Music heals: a brief background of Healing in Harmony

Make Music Matter believes that music can play an integral role in the healing of individuals and communities in a concrete and measurable way. (See https://makemusicmatter.org/). Together with our partners at Panzi Hospital and Foundation in Bukavu in the Democratic Republic of Congo (DRC), and with the support of Elhra’s Humanitarian Innovation Fund, we have been able to transform this belief into innovation through the Healing in Harmony programme. At its core, Healing in Harmony develops the potential for transformative change in traumatised people and their communities. While our primary focus is on survivors of sexual violence, we have also successfully applied the model in the case of abandoned children, adolescents of child-headed households, former child combatants and other vulnerable individuals.

How it works

Healing in Harmony uses music therapy to help survivors of trauma. Over a four-month period, working in tandem with a locally trained therapist and music producer, participants begin to heal by writing, recording and producing songs about their emotions and experiences. Psychosocial group counselling incorporated in the recording sessions uses various methods adapted from the cognitive behavioural approach to provide participants with tools to overcome PTSD, anxiety and depression. As they talk through their experiences, participants are encouraged to write down their stories. When a narrative emerges,  the  producer  begins  composing  an  instrumental accompaniment that eventually results in a song performed individually or in groups. The articulation of participants’ traumatic events through song enables a more specific, detailed and therefore effective treatment pathway to be established and utilised.

The emotional state of each participant is closely monitored and individual counselling is provided when required. The environment created is one of joy and healing, focusing on turning negative thought patterns into positive and more adaptive ones through cognitive restructuring. Participants emerge as confident artists and advocates, publicly dissemin- ating their music through local radio and television broad- casts, social media, community concerts and CD distribution. Internationally, artists and their songs are promoted on major digital streaming services and in stores via our record label on Warner Music Canada (A4A Records).

Preliminary research by the International Centre for Advanced Research and Training (ICART) has shown that Healing in Harmony has a positive impact on participants’ mental health, with reductions in the prevalence of PTSD, anxiety and depression. The data suggests that these benefits are substantially maintained up to six months after completion of the programme, though there is some evidence that participants continue to experience conflict-related trauma. Further benefits include:

• Giving participants a new and more effective channel to express their feelings, experiences and needs.
• Facilitating improved communication and contact with caregivers.
• Strengthening solidarity among survivors through participation in musical groups, forming peer-to-peer support mechanisms and eventually promoting the emergence of group leaders.
• Opening up channels of communication to facilitate the reconstruction of families and reintegration into communities.
• Combating stigma and helping to reduce feelings of isolation.
• Creating powerful messages for positive change in the form of tangible and professionally produced music that can also be a beacon for others in need of help.
• Supporting partners, including therapists, music producers, researchers and humanitarian profess- ionals, through an innovative community of practice.

Scaling up

Demand for the programme has been remarkable given the stigma usually associated with participation in psychotherapy programmes, particularly around sexual violence. There has been a three-fold increase in those wishing to participate since the programme began in 2015. Frances Hill, ‘Local Songs with a Global Voice: Resilience through Music Therapy in Eastern Congo’, Elhra blog (www.elrha.org/project-blog/local- songs-with-a-global-voice/). Based on this evident demand the programme has been scaled up, and is now working in a hospital in Mulamba, a rural area one and a half hours from Bukavu. Standard Operating Procedures (SOPs) and an easy-to-use manual were developed based on experience in Bukavu and Mulamba to enable other organisations to ‘franchise’ the Healing in Harmony model. In partnership with World Vision DRC the first affiliate site, at Beni, was launched in September 2018, though insecurity and the presence of Ebola made this challenging. In March 2019 another affiliate site was launched in Conakry in Guinea, this time in partnership with the Mukwege Foundation. There are also plans to launch sites in Uganda and South Africa in July 2019 with more potential DRC sites in August 2019.

Recognising the cultural context

Throughout the scaling process and adaptation of the model, it has been important to identify and articulate the cultural nuances in each area, in particular by drawing on local expertise. Without this local touchstone it would have been easy to miss material cultural differences between the various sites. For example, from a local perspective Bukavu is considered a very metropolitan area, where multiple cultures co-exist and people are more exposed to the modern world. Residents also face more standard life pressures, such as having to find the money for store-bought food, rent and school fees. The issues surrounding an individual or community’s trauma are diverse as people tend to migrate to Bukavu as refugees from different areas, and a variety of reasons might have caused the trauma. In contrast, rural areas in DRC such as Mulamba and Beni are active conflict zones, where various rebel groups are a direct source of stress and resulting trauma. People in these areas are trying to protect themselves physically, while growing food and gathering water to sustain themselves and their families.

There are also material differences in the cultural view of the family. For example, communities in rural DRC are heavily patriarchal; women are viewed more as servants than equals and are expected to care for the family. They are rarely afforded the luxury of medicine or medical intervention to treat illnesses, which can make their trauma more pronounced and endemic. The ways in which a community manages trauma can also differ between a relatively safe area such as Bukavu and areas of conflict, where recently deceased bodies are routinely left in the open for everyone to see and homes are regularly burned down in violent attacks.

Articulating these subtle but profound differences is critical to the successful adoption of the Healing in Harmony model as it expands into different contexts and works with different partners. The model needs to be flexible, robust and dynamic enough to respond to different problems in different communities driving the trauma the programme is designed to heal. The key to this challenge is to fully understand the issues that the environment presents, and to let groups themselves present the problems at hand. From there, techniques within the Healing in Harmony framework can be adjusted. We are not aiming to dictate to a community specifically what it needs to be healed from, but rather to create an environment and space where the community can inform us of their needs.

A concrete example of how we are addressing this challenge relates to the music and songs people create. These stem from participants’ emotions, which are usually conveyed in their mother tongue. This is a critically important note as mental formation is predicated on culturally based values. As such, cultural values that are integrated into the creative process and the songs that are subsequently produced are a main tenet of Healing in Harmony. The programme and model are as malleable as music itself.

Looking ahead

One risk is that quality control will suffer as the model expands and the number of partners and range of cultural and political contexts increases. The vulnerable populations Healing in Harmony aims to help deserve the highest quality programme with the highest ethical standards. To mitigate this risk, we provided further detail in the codification of our model after receiving critical community feedback and the successful replication of the model in our first scaling site. An example of this can be found at our site in Beni with World Vision DRC, where we subsequently focused on combining groups of women from forced prostitution and male former combatants in order to create empathy among them and coherence within the community they reside in. Because of this community feedback, each site becomes more precise and therefore more effective in the trauma we are trying to heal. This subsequent step in our codification process has resulted in a step-by-step guide for replication within our Standard Operating Procedures, as well as clearly outlining essential standards. For example, for affiliates to receive official certification as Healing in Harmony practitioners, they must demonstrate that they have the policies and procedures in place to ensure the ethical protection of the vulnerable groups they are working with. They must also apply for re-certification annually following an evaluation/audit of the programme by Make Music Matter. In return, they have permission to use the model and brand and have access to the manual and its various modules, training and oversight, post-production and dissemination services and the Healing in Harmony community of practice.

There is a constant need for analysis by Make Music Matter to judge the proper rate of growth so that organisational capacity and bandwidth are sufficient to ensure that a high-quality service is provided to our artists. While to date we have not had a single instance where lack of musical ability or lack of desire to participate musically negatively affected the roll- out of the model, we must guard against thinking that there are no barriers to participation. Africa in general is a very musical culture, but we do not yet have substantive feedback in operating contexts such as the Middle East, where artistic participation may not be viewed as culturally acceptable or inclusive, particularly for females.

Finally, Make Music Matter must itself be wary as an organisation as Healing in Harmony grows. In the early stages, the organisation comprised passionate innovators, mostly from the music industry, who over time closed the gap between music creation, psychosocial care and formalised research. As we continue to build our organisational capacity to maintain more Healing in Harmony sites, we must not lose the entrepreneurial spirit and innovative vigour that gave birth to the programme in the first place. Conversely, as the Healing in Harmony model spreads, it must remain bespoke in order to be as effective as possible for the local context it is operating in and the population it is serving. If we grow too fast and present a homogenised version of Healing in Harmony, we run the danger of hollowing out our core and imploding.

Darcy Ataman is Founder and CEO of Make Music Matter and Co-Founder of A4A Records and Publishing. Shannon Johnson is Operations Director, Make Music Matter. Justin Cikuru is Lead Psychologist, Make Music Matter, Panzi Foundation DRC. Jaime Cundy is Board Chair, Make Music Matter.