The advent of the COVID-19 pandemic has exacerbated an already challenging level of mental health concerns for young people. Research into the impact of the virus both in Australia and overseas has revealed significant increases in presentations at mental health services and online support services (Kaleveld et al., Reference Kaleveld, Bock and Maycock-Sayce2020). Almost a third of the world’s population has been through some form of lockdown with the consequent impacts of increased isolation, disruption to existing supports, and increased feelings of stress, frustration, anger, sadness, loss and grief (Nicholson et al., Reference Nicholson, Newell and Collyer2020). For young people who had an existing vulnerability to mental health issues, those from lower socio-economic families, Aboriginal, migrant and refugee families or who live in rural communities, the risk was exacerbated even further (Jones et al., Reference Jones, Woolfenden, Pengilly, Breen, Cohn, Biviano, Johns, Worth, Lamb, Lingam, Silove, Marks, Tzioumi and Zw2020).
This new COVID-19 reality, coupled with a role that was already significantly impacted by job-related stress and burnout (Earle, Reference Earle2017), creates a perfect storm for school counsellors and school psychologists who will logically be tasked with the major role of supporting this increased demand for mental health support. While many school counsellors and school psychologists enjoy their work, there is a growing recognition within these professions of increased stress and unsustainable workloads (McCarthy et al., Reference McCarthy, Kerne, Calfa, Lambert and Guzmán2010). One simple way to reduce the demand for school psychological services is to increase the number of students a therapist can support at any one time by encouraging more group work and reducing the current reliance on intensive one-to-one counselling. As well as allowing therapists to work with more students at any one time, groups directly address one of the major issues nominated by young people as impacting their wellbeing, namely, social isolation (Nicholson et al., Reference Nicholson, Newell and Collyer2020).
Group work is a natural and effective way to engage young people who come to school with the expectation of working alongside their peers. Meta-analysis of group interventions shows their effectiveness in reducing mental health conditions (Feiss et al., Reference Feiss, Dolinger, Merritt, Reiche, Martin, Yanes, Thomas and Pangelinan2019; Gerrity & Delucia-Waack, Reference Gerrity and Delucia-Waack2006). The emphasis on ‘natural’ extends to appreciating, normalising and destigmatising many of the issues that have an impact on people’s mental health and the importance of social support, including from their classmates, in overcoming the challenges of these issues. However, group work in the traditional sense, which relies solely on dialogue, faces significant hurdles in engaging young people, particularly those from vulnerable populations (Kelly & Doherty, Reference Kelly and Doherty2016).
One response of therapists looking to increase group engagement in school settings is to combine experiential learning activities with traditional group discussions, and increasingly these activities involve the expressive modalities of music and art. In particular, the collaborative nature of group music making lends itself to the group process, where many of the therapeutic factors of group work are evident (see Figure 1). Young people engaged in collaborative music making linked to reflective discussions benefit from both the positive outcomes derived from playing music, including the important element of social bonding, which has been lost to many through COVID related isolation, and those of interpersonal learning and insight associated with facilitated group discussions.
Figure 1. A model of rhythm and reflection, combining experiential group music making with reflective practice.
The role of music in the lives of many young people is significant, closely contributing to their sense of self and supporting them emotionally through times of trouble (Hallam, Reference Hallam2010). Young people have reported that music helps them in times of stress to regulate their moods, release negative emotions, problem solve and relax, and that it was a fundamental strategy they employed to enhance wellbeing (Papinczak et al., Reference Papinczak, Dingle, Stoyanov and Hides2015). Music also has a large role to play in supporting young people’s learning, with research showing it can improve language acquisition (literacy), spatial reasoning (mathematics) and general intellectual capacity (Hallam, Reference Hallam2010). This learning may be extended to the social and emotional sphere, with studies showing that memories formed in association with musical and rhythmic stimuli are embedded deeply and maintain their integrity over time (Jäncke, Reference Jäncke2008). Despite a wealth of research evidence supporting the use of music as both an educational and therapeutic aid, the number of music programs in schools in Australia and other western countries is declining (Pascoe et al., Reference Pascoe, Leong, MacCallum, Marsh, Smith, Church and Winterton2005), and it is rarely utilised by therapists outside the music therapy profession.
Many forms of music harbour barriers to inclusion and engagement, and there can be resistance from students to participate in therapeutic music programs due to anxiety from previous experience. The competitive nature of formal music instruction and the requirement to read musical notation limits access for many, and these same barriers can also prevent adult facilitators from utilising music in their practice. Rhythmic music, played on hand drums and percussion, provides therapists with one of the most accessible forms of participatory music and one that has an unbroken history of thousands of years within the traditional healing practices of cultures across the world (Kenny, Reference Kenny2006). These universal cultural traditions make rhythmic music programs particularly useful for school populations that include students from multicultural and Indigenous backgrounds.
Rhythm-based music in this model is played on hand drums and percussion, with a focus on improvisation. Students are taught the basics of the instrument and within minutes are playing together in a powerful way that would be unimaginable on any other instrument within the same timeframe. This accessibility is fundamental to its appeal and makes for a skill-set that can be readily acquired by any therapist. The group represents a community, and their musical interactions replicate many of the social interactions they will utilise on a daily basis. The facilitator can draw attention to a range of social skills and the many links between musical harmony and social harmony. With so many students spending significant time isolated from their peers as a result of the pandemic, and concurrently experiencing a rise in social anxiety (Buckner et al., Reference Buckner, Abarno, Lewis, Zvolensky and Garey2021), this format can provide a safe platform for resuming social connection, practising neglected social skills, and examining a range of other issues that impact healthy social relationships.
In both music therapy and music education, the benefits of improvisation are well documented (Wigram, Reference Wigram2004; Yun & Ji-Eun, Reference Yun and Ji-Eun2013). In particular, improvisation is associated with creativity, self-expression and self-efficacy (MacDonald & Wilson, Reference MacDonald and Wilson2014). Improvisation, within the model demonstrated in this article, empowers each individual to express themselves freely (i.e., individual identity, individual strengths) but with the proviso of finding connection to the group as a whole (i.e., social responsibility, community values). This focus away from the traditional music instruction where students learn set rhythm pieces also reduces the resistance many young people feel in being told what to do (i.e., what to play) and the power dynamic between the therapist and their clients. Another key benefit is that it allows for the group to incorporate students whose drumming ability and motor coordination may vary significantly.
Not only does rhythmic music provide an easy access point to music-based interventions but its therapeutic potential is supported by an increasing body of evidence, with over 20 peer-reviewed studies showcasing benefits across physiological, psychological and social domains (www.rhythmresearchresources.net). In particular, research from the field of neuroscience has demonstrated how rhythmic auditory cues connect to our motor systems to impact the firing rates of motor neurons that directly impact many of our primal functions, including our heart rate, respiratory rate, and stress response (Chandra & Levitin, Reference Chandra and Levitin2013; Toyka & Freund, Reference Toyka and Freund2006). This synchronisation is at the heart of the process of entrainment, where students playing the same beat and tempo connect not only socially but on a biological level, and through this shared process, empathy and people’s positive regard for each other is increased (Overy & Molnar-Szakacs, Reference Overy and Molnar-Szakacs2009).
Fear and anxiety have been among the most common issues reported by young people in response to COVID-19 (Nicholson et al., Reference Nicholson, Newell and Collyer2020). Music provides a safe conduit for responding to the emotional needs of young people impacted by lockdown and the disruption of the pandemic, and can be used to help identify their feelings and assist in regulating them. Young people often struggle to articulate the complex nature of their feelings, and words alone can fail to covey what they are truly feeling, leaving them open to misjudgment. Using music avoids these issues and also the self-consciousness and shame that often accompanies revealing one’s feelings — the response between students asked to ‘describe their feelings’ or ‘play their feelings’ can be marked. Therapists can also use the stimulating nature of music, played loud and fast to replicate emotional arousal, and practise regulating activities in response. One common regulation exercise involves holding onto a steady tempo (remaining calm and in control) while those around you get faster and louder — these techniques are often initiated on the drum but can also be transferred to the body in times of stress.
Rhythm is fundamental to learning on any level with repetition at the heart of skill acquisition. In ancient Greece, Aristotle highlighted the role of repetition in learning by saying, ‘it is frequent repetition that produces a natural tendency’. In oral cultures learning is passed down across successive generations using rhythm and song. In all areas of learning, repetition and practice are central to levels of attainment and skill (Campitelli & Gobet, Reference Campitelli and Gobet2011). Learning through repetition strengthens neural connectivity through myelination, which is central to the development of specific cognitive functions, including memory (Hasan et al., Reference Hasan, Kanna, Ramkrishnan, Iqbal, Lee and Li2019). The importance of repetition extends to learning new behaviours, through repeated observations and practice, and thus is particularly relevant to the counsellor or psychologist working with behavioural issues.
This link between rhythm, repetition and behaviour is amplified when we consider the patterned nature of much of human activity. We are creatures of habit and fall quickly into patterns or routines that may be constructive or destructive. Counsellors and psychologists using rhythm-based interventions can readily draw on this connection to initiate group discussions on a myriad of topics drawn through analogy from the experiential rhythmic musical exercises. A simple example would be to name one particular rhythm as a positive behaviour (perhaps standing up against bullying or not drinking when driving) and then represent the more problematic behaviour (bullying or drink-driving) with another rhythm and have students test themselves to maintain the positive rhythm against the pull of the rest of the group playing the ‘negative’ pattern. Exercises like these can lead naturally into group discussions — in this example on the issue of negative peer pressure and the skills and strategies that can avert it — and do so in an engaging manner that makes participation and learning fun.
The use of rhythm and rhyme is also a common strategy for enhancing learning across cultures. Traditional nursery rhymes often conveyed social messages or moral lessons (Kulshreshtha, Reference Kulshreshtha2017), just as rhythm and rhyme are used to teach children the letters of the alphabet, days in each month, or their multiplication tables. Memories lodged through music are known to be long lasting and robust, as is evidenced in people with dementia and Alzheimer’s disease who hold on to these musical moments well after others have disappeared (Vanstone & Cuddy, Reference Vanstone and Cuddy2010). In supporting social and emotional understanding with young people, exercises that pair rhythmic music to rhyming affirmations on these principles can be deeply embedded in the same way. Students can compose, and play along to, simple raps that articulate social and emotional learning concepts, thus incorporating a popular contemporary music style into an engaging and fun, therapeutic activity.
The integration of the experiential and the cognitive allows the counsellor or psychologist to draw upon the benefits of both models and deepen the learning outcomes for the student. The use of analogy reduces the confronting nature of overt personal exposure within the group process and is extended by the freedom of each individual to draw their own associations and meaning from this symbology as it relates to their own life experience. Analogies help facilitators develop rapport and help students clarify concepts that otherwise remain beyond their understanding by shifting perspective, removing blockages and opening doors to growth (Blenkiron, Reference Blenkiron2005). At the same time, the experiential nature of accessible rhythmic music allows the therapist to work nonverbally when required, drawing on the social, creative and expressive benefits that arise from playing music collaboratively with others, and so essential to recovery from the deprivations brought about by lockdown.
The use of rhythmic music also allows the therapist to work somatically with young people and assist them to process the pain of their experiences held internally within the body, and release this safely. The resonance of the drum permeates the body and can help loosen the rigidity that is often seen in bodily responses to trauma (American Psychological Association, 2001). The drum is also a useful tool for advancing mindfulness and grounding exercises with young people. Drumming at specific tempos is used by many cultural traditions to enhance states of calm and reflection, with studies showing increased levels of theta brain waves that are linked to improvements in mental clarity (Winkelman, Reference Winkelman2000).
While there is a significant evidence base for the benefits that young people derive from these therapies (Ho et al., Reference Ho, Tsao, Bloch and Zeltzer2011; Martin & Wood, Reference Martin and Wood2017; Wood et al., Reference Wood, Ivery, Donovan and Lambin2013), there is also research that demonstrates a positive impact on the therapist themselves. A study by Bittman and colleagues (Reference Bittman, Bruhn, Stevens, Westengard and Umbach2003) with long-term care workers using group drumming showed a significant reduction in multiple burnout and mood dimensions. Many counsellors and psychologists know the limitations and accompanying frustrations of working with ‘talk-based’ therapies and young people (Bradford, Reference Bradford2018). Burnout is a significant issue in the profession (McCarthy et al., Reference McCarthy, Kerne, Calfa, Lambert and Guzmán2010), with up to 60% of those working in the mental health professions as a whole reporting emotional exhaustion and feelings of burnout (Morse et al., Reference Morse, Salyers, Rollins, Monroe-DeVita and Pfahler2012). These frightening statistics are likely to grow with the demand placed upon these professions in the wake of the COVID crises. Introducing therapies that are engaging, pleasurable and impactful for students and their therapists is a logical way to reduce such indicators.
After the dislocation and uncertainty brought on by the impacts of the global pandemic, COVID-19, and with ongoing uncertainty into the years ahead, young people will be needing additional support from those within the school system charged with looking out for them. This growing demand and the limited availability of professional mental health clinicians makes the use of evidence-based group programs that positively impact mental health and reduce psychological distress an important option for the school therapist. The use of an integrated model combining rhythmic music and reflective discussions offers many positive benefits to both the students and the practitioner; in particular, the joy and sense of connection and belonging that playing music with others can bring. Thankfully there are now several well-researched, therapeutic programs utilising this model that are available to therapists and educators.
In the past we have learned costly lessons by ignoring the knowledge of those who have come before us. Many continue to view music, particularly rhythmic music, as a simple vehicle for fun and entertainment. Much of the power of music cannot be measured according to the scientific method, but research is increasingly validating what our Indigenous ancestors have known for thousands of years, that the healing properties of rhythmic music are significant and have a central role to play in our mental health and that of our youth. Now, in the face of the significant challenges brought on by the disruption and uncertainty of the pandemic, this traditional form of community music offers young people a path to healing, connection and regeneration; and for the school therapist, a practical, effective and rewarding option to support them.
