Jazzin’ up CBT: Integrating popular music in youth CBT Warren Matofsky

This paper describes a brief evaluation of integrating popular music into a youth CBT group and the personal and professional enablers of this interest.

‘Coltrane said jazz was about hope & despair, life and death. I disagree, it’s much more serious than that.’ Lenny Bruce, 1965

Introduction HIS PAPER will explore how a youth CBT because of it, my words come from a positon group was adapted to integrate the use that’s bound up with jazz, almost as much Tof popular music to support the work of as my whiteness, Jewishness and ambivalence the group. Before setting out the implementa- towards authority. The jazz in my life repre- tion and evaluation of ‘Kim’s tune technique’, sents a family tradition and a soundtrack to which sought to engage a group of young both personal experience and time typing people with sharing their preferred tunes, psychology at my laptop. Speaking as a white I will explore the personal & clinical reso- Jew about jazz, is not without its problems, nances of extending the mediums through but other psychologists have tried to attend which group CBT is delivered. to that (Billig, 2000). It’s probably not coinci- dental that it’s jazz; the psycho-active nature of Personal context jazz has been reported as often as the psychi- As a jazz record collector, banjoist and DJ atric toll of a life devoted to jazz (Mingus, over 40 years, despite being a psychologist or 1971), not to mention its ability to expose

12 Clinical Psychology Forum 334 – October 2020 Jazzin’ up CBT: Integrating popular music in youth CBT the hypocrisy of social norms (Dyer, 2012). But jazz is both public and private (Mingus, All three themes have featured in popular 1971). Jazz has been there for me when recov- and official myth-making about jazz since its ering from mental health crises (‘Below the birth, when Buddy Bolden first ‘blew away’ Baseline’, Ernest Ranglin), during those said New Orleans. Bolden, it should be noted, crises (‘Making Music’, Zakir Hussain) and stopped performing the ‘new music’ in 1906, connecting with an equally uncommunicative age 29, when he was committed to Louisianna peer on the ward, also in crisis (‘Better things’, State Asylum, where he was held until his Massive Attack). Jazz was there for more ordi- death in 1931. Hospital records show that nary anguish, separations (‘In the name of Bolden, the first king of jazz, was assessed as love’, Kenny Rankin), bereavements (‘Sexual ‘delusional and grandiose’ by the psychiatrist. healing’, Hot 8 Brass Band) and expressions Local press reports suggest he accessed the of devotion (‘Whatever Lola wants Lola gets’, hospital music therapy group and joined the Sarah Vaughn). Jazz is bound up with many hospital band performing at the Elk Theatre, separations and celebrations, with my standard Baton Rouge in 1907 (Karst, 2019). This latter gift a mix tape/CD to old supervisors, trainees, performance was all the more striking in the mates and lovers. Jim Crow era of enforced musical segregation, with Bolden accompanying a group of white Clinical context men and women. As a CBT supervisor, I enjoy sharing with prac- My own experience of jazz as the soundtrack titioners and training cohorts the dynamic to my professional life, is that the music is way we use CBT in CAMHS. For our CAMHS fundamental to my self-care. The tune that practitioners where complexity and resource takes you to a smoother plane, after a tricky scarcity is the norm, their CBT creatively encounter with one’s own limitations in clinic engages with the family of models in the tradi- (‘Sweet Honey Bee’, Duke Person); or the one tion, with multiple waves informing the way that acknowledges your indignation when the we grapple with working with child, parents, business meeting ignores your idea (‘Return carers, education and what’s left of profes- of the prodigal son’, Freddy Hubbard). Jazz sional networks post-2010. The CBT we work can comfort, connect with my feelings, drag on with families, is informed by attachment me out of my current feeling state, pluck me theory and seeing the child as part of a system, out of rumination into the melody or direct which only enriches the way we formulate, me to the rhythm through foot tapping and involve the system in behavioural experiments head nodding. Embodiment is one of the and conceptualise the relational barriers to cornerstones of jazz (Dyer, 2012), which not graded exposure. CBT with children and fami- only offers flow (Csíkszentmihályi, 1990) to lies, has always involved sustained sensitivity to players and listeners, but also swing. The cura- the 6th P, long before it became codified in tive value of Gil Scott Heron’s ‘The Revolution the Power Threat Meaning Framework (John- will not be televised’ in the face of an impover- stone & Boyle, 2018). ished, electronic patient record system has not New research is changing the way diminished after years of use; nor the spiritual we deliver group CBT in our department. escape of ‘Oh lord don’t let them drop that Leibowitz & Omer (2013)’s innovative integra- atomic bomb on me’ by Charles Mingus, to tion of the New Authority model of parenting, get over the anguish of having driven both with research on family accommodation ways to work in the dark and just realised processes, informs our parent/carer CBT it’s still eight days to pay day. Perhaps this is groups and parallel accommodation work- a rare advantage of covering a rural patch shops for education staff (Matofsky, 2018). across multiple bases and whose impoverished Hayes & Ciarrochi (2018)’s DNAv model has transport system means more car journeys, supported our efforts to develop more crea- more jazz. tive and experiential mediums for delivering

Clinical Psychology Forum 334 – October 2020 13 Warren Matofsky developmentally-sensitive, youth CBT groups. related tune at the beginning, which was subse- Pilots of both interventions have shown quently played during the task. In revising encouraging results, and this paper covers the the protocol for the CBT group, ‘Kim’s tune process of refining the protocol based on feed- technique’ was included, structured across the back and evaluation, of the pilot youth CBT intervention. At screening, where participants group. The youth CBT group comprises of 10 & their families were met separately, young 90 minute sessions for up to 8 young people people were invited to nominate valued tunes and one family celebration event. The task of for the group playlist, for playing throughout the group is to promote psychological flexi- the weekly creative task. bility and reduce experiential avoidance, with the tag line on the group leaflet ‘Create, chill, Method choose.’ Each session includes a signature, The plan for evaluating the integration of creative task related to the key theme, set out ‘Kim’s tune technique’ into group CBT, was to in the protocol (Hayes & Rowse, 2008). summarise any references to the use of music CBT with group work protocols involves in supervision and session debrief notes, Expe- a complex process of sustaining flexibility rience of Service Questionnaire data (ESQ: within fidelity (Kendall et al., 2008), whilst Brown et al., 2014) and group feedback. The ensuring adaptation to local culture & prac- limitations of this data set and the challenges tice contexts (DeLucia-Waak, 2005). Addition- around evaluating one element in a complex, ally, given the length of the research cycle, specialist intervention delivered as part of the content of published, trial protocols can routine care, were acknowledged throughout struggle to remain relevant to shifting youth the process. All data was collected as part of culture. However the map is never the terri- a supervised quality improvement project with tory in group work, and given what we know documentation completed and stored in line about the curvilinear relationship between with service guidelines. protocol adherence and effectiveness (Hogue et al., 2010), every evidence-based group is, in Participants many ways, bespoke. Six young people (aged 14–17) started Feedback from our pilot youth CBT group the group and four met criteria for being included appreciation for playing music ‘completers’ (attended at least 70 per cent during creative tasks, which we had imple- of sessions), all of whom were accessing the mented in the latter stages of the pilot, in group as part of a multidisciplinary care plan response to a live request from the group. provided by specialist community CAMHS. The Whilst one has to be cautious about such ad group was facilitated by a children’s wellbeing hoc adaptations to protocol (Webster-Stratton, practitioner and the author, supervised by 2004), this decision was grounded in being a senior clinical child psychologist. Seventy consistent with the intervention ethics (Hayes five per cent of completers showed reliable & Ciarrochi, 2018) and was worked up by the improvement on parent-rated child func- group, by consensus. tioning (Child Outcome Rating Scale: Miller & Duncan, 2006) and 100 per cent showed Kim’s tune technique improved psychological flexibility, as meas- I first experienced ‘Kim’s tune technique’ ured by the Acceptance & Fusion Question- at a reflective practice session at a Specialist naire- Youth (Greco et al., 2008). Seven out CAMHS team away day (Geffray, 2019). The of 8 young people, parents and carers rated as exercise sought to explore the multiple mean- ‘certainly true’ that ‘the help I have received ings of happiness in domestic and professional here was good’ (ESQ: question 9). contexts using traditional art therapy tech- niques. The innovation was to ask all partici- pants to write down the name of a happiness

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Results dialogue, with limited success. The group Screening interview adapted quickly to the structure, within a few The screening interview aimed to check suit- sessions self-managing the transitions around ability for group, establish goals, build moti- the creative task, supported by the music that vation through family support and socialise marked its beginning and end. the young person to the model. The group The function of the music for the group, therapists noted that the playlist discussion was explored in the second supervision supported the latter function. Questions about session. One of the group therapists spoke music were placed in the semi-structured inter- of their intense anxiety in the session, when view schedule after the discussion of goals. the playlist failed to function. The supervision It was noted that in five of the screening group explored how the intensity of this expe- sessions, the question shifted the pace of rience might reflect the investment the group the interview, but in contrasting directions. had in the ‘music-as-break-from-conversation’, For three young people, their contribution a defensive group process of pairing (Bion, gained pace and richness, as they moved 1966) that positioned the music as the only from a more hesitant response to the goals possibility for managing the anxiety generated topic, speaking with greater fluency about an by the group task. evident interest in music. Brief questioning about the way young people engage with the Written feedback from families suggested tunes, generated responses relating From the 59 written comments, five (three from to coping and seeking empathy and acknowl- young people) related to the inclusion of music. edgement in lyrical content. With two young Two young people and two parents commented people the playlist question shifted the pace on how the music promoted involvement, with and engagement into a more self-silencing the other young person expressing concern response. Inquiries by the therapist generated that ‘the people who didn’t come back, their comments suggesting embarrassment and tunes remained on the playlist’. assumptions of group stigmatisation, if others had to listen to their choices. Exploring these Discussion assumptions as they arose in the interview, The facilitators found that the integration of enabled the therapist to highlight the young popular music into this CBT group aided the person’s relationship to thinking, providing an process of socialising participants to the model early opportunity for socialising to the model at screening and supported the structuring of and its formulation of problem maintenance the group. The few written comments and live (Hayes & Ciarochi, 2018). observation suggested the use of music was well-received by the group. Both group therapists Across the intervention and families referred to its role in co-developing The creative task and the playlist marked the group environment. This latter factor is a shift in the culture of the group, bringing significant in terms of the current CAMHS with it a shared sense of relief for partic- service development priority of ensuring service ipants (and therapists), as they enjoyed delivery is more participatory (Department of a break from their shared efforts building Health, 2015). Despite the small sample and new conversation. The creative task and its limited data set, further small-scale investigation playlist gave permission for a more solitary is warranted to explore music’s contribution to but shared activity, in contrast to the rest keeping CBT relevant to young people. The pilot of the session that involved either pair or also left me sensitive to the need of remaining whole group participation. The creative open to the wide range of relationships and task generated conversation at the margins, responses young people can have to music. between pairs, mostly between the facilita- Finally, as a theme tune for this ending, tors, who sought to draw the group into their I might be tempted by the ebullient baseline of

Clinical Psychology Forum 334 – October 2020 15 Warren Matofsky

The Cinematic Orchestra’s ‘Ode to the big sea’. Acknowledgments Yet endings, depending on your attachment Special thanks to Rosie Wooldridge and Dr style, can also leave something more compli- Alex Robinson for feedback on the draft data cated, so perhaps a more ambiguously rousing summary and co-delivering this group. tune, ‘Coffee cold’ by Galt Macdermod. Jazz. Since Lockdown, 2020 a low intensity format of this group has been run remotely Warren Matofsky, Clinical & Community via https://www.youtube.com/channel/ Psychologist, Worthing Hospital, Sussex Part- UCeFnMcsLULg2f_EjVkf7mmg/ nership NHS Foundation Trust [email protected]

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Discography Cinematic Orchestra. (1999). Ode to the big sea. On Gaye, M. (2007). Sexual healing. [Recorded by Hot Motion [Vinyl]. London: Ninja Tune. https://www. 8 Brass Band]. [Vinyl]. Brighton: Tru Thoughts youtube.com/watch?v=fxDcsp6eklE Records. https://www.youtube.com/watch?v=Zs- Hubbard, F. (1966). The return of the prodigal son. On DUXo5TcZY Backlash [Vinyl]. New York: Atlantic. https://www. Hussain, Z. (1987). Making Music [Vinyl]. San youtube.com/watch?v=QnQBY7hLlRA Anselmo: ECM Records. https://www.youtube. com/watch?v=wQRvrkSj5rA

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Macdermod, G. & his Mid Manhatten Rhythm Section Rankin, K. (1974). In the name of love. On Silver (1966). Coffee Cold. On Shapes of Rhythm [Vinyl]. Morning [Viynl]. New York: Little David Records. Montreal: Kilmarnock. https://www.youtube.com/ https://www.youtube.com/watch?v=tzXTUk4TfSg watch?v=vNQ_A9r_hBA Scott-Heron, Gil (1974). The revolution will not be tele- Massive Attack (1994). Better things. On Protection vised. On The revolution will not be televised [Vinyl]. [Vinyl]. Bristol: Wild Bunch Records. https://www. New York: Flying Dutchman. https://www.youtube. youtube.com/watch?v=hfGW7-709i8 com/watch?v=qGaoXAwl9kw Mingus, C. (1961). Oh lord don’t drop that atomic Vaughn, S. (1955). Whatever Lola wants Lola gets [Vinyl]. bomb on me. On Oh Yeah [Vinyl]. New York: Chicago: Mercury Records. https://www.youtube. Atlantic Records. https://www.youtube.com/ com/watch?v=QvcaSBN82ns watch?v=eaeVLd4G1Zg Pearson, D. (1966). Sweet honey bee. On Sweet Honey Bee [Vinyl] New York: Blue Note Records. https:// www.youtube.com/watch?v=xaycK3XFnNo Ranglin, E. (1996). Below the Baseline [Vinyl]. London: Island Records. https://www.youtube.com/ watch?v=NuyrY--vs3U

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