Annie Heiderscheit, Ph.D., MT-BC, FAMI, MFT has nearly 20 years of clinical music therapy experience. She is on the graduate faculty at the University of Minnesota Center for Spirituality and Healing , and maintains a private music therapy practice employing five music therapists providing services to a variety of healthcare settings. In this AMTA.Pro symposium, Annie shares her insights and experiences  as a clinical music therapist at The Emily Program, an outpatient eating disorder treatment program, where she provides music therapy in the residential, intensive and outpatient settings.


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Music Therapy and Eating Disorders

Annie Heiderscheit, Ph.D., MT-BC, FAMI, MFT

August, 2009

Podcast Discussion Outline

Note: a complete transcript of the podcast is below.

Case of Lucy

  • 22 year old social worker
  • Residential ED treatment
  • Song example – Stand in the Rain – Superchick
  • Revealing trauma history

Basic eating disorder statistics

  • 8-10 million Americans are diagnosed with eating disorders
  • Prevalence rate is 9:1 women to men
  • Incidence of bulimia is 6 times higher than anorexia
  • Anorexia is among the most lethal psychiatric disorders

Types of eating disorders

  • Anorexia Nervosa
  • Bulimia Nervosa
  • Eating Disorder – Not Otherwise Specified (ED-NOS)
  • Compulsive Over Eating

Case of Jane

  • 31 year old marketing professional
  • Long ED history – compulsive exerciser
  • Current treatment episode – inpatient treatment
  • Her description of the eating disorder experience in song
  • Song example – Remember the Tinman – Tracy Chapman

Eating disorders behaviors and symptoms

  • Bingeing
  • Purging
  • Restricting
  • Compulsive exercising
  • Laxative Use
  • Stimulant use

Complexities of eating disorders

  • Comorbidities
  • Physical complications
  • Barriers to treatment
  • Length of treatment
  • Levels of care

Music therapy goals and objectives in eating disorder treatment

  • Manage stress and anxiety
  • Develop new ways of coping
  • Facilitate expression
  • Access repressed feelings and experiences
  • Address issues around self-esteem

Implementing music therapy in eating disorder treatment

  • Song analysis (illustrated in previous examples)
  • Song autobiography – Case of Molly, 23 year old nursing student Song illustration – Breathe by Sia
  • Songwriting – Goodbye ED (recording of song as sung by clients)
  • Bonny Method of Guided Imagery and Music – Anna in outpatient treatment, addressing multiple traumas
  • Improvisation – Case of confronting perfectionistic tendencies, exploring new ways of being, connecting to others, processing through trauma
  • Music and imagery for relaxation – examples of live music, recorded music, and combinations

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Resources

Frish, M., Frank, D., & Herzog, D. (2006). Arts-based therapies in the treatment of eating disorders. Eating Disorders,  14, 131-142.

Heiderscheit, A. (2008). Discovery and Recovery through Music: An Overview of Music Therapy in Eating Disorder Treatment. In  Brooke, S. (Ed.). The Creative Arts Therapies and Eating Disorders (p. 122-141). Springfield, IL., Charles C. Thomas Publisher.

Heiderscheit, A. (2008). Creative Arts Therapies. Published through the Center for Spirituality and Healing, Academic Health Center of the University of Minnesota at www.takingcharge.csh.umn.edu.

Heiderscheit, A. (2008). Music Therapy. Published through the Center for Spirituality and Healing, Academic Health Center of the University of Minnesota at www.takingcharge.csh.umn.edu.

Hilliard, R. (2001). Cognitive-behavioral music therapy in eating disorders. Music Therapy Perspectives, 2, 109-113.

Jusitce, R. W. (1994). Music therapy interventions for people with eating disorders in an inpatient setting. Music Therapy Perspectives, 12(2), 104-110.

Loth, H. (2002). There’s no getting away from anything here: A music therapy group within an inpatient programme for adults with eating disorders. In A. Davies & E. Richards (Eds.), Music therapy in group work (90-104). London: Jessica Kingsley.

Nolan, P. (1989). Music therapy improvisation techniques with bulimic patients.  In L.M. Hornyak & E K. Baker (Eds.), Experiential therapies for eating disorders (p. 167-187). New York: Guilford Press.

Nolan, P. (1989). Music as a transitional object in the treatment of bulimia. Music Therapy Perspectives, 6, 49-51.

Parente, A. B., (1989). Music as a therapeutic tool in treating anorexia nervosa. In L.M. Hornyak & E K. Baker (Eds.), Experiential therapies for eating disorders (p. 305-328). New York: Guilford Press.

Parente, A. (1989). Feeding the hungry soul: Music as a therapeutic modality in the treatment of anorexia nervosa. Music Therapy Perspectives, 6, 44-48.

Robarts, J. (1995). Towards autonomy and a sense of self: Music therapy and the individuation process in relation to children and adolescents with early onset anorexia nervosa. In D. Dokter (Ed.), Arts therapies and clients with eating disorders (p. 229-246).  London: Jessica Kingsley.

Robarts, J., & Sloboda, A . (1994). Perspectives on music therapy with people suffering from anorexia nervosa. Journal of British Music Therapy, 8(1), 7-14.

Rogers, P. (1995). Sexual abuse and eating disorders: A possible connection indicated through music therapy? In D. Dokter (Ed.), Arts therapies and clients with eating disorders (p. 262-278).  London: Jessica Kingsley.

Siegel, S. (2007). Music therapy practice for clients with eating disorders. In B. Crowe & C. Colwel (Eds.), Music Therapy for Children, Adolescents, and Adults with Mental Disorders: Using Music to Maximize Mental Health, (165-174). Silver Spring, MD: American Music Therapy Association.

Sloboda, A. (1993). Individual therapy with a man who has an eating disorder. In M. Heal & T. Wigram (Eds.), Music therapy in health and education (p. 103-111). London: Jessica Kingsley.

Sloboda, A. (1995). Individual music therapy with anorexia and bulimic patients. In D. Dokter (Ed.), Arts therapies and clients with eating disorders (p. 247-261).  London: Jessica Kingsley.

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AMTA.Pro Symposium Podcast Transcript

We begin with a story about Lucy – a 23 year-old social worker. Lucy had entered treatment in an intensive day treatment program but had continued to struggle with her symptom use even while in that level of care, so she was admitted into a residential treatment. When I initially met with her to complete her assessment, it was really challenging. She was not very forthcoming with information and so it was difficult to really get much of a sense of her or her story, so what I asked her to do was to bring in three different songs that just helped to tell her story or that said anything about her. And what I want to share with you is one of the songs that she brought in to the next session that revealed a bit more about her.

Stand in the Rain by Superchick

She never slows down..She doesn’t know why but she knows that when
She’s all alone feels like it’s all coming down..she won’t turn around
The shadows are long and she fears if she cries that first tear the tears will not stop raining down

So stand in the rain..stand your ground..Stand up when it’s all crashing down..
You stand through the pain..You won’t drown..And one day what’s lost can be found..You stand in the rain

She won’t make a sound..Alone in this fight with herself..And the fears whispering
If she stands, she’ll fall down..She wants to be found but the only way out is through
everything she’s running from..Wants to give up and lie down

So stand in the rain..stand your ground..Stand up when it’s all crashing down..
You stand through the pain..You won’t drown..And one day what’s lost can be found..You stand in the rain

As a result of Lucy sharing the song in the session was that when she was a junior in high school, she was a foreign exchange student in Europe. During that time she stayed with a host family and she was sexually abused by the father of that host family. This was seven years prior to her coming into residential treatment, and it was something that she had never talked about. She had never told anyone about – nobody in her family, none of her friends. She had been holding this information for seven years.  And it was at this time in her residential treatment that she began to process through the trauma that she encountered seven years ago. It was difficult for Lucy to find the words to talk about her experiences, but she could begin to share those through music. That felt safer and less threatening. So music was a way for her to begin to tell her story, especially those difficult parts that she had never talked about.

In eating disorder treatment, there are many things that can compound the process. What I’d like to start with are just some basic statistics about eating disorders. About eight to ten million Americans are diagnosed with eating disorders, with the prevalence rate being nine to one, women to men, and that the incidence of bulimia is 6 times higher than that of anorexia, but anorexia is one of the most lethal of the psychiatric disorders. There are various types of eating disorders as well, being anorexia nervosa, bulimia nervosa, and there is eating disorder not otherwise specified or ED-NOS and that is typically given when someone does not fit within the diagnostic criteria of anorexia or bulimia, and then there is also compulsive overeating. I will not go into the diagnostic criteria for each of the types of eating disorders, but if you are looking for more information, I encourage you to go to the DSM and under each of those look at the specific diagnostic criteria for each.

I’d like to give you another case example of Jane. Jane was a 31 year-old marketing professional. She had a very long eating disorder history, was a compulsive over-exerciser with a diagnosis of anorexia nervosa. I was working with Jane in her current treatment episode which was on an inpatient unit and she came in because her weight was quite low and she was becoming medically unstable. Vital signs, heart rate, and EKG’s were demonstrating medical instability. One day in a group session, I asked the each member of the group to share a song that they felt described what it was like to have an eating disorder. What I want to share with you is the song that she shared in that session. A song that she picked out that expressed what it was like to have an eating disorder.

Remember the Tinman by Tracy Chapman

There are locks on the doors..And chains stretched across all the entries to the inside
There’s a gate and a fence..And bars to protect from only God knows what lurks outside

Who stole your heart left you with a space that no one and nothing can fill
Who stole your heart who took it away knowing that without it you can’t live

Who took away the part so essential to the whole…Left you a hollow body
Skin and bone…What robber what thief who stole your heart and the key

Who stole your heart…The smile from your face…The innocence the light from your eyes
Who stole your heart or did you give it away…And if so then when and why

Who took away the part so essential to the whole…Left you a hollow body
Skin and bone…What robber what thief who stole your heart and the key

Now all sentiment is gone…Now you have no trust in no one
Who stole your heart…Did you know but forget the method and moment in time
Was it a trickster using mirrors and sleight of hand…A strong elixir or a potion that you drank

Who hurt your heart…Bruised it in a place…That no one and nothing can heal
You’ve gone to wizards, princes and magic men…You’ve gone to witches, the good the bad the indifferent

But still all sentiment is gone…But still you have no trust in no one
If you can tear down the walls…Throw your armor away remove all roadblocks barricades
If you can forget there are bandits and dragons to slay…And don’t forget that you defend an empty space

And remember the tinman found he had what he thought he lacked
Remember the tinman…Go find your heart and take it back
Who stole your heart..Maybe no one can say…One day you will find it I pray

What Jane shared after the group had listened to her song was that the eating disorder works to take that very piece that is essential to the whole. It works to attack you at your core, but even though visually the body seems to be attacked, what it is really going after is the heart of the person. Not the heart that is just the physical heart, but the heart or the soul of the individual. She felt that that is what had been lost and what had been taken from her. The very heart of who she was. That had been stolen, and that essence of who she was, was the very thing that the eating disorder worked to attack and to take away.

Hearing the stories of clients for me is always helpful in better understanding each individual’s process and therapy. While with eating disorders we do see behaviors and symptoms, each person’s story is still quite unique.

I do want to just talk for a moment about behaviors and symptoms of eating disorders. Some of those include bingeing, purging, restricting food, laxative use and stimulant use, and all of those are symptoms that are connected to the eating disorder. So if someone is bingeing, they may also be purging, and there are various types. Even with anorexia there can be a restricting type, there can be a compulsive exercising type, there can be a purging type, so for each individual it is different, and their story around that may be different as well. Whether there is laxative use, diet pill abuse or use, their story is what is important within that as well.

For me some of the challenges of working with individuals with eating disorders is that eating disorders are quite complex, that there are many comorbidities with eating disorders, that eating disorders are their own mental health diagnoses. And then someone may have other mental health diagnoses. They may have an anxiety disorder or depression, a personality disorder. They may have a trauma history, they may have PTSD. There can be many other diagnoses along with the eating disorder diagnosis. There can also be the physical complications when someone becomes medically unstable. Their weight is very low, or their metabolic system is thrown off from purging and bingeing. So there can be lots of medical or physical complications that arise from that. They may develop osteoporosis or osteopenia. Due to the medical and physical complications, that can make the process more challenging to treat. There are also barriers to treatment. There is not always insurance coverage. We see that in challenges getting people into treatment at an appropriate level of care, so barriers to treatment are also a challenge in the process. Length of treatment – that someone with an eating disorder may need, especially if they are needing to restore weight or if we are working to interrupt symptoms, that may require a longer period of treatment. Eating disorders in general tend to require longer periods of treatment, again because of the complexities themselves of eating disorders. It also requires various levels of care. A patient with an eating disorder may need more intensive levels of treatment at times and then may need to work on stepping down to lower levels in their process.

One of the benefits that I find in utilizing music therapy in all of these different levels of care for eating disorders is that music therapy allows me to meet the very unique needs of individuals in a variety of levels of care. From the inpatient setting where someone might be quite medically unstable – they’re very low-weighted, very medically unstable – they can experience light-headedness, and they need something that can meet them where they’re at within that. They may not have a lot of energy. They may not have very clear thinking patterns, but I can use music to ground, calm, and meet them at that place, even at that very fragile state. To a point where someone is in more intensive treatment and working on the deeper issues as in a residential treatment setting, and we need to address issues around trauma, or deeper emotional issues, music therapy lends itself very well to that. Or when we move to lower levels of care such as an outpatient setting and patients are working from a more functional standpoint on maintaining their health and well-being and music again, music therapy can integrate very easily into that level of care as well. It is a very flexible modality to meet them at these different places at all of these levels of care.

So within that I have a variety of goals and objectives that I work to address, and I am going to share just a few to get a sense of that. One of the things is that in individuals with eating disorders, the symptoms, so whether they’re bingeing, purging, over-exercising, those symptoms are often a means of coping – whether that’s coping with stress, anxiety, feelings, whatever that might be – and so we want to look at new ways of coping, and using music, music therapy is a great way to give them new coping skills. So whether I am working with them to manage stress or anxiety, or even more active ways of coping, we can implement music within that. Those are skills that we can work on developing during the course of their therapy. So we may be using music listening, music for relaxation, guided imagery, or we may be doing some drumming or some active music making as ways of coping. We also look at how do facilitate expressing what is going on because that may be an area of struggle as well. Talking about our emotions, those that may be more intimate, those that may be around more difficult issues about trauma, or just very personal feelings, and so we utilize music as that means of expression. It also allows me to access feelings or experiences that they may have pushed away or they may have repressed. Feelings that could be related to trauma or memories that they have not dealt with and that they have just pushed aside and are important in their process of recovery – to begin to work through those. It also allows me to look at their sense of self – their concept of themselves, their self-esteem – to explore their view of themselves and begin to change that view. To begin to develop that self-esteem and to also begin to empower them. Those are a few of the things that I am looking at for goals and objectives and again it is a very individual process. So when I am working with someone and completing their assessment, I am looking more specifically and collaborating with them on their goals and objectives for treatment.

I would like to talk a little bit now about how I incorporate music therapy specifically with the eating disorder treatment process. I have already shared a couple of songs with you in the podcast that to me help to illustrate the use of song analysis – using a song as an expression, using a song to tell their story — and when I have a client bring a song into a session, I’m doing my full analysis of the song: of not only listening to the lyrics, but picking up on all of the elements of the song. So I am listening to the tonality and the rhythm, the instrumentation and the form. I am listening to the qualities of the vocalist, and picking up on all of these elements because each of these elements of the song are telling the story that the client is sharing. I want to take in the whole story. The story is not simply contained in the lyrics. It is contained in every element of the song. So I am listening to all of those elements to better understand their story. Song analysis is a wonderful way to get a window into the life of the client. I also use what I call a song autobiography and that is, to me, the life of the client brought forward in song. It is in essence their life in a collection or compilation of songs. The way that I approach the song autobiography is by having the client select significant moments in their life. Those significant moments can be moments that were very positive or they can be moments that were challenging. I ask them to identify the significant moments, whatever those may be, and then to identify songs that they feel express or connect to those significant moments. Then once they have their song autobiography complete, we begin to listen together to their song autobiography and it is their life as they see it though the songs. So I’d like to share with you another example of a song from a song autobiography that a young woman by the name of Molly did. Molly was a twenty-three year-old nursing student and she was in the residential treatment program. She had been through various levels of treatment for many years and had a long history of her eating disorder, and this was her third time to be in residential treatment. This was actually the very first song on her song autobiography. The song is called Breathe by Sia.

Help, I have done it again…I have been here many times before
Hurt myself again today..And, the worst part is there’s no-one else to blame

Be my friend…Hold me, wrap me up…Unfold me
I am small…I’m needy…Warm me up…And breathe me

Ouch I have lost myself again…Lost myself and I am nowhere to be found,
Yeah I think that I might break…I’ve lost myself again and I feel unsafe

Be my friend…Hold me, wrap me up…Unfold me
I am small…I’m needy…Warm me up…And breathe me

What Molly shared about this song was that it represented where she was coming into residential treatment — feeling very tired, very weary, feeling very unsure if it was something she could do, feeling very ashamed that she had essentially hurt herself again through the eating disorder and feeling like she was stuck in this cycle. In the song you can hear that when it begins there is a sigh, you can hear this deep sigh, you hear the tiredness in the voice of the vocalist as well as the great power of her words saying, “Help.” The song starts with “Help” again and again. And that is very much where Molly was coming from. She recognized she needed help but struggled to often accept it, but this song gave a strong sense of where she was in the moment and her willingness through the song to be vulnerable within that.

Another intervention that I use is song writing, whether it is with a group or individuals, allowing the individual or group to determine what they would write about, what their song would be about, and I have a song example that I’d like to share that was written by a group of clients in a partial hospitalization program where they come for the day, have treatment during the day, and then are home in the evenings and weekends. The topic that the group decided to write about – they were very struck by a song that was written by the Dixie Chicks called Goodbye Earl and how that song felt like it mirrored the process of the eating disorder of stepping out of an abusive relationship in the song Goodbye Earl and that they felt that that paralleled the process of the eating disorder. That the eating disorder had similarities to an abusive relationship, so this particular group wanted to take the melody of that song Goodbye Earl and write their own words to it, which they entitled Goodbye Ed.

Goodbye Ed
Written in music therapy. Sung to the tune of Goodbye Earl by the Dixie Chicks.

I ate ice cream bars and doughnuts too all through my carefree days.
Until all the girls started skipping lunch and then I changed my ways.
If the scale and weight didn’t suit my taste I went back to bed.
And when all the other girls were getting boyfriends, I hooked up with ED.

Well, it wasn’t two weeks until ED started saying, “Ya gotta start losing weight.”
So put the Oreos and cheesecake down or you’ll never get a date.
I started getting crabby and irritable, I couldn’t concentrate.
I got skinnier and skinnier and ED kept saying “You gotta lose more weight.”

I started losing my hair and people got scared, But I didn’t give a damn.
My friends held my hand and we worked out a plan, And it didn’t take us long to decide,
That ED had to die. Goodbye ED.
That mac-n-cheese tastes alright to me, ED. Ya’ wonna put up a fight? I’ll take another bite.

I went to the clinic for my regular check-up, the doctors said I had to stay.
They talked to my parents and then they locked ED and I away.
I was mad that I had to gain weight, ‘cuz my BMI was low.
They started feeding me fats and all kinds of snacks, but I could not say no.
Well as time went on, my support stood by an helped me stand up to ED.
My clothes started fitting and I now find ED’s not always in my head.
Well the meals went by and spring turned to summer and summer faded into fall.
And it turns out ED was a cruel disorder that nobody missed at all.

So I held my head high and reclaimed my life, And ED doesn’t win the fight.
I eat three meals a day and snacks are okay, And I don’t lose any sleep at night.
‘Cause ED had to die. Na, na, na …..Goodbye ED…Na, na, na …..
We need a break. ED’s such a big fake. We’ll pack a lunch and stuff ED in the trunk.

Clients are able to tell their story from how the eating disorder began to their process of entering into treatment and then the process of treatment itself and how that evolved and then how they evolved to where they were at that point in treatment. In the midst of writing the song, a lot of discussion came forward – the challenges they experienced not only with the eating disorder, the process of acceptance, of receiving the diagnosis of an eating disorder and the sometimes lack of willingness to go into treatment although their family was bringing them in for treatment, so a lot came in the discussion from the process of writing the song.

Another approach that I use is the Bonny Method of Guided Imagery in Music. The Bonny Method of Guided Imagery in Music is a music psychotherapy approach which uses classical music where the client is drawing forward their own images. Images are not being directed from the therapist. They are generated from the client. So this is very much an uncovering approach and I am not going to into great description about what the Bonny Method is but I would encourage you to do any reading. Also visit AMI or the Association for Music and Imagery website to learn more about the Bonny Method. What I will say from my work in using this – especially within eating disorder treatment – is that we are often looking to explore the underlying issues of the eating disorder, so the eating disorder itself, although it is the diagnosis, the eating disorder itself is really a symptom for something deeper, so we’re looking to explore: What is the function of the eating disorder? Why is the eating disorder in existence? So we’re trying to get underneath, we’re trying to dig a bit deeper, to find out what led to the existence of this eating disorder?

So what I would like to share with you are just a couple brief examples of illustrations for client sessions. I am not going to read through transcripts, but just give you brief synopses of illustrations. One that I would like to start with is a young woman who was 22. She came from out of state and was in our residential treatment program and was very – I would say she was very much in her head – not really connected to her emotions. The eating disorder really served as a way of avoiding her emotions and we had been doing some work and I chatted with her a little bit about using the Bonny Method of Guided Imagery in Music to get to things that were may underlying or a little bit deeper and she was willing to do that. So during our next session we began with our first imagery in music session and as the music began and I guided her through a brief relaxation experience and then we began with the music. As I began my dialogue with her asking her, “What is she experiencing?” nothing was coming forward. This happened for several minutes. She finally stopped, sat up, and burst into tears, and was very emotional, very emotional. My concern was that she was putting too much pressure on herself, trying something that was may new to her, that was new to her and felt that she needed to do this perfectly. She had a lot of perfectionist tendencies. So we spent a little time talking, and so I said, “You know, let’s just take some time.” So I met with her the next week and my concern was that she may close that door and not be willing to do this again. We met for the next session and she and I talked about how she was feeling and she felt that she wanted to approach this again. So we moved into the imagery and she – we did several sessions during her time in residential treatment and it was a very informative process. One of the images that came forward was that she was on a path and she came to a fork in the road on the path, and one fork in the road was paved and smooth and very easy to walk. The other path was rocky and went into a dark forest. She decided in her imagery that she wanted to take the path that was paved and smooth and easy to walk, so she followed that path and it came to a brick wall. There was no way over this, there was no way around it, it was a brick wall. It was a dead end, so she headed back to the fork in the road and she stood at the fork in the road again, and she looked at the other path and she did not want to go that direction – the bumpy road that headed into the dark forest. So she headed down the paved path again and came again to the brick wall, so she walked back again to the fork in the road, and she did not want to walk that path that was bumpy and that led into the dark forest. So she continued repeatedly to go back to the fork in the road and walk down the path that led to a brick wall, and in the midst of her imagery she was recognizing that her life with the eating disorder is this dead end and yet she somehow kept herself on that path and in that place. Even though she knew it was a dead end, that is where she stayed. It was not until the next session, that session ended with her staying in that stuck place and she needed to sit with that. It was in the next session that this path reappeared. She was at the fork in the road and she choose at that point to go down that path that was bumpy and that led into the dark forest. And she was apprehensive and nervous, and she stayed with that path. She went through the dark forest. And as she found the courage to face that fear, light appeared and she was better able to see the bumpy path that led through the forest. And as she navigated through that, navigated feeling her anxiety and feeling her fears, she found her way through to the other side. So that image of the fork in the road and those paths was very metaphorical for the path that she was on with her eating disorder. And as she navigated that path through the forest, it allowed her to be able to sit and feel her emotions, which was very significant for her process in treatment. And she continued to strive and do very well as she continued in her process of development.

Another example that I would like to share with you is that of a client that I do some work with on an outpatient level. This young woman has multiple traumas, from…She is in her mid thirties…from being sexually abused as a young child, being raped in high school, and then having an abortion later in life, so there are multiple traumas that are there. And all of those multiple traumas have come forward in the imagery. And two of her traumas — prior to any of her imagery – there was knowledge of. And I think the third that had not come up previously which was the abortion, that that is something that she had really pushed away. I do not know that she had a conscious awareness of how that was connected to her eating disorder and to these other traumas. So that experience came forward in the imagery along with the other traumas and she began to process her grief around that abortion and began to allow herself to deal with having made this decision to let go of this child and had never really had the opportunity to grieve it before. So her experience with the imagery had not only allowed her to grieve and address the trauma, but to find strength, to be able to move through these traumas as well.

In addition to the approaches I have already mentioned, I also use drumming and improvisation in the work that I do. And there are wonderful ways I find with drumming and improvisation, there are wonderful ways to confront some of the perfectionistic tendencies with improvisation and even within drumming. There is not a right, there is not a wrong. It can be very unnerving for people who want, “No, this is how you do it” that we open the process up just beginning where we begin. We do not set a starting point. It just is. That gray area feels very uncertain and very nebulous to them. So navigating through that, practicing that, challenges some of those perfectionistic tendencies. And we experience, and we learn, and we create, and we confront some of those areas that feel uncertain in their lives.

It is also exploring new ways of being. If they are used to things that are very structured, it is stepping into things that are unstructured, so it is practicing new ways of being. I find that is also lets them connect with one another in ways that they have not connected before, experiencing being with others in ways that that have not experienced before, process through emotions that they may struggle to verbalize or find words to express as well as navigate through some of those emotions around traumatic experiences.

’ll give you an example of that. I was ready to start group one day and one of the residents at our residential treatment program came in and was extremely angry. She had been in an individual session and processing through some of her trauma but had not worked through all of the feelings yet, so there was a great deal of emotion there. And so when everybody from the group came in, I had asked this resident previously if she would like to sort of process through those emotions with the group if that felt okay for her. She said it did, so we asked the group then if they felt okay working to process through some of these feelings with her and the group was okay with that. So we brought out the drums and the rhythms instruments and we let this young woman who was processing through her emotions, we let her begin. She played a very large tubano very loudly and I asked the rest of the community to come in and play in a way that they felt would support her in this process. Again, we did it all musically. There were no words and the group followed her. Wherever she went they followed and supported. The improvisation ebbed and flowed and eventually it reached a place that was much more calm and much more soothing. Again, the group followed this young woman. As she began to find that place of calmness, they followed her there. After we had finished the improvisation, we talked about the experience. We talked to this young woman to see how she felt. The group listened. We asked the group how they felt in this process. It was a very empowering process that they supported, they listened, they gave musically — not with words, but just musically. It was a very significant process for many of them. Even though we were being very specific in what we were giving to this young woman, each of them took something from that process.

The last piece that I would like to talk about is using music and imagery. Individuals with eating disorders tend to have a great deal of anxiety and a high percent of individuals are also diagnosed with an anxiety disorder, so I work to use a variety of ways, of not only using music, but music and imagery for relaxation. I will combine live music – I have Native American flutes that I will play, guitar, we will use rhythm instruments, I may have them actively playing music as a means of relaxation, I will also use recorded music, and sometimes I use combinations. I have recordings of ocean waves or lake sounds or rain, and I will at times combine instruments with those different sounds. Whether it is ocean waves with a Native American flute or some drums with different environmental sounds, there are wonderful ways to combine those and wonderful ways if I have a client whose anxiety is very high to have them actively playing while I am doing some playing as well. So there are wonderful ways of using active music making as a means of relaxation.

I think that is all that I have time to really cover today, but I will encourage you – there are great websites – One is NEDA, http://www.nationaleatingdisorders.org/, with great information on eating disorders, or the website of the Academy of Eating Disorders, http://www.aedweb.org/. To get information about eating disorders, you can read about some of the statistics, explore the DSM-IV, also get more on the diagnostic criteria, the Association for Music and Imagery website, http://www.ami-bonnymethod.org/ to get more information about the Bonny Method of Guided Imagery in Music, and then other piece that I wanted to give just as a good resource – if you are looking for some good research on drumming, or applications, look at the REMO website, http://www.remo.com. Their research articles are available on the website. So there is great information there as well. Or you can contact me through the American Music Therapy Association, http://www.musictherapy.org, and I am happy to talk more with people about the use of music therapy with eating disorders. It is an area I have been working in for probably twelve years now, so I very much enjoy the work. It is very complex and very challenging. I very much enjoy it. Thank you!

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Symposium Speaker Bio

Annie Heiderscheit, Ph.D., MT-BC, FAMI, MFT has nearly 20 years of clinical music therapy experience. She is on the graduate faculty at the University of Minnesota of Center for Spirituality and Healing and a clinical music therapist at The Emily Program, an outpatient eating disorder treatment program, where she provides music therapy in the residential, intensive and outpatient settings. She maintains a private practice in music therapy, which employs five music therapists providing services to a variety of healthcare settings. She actively conducts research in a variety of clinical settings from pediatric intensive care, eating disorders and mechanically ventilated patients in the intensive care unit. Dr. Heiderscheit is currently the secretary/treasurer for the World Federation of Music Therapy, as well as a member of the reimbursement committee for the American Music Therapy Association.

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