating an Approach to Clinical Work
MICHAEL L. ZANDERS, PhD, MT-BC
ABSTRACT:  The purpose of this article is to present a framework
for music therapy processes and practices with foster-care youth. The
author describes how music therapy is used to create stability, find
resources, and find meaning through three distinct stages. Further the-
oretical underpinnings are drawn upon to provide a clinical rationale
for music therapy approaches in each of these three stages. When
viewed as a whole, these stages suggest healing as a multidimen-
sional process, addressing the displacements, abuse, grief, and loss
that many foster-care youth experience, and adds to our practice-
based knowledge of music therapy.
Introduction
Working with foster-care youth is a complex, challenging
experience. The trauma experienced by these youth, often occur-
ring over years, brings about basic problems in relating, coping,
and finding meaning (Zanders, 2013). There is little information
on music therapy approaches when working with this popula-
tion. As a music therapist, I was challenged to find ways of using
music to help these youth understand and work through their
emotional, behavioral, and social problems. During the course
of my work with these youths, I was astounded to discover that
the biggest challenge would be that they seemed to have very
different musical lives when compared to their peers without
foster experience—in fact, their very relationship to music
seemed to reflect their life circumstances both before and during
foster placements. The more I learned about their past experi-
ences in foster care, the more I learned about their relationships
to music. In doing so, these youth taught me not only about
their experience of pain, loss, and hopelessness, but also how
something else, more hopeful, might emerge, through music.
I also learned that no single therapeutic perspective was helpful;
rather, drawing upon a range of theoretical perspectives served
these children more effectively, and helped me see that heal-
ing from trauma meant moving through several distinct stages
of work, as documented in current trauma and attachment lit-
erature, each with a distinct emphasis and treatment rationale.
Told through John’s journey, this composite case study1
describes stages of the therapeutic process, drawing upon
relevant theoretical, research, and practice concepts, and
Michael Zanders is an Assistant Professor of Music Therapy at TWU. He has over
17 years of clinical experience, including work with foster-care youth.
1 
John (name changed for confidentiality) was one of the first foster-care youth
I worked with. Much of the information in this manuscript is about him. However,
some therapeutic applications and processes about other foster youth were used to
help explain significant concepts and ideas.
© the American Music Therapy Association 2015. All rights reserved.
For permissions, please e-mail: journals.permissions@oup.com
doi:10.1093/mtp/miv028
Advance Access publication August 12, 2015
Music Therapy Perspectives, 33(2), 2015, 97–107
97
Texas Woman’s University
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connecting these to specific music therapy experiences. In
stabilizing John, music experiences were used to enhance his
life skills so that he could prosper outside treatment. In finding
resources, John was able to access his inner resources and bring
balance to his life in spite of his history (Eyre, 2013; Rolvsjord,
2010). In finding meaning, John sought value and purpose in
his life even while questioning who he was and would be.
What emerged from my experiences working with John and
other children in foster care has implications for a developing
practice-based theory (Stige, 2015). This not only provides a
perspective on working with foster-care youth, but illuminates
patterns or themes “that underpin practice or knowledge,
so as to gain new insights” (Bruscia, 2012, Kindle Locations
379–382). Furthermore, it reflects my own experiences with
a “phenomenon, relating these reflections to existing ideas or
perspectives of other theorists, looking at research, and intui-
tively synthesizing all these sources into an original theory or
vision” (Kindle Locations 542–544).
Meeting John
When I  met John, he was 13  years old and had already
experienced much trauma in his life. Before going into foster
care, while living with his biological mother and father, his
father often took him to sell drugs; during these times, he wit-
nessed gunfights and was present when someone put a gun to
his father’s head. Throughout his life, his mother was unable to
care for him, due mainly to her ongoing substance abuse and
domestic issues. At about age 7, his parents divorced, and his
mother began a cycle of failed relationships. Each time John’s
mother found a new partner, she would cycle between being
sober and using substances. When his mother was no longer
able to take care of him, John was placed with new foster par-
ents. His mother worked hard to get him back, but once she
succeeded, she quickly fell into misusing drugs and alcohol,
and John was once again placed in a different living situation.
John never saw his biological father after the divorce. During
one of our initial sessions, John related to me how he was sex-
ually abused by a stepbrother at age 11 while living with his
mother, and at the time, stepfather. This abuse created another
dynamic in an already disruptive life.
With each new placement, there were new “rules” that
John had to conform to in order to remain in that placement.
Unfortunately, the means by which some foster parents “cared”
for John were inappropriate, if not abusive. For example, in
one foster home, the foster mother punished him by refusing to
allow him to use the bathroom. Instead, she forced him to def-
ecate and urinate in a bucket in her basement. John had other
instances in placements where he was physically, sexually, or
emotionally abused. In reaction to these circumstances, John
98
would inevitably act out, which was often followed by hospi-
talization or placement in another home.
To the caseworkers, it seemed that John was the problem
rather than the adult caretakers in his life. For John, this situa-
tion created much internal confusion, and little hope, resulting
in desperate acts. For example, in one placement John took a
knife out of a kitchen drawer and put it to his neck. His foster
parent at the time immediately called 911, and John was taken
to the hospital. During one of our sessions, when I discussed
with him his history of suicide attempts, John mentioned that
he did this on purpose so that he would be taken out of the
home. His foster brothers at the time were physically abusing
him, and he thought the only way out of this home would be
to “scare” the foster family into thinking he was trying to com-
mit suicide. I had no reason to doubt his explanation, as I had
had similar experiences with other youth that I  had worked
with. This “suicide attempt” was a cry for help, a desperate
plea for someone to listen to him and recognize what was
going on in his life.
John was referred to music therapy after several hospitali-
zations, residential facilities, and partial programs. He was
referred because although he was doing relatively well, he was
not considered stable enough to go to a foster home unless he
received intensive therapy. My practice at the time included
working with foster-care youth who were in crisis situations in
both their living circumstances and psychologically.
In agreement with the family court, his child advocate
(court-appointed attorney for foster-care youth), and his social
worker, John was placed with his grandmother. Although this
is a family member, it was still considered kinship foster care.
Kinship care is a level of foster care. Relatives are preferred
for youth, because it allows them to still have connections
with their family. John did not have any biological siblings,
but within his grandmother’s home, his aunt and uncle also
lived there. Although this was John’s maternal family, the fam-
ily dynamics that may have led to his mother’s own problems
were evident in the relationships that John had with his grand-
mother, aunt, and uncle. At times John would question why
the disruptive behaviors, problems, or issues of his mother,
aunt, and uncle were not met with the same disruptions in
his life, like hospitalizations, residential facilities, and partial
programs.
The events John experienced in his life left him feeling lost,
anxious, isolated, and hopeless. He then conveyed these feel-
ings of desperation through his behavior. A cycle of escalation
in problems and eventual rejection was created. It is difficult
to break this cycle once it becomes entrenched. For exam-
ple, John was not willing to engage with his peers or kinship
family, and he did not want to participate in any community
or school activities. He would consistently be in trouble at
school, receiving multiple suspensions and detentions. At dif-
ferent times in his life, he was expelled from schools, whereby
he would then be placed in another home or facility. John
faced rejection and abandonment throughout his life. With
each new move he was required to establish new relation-
ships, only to see those relationships met again with rejec-
tion, abandonment, and abuse. Also, with each new home, he
encountered a new community and school.
John was questioning the very foundations of his life and
whether his life had any meaning, value, or purpose. John
Music Therapy Perspectives (2015), Vol. 33
needed to face the realities and choices that challenged and
shaped his life, and eventually, confront the meaningless-
ness, suffering, grief, and loss he was experiencing. Perhaps
paraphrasing one of the songs John used for lyrics discussion
by Tupac and the Notorious B.I.G., entitled “Runnin’,” best
describes his crisis: “Why am I fighting to live, if I am just liv-
ing to fight? Why am I trying to see, when there ain’t nothing
in sight? Why am I  dying to live, if I  am just living to die?”
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(Tupac, 1994).
John’s Therapeutic Process
Stage One: Stabilization
Establishing a therapeutic relationship.  John was referred
to me involuntarily. As in most aspects of his life, John had
few choices in the decisions made about his life. For exam-
ple, he had no control regarding where he lived or what he
wanted to do, and ultimately, how he wanted to be. Having
so little choice, it is not surprising that John questioned why
he needed therapy and would not readily discuss any issues
or problems he had in his life with me. He could not see any
connection between his behaviors and his placement moves,
and he blamed others for life’s inequities. At this time in his
life, John would immediately “act out” or react inappropri-
ately even to the most innocuous of situations.
I received reports from social workers, school personnel,
and other stakeholders in John’s care. Many of these reports
were about situations in which John acted out toward others,
including teachers and other students. One time, John threat-
ened to stab both himself and another student with a pencil.
In therapy, when I attempted to question John about these situ-
ations, he had no memory of them. I was not sure if he was
being avoidant or dishonest, or if he was disassociating.
John did not want to have any relationship with me. In
response to this, as our work began together, we spent numer-
ous therapeutic hours without talking or interacting with each
other. Significantly, silence was the most salient part of our
therapeutic relationship. In controlling what occurred in ther-
apy with me, John was exerting control in the one area in his
life where he could.
John’s background was very troubling, and as I  reflected
on his therapeutic needs in those hours of silence, I  strug-
gled with understanding the focus of his treatment. Should
I  begin by addressing past abuses, or should I  focus on his
current relationships? Should my interventions focus on psy-
chosocial skills or on healing past abuses and trauma? Which
approach would best help him with his relationships? Finally,
little by little, John allowed some small exchanges between us.
Through my reflective questioning, and by listening carefully
to him, I came to understand that the first and most important
of John’s needs was to feel safe—safe with me, but also in a
safe-enough place that he could then begin to explore some
of the deeper, underlying issues in his life.
The challenges and life events that John experienced were
different than those of other youth from more “normal” envi-
ronments. Because of the types of trauma he experienced, and
continued to experience, I would need to implement unique
ways of practicing therapy with him. John had developed
fundamental problems relating to others and succeeding at
school, which made him susceptible to further trauma. The
Music Therapy with Foster-Care Youth
possibility of additional foster placements, disrupted medical
and educational services, and the potential for abuse while in
foster care all placed John at risk for increased adversity and
concomitant psychiatric symptoms (Sieracki, Leon, Miller, &
Lyons, 2008).
The therapeutic process needed a focus that extended
beyond John. Not only was he struggling with the trauma and
abuses in his life, but every environment in which John found
himself led to further disruptions in his life. I noticed that sta-
bilization could not occur only within our sessions; it also
had to occur within John’s own ecology. If our work was to
progress, I needed to understand how his emotional and psy-
chological stability was affected by his physical environment.
Stabilizing the physical environment.  Since John came
from disruptive and explosive foster family situations, I  pro-
vided music therapy both in my office and in his grandmoth-
er’s home. This was a form of community-based treatment,
where I would “meet” John in his own environment. As soon
as I entered John’s home, the level of tension and anxiety was
evident, with both John and his family. Preliminary therapeu-
tic questions and music experiences were met with resistance
and defensiveness. The family was not easily engaged, and
attempts to assist or guide them in dealing with John’s behav-
iors were met with blame and scapegoating. His grandmother
was exhausted from dealing with the repercussions of John’s
behaviors, whether it involved picking him up from school for
suspensions or meeting with the principal. Essentially, she had
the primary task of taking care of John, while at the same time
taking care of all the other family members, including her own
daughter’s (John’s mom’s) substance issues.
Although John was obviously showing signs of psychiat-
ric symptoms, his family presented some symptoms as well.
John exhibited symptoms of Attention Deficit and Hyperactive
Disorder (ADHD), Oppositional Defiant Disorder (ODD), and
Posttraumatic Stress Disorder (PTSD). Both John and his fam-
ily showed pathological features related to worries, concerns,
attention, and concentration. While working with John, it
was difficult to orient him to the here and now, particularly
as the activity level in the home could be viewed as chaotic.
Significantly, the psychotropic medications John was pre-
scribed also played a role in the home. For example, when the
medications were effective, John was calm and able to man-
age simple tasks at home. This provided a respite for the fam-
ily, as the daily activities of life proceeded smoothly. However,
if something triggered John or there was a disruption in taking
the medications (i.e., wrong time of day, too little, too much,
etc.), John acted differently, and usually very disruptively. The
family then reacted to John, who would respond by further
acting out. These circular reactions created a lack of interper-
sonal trust and safety, which were also manifest in my work
with John. Fortunately, at this stage, I  discovered that John
enjoyed improvising on percussion instruments, as it seemed
to be the one area where he could express himself while also
feeling safe.
In my initial work with the family, I  believed it was nec-
essary to provide some psycho-education to create changes
in John’s environment. John and his family needed clarity on
the rationale for his treatment, but it was also very important
to reduce potential risks for disruption by introducing strat-
egies that reduced negative behaviors in the home. John’s
99
grandmother felt like his thoughts and emotions were out of
control, and she typically felt confused and upset about her
experiences in trying to help him. The feelings that the whole
family experienced also needed to normalized, so that they
did not feel so alone and lost in believing that they were the
only family who suffered with these issues.
In response to this need, I provided important information
on topics such as treatment planning, medications, and work-
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ing within the system; however, I  understood that the effec-
tiveness of this work was dependent on being present with
them and listening without reservation or judgment. At times,
I  would tell stories of my own childhood, noting that some
of my behaviors had not been so different from John’s. In so
doing, I  provided anecdotal information that some of John’s
behaviors were typical of any child. I viewed the role of this
self-disclosure as creating a therapeutic alliance with the fam-
ily. As John and his foster family became more comfortable
with me and with one another, John and I began to work in his
individual sessions on stress management, including breath-
ing, relaxation, and mindfulness experiences.
Stabilizing John’s anxiety and stress.  Before introducing
relaxation and mindfulness experiences to John, I introduced
him to safe and effective breathing exercises that would help
him feel calm. I also demonstrated proper body positions to
use when breathing, to instill calm. Initially, I practiced the
techniques with John, and then I asked him to demonstrate
them to me to ensure that he had integrated the techniques
adequately. At first, John was not able to simply breathe in
for four seconds or breathe out for four seconds. His psy-
chological and physical tension and anxiety were manifested
in short, irregular breathing patterns. He typically took short
inhalations and did not know how to properly exhale. Since
I knew that he liked playing percussion instruments, I used
a Guiro to provide him with a visual and musical cue for
controlled breathing. For example, breathe in on the up-
stroke, and breathe out on the down-stroke. As he mastered
this controlled breathing, the up-and-down strokes would
be longer and more regular. After several sessions, John was
feeling less anxious, but I could still see and sense the ten-
sion in his body.
I then began to use a mantra or calming word/phrase with
John to assist him in breathing, saying, for example, “breathe in
the good feeling, breathe out the bad.” To continue to enhance
his controlled breathing, I  also used a chord progression on
the piano (1–2 suspensions with I, IV, and V chords), which,
when I used it regularly, provided a stimulus for appropriate
breathing. These mindfulness and controlled breathing experi-
ences allowed John to manage physical symptoms when he
was feeling anxious or distressed.
When John was able to accomplish these techniques, I pro-
ceeded to progressive muscle relaxation by having him alter-
nately tense and relax specific body parts. This helped him
know what tensed and relaxed felt like from a cognitive or
conscious perspective, and provided a metaphorical frame-
work through which he could understand how his body would
become tensed, and to then subsequently be able to relax.
Musically, I incorporated chord progressions on the piano or
guitar that included harmonies that went beyond I, IV, and V
chords. For example, I would use the Canon in D chord struc-
ture while incorporating secondary dominants and leading
100
chords. As the music experiences expanded, so, too, did
John’s breathing and awareness—or mindfulness.
Mindfulness assisted John in understanding the relationship
between his mind and body, thoughts and emotions. While
introducing mindfulness clinically, when John had intrusive
or racing thoughts, I asked him to focus on a part of his body
that related to his thoughts. Musically, this took the form of
finding sounds that related to or “sounded like” the intrusive
thoughts he had and their physical relationship to his body.
Moreover, mindfulness experiences were useful at this stage
because I expected that his emotions might at times become
overwhelming as the treatment progressed, and John could
then rely on the relaxation/mindfulness strategies he learned
to help regulate his feelings.
Identifying and expressing emotions. John found it dif-
ficult to identify specific emotions, to differentiate between
emotions, and to express his feelings appropriately. This is
not uncommon for youth like John, since trauma and disrup-
tive life events lead to a “closing off” of repressed emotions
and memories. With John, we worked on building skills so
he could identify and understand the different ways he was
feeling and be able to cope with these feelings. To accomplish
this goal, I asked him to verbally share everyday common feel-
ings and to accurately identify and express a range of feel-
ings. Referential improvisations were used to assist him with
describing or labeling emotions.
As the improvisations expanded into more subjec-
tive experiences of emotions, various intensities of these
emotions were explored. For example, John would list as
many emotions as he could, and I  would then ask him to
choose one emotion and one instrument that would help
describe that emotion. This revealed a lot about John’s abil-
ity to connect the music experiences with his emotions or
what he was feeling. For example, in one session John told
me that he was very angry (neither his affect nor his body
matched), but then he proceeded to play the triangle very
softly and slowly. This indicated that John needed to work
on establishing stronger connections between his emotions
and physical sensations. To do so, we experimented with
various instrument sounds and their relationship to emo-
tions and also used mindfulness techniques to connect his
thoughts to his bodily sensations. Through this process, John
was able to better match his emotions to the sounds in his
improvisations.
John still had difficulty discriminating between thoughts
and feelings. When I  asked him to name a feeling, he often
described a thought. For example, when role-playing with
John, I asked him how he would feel in a specific situation.
At times, John did not grasp the distinction and would say,
“I didn’t like being there,” which is a thought instead of an
emotion such as “I was afraid.” It was necessary for him to
establish the connection between the music and his emotions
before he would be able to successfully self-regulate his emo-
tions. If John could not comprehend how he was feeling, he
would be unable to manage the emotion and would then fur-
ther act out and be at risk for further disruption. Subsequently,
both the instruments he used and the music improvisations he
created changed when he was able to recognize and regulate
his emotions. John was now ready to explore how these emo-
tions related to both his thinking and behaviors.
Music Therapy Perspectives (2015), Vol. 33
Connecting emotions to thoughts and behavior.  To help
John form connections and distinctions between his emotions,
thoughts, and behaviors, I asked him to play an improvisation
of “where he was” at that moment and record the improvisa-
tion. In listening to it afterward, we noted how his thoughts,
feelings, and manner of playing were connected, matched, or
did not match. For example, while listening to a recording of
one of his improvisations, at specific key points or changes
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in the improvisation, I stopped the recording and asked John,
“What were you thinking?” Then I asked him, “How were you
feeling?” Before beginning to play the recording again, I asked
him, “What do you think you did next in the improvisation?”
After he answered, we listened to the improvisation again to
see how the music expression compared and contrasted with
his initial responses about what he was thinking and feeling.
Through this intervention, John was able to gain insight about
how his thoughts, feelings, and behaviors were connected.
Eventually, he also came to understand the cognitive distor-
tions he was experiencing.
This newfound insight was evident in the following anec-
dote. In school one day, John thought another student was
laughing at him. Before being more emotionally stable, he
would have become angry and may have violently attack the
student. However, after these music experiences (connecting
his thoughts, feelings, and behaviors), although John still had
similar thoughts and feelings, he did not act out. Instead, he
was able to be more aware and mindful of his behaviors. The
idea that the student was laughing at him may have been a
cognitive distortion for John, but he was unable to realize that
perhaps the student was not laughing at him at all. In any
event, John was better able to regulate how he was feeling and
less likely to act out.
As John experienced greater relief from anxiety, he began
establishing more stable relationships at home and school.
He was acting out less and beginning to understand how
his actions and behaviors related to his emotional stability.
In evaluating John’s progress in treatment, it was important
that I  recognized obstacles that might arise and impede fur-
ther progress, such as ambivalence, lack of confidence, and/
or fear. At this juncture in John’s therapy, it was necessary for
me to evaluate not only his progress, but also the therapeutic
strategies I had been employing with regard to environmen-
tal and psychosocial goals. I asked myself several questions:
Have I provided serious and timely responses to his family’s
questions and concerns? Have I invited and encouraged John
and his family to participate actively with the treatment and
planning process? Have I kept a clear professional boundary
with all family members at all times?
Stage Two: Finding Resources
Establishing external resources to continue the treatment. 
At this point in treatment, John and I were at the three-month
mark for his insurance eligibility. As I evaluated John and pro-
vided clinical information to his insurance company, I  was
given an extension to deliver therapy for an additional three
months. I received this extension for two reasons. One, I pro-
vided strong and reasonable clinical documentation so that
the care manager from the insurance company was aware of
both the process and John’s progress. Two, I had a strong rela-
tionship with the care manager based on my past experiences
Music Therapy with Foster-Care Youth
with clients. Anecdotally, in the child welfare system there is
an “Orwellian” fear that insurance companies rule the world
and are “taking over” treatment. Although I have had my share
of negative experiences, I  have found that by maintaining
integrity through appropriate documentation about the thera-
peutic process, I was more apt to receive approval for further
clinical work, regardless of my own orientation or model of
therapy.
Developing a collaborative relationship.  A broad goal for
John was to help him access inner, healthy resources and
bring balance to his life, in spite of his history (Eyre, 2013;
Rolvsjord, 2010). Although John was now experiencing less
stress and anxiety, and was better at understanding how his
thoughts related to his feelings and behaviors, he needed to
further enhance his coping skills. As he became more sta-
bilized, I  moved from a directive approach to a more col-
laborative one. The collaborative approach had two over-
arching concerns. It addressed what it meant for John to be
fully human as he developed greater volition and agency,
and it demonstrated to John, in a concrete manner, how that
perspective contributed to a fulfilled life. Therapy provided
conditions that allowed him to grapple with who he was
and who he was becoming in his relationships with others
in the world. John and I had developed a richer, deeper, and
stronger therapeutic relationship, and in order to honor that
relationship, he needed to be empowered to guide the treat-
ment process.
Understanding John’s psychological and sensory experi-
ences.  John had internalized his emotional responses, result-
ing in significant depression, anxiety, and anger. Thus, his
emotional expression was at times unpredictable or explosive.
Since John had a complex trauma history, there were constant
reminders of traumatic events in his environment. “Having
learned that the world is a dangerous place where even loved
ones can’t be trusted to protect you, children are often vigilant
and guarded in their interactions with others and are more
likely to perceive situations as stressful or dangerous” (Cohen,
Mannarino, Kliethermes, & Murray, 2012, p.  6). This aptly
describes John’s situation.
John was also plagued by the return of dissociated, incom-
plete, or ineffective sensorimotor reactions in such forms as
intrusive images, sounds, smells, body sensations, physical
pain, constriction, numbing, and the inability to modulate
arousal. While we initially addressed the cognitive and physi-
ological elements of his trauma in stage one, John still needed
to work directly with the emotional trauma. The relationships
among his cognitive, emotional, and sensorimotor (body) lev-
els of information processing were impacted by trauma symp-
toms. He needed to enhance his coping skills while establish-
ing and maintaining healthy relationships.
Developing internal resources through the musical and
therapeutic relationship. John entered into foster care with
developmental delays, dependency needs, rigid defenses, and
a weak sense of self. These areas of concern were manifested
in his relationships with others and in his musical relationship
with me. In order to help John find his own internal resources,
treatment in this stage focused more on the music relationship
than on interventions. This was a phenomenological approach
in that our experience in the music was the lived expression
of our experience together. It required intense work and much
101
practice to develop this sense of here-and-now presence
with John.
John had an ability to see through a judgmental or non-
empathetic relationship. This ability most likely stemmed from
his past relationships. I  was operating on the premise that
if John and I  were able to develop a relationship, there was
potential for him to develop relationships with others outside
therapy. Relationships with friends, family, and the community
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would have a broader impact on his emotional health. I sug-
gested to John that we create a musical journal of our relation-
ship together.
Musical journaling is the use of improvisation, re-creative
methods, and composition/songwriting, all of which are
recorded during sessions. This allowed for an ongoing musi-
cal dialogue about what was happening in the moment and
illuminated what issues and feelings were most present with
John. The journal recordings did not necessarily include
whole songs or lengthy music experiences, but rather a sort
of a musical diary that occurred throughout the sessions. Over
time, we evaluated these experiences to gather a sense of the
whole. Musical journaling also allowed John to constructively
release tensions or anxieties that he was experiencing.
The music journaling started with current concerns (e.g.,
fears, school, family, etc.) or specific changes (e.g., making
friends, controlling anger, etc.) that John was seeking. As noted
before, John was initially not ready for, nor did he even want,
in-depth therapy. But we had now come to a place where John
recognized that he did have areas he wanted to change, and
that his current concerns were valid. He no longer had to hold
on to the inner turmoil he had been experiencing, and could
express himself more readily in and through the music.
At this point, John was comfortable with improvising, but
not so comfortable with composing songs. Sometimes we
would do lyric substitutions or writing exercises while we
were playing music together. However, it seemed that impro-
vising was more apt to tap into John’s internal resources. John
and I would do several free or non-referential improvisations,
which we had previously connected to lyrics. I recorded each
improvisation, and then we listened to the recording together.
After listening to it, we titled the improvisation and discussed
how the title related to John’s life experiences. From this, we
developed themes and recognized patterns that occurred
through the music. For example, John gave several record-
ings titles that related to change: “I need help,” “What should
I  do?” and “Unsure.” Based on such titles, we discussed
aspects of change, including what change might feel like. John
was gaining a conscious understanding of what was changing
and where the emotional valence was in his life, and these
issues and feelings were brought into the “here and now.” As
we recorded and discussed improvisations each week, John
become more comfortable with songwriting, which opened
the way to working on significant biographical events.
Musical biography uses music experiences to describe
significant events in one’s life. This type of musical journal-
ing helped John develop his personal life story in a narrative,
and more specifically to work through his trauma narrative.
The narrative focused on any life events that John decided to
describe musically. The narratives ranged from being a sim-
ple description of an event, such as “playing with the family
dog,” to something more substantial, such as “wanting to be
102
loved.” The key point of the narrative was that each part fit
into a story with a beginning, middle, and end. Thus, if the dif-
ferent events were not chronological, we would discuss how
his specific biographical events could be made into a musical
narrative whole.
Throughout these music experiences, John had the option
to listen or add to it at home. This was his music, and I offered
him the opportunity to change it in any way he deemed suit-
able. This is not to say that I did not have a role, but it was
more like a homework assignment, where John could change,
edit, or add to the music as necessary. Using a digital recorder
that input into my computer, I  was able to save the original
music files so that John could take the recorder home and
continue to work on his recording if he wished. This allowed
John to be alone with the music, which provided a stronger
sense of self by empowering him to be comfortable with who
he was and what he liked. This was also a way for John to
“hear” his experiences and subsequently “hear” himself. He
had been conditioned, or not allowed himself, to have his
own thoughts and feelings. These music experiences further
added to John’s musical narrative based on the events of his
life. He was encouraged to share whatever he wished, thereby
experiencing being heard, being seen, and being understood
through the musical narrative.
Strengthening external resources.  John’s ecological health
was a significant issue in his treatment. Bruscia describes eco-
logical health as consisting of the society, culture, and envi-
ronment (1998). At this stage of therapy, John was primarily
focused on developing internal resources, but it would be an
error to underestimate the influence of his home and school
environment. For example, after a particularly cathartic ses-
sion, John felt emotionally vulnerable. When he expressed
these feelings at home, he was treated with disdain and con-
tempt for being “wimpy” or a “cry baby.” John had actually
gone through a rather difficult part of his biography, and he
needed more support. Unfortunately, this did not occur. So,
while working with his internal resources, it was necessary to
confront an external resource, namely, his family.
John told me about this experience in our next session. I felt
angry, upset, and frustrated at the way he had been treated.
John had developed so much in therapy, and yet he did not
have his experiences validated in his home environment.
I  thought this reaction from his family would have negative
consequences, but I misjudged how resilient John was. John’s
initial reaction was that he became defensive with his family,
but he remained open with me. He trusted our relationship
and realized that I was also an external resource for him, and
not just his therapist. I decided, with John’s permission, to have
a discussion about the therapeutic process with his family.
Although I  was hesitant and worried that I  might be met
with the same reactions from the family, something in his envi-
ronment changed. When I  talked with his grandmother, she
immediately understood the situation and apologized. She
recognized that after the family had given John a hard time,
John did not explode or become violent. He simply asked for
permission to go to his room. This struck her as a tremendous
change in the behavior she was accustomed to, since her only
experience of her family was that they expressed stress and
anxiety with displacement and projection, which was typi-
cally manifested through anger. She saw a change in John, and
Music Therapy Perspectives (2015), Vol. 33
subsequently felt that the family had difficulty accepting that
John was becoming someone new and different. Ironically,
she also saw how the rest of the family was not changing.
After our meeting together, she informed me that she would
allow John space after his therapy session and she would also
talk with him when he came home. She promised not to ask
any questions, but to just be with him. So, just as John’s rela-
tionship to himself was changing (internally), so too was his
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impact on his environment. Although these changes were
met with negativity at first, a deeper relationship had begun
to develop with John and his grandmother. Through his music
experiences, John’s internal resources expanded and he was
able to use new ways of being in his environment. He could
see that people were treating him differently, and he could
now experience himself differently.
John’s external resources also included working with com-
munity supports such as school, sports, arts, spiritual supports
through religion, and other creative and healthy outlets. In
my own research, based on work with youth like John, I have
found that those who were simply involved with music for-
mally, such as school band/chorus or church musical groups,
tended to have greater stability in foster-care placements
(Zanders, 2012). Initially, I had concerns about John’s environ-
mental stressors, which included a lack of permanent hous-
ing, living with others who may have been using substances,
and other psychosocial factors that inhibited healthy access to
external resources. However, as John was growing, his ability
to navigate and deal with the environment changed.
When we worked on enhancing his internal resources and
expanding external resources, John, through these music
experiences, was further able to integrate various parts of him-
self in relationship to his biological and foster family. He also
became more involved with school activities such as band and
sports, and was better able to cope when stressful situations
arose. Finally, John began to establish more long-term rela-
tionships with his biological family, foster family, and peers.
Stage Three: Finding Meaning
Establishing external resources to continue the treatment. 
I had already received a three-month extension to work with
John, so that we could continue developing essential life skills
in coping and finding resources. John was about to move
back again with his biological mother. In collaboration with
his caseworker (social worker with foster-care agency) and
case manager (for managed-care organization), we thought
John would benefit from an additional three months of ther-
apy to ensure that he remained stable and could handle the
move. This is not uncommon, and my main concern was that
although John was flourishing in his relationships, he had still
not found his own identity, and lacked self-worth despite the
gains he’d made. In exploring meaning-making, John worked
with two main themes: finding meaning through strengthening
his identity, and finding meaning through his experiences of
grief and loss. Themes related to identity included culture, eth-
nicity, gender, familial patterns, spirituality, and self-concept.
Themes related to grief and loss included transitions, separa-
tion, abandonment, and lack of support.
Treatment approach to finding meaning. At this stage,
I  continued to explore different music experiences with
John, which assisted him in finding meaningfulness in his life
Music Therapy with Foster-Care Youth
(Bruscia, 2000). In the child welfare system, there has been a
push toward positive psychology (Peterson, 2009), focusing
on strengths as opposed to weaknesses. This focus incorpo-
rates resilience and recovery models (Zanders, 2013), which
are essentially new concepts built from a humanistic founda-
tion. However, an exclusive focus on positive psychology may
create a pseudo well-being in that focusing only on the “posi-
tive” aspects of health, such as joy, creativity, and so forth,
devalues the experience of struggle, loss, grief, and pain. Thus,
I  favored a dual understanding of John’s experience to help
him find meaning in the entire scope of his lived experience.
In our sessions, we continued to review the significant events
in his biography. Much of his biography dealt with some type
of abuse and/or trauma. Thus, John was beginning to find
meaning in the worst of his experiences and incorporating it
into his identity and sense of self.
Meaning through finding identity in the music process.  improvisation (process) as compared to experiences that have
I  focused on helping John choose music experiences that
enhanced his understanding and sense of self through his iden-
tity as a person. Together, we considered how the self related
to the music and then how his identity related to others. John
chose songs that represented different parts of his identity, and
we worked to integrate them. For example, I  asked John to
bring in songs that represented the different roles he played
in his life (son, foster son, student, friend, etc.). We discussed
them and related them to significant lyrics that represented
each role as we integrated their various aspects. At times,
we also used lyric substitution or songwriting to process that
integration.
In songwriting, we typically used a computer-based pro-
gram with MIDI capabilities, such as GarageBand. In this
way we had the benefit of a full range of instruments (through
the application), as well as the ability to record. This process
occurred in two main ways: music first, then the lyrics or lyrics
first, then the music. For example, John might begin by using
the various beats in GarageBand to find a rhythm or beat for
the song. We then layered the beats with different instruments
or sound effects. Usually we added chords, melody, or other
tonal aspects that related to his beat and instrumentation. After
establishing that John had a good foundation for a song, he
added lyrics over the music. At other times, John preferred to
begin with the lyrics. This process was similar, but instead of
matching lyrics to the established music, the music was com-
posed to reflect the lyrics. This process occurred over time,
and we worked on the songs until they “felt right” to him. The
songs revolved around life issues that had an impact on his
identity and the problems he continued to encounter.
The songs fulfilled the psychological role of providing a
foundation for hope in the future, but they also provided John
with the skill of knowing how to write songs. Thus, even after
the therapeutic process was completed, John was still able to
use these musical resources in his own life. Songwriting can
be thought of as art imitating life, and as such, it provided a
corrective experience, a sense of empowerment, and a coher-
ent life narrative. Our songwriting was used to explore past
relationships through the music. Themes that emerged, for
example, were how John developed a lack of trust in adults,
distorted ideas about his sense of self, and feelings of shame,
lack of self-worth, and avoidance of attachment. These songs
were a representation of the meaning that John had found
103
within the therapeutic process. This was the essence of our
therapy: we worked together to find meaning in John’s life,
while I  provided the necessary resources for him to do so.
The songs became artifacts of the therapeutic process and
relationship.
A similar meaning-making process occurred through
improvisation. John explored his identity by creating different
types of improvisations: free vs. guided improvisation, non-
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referential vs. referential, and processed vs. unprocessed. For
example, in a free vs. guided improvisation, John might play
about “anything he wants” vs. “let’s improvise on the emo-
tions you mentioned when you were going through that expe-
rience.” A referential improvisation refers to an idea external
to the music (i.e., a thought or feeling), while a non-referential
improvisation does not. Finally, process describes working
through multiple themes that developed from one idea in an
not been worked through (unprocessed).
Improvisation provided access to significant themes related
to John’s identity that could then be explored. The improvisa-
tions were organized around the themes, which allowed us to
see how John developed his identity. For example, John might
play what it was like to be in therapy, or he might play the rela-
tionships between different people in his life. In subsequent
sessions, the themes became organized around larger topics,
which included:
Life stages. John divided his life into stages or periods.
A stage could be any period in which John exhibited a distinc-
tive trait or behavior or lived under specific circumstances.
We gave each stage a name, and created an improvisation that
described the stage (Bruscia, 2014, p. 177).
Significant people. John chose significant persons in his
life, some that he had positive feelings toward and others for
which he had negative feelings. We created improvisations
describing each person. We listened to the improvisation
afterward and gave each improvisation a title (Bruscia, 2014,
p.  178). We processed these improvisations by developing
themes related to the “positive and negative” people in his life.
These improvisations were used to evoke discussion, which
could also be processed through further musical exploration
to promote insight regarding the process as a whole. For
example, trauma was a theme that was encountered in John’s
life experiences. While working through the improvisations,
John not only found meaning in his past experiences, but he
was also able to reflexively understand how he changed from
who he had been to who he was in the present. The improvi-
sations provided a musical portrait of the different parts of
his experience and helped him understand and integrate it.
This does not necessarily mean that the trauma was resolved,
but the music experiences helped him incorporate his ear-
lier life experiences into his present. This was accomplished
by using the musical data to make inferences about John’s
experience and relationships within and outside music ther-
apy. Improvisation, and music in general, “has an ability to
evoke images, associations, and feelings; it is engaging and
motivates people to connect to others; it offers a medium of
nonverbal communication that transcends words, transport-
ing people to a common, shared field of experience” (Eyre,
2013, p. 7). The therapeutic relationship was essential to this
work with John.
104
Finding meaning in grief and loss.  John had to endure
much grief and loss at an early age and continued through-
out his childhood. The repeated experience of being removed
from one home and placed in another home, often with peo-
ple he did not know, was a form of grief and loss. This con-
stant threat was amplified by the other grief and loss events
that occurred in John’s life, related to trauma brought on by
abuse and bereavement, repeated separation from his bio-
logical mother, and loss of his father. It might seem that being
removed from a neglectful or abusive environment provides a
new opportunity for having a meaningful life. However, this
is not necessarily the case, and at times is likely the opposite.
John was often confused and troubled about why he had to be
removed from his current living arrangements.
This confusion was exacerbated by the manner in which
these moves occurred. Through one of our discussions, John
told me that when he was in school one day a social worker
came to pick him up. He thought perhaps he was going to an
appointment; however, as he got in the car, he was told that
he was again being removed from his mother’s home. No one
had prepared him or given him any reason other than that his
mother was again not able to take care of him and he had to
move. John immediately got out of the car and ran away. The
social worker called the police, and John was found a cou-
ple of blocks away. If John had been more prepared or made
aware of his imminent move, he might have acted differently.
This sudden movement created another loss for John, and at
the time further impacted his feelings of anger, abandonment,
and control. Fortunately, John and I worked though this expe-
rience during one of his musical narratives. Thus, in working
with both his identity and grief and loss, we focused on the
“here and now,” as well as on more latent emotions. It was
up to John to express this through his choice of music expe-
riences and/or through the discussions following them. John
was finally able to find meaning through the music experi-
ences so that who he was, is, and will be could become a part
of his integrated identity.
Throughout our work together, John viewed his life as empty
and void of any reasonable understanding of what value his
past experiences might hold for him. He questioned how he
could make sense of life in the midst of his pain and suffer-
ing. He came to a realization through the music experiences
that being loved, cared for, and feeling secure was important
for him. If others could not provide that love, care, and secu-
rity, then John at last had the foundation to provide that for
himself. He was able to integrate his life experiences with the
music experiences to reconstruct the internal dynamics that
were destroying his ability to establish healthy relationships.
The therapeutic essences that emerged were that there was a
future for John and he would be able to use this therapeutic
process to help navigate the rest of his life.
Integrating internal resources and terminating therapy.  he/she will tend to develop unhealthy attachments. Attachment
John seemed ready to proceed with his life without further
treatment. He became more involved with school and com-
munity activities, and his relationship with his foster family
flourished, particularly with his grandmother. His relationship
with his biological mother also transformed, in that he was
able to feel safe with her and begin a new chapter in their lives
together. Although he lived with his grandmother, John began
to spend more time with his mother and was even able to help
Music Therapy Perspectives (2015), Vol. 33
her understand how their past experiences, albeit negative,
could provide a starting point to further developing their cur-
rent relationship. Although our work together was complete,
John knew he could check in with me whenever he might
need to deal with a situation that made him feel insecure. This
was not a dependent type of check-in, but more of a connec-
tion or “lifeline” to help him realize that the meaning he had
found through and within the music would be there for him
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throughout his life.
Theoretical and Practice-Based Premises and Constructs
John taught me the importance of reflexivity in music ther-
apy. We could share our experiences through the music, so as
John learned from me, I learned from him. The key question
that guided me throughout our work together was how I could
work with John so that I was just not “fixing” a problem, but
empowering him to make his own discoveries and changes. It
wasn’t about “doing,” but about “being.” I learned that music
therapy requires me to have different areas of focus, and that
one treatment method or model is not necessarily suitable for
working with foster-care youth. I  needed to understand that
as John shifted in his awareness, I needed to match the shift
through my musical and clinical presence. This also required
an integrative approach in which I  could pull from various
theories and practices, while still maintaining authenticity
and genuineness throughout the process. This also required
different, and not necessarily hierarchical, stages of therapy
where the focus was building on previously gained skills.
I learned that music therapy needed to meet John’s most sali-
ent needs until he was able to manage his life outside therapy.
Each stage of the process was developed through our work
together, while each stage was also influenced by theoretical
and practice-based premises. What follows is a description of
those constructs that related closely to my own work with John
and how these constructs relate to practice-based theory.
Stage One: Stabilization
The first stage of John’s work involved understanding his
emotions and how he managed his emotions while also sta-
bilizing his current home environment. Stabilization can be
defined as being able to cope with normal life stressors, estab-
lish healthy relationships, and maintain the necessary life skills
for dealing with environmental disruptions. John needed a safe
place—both literally and metaphorically. Literally, he needed
to be in a home where he felt safe and secure. Metaphorically,
he needed to be in an emotional space with similar safety
and security. Once a youth “experiences placement change,
momentum for additional changes may develop since change
is part of what the child expects, knows how to do, and may
even work to invoke” (Tucker & MacKenzie, 2012, p. 2211).
When a youth is not stabilized, literally or metaphorically,
theory is based on the concept that human beings have an
innate need to become attached with others, and these basic
developmental processes are universal in all beings, tran-
scending culture and individual experience (Bowlby, 1988).
Attachment theory helps explain the relationship patterns of
foster-care youth that are crucial for healthy psychosocial
development, including “stable and secure bonds with car-
egivers” (Tucker & MacKenzie, 2012). If healthy attachments
Music Therapy with Foster-Care Youth
can be formed, at-risk factors for instability may be mitigated,
thereby fostering long-term positive outcomes.
Foster care, by definition, denotes a disruption in early life
and family experiences. In addition, the majority of foster-care
youth have been exposed to drastic and traumatic experiences
that can further damage their ability to connect with caregiv-
ers (Zanders, 2012). Disruptive past experiences can influ-
ence future attachments, which leads to further disruption.
In essence, John would ask, “Why should I  change to meet
the needs of these new parents, when I  will just move and
have to change again?” Thus, the ability of foster-care youth to
expand or find ways to negotiate changes in new care settings
is instrumental to their overall stability and health. Fortunately,
through our process, John still had a fundamental inclination
to create secure and predictable bonds, while minimizing dis-
ruptive events.
As part of stabilization, an overall objective was for John
to develop self-efficacy, providing life skills that enhanced
his individual strengths so that he and his foster family might
continue to thrive after treatment had ended. This involves
three main therapeutic tasks. First, because foster-care youth
cannot change their external situations, interventions that
help them change their perspectives of these situations are
particularly helpful. Second, the use of directive techniques
creates stability in a brief and time-limited manner, which is
essential when working with managed-care organizations,
where treatment may be abruptly terminated. Third, the
therapist must ensure collaboration between the therapist,
the youth, and the foster family. This is especially important
because of the lack of control these clients encounter within
the foster-care system. Working collaboratively empowers
them to develop coping skills and improve their perspec-
tives so that they gain a greater sense of empowerment.
Cognitive behavioral therapy (CBT) is particularly helpful
in this regard. Treatment proceeded through the stalwarts
of CBT: psycho-education, stress management, affective
expression and affect modulation, and cognitive coping and
processing.
Psycho-education  focuses on clarifying treatment goals
and rationale while engaging the foster parent. This helps
reduce the risk of negative behaviors and provides strategies
for reducing them when they occur. One of the first tasks is to
normalize the client’s and foster parents’ responses to disrup-
tive events and to reinforce accurate cognitions about those
events (Cohen, Mannarino, & Deblinger, 2006).
Another task is risk reduction, which aims to put into place
a safety plan for crisis situations. This includes providing con-
tact information and emergency numbers, particularly for
psychiatric emergencies. The client and foster family are also
provided with information about what to do and where to go
in unsafe situations.
Stress management  includes breathing, relaxation, and
mindfulness. When clients direct their attention to the act of
breathing, there is a decrease in tension and an increase in
focused awareness. Relaxation reduces and reverses the nega-
tive physiological and psychological manifestations of stress,
which engenders disruptions such as increased heart rate,
increased startle response, hypervigilance, agitation, difficulty
sleeping, restlessness, irritability, and anger/rage reactions
(Cohen, Mannarino, & Deblinger, 2006).
105
Affective expression and affect modulation  help youth
understand and manage their emotions and increase their
coping skills so that cognitive distortions of self and others
are not manifested in negative behaviors. I encouraged John
to further understand his cognitive distortions and how they
related to his overall well-being. Foster parents and their chil-
dren often have unhealthy or distorted thoughts and beliefs
about therapy as well as about earlier life experiences. The
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term “cognitive coping” refers to a variety of interventions that
encourage clients to explore their thoughts in order to chal-
lenge and correct cognitions that are inaccurate or unhealthy
(Cohen, Mannarino, & Deblinger, 2006).
Stage Two: Finding Resources
As stabilization focused on specific aspects of John’s well-
being, in finding resources, the emphasis was on the interper-
sonal musical relationships that we shared. Finding resources
empowered John to understand the connections between
the music and his life both internally and externally. Finding
resources is therefore defined as the therapist guiding the cli-
ent to find and subsequently access both internal and exter-
nal supports. Rolvsjord (2010) emphasizes that music therapy
should stimulate the client and not necessarily aim to fix or
cure pathology. In finding resources, the therapy focused on
less directive approaches employed in the stabilization phase
and used a more resource-oriented approach.
Within this context, foster-care youth used music as an
internal resource in the following ways (Zanders, 2012, p. 97):
• To calm themselves: They purposively chose music to relax
or “chill,” either by themselves or with others.
• As an escape: Music listening was used to get away from
the stressors and difficulties they faced regularly, and some-
times to create distance from the people that caused them
distress. Adolescents reported finding a place of solitude and
then listening to music by themselves. This “alone” listening
seemed to meet a metaphorical and literal need of the ado-
lescents for their own space, away from others.
• As a distraction: Music listening helped divert their attention
away from their mental turmoil or worries; and sometimes, it
served as an obstacle to appropriately attending or focusing.
• As a way to forget the past: Youth used music to help forget;
there was an intention to neglect or banish their thoughts, to
forget past experiences and avoid dealing with them.
• As a catalyst for socialization and identity formation:
Listening to music with friends provided an opportunity to
discuss and debate life issues, and thereby compare one’s
own perspective to those of others. This in turn helped them
find themselves and shape their own identity, musical as
well as personal. A similar effect occurs when adolescents
sing or play in musical groups.
Understanding how John used music was essential to assess
his internal resources. For example, did he listen to music as a
distraction from mental turmoil or as a way of finding his met-
aphorical space? This knowledge provided important informa-
tion about his coping mechanisms.
Rolvsjord (2010) emphasizes equality and mutuality and
uses terms such as collaborations, negotiations, and interac-
tions as a way of describing treatment, without necessarily
doing interventions in music therapy. Interventions connote a
106
power relationship, and thus the therapist acts on the client.
In finding resources, there was a co-participation and reflex-
ivity, where John and I  learned from each other. Rolvsjord
(2010) notes that “musical interaction in music therapy offers
opportunities not only to explore problems, trauma, and dif-
ficult emotions, but also to explore strengths; to explore
pleasure, joy, and mastery; and to try out ways of using music
as a resource in everyday life” (p. 5). In this way, I felt I was
no longer doing “treatment,” but providing affordances and
opportunities for John to be in a relationship with both me and
the music (Abrams, 2012).
This stage included a different level of self-awareness in my
role as therapist. Stabilization included a self-awareness of
treatment applications that would work in stabilizing John’s
emotions and ecology. However, in finding resources, self-
awareness required more in-depth introspection of my rela-
tionship with John. The relationship that exists between cli-
ents and therapists is generally considered to be a vital part
of psychotherapy, regardless of theoretical orientation (Gelso,
Palma, & Bhatia, 2013). Anytime a music therapist is work-
ing with the psyche in a way that relates to the recognition of
dynamic interplay of thoughts, feelings, and/or behaviors, this
is a form of psychotherapy. Thus, the music therapist work-
ing with foster-care youth should be mindful of transference
and countertransference as salient dynamics of the therapeutic
relationship.
The music therapist is wise to have at least a basic under-
standing of the transference-countertransference relationship.
“Some therapists prefer well-timed interpretation, others pro-
vide a safe relationship, and still others ignore transference
unless it poses a problem, preferring instead to focus on
modifying problematic cognitions and behaviors” (Gelso,
Palma, & Bhatia, 2013, p.  1162). Even if the transference-
countertransference relationship is an ascribed meaning, the
natural resistance of foster-care youth in therapy stems from
past attachments and lack of developed relationships, which
interacts with the music therapist’s own past attachments and
relationships.
Austin (2007), in working with inner-city youth (including
foster-care youth), noted that “clinical work with adolescents
requires a high degree of self-awareness and self-observation
because adolescents are able to ‘push buttons’ in areas where
a therapist is most vulnerable” (p.  102). She added that the
countertransferences that emerge included parental dynamics
such as authority and being the “good” parent, over-identifi-
cation with youth and a desire to be accepted, and induced
anger or rage from the youth’s transference and projective
identification. Youth with “inadequate, rigid working models
of attachment relations are likely to inappropriately impose
these models on interactions with the therapist” (Bretherton,
1992, p.  768). “Toward this end, the therapist can be most
helpful by serving as a reliable secure base from which
an individual can begin the arduous task of exploring and
reworking his or her internal working models” (Bretherton,
1992, p. 768).
If we view transference as patterns and themes from signifi-
cant figures in childhood, then these themes will be activated
during therapy. However, with foster-care youth, there may
be a tendency to avoid attachments, due to the conflicts they
Music Therapy Perspectives (2015), Vol. 33
have had with significant people in their life. Thus, in exam-
ining the transference and countertransference relationship,
the music therapist may want to explore whether the attach-
ment transference is avoidant, which reflects the tendency to
avoid or withdraw from close relationships and minimize their
importance. This is in contrast to other clients, who may have
a transference based on attachment security, which is “rep-
resented by low levels of avoidance and anxiety, such that
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persons feel relatively secure about attachment-related mat-
ters and relatively comfortable opening up to others and rely-
ing on them as a secure base” (Gelso, Palma, & Bhatia, 2013,
pp. 1164–1165). According to Bowlby (1988), understanding
transference and countertransference will help both the thera-
pist and youth in examining how their internal concepts of self
and others may or may not be appropriate to their current and
future circumstances.
Stage Three: Finding Meaning
Initially, I  did not construct our work together as stages.
However, it was at this point in our relationship that I saw a
change in John’s personal life. John was blossoming at both
home and school, but there was still an aspect of John’s emo-
tional health that we had not fully explored. We had touched
on his past traumatic experiences in finding resources, but
John had not really found freedom from those experiences.
John would at times still have flashbacks or other internal
reminders of his abuse. In the stage of finding meaning, it was
important for me to provide a layer of support so that John
could be vulnerable while still having sufficient ego strength
to function in the world. Thus, in this stage, we used music
experiences as a narrative for John’s life so that he could find
meaning in his past, build relationships in his present, and
experience a more enriching future. In doing so, John was
able to develop a more integrated identity and find meaning
through his grief and loss.
Victor Frankl’s seminal work, Man’s Search for Meaning,
provides the foundation for his development of Logotherapy.
This work reflects how, even in the most miserable of circum-
stances, life has meaning. In living, we are finding meaning,
and finding meaning in freedom and experience allows us
to confront unimaginable suffering. Although Frankl’s work
stems from his experience during the Holocaust, his con-
ceptualization of his experience of finding purpose and
meaning resonates with the foster-care youths’ life. I  have
seen foster-care youth experience deeply painful and lasting
events. While I am not metaphorically, or analogically, com-
paring the Holocaust with foster care, I am suggesting that
suffering and pain are part of living, and integrating these
experiences brings about more meaningful, cogent ways of
being in the world. Thus, for John, integrating his past into
the present, and making meaning of his past experiences,
helped him live more fully in the present, and feel hope for
the future.
Summary
As John and I  worked together, I  realized that therapy
required a comprehensive, yet reflexive, understanding of
both John and myself. I learned that being able to take mul-
tiple perspectives, and not rely on any one particular way
Music Therapy with Foster-Care Youth
of thinking, allowed us to share in the joys and struggles of
the therapeutic process. It was through the process of being
both integrative (having multiple perspectives) and reflex-
ive (learning from John) that these stages developed. There
were common themes of abuse, neglect, and disruption
with all of the foster-care youth I  worked with, and these
stages provide a template to help clients navigate through
life and develop the necessary internal and external sup-
ports to do so.
While these stages are presented as a framework, they are
not necessarily hierarchically or procedurally based. Each
stage can be navigated fluidly, and any stage can be returned
to, based on the needs of the youth. For example, stabiliza-
tion is a good place to start, but during times of disruption,
even a youth who may be in the stage of finding meaning
will need some stabilization. Additionally, assessing the foster
family is an important dimension in considering the youth’s
stage of readiness. When designing and selecting therapeutic
experiences or tools the therapist wishes to propose to a fam-
ily, it is important to match these interventions with the fam-
ily’s readiness, and carefully monitor the foster youth–family
dynamics.
Finally, I would like to further stress the importance of under-
standing complex trauma with foster-care youth and how it
manifests itself both physically and emotionally. “Complex
trauma is characterized by significant problems with attach-
ment security, affect regulation, biological regulation, disso-
ciation, behavioral regulation, cognition, and self-concept”
(Cohen, Mannarino, Kliethermes, & Murray , 2012, p.  528).
It is also characterized by continued exposure to protracted
social and/or interpersonal trauma and may result in the lack
or loss of control, helplessness, and deformations of identity
and sense of self (Appleyard & Osofosky, 2003). The Adverse
Childhood Experiences (ACE) study provided the foundation
for understanding complex trauma by noting not only the
emotional or psychological damage that occurs, but also the
physical and physiological damage (CDC, 2014). This was
clearly evident for John, and provided an important context
for our work together.
John taught me a great deal, and it is through my work
with him, and clients like him, that this multistage prac-
tice-based model has emerged. It draws together a range
of theoretical perspectives, links them to specific kinds of
music therapy experiences, and emphasizes both the reflex-
ive nature of clinical practice and the flexibility of inter-
ventions to meet the ever-changing needs of clients. Such
flexibility requires self-awareness, accepts the dynamic
interplay of client and therapist (i.e., transference and coun-
tertransference), and suggests a salutogenic understanding
of health (Antonovsky, 1987), one that emphasizes manage-
107
ability, comprehensibility and meaningfulness, situated in a
social web.
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