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Music Therapy with Clarissa Karlsson

6 years ago

Today on the podcast, we have Clarissa Karlsson. Clarissa is a music therapist out of Washington, DC. She provides music therapy for cancer patients, kids with sickle cell anemia and has also done work with trauma in psychiatric hospitals. She has also worked with a good friend of mine, Ryan Gebler, who lost his fight to cancer in 2012. The therapy Clarissa provided for him goes beyond words and I know all his family and friends are beyond grateful for the wonderful musical outlets she provided for Ryan in his fight with cancer. This episode is dedicated to Ryan Gebler and The Never Retreat Foundation.


Listen To The Episode Here

Music Therapy with Clarissa Karlsson

Please welcome, Clarissa Karlsson. **Clarissa, where are you from?**

Right now, I’m living in Washington, DC. I was born in Canada and I have traveled up and down the East Coast for most of my adult life. My parents emigrated from the Philippines.

What part of Canada did you grow up in?

I was born in St. John’s, Newfoundland, right on the wharf, lots of lobsters. I hear you could get a box lunch of two lobsters for $5, which is crazy.

It must have been freezing up there too.

It’s pretty cold. I think I recently read something about they can see icebergs off the coast of where I used to live right now. We also lived in Halifax, Nova Scotia and then in Winnipeg.

Did you grow up in your teenage years up there as well?

No, I moved to Florida when I was eleven. I like to think that my parents got tired of the cold.

Where in Florida did you grow up?

That was St. Petersburg, Florida, right on the West Coast.

What were you into as a teenager?

I have always been into music. I’ve always been into classical music. I don’t know why or how I even knew what they were. I told my parents when I was three I wanted to play either the cello or the harp.

Two very unconventional instruments for someone growing up today.

Inconvenient too, they’re both very large.

Did you get good at playing the harp and the cello?

I went with the smaller of the two. I played the cello. I’ve been playing the cello since I was eight.

You have one of the most noble and amazing professions I have ever heard of and you provide an outlet to so many people and not only those people that you’re helping, but to their families who are also going through all those tough times. Can you just elaborate a little bit on what you do, how you got into that and how you even found that niche of a field? That is just amazing to me.

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It had this capacity to hold conflicting feelings and emotions in its expression at the same time.

It is a small field. I think that there are 7,000 music therapists in the states, pretty small comparatively. Like I said, I’ve always loved classical music. The reason I loved it was because it had this capacity to hold conflicting feelings and emotions in its expression at the same time. I think that is what lots of people love about whatever music it is that they like, that capacity to express poignancy. I was a professional musician. I went to conservatory. I freelanced as a cellist for a while. I think being a professional musician is a lot less romantic than what it sounds like. I’m sure you probably know people who are and what that’s like.

I’m still aspiring to be a professional musician myself. Kind of joking, but kind of not. I’m awful but I play the harmonica. Hopefully one day, it will take me somewhere.

We’re going to have to talk about harmonica because I’m doing a study with the harmonica in the hospital. When I started feeling like, “I don’t think I can do this professional musician thing for the rest of my life,” in my mid 20’s, I really realized that I miss people. To be a professional musician in the classical world, you do have to spend a lot of time practicing and putting a lot of hours going to rehearsals and concerts and playing weddings because that’s how you pay your rent and all that kind of stuff. I felt like I’m playing for people but I’m not really playing with people. I started shadowing a music therapist. I cannot really remember where I heard about music therapy, but I did hear about it at some point somewhere.

What area of the country were you in when you heard about it?

That was Baltimore.

The first time you shadowed a music therapist, what was your experience like?

It was pretty great. She worked with adults with developmental delays. It was an evening group program, an hour and a half. It was really amazing to see how she made the music making very approachable and inclusive, helping the participants in the group to play the instruments, to feel like they’re part of the music making. We were doing popular songs and stuff.

What was the group that she was working with?

Adults with all kinds of developmental disabilities. I don’t remember, I think it’s a day program at a center. It was probably about ten adults and they went through a bunch of their favorite songs and singing and playing instruments along with it. Then I also shadowed a music therapist at Kennedy Krieger Institute, the rehab hospital. They were working with kids mostly on things like self expression type of stuff. There was a little bit of music therapy co-treatment with physical and occupational therapy, but I didn’t get to see that when I was there.

How did you meet Ryan Gebler? Knowing Ryan Gebler, you probably just fulfilled his life beyond words because the amount of struggle he was going through and the amount of how much he love music, that outlet that you provided him must have just been one of the best combinations I could think of in a person that loves music and is fighting a battle of cancer that’s very hard, especially for someone that loved music as much as him. I can’t imagine what you were able to do for him. I know his family speaks very highly of you because I heard you talked at this foundation. It blew me away. How did you get into that niche where you started working with the cancer unit and all that?

Let me start just talking about Ryan. I can’t even begin to express how much of an inspiration Ryan was to me at the time that I met him. I had just started working at Children’s National a few months before I had met Ryan. He came with this vivacity and this zest for life. Everything to him was whether it was challenging, he always had a smile on his face, he was ready to meet anything. Honestly, he was a consummate musician in his own right before I ever stepped in the picture. I feel like he taught me.

He was always playing shows and everything. He loved it.

I feel like he taught me more than I could have ever taught him. Again, it’s not about teaching. Ryan came to Children’s because he was diagnosed with a cancer that although he was an adult, it’s considered a pediatric cancer for medical reasons that I don’t know. What we were working on with him, because he was such a great musician in his own right, I really wanted him to not lose touch with that. What we see in the hospital and with illness in general is that your whole sense of self reshapes itself or has it integrate the illness into, “This is part of yourself,” concept now like who are you.

I’m sure a lot of people struggle with that. They feel like their disease becomes them and they get trapped inside of a world that they might not have a lot of outlets, so for you to provide that for him. The music is one thing. Do you have to provide them almost a therapy of, “You are not your illness?”

My Master’s Degree was Music Therapy and Counseling. I’m very much steeped in that approach of really trying to support the sense of self within illness and within wellness. With Ryan, because making music was such a big part of his identity, it was apparent to me immediately that what he got the most out of was making music. I didn’t really feel he needed to talk through a bunch of stuff with me. Also, because we have a very robust psychosocial team and he was seeing my good friend and colleague psychologist at the same time, I knew he had that verbal outlet with a licensed psychologist.

When he sat down with you, was it like, “We’re making songs today. We’re making music.” You provided him with that outlet as well?

Yeah. I think that was a bulk of what we did, honestly. At the beginning, he bought his guitar. He wanted to learn Pachelbel’s Canon. We would improvise on things like that. He wrote his own stuff so I would bring my cello. Honestly, I wasn’t nearly as good a guitarist as Ryan was. I felt like I needed to bring my main instrument to meet him where he was.

Did you do it in the hospital room or do you bring the patients into another wing of the hospital where it’s all music or it’s just right bedside?

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It was all there in the experience of the music, whatever he was going through.

Right at the bedside because those patients can’t move too far and also I didn’t have another space. The work really changed over time. As he became more ill as he relapsed and things got a little bleaker, he wanted to listen to music more, he wanted to share music that he had recently heard, recently discovered with me more and just talk about that. I remember this one time I played Hallelujah for him, just guitar, singing. He just wanted to hear it for weeks. For week on that was the only thing he wanted to hear. I knew that this song means something to him. While I allowed the silence for him to talk about it, he never did. I don’t think he needed to. I think it was all there in the experience of the music, whatever he was going through. He just wanted to hear it. Whatever he was going through internally, he was going through and he didn’t need to talk about it with me.

I guess every single appointment that you have with your clients is different depending on what their needs are. I’m just curious how you get assigned to patients even if they’re not musically inclined. Ryan was obviously very gifted at it. What if someone just wants to try it out?

I would say the vast majority of my patients don’t have any musical training at all. Really, the bulk of my work as a music therapist is bringing them to the music, making the music more accessible to them so that they can participate in it. Some examples of this: I’ve worked with patients who have young children at Children’s but also other places. I might do some mommy-and-me type stuff, showing them ways of engaging with their baby musically. In that context, it’s not so much about the music as it is about the mom or dad and infant interaction. My goal with that would be to A, support the baby’s development and B, provide some shared experience for bonding and just enjoyment of one another within that parent-child relationship. My goals really are they can be informed by lots of different things. I tend to take a very developmental perspective like, “This is what one needs for optimal development. Here’s how music can support that.”

I think that’s huge because music has the ability to change whatever mindset you’re in, it has the ability to bring you back to a certain moment in your life. It can literally take you anywhere and it can be extremely healing. It might even be more effective than medicine in some cases. I don’t even think we even realize how powerful our minds can be. They’ve done studies where they’ve given people placebo drugs and they told them that it was the real thing. Just the power of the mind thinking those people are actually taking those drugs, some of their illnesses went away just from mind power. You are bringing a completely different element to the healing process. Who knows even how powerful it actually is because you can be having as great an effect as all the medication and all the other healing aspects are just from sitting with these people and giving them the gift of music. I think that’s incredible.

Thank you, that’s incredibly complimentary. I can’t say that it’s me though. There are very, very many fantastic thinkers and professors and teachers and therapists. Music has been used in medicine since the 1800’s really. If you want to go all the way back to David and his harp and all that kind of stuff, you can.

I don’t mean to put you in the spot, but can you provide any examples of what they were doing back then?

In the late 1800’s, there was a psychiatrist who started providing music for recreation and education on psychiatric wards. He saw it as a rehabilitative therapy. That was one way and that was way back when psych institutes looked nothing like they do now. Then fast forward to after World War II, you had volunteer musicians going into these hospitals, into veterans’ centers, which we’re seeing resurgence of that now in a different format. They would play music for these veterans. Without really being prepared for it elicit very, very intense emotional responses. Back in the late ‘40s, ‘50s, musicians started to realize, “If we’re going to provide this and it’s going to be helpful, we need to know what we’re walking into.” That is when the modern profession of music therapy started in the United States. I think the first training program was developed in 1945 up in Michigan. Today, we have something like 80 undergraduate music therapy programs and then there are a number of Master’s programs and a couple of PhD programs.

If you look back at the development of music therapy through the ‘70s, ‘80s and ‘90s, it tracked with what was really not popular. You had music therapy that was more behaviorally oriented at the same time as behavior therapy was a huge thing in psychology. Then we had the reaction to that, which was music therapy that was more psychoanalytically driven when that was the thing. Now, I think we’re starting to really understand that there are so many different ways of practicing music therapy and so many different client needs in context. There’s no one approach. Music therapy is trans-disciplinary. It has so many different homes depending on the context.

I love how it can be physical like if someone just needs to have an actual outlet of playing the instrument. It can also be internal of the music coming outside in and taking care of the patient that way. I feel like everybody these days wants to quantify everything scientifically of, “How is this exactly affecting that person or patient?” Sometimes, it’s so hard to quantify because you can’t measure that person’s reaction. Like how you were saying with Ryan, you can’t get inside that person’s head and know what they’re feeling the actual release in that.

I think you’re absolutely right. One of the things that’s really central to all creative arts therapies not just music therapy is that art, sound, vision, all these senses are preverbal. We understand the world in images and in sounds and in movement before we can language it, before we can talk about it. Music and art and dance and all these artistic modalities, all these aesthetic modalities, are ways of expressing a psychic truth, a reality. I just read about this yesterday, by the way. This is all fresh in my mind. If you look at art as a way of expressing a psychic reality, everybody’s reality is going to be different. That person might not even know what their truth is, what their inner experience really is before expressing it.

That is one of the principles that underlie therapy too. If you can talk about it, then you can understand it. Sometimes, you can’t talk about it, but you can express it in music or you can express in art or in movement. Then through that, you might be able to get to a more verbal cognitive understanding of whatever it is. Trauma is a huge arena where this is practiced because the way that, and I don’t know all the neuroscience behind it, but the way that memories are stored when one has a traumatic experience is disintegrated. Part of that integration is responding to it in all these visceral ways before one can really understand what just happened.

Music can be extremely visceral in the way like you can feel it and everything. For traumas, do you think it can almost unlock some of those past emotional traumas and help get that out?

Yes, I do. I know music therapists who work almost exclusively with trauma. I am not one of them. I think that those music therapists would say that music can approach what is that traumatic material, an approach that’s starting to make sense of it. You have to be really aware, as a therapist, what are you eliciting and how will you contain it? There’s only so much you can open up in a single session and work through before you have to close that person up and send them back out into the world to function again. It’s not just, “Let’s immerse ourselves in this music that will flood your senses with memories and all that kind of stuff,” although while that could happen, it’s not necessarily helpful. A music therapist working with trauma might choose music that addresses one particular aspect of whatever that trauma was.

A person that has been through a ton of trauma might not be all that verbal. When you give them an instrument and they can express themselves in that manner, you’re opening pathways and gates that you wouldn’t be able to do with just by talking.

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Every time she wanted to talk about it, she couldn’t. Her throat would close up.

I think you’re right. I’ll talk about a case that I worked with when I was working in the psychiatric hospital. There was a teenage girl who had experienced some kind of trauma. Every time she wanted to talk about it, she couldn’t. Her throat would close up. I happen to have here in an individual session. We worked with drums and just really basic rhythm not just a beat like a one, two, three, four, but just something very simple on the drums. We would breathe to it and then we would start toning to it and just start getting that voice moving again through it with the drums underneath it.

Over time, we started to really work with just using her voice more loudly and then starting to talk about what was going on, what the trauma was with her. At that point, I went to my team and I said, “Here’s where we are. This is where I need everybody else’s expertise to start working through the material of this trauma.” We started with unlocking the voice.

With the drums and the breathing, were you unable to walk that voice with that? Was she verbally talking to you about that?

Yeah, she was talking. You would see her in the middle school and think nothing.

When it came to the traumas and you started playing the drums, while she was playing the drums, was she unable to unlock that voice or then she finished with you and then she was able to unlock it enough?

I’m talking about the physical mechanism of vocal sound production. We practiced by yawning, yawning with sound because that is not threatening. That’s not nearly as threatening as talking about emotionally charged materials. We did a lot of things like vocal exercises, warm-ups, things you would do as a singer or just for fun, whatever, just to get her voice. The fact that she was there on a therapy session, on an inpatient psychiatric ward, that trauma was close by. I didn’t need to talk about it for her to think about it. Just being able to use her voice in this context and then use it to talk about what she was feeling in the moment and then use it to talk about what she had been feeling or what she went through before. It’s like a ladder.

Is your niche with music therapy, is it strictly right now with people diagnosed with cancer or is that primarily what you’re working with right now?

Children’s, I worked in the Center for Cancer and Blood Disorder. It would be kids who have cancer. It would also be kids who had blood disorders like sickle cell disease. With sickle cell disease, we’re working a lot on many, many different things. The hallmark of sickle cell disease is pain and there are a lot of patients who had chronic pain and all of the psychosocial sequelae that come with that.

When the kids who had sickle cell disease are inpatient, I might work with them on just relaxation skills again with the breathing and learning autogenic relaxation, imagery exercises, learning how to think their way through the body and breathe through the body to help manage pain. The sickle cell practitioners were very, very keen on anything on pharmacological that we could do for these patients because they’re going to be living with pain their whole life.

That’s was one niche you had. You recently just left that and so you’re back in school now?

I will be starting in school in September. It’s a PhD in Creative Arts Therapy Research, which is why I was reading about aesthetics last night. What we have right now in music therapy and in creative arts therapies are a lot of theories that draw on different fields. My colleagues who work with neuro rehabilitation are drawing from that science to inform what it is that they do. My colleagues that work in education, same thing; even my own practice, I’m drawing on psychology and counseling theories to inform what I do. What we don’t have are really robust theories that explain how we know what we know about our inner lives. That is what I’ll be studying.

I think there are a couple of different things that I’ll be doing. My advisor is Joke Bradt and she is amazing. She’s an amazing researcher. Right now, I think she has a study or an NIH grant for something to do with chronic pain and vocal methods of working with chronic pain. The focus of the program is interdisciplinary. I’ll be learning a lot about aesthetics, theory of aesthetics, but then I’ll also be learning about neurobiology and sociocultural anthropology and all these different ways in which music can be understood. Having that as a base, then I’ll be better prepared to create interdisciplinary studies like team science research.

You’re going back to school to improve on your skillset.

I’m hoping to broaden how music therapists think and talk about how we’re helpful. Because in my mind, we don’t make any sense to exist as a profession if we can’t talk about the context and the mechanism and the outcome that we’re going for and how the aesthetic experience and the process of creating art helps that.

I think this is not only for the cancer patients and people in the hospital setting and even for the trauma patients in the psych wards that we’re talking about, this could be beneficial for anybody suffering in any type of pain, any emotional pain, anything they want to work through. Is music therapy available? That’s pretty much why I have the podcast is to get this message out there. I didn’t hear about music therapy until I met you when you were speaking at the foundation. I was blown away and I was fascinated by it. I guess my question is, I know this could be beneficial for a lot of people, can anybody just come up the street like, “I want to see a musical therapist,” rather than being in a lot of pain or being in the hospital?

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Public awareness of the field is pretty low in areas of the country where there aren’t a lot of music therapists.

I do know what you’re saying. I think that recognition of the field, public awareness of the field is pretty low in areas of the country where there aren’t a lot of music therapists. The music therapist and art therapist separately have been working towards state recognition of the profession and state licensing under various boards. Some states have been successful and other states are still working on it. Like in Maryland, there’s a bill on the floor right now I think to recognize music therapy as a profession.

You guys are relatively new then?

On that front, yes; state recognition, relatively new. There’s always so much to say about professional issues and all that. You’re probably no stranger to that like being a chiropractor. That’s far more widely recognized.

I do a specialty within the chiropractic field. It’s called Upper Cervical Chiropractic. I didn’t hear about it myself until someone tapped on the shoulder and told me about it and it saved my life. I went four years in miserable, unbearable pain. I didn’t hear about it until four years later. It’s pretty much why I have the podcast is to get the word out of all these amazing therapies that are going on because the internet is literally leveling the playing field.

There’s so much information and access to this information now that people haven’t had even ten years ago. When you get people like yourself on here talking about what you do here, all it needs to land in is the right person’s hands, like one person and it could change someone’s outlook on a perspective or it could literally save their life and get either treatment or whatever it is that person is looking for, they can find it.

I think it’s really cool that you’re doing this podcast. I have to say, I was completely captivated by your podcast with Galina. I was like, “I am learning so much right now. It’s crazy.”

Just to talk to somebody that’s from another side of the world and you get how they grew up, it’s fascinating. You get to interview a lot of people and you get to figure out that there’s a common denominator in a lot of healers and a lot of people that are doing great things. You get to learn a lot from other people.

It’s really cool that you’re doing it.

As far as music therapy goes, is there any good books or information or any renowned people that are doing the work that are public figure like any lectures on YouTube or books or anything that you think highly of?

I will say, there’s a lot of media out there that claims to represent music therapy that does not represent music therapy. Not to say that what is being done out there therapeutically with music isn’t helpful, because certainly it can be, it can absolutely be.

I understand what you’re saying. You have to represent it the correct way.

To call it music therapy, you’d need to represent it the right way. For that, I would point to news coverage of Gabby Giffords and her recovery, her speech recovery using neurologic music therapy as part of her speech rehab. That’s a really powerful and accurate depiction of what music therapy can do on that front.

Are there any universities on the forefront of music therapy that have pretty good solid programs?

There’s a lot actually.

I had a patient the other day that said she was going to school for music therapy at Montclair State University.

They’ve got a great program.

They must have a program. It must be getting bigger and getting some recognition.

I think certain areas of the country have a wealth of programs like New York, New Jersey, Philadelphia. Those areas have a ton of programs under all very strong programs. There’s a strong bent toward humanistic and psychodynamic thinking in that area of the country. Then if you go further south to like Texas or Florida, you’ll get a little bit more about bio mechanic and/or behavioral approach to music therapy. If you go to Colorado, that’s going to be your neurologic music therapy. These are just broad, broad brush strokes. There are other programs that also do all of those things and do them well, but those are in terms of name recognition.

I’m just curious, what are some of your goals and dreams? In the near future, ultimately, where would you like to take your music therapy career?

If I could have anything I wanted, I would want to direct a creative arts therapy research program at a large medical institution. That’s what I’d want to do.

It seems like you’re on the right path.

I hope so. Really, what I want to do is bring together a bunch of different types of practitioners. Can I talk a little bit about my harmonica study?

What’s the harmonica study?

I’ll practice this by saying that I am not a wind player or a harmonica player at all, but you know how you can get sound in the harmonica by drawing breath and blowing through it. When kids are in the hospital who have sickle cell disease, they are prescribed the use of an incentive spirometer to help distend their lungs, to help prevent lung collapse. There are those diatonic harmonicas that West Music sells really $4 a pop. They’re super cheap and they sound good. If you are on holes four and five and you draw in, you get the notes for a D minor chord. Do you know what’s in D minor? Uptown Funk is in D minor.

I’m sure all the kids would love to play that.

It’s such a good song. What I’m doing is pairing Uptown Funk with this harmonica with a little bit of education about why we would be doing this and how to do the deep breathing technique. When kids are in pain and they have pain in their chest cavity or abdomen or anywhere, they tend to breathe in very shallowly. You have to get the air all the way down to the bottom of your lungs.

I worked with a pulmonologist and hematologist to develop the interventions so that it’s clinically useful. I am working with a nurse researcher and a bio engineer. They’ve developed a device to measure the airflow through the harmonica somehow because that’s their part of this. I don’t know exactly what it is that we’re going to find out from that but they do. They’ll work with the pulmonologist to figure out how it’s relevant.

What’s great about the whole study is they’re definitely going to be getting more oxygenated blood flow just from breathing rather than just sitting in the hospital bed doing nothing. Right there alone, that’s a plus and they get to play music.

From the music therapy side of it, I’m looking at engagement because people say they don’t want to do the incentive spirometer because it’s boring or they forget about it or they don’t like it.

You’re hooking those two devices up?

Yes. We’re making the incentive spirometer, the function of it, electronic; the measurement function electronic. Then we’re hooking the harmonica up to that device.

That is genius. They’re going to want to do it, most of them.

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I’m trying to hook in the patient’s preference with the music.

That’s my hope. My hope is also to develop a library of songs that work with it because eventually, Uptown Funk is going to get old. There’s also like Come Together, the Aerosmith version, not The Beatles recording, is a really good one for that. Just to cater the different tastes and to have different styles and all that kind of stuff. I’m trying to hook in the patient’s preference with the music so that it’s something like, “This is really cool. I want to be a part of it,” and then they’ll do that.

That’s great and they get to learn how to play the harmonica.

They get to learn how to breathe into the harmonica. I don’t know how to play the harmonica, but I can teach you how to breathe in deeply and stick a harmonica in your mouth while you’re doing it.

Clarissa, are you still involved with The Never Retreat Foundation?

I am not. I need to actually call them because I just recently left Children’s, but they filled the position. The funding for The Never Retreat has raised for the Children’s National music therapy program will still go to the Children’s National music therapy program. The person who’s in there is actually somebody I trained. She was my first intern. I’m really proud of her. She’s really great. She’s got a different skillset and different energy and she’s much more outgoing and all those kind of stuff. She’s the kind of person who she would love to organize a talent show. That’s my worst nightmare. I don’t want to do that. That’s the kind of thing that the kids would love to do. I’m happy about that.

Clarissa, thank you so much for coming on. I learned a lot. I think it’s absolutely amazing what you and everybody in your field gets to do. I think you guys are on to something great. It’s only going to go up from here.

Thank you so much for having me. It’s been a real pleasure to be a guest on this podcast.

I would love to have you back on, maybe when you finish your program. I would love to find out more of how that harmonica study goes.

I will definitely keep you posted.

Thank you so much, Clarissa.

Thank you, Kevin. Have a good one.

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