On today’s episode, Dr. Karen Nelson is joined by Mandi Verstegen, a board-certified music therapist at Melrose Center. Recovery isn’t just about therapy or your dietician - it’s much more holistic. The practice of music therapy in treatment dovetails with Melrose’s overall goal to treat mind, body, and spirit. Mandi and Karen will discuss the importance music plays in anyone’s recovery journey.
On today’s episode, Dr. Karen Nelson is joined by Mandi Verstegen, a board-certified music therapist at Melrose Center. Recovery isn’t just about therapy or your dietician - it’s much more holistic. The practice of music therapy in treatment dovetails with Melrose’s overall goal to treat mind, body, and spirit. Mandi and Karen will discuss the importance music plays in anyone’s recovery journey.
For a transcript of this episode click here.
For more information visit:
American Music Therapy Association (AMTA) website if people would like more information:
https://www.musictherapy.org/about/musictherapy/
And Mandi put together a playlist of songs for recovery.
Shake it Out – Florence and The Machine
The Middle – Jimmy Eat World
I’m Still Standing – Elton John
Brave – Sara Bareilles
Never One Thing – May Erlwine
Whatever We Feel – Sammy Rae & The Friends
Back in My Body – Maggie Rogers
Bird Set Free – Sia
Rise – Katy Perry
The Breakup Song – Francesca Battistelli
You Have Always Been Enough – Lynn O’Brien
Hearts in Needs of a Little Repair – Sarah Morris
Show Love – Harper Still
The Climb – Miley Cyrus
Keep on Keeping On – Colony House
Stand By You – Rachel Platten
Lease on Life- Andy Grammer
If I Dare – Sara Bareilles
Rainbow – Kacey Musgraves
Age of Worry – Madison Cunningham
This is Me – Greatest Showman
Who You Are – Jessie J
Skyscraper – Demi Lovato
Be OK – Ingrid Michaelson
Dr. Karen Nelson 00:02
Eating Disorders thrive in secrecy and shame. It's when we create a safe space for honest conversation that will find the opportunity for healing. Hi there. I'm Dr. Karen Nelson, licensed clinical psychologist at Melrose center, welcoming you to Melrose heals, a conversation about eating disorders, a podcast designed to explore, discuss and understand eating disorders and mental health. On today's episode, I'm joined by Mandi Verstegen, a board certified music therapist here at Melrose. Mandy and I will talk about the importance music plays in anyone's recovery journey. Recovery isn't just about therapy or your dietitian, it's much more holistic. And the practice of music therapy dovetails with Melrose’s, overall goal to treat mind, body and spirit. Now, before I begin, I invite you to take a deep breath and join me in this space. Well, welcome to the podcast. Mandy. I'm absolutely delighted to have you here with me today.
Mandi Verstegen 01:13
It is so good to be here. Thank you for having me.
Dr. Karen Nelson 01:16
Well, I'm so excited to learn more about music therapy for eating disorder recovery. But before we move into that, I would love it if you could introduce yourself and tell us about your role here at Melrose.
Mandi Verstegen 01:28
Sure, my name is Mandi Verstegen, and I'm a board certified music therapist. And I work for Park Nicollet. I spend some of my time at Methodist Hospital and then the rest of my time at Melrose center. So for nearly as long as I've been a practicing music therapist, which is about six years I've been with Melrose
Dr. Karen Nelson 01:46
So Mandi, I would love it if you could maybe describe what does it mean to become a music therapist?
Mandi Verstegen 01:54
So to be a board certified music therapist, you do go through an academic program. And after your academic program, you go through an internship, so I was lucky enough to do my internship with Park Nicollet. It is 1000 I'll say 1000 Plus clinical hours that you have to go through to meet that part of the certification. And then you do take a board certification exam. And music therapy training, as you might have seen in other areas, it's pretty vast, right? So we have, I have this beautiful, almost niche job in eating disorders, but it exists in hospice at the end of life that exists with kids with autism. And so it's quite, I would say the training is quite vast, right that it can meet a lot of these different areas.
Dr. Karen Nelson 02:44
I love that. I love that. So being really broad is kind of the word that maybe comes to mind? So as I hear the word or term music therapist, what comes up for me is I wonder in your training, are you required to take classes in psychology?
Mandi Verstegen 03:04
We are required to take classes in psychology and anatomy and the music pieces. So it is really, it's a pretty apt term. Right? It does. It encompasses the musical training and also encompasses the therapy piece.
Dr. Karen Nelson 03:20
Absolutely. So like biology and physiology, those were also parts of training?
Mandi Verstegen 03:25
Yes, I remember my anatomy class. Well, if not favorably. Right?
Dr. Karen Nelson 03:32
Kind of sweaty when I remember that. I really, really get that. Let's maybe explore and I would love it if you could share with our listeners about what types of clinical experiences you have had as a music therapist.
Mandi Verstegen 03:52
Oh, wow, I feel extremely grateful because I feel like my clinical experience has been vast. So Well, I was in school. And that's part of the training too is coming from an academic program where you are doing practicum at any given time. So I have practicum experience with children with special needs at the end of life. And then coming into my Park Nicollet internship, I was working with oncology patients, hospice patients, patients with Parkinson's and then patients with eating disorders. What's really interesting is that music is a very human phenomenon. And so it feels like it stands to reason that it would meet us in these extremely human moments, right? Human moments as in eating disorder, treatment at the end of life going through a cancer diagnosis that music can and does meet us in those moments where life has handed us something to work through. Right and that music can be one of the strategies and tools we use in the journey of that.
Dr. Karen Nelson 04:56
Oh, what a beautiful description. Maybe help us know about the experiences that potentially have had some of the biggest impact on you as a music therapist.
Mandi Verstegen 05:09
Oh, wow. I would say doing this work feels like a real privilege because that feels like a really hard question. When you're going through your day, and you have; and profound experiences, feel like a standard day, write that music. And we know this, that music touches parts of us that other things don't. So you merely look at a brain scan of a brain in its normal workings. And then as it's listening to music, and you see the way it's lighting up completely changes. We know that music lights up more parts of our brain simultaneously than other things do. And so then that starts getting us into music as a way it evokes emotion as a way that it evokes connection to ourselves and to each other. Which as a side note, in the context of eating disorders is extremely important, especially when isolation is so at the forefront at times that it's really estranging us from ourselves, that it's estranging us from the people in our lives. And to have an intermediary like music, facilitate connection, where it's needed most. Just feels like a real privilege. And I don't mean that to be a cop out answer to say, where do I start? But just to say it feels, you know, when you look at your work, and you think, wow, there's no shortage, no shortage of times that it has felt really impactful, or it has touched people in a really unique place for them. Yeah.
Dr. Karen Nelson 06:47
Well, what you know, as you were describing some of those different experiences you had, you know, working with people in all different types of healthcare settings, the thing that came up for me was all the emotion that must have been present. And I think sometimes emotion can feel really scary. And we might not know how to translate talking about it. And I wonder if music becomes a way for us to maybe bridge that gap?
Mandi Verstegen 07:12
Absolutely. So as you're asking that question, my brain immediately goes to music as a container, right? So if we start to unlock emotion, it can feel extremely threatening and extremely scary to think we'll just open it up. And that's it. How do we stop it? How do we stop the floodgates? How do we, I hate to use the word control, because of course, with eating disorders that comes, you know, it's loaded in its own way. But how do we feel like we harness it in a way that feels manageable. And I feel like music can not only evoke the emotion, but it can hold really important space for the emotion. So it's not saying it's a free for all your emotions can do whatever it is, but that it gets to hold you in important space. As you explore what kind of emotions it feels like it might evoke for you at any given time.
Dr. Karen Nelson 08:04
What a beautiful description, as you talk about that hold the emotion. Interesting. Lee, as a psychologist, we often talk about that is part of the power of the therapy room, that the therapy room can hold emotion for people, it can be the safe space to have conversations that I might not have anywhere else. And it and it sounds like music can become another medium to potentially do that hold emotion, hold space or connect through that.
Mandi Verstegen 08:33
Absolutely hold emotion to hold space. And I think there's a place for both of it, right holding space, just generally. And then when you even think about going about your day, you go into a store, there's music playing in the background, you go do this thing. There's music playing in the background, it's holding space for us whether we're conscious of it or not. And so being able to, yes, hold really important space, but you're doing it in a way that feels like I don't know, one time someone described background music to me as musical wallpaper, that it's not something you're thinking about all the time. But it is something that enhances the space, right? It makes you feel different in this space. If you were to come into a room and it's completely stark white, versus if you were to come into a room, and it's beautiful, very pleasing to the eye wallpaper, right will say beautiful pleasing to the eye, much like preferred music might be beautiful and pleasing to your ear is that it's just going to change the space for you a little bit. Enhance it. And that I would say not to launch into, you know, not to get tangential but I would also say just generally with the power of music, as we're talking really affirmatively about the power of music to evoke positive emotion, but we also know that music is right up there with smell in the way that it holds memory. So we might listen to a song that evokes, I was 16, I was riding in the car, the windows were down, I can still feel the breeze on my face. And this song was playing. Well, that's a really beautiful memory, right? It evokes happiness for me. And there might be music that holds space, that's not that you don't want to hold space for. And I think that's really where we come into music in a more strategic and skill based way, where we say, Oh, this music holds this particular space for you. Is that space you want held? Well, there are a bajillion songs in the world. Can we explore this and change it a little bit? And that's for when we talk about music therapy is individualized, are really meeting in the moment needs? Those are some of the things that come up.
Dr. Karen Nelson 10:48
Oh, that just feels really beautiful. So working in a hospital setting as well as Melrose center, we should be clear and specific working at Melrose, you work specifically with our inpatient patients. So people who are in our residential care or inpatient setting, correct?
Mandi Verstegen 11:10
Exactly, yes, I work with the inpatient population, and then do a little bit of outpatient work. So with our partial hospitalization program, and then there are some patients who, for the sake of continuity of care, do decide to continue to pursue music therapy, as outpatient support.
Dr. Karen Nelson 11:27
So tell us about how might a patient access your services? Or how might they come to know about the beautiful services that you do provide? Maybe tell us about that.
Mandi Verstegen 11:39
We are currently in a, of course, in the pandemic era of health care, we're always shifting, always growing, always adapting. And I think at this point, with my time at Melrose, we do try to get in patients into intro to music therapy sessions. So it's a time for me to meet them, for them to meet me, for us to explore a little bit of what's possible for us to explore what their existing connection to music is. And once someone starts talking about the ways that they're connected to music, I feel like I sometimes have to rein myself back because the cogs start shifting, and I'm like, we could do this, we could do this, we could do this, right, all of these rich ways, we're already engaging with music oftentimes just need a little bit of molding and shaping to get to a place where they're really extra supportive to a patient. So that's one way, if patients maybe have never heard of music therapy, and they're coming and completely cold that they might be part of an intro to music therapy session. Some folks have been in other treatment centers where they've experienced music therapy and are curious about what that looks like at Melrose or, might want to explore music therapy as part of their treatment. And then sometimes it's other staff hearing things in interactions where a patient may make a comment that alludes to their connection to music and something goes off in the staff person's head that's like, okay, we should get you in music therapy. And often, I'm so grateful for those referrals, because it's one of those things where you start pulling on the thread and the thread is actually quite long, right? And meaningful.
Dr. Karen Nelson 13:14
It usually is, well, if a patient has never heard of music therapy, or maybe if our listeners had never heard of music therapy, I would love it if you could describe what is music therapy, almost kind of as a basic definition or almost in like layman's terms. What does that mean?
Mandi Verstegen 13:31
I would start by saying, and this is sort of in line with the official music therapy definition is that it's using music to achieve non musical goals. And so that's not often what people think of right? We our heads have all sorts of connotations of these words. And so oftentimes, now this is specific to the Melrose context is we're working on the same goals as everyone else in the building. And that's sort of the beauty of this interdisciplinary, holistic approach, where everyone's really coming at similar goals and objectives, but they're coming at it from a slightly different angle, so occupational therapy, physical therapy, nursing staff, therapists, it's the same, but our entry point is music. And that gets to be the medium that we come at some of those things. And that's where sometimes it's extremely helpful where some patients haven't been responding to other entry points right to other methods of treatment, that this is another I'll, I'll say even language we can try, right, a way of communicating a way of connecting that we can try where maybe other things haven't quite been able to, to connect in the same way.
Dr. Karen Nelson 14:43
How does music promote physical healing or emotional healing?
Mandi Verstegen 14:48
It's not a singular answer, right? It really depends on the person. We know again, just by the virtue of the way that their brain and body works that music has the way to have physiological impact, it can slow our heart rate, it can slow our breathing. Oftentimes when we're talking about a context where anxiety is something that is a common vocabulary word that is thrown around all of the time in our space, and honestly all the time in our world, right, right becomes that's become a lot more of a mainstay in our vocabulary is this idea of anxiousness and anxiety. And for music to be a medium that can actually physiologically we know that it can affect that. And so how can we use music to meet someone where they're at in anxiousness and wherever they are, and their current emotional state, and move them a little closer to where we want, where they want to be? I was gonna say where we want them to be. That's not really what we focus on, where do you want to be? And then I would say, from an emotional standpoint, again, emotion, the emotion centers of our brain are lighting up like mad sometimes when we're listening to music, where that might even take us by surprise, sometimes where we're listening to a song and all of a sudden, there are tears in our eyes in a way we weren't anticipating. Right, these music allows us to kind of sidestep some of that script, right, some of that those, it gives us opportunities for surprise, right and connection with with, with our emotions, I've definitely had patients say to me, that they hadn't really processed something until they were given that space to do it. Right, that music felt like it opened something up in them.
Dr. Karen Nelson 16:36
For sure. Well, sometimes just being given the permission to feel or to almost like welcome the emotion into the space becomes really powerful. And again, it feels like music can become, you know, kind of the entryway into that.
Mandi Verstegen 16:53
Well absolutely and when you start to look at even if we look at specific songs, you might even have had the experience where you've had a feeling and you hear someone articulate it in a song. And you think that's maybe not word, those words I maybe would have come up with. But yes, that's it, that is exactly how I'm feeling. So I think, by its nature, music helps us normalize, it helps us feel a little less alone. If this singer is articulating something I'm feeling so deeply. By virtue of that math, there's at least one other person in this world that has felt similarly to the way that I feel. And that it gets to serve as that for us. It gets to normalize, it gets to articulate, right, things that are really quite universal human experiences, but that we're all experiencing in slightly different ways.
Dr. Karen Nelson 17:47
Well, the aspect of loneliness often comes up in therapy for me, and what I hear you talking about is having an ability to connect with something maybe bigger than us or outside of us. And that feeling of not being alone, that that some other artist or musician is maybe speaking about anxiety, or loneliness, or yearning and how comforted we might feel in that.
Mandi Verstegen 18:12
Absolutely, I do an intervention with groups sometimes where I have these cards that have lyrics from about 1000 different songs really just lyrics that I felt might be poignant in the context that we're working at in the context of eating disorders. And it is so fascinating to me how the same cards are chosen every time I do it. Right. And it just and I feel like though that's not necessarily information that the patient always knows is the person going through it for the first time. But as the person with the privilege of being the practitioner, I see, wow, we are not alone, look at how universal some of these things are. And look at where we gravitate and look at, you know, just these inherent connection points that like I, you know, like I was saying, by virtue of that math, the Calculus says we're not alone. And here we go from, you know, into these really quantitative numbers. We know, just by virtue of that we're not alone.
Dr. Karen Nelson 19:15
For sure.. Well, I got to know what's on the cards!
Mandi Verstegen 19:20
I absolutely can. So I actually started doing this intervention, not long after David Bowie died, because I find I found it a really interesting thing about the way he would song right. And I have to say, I don't know that this is true. I just heard it. So –
Dr. Karen Nelson 19:34
I'll take it. I'll preface that.
Mandi Verstegen 19:37
I want to be really clear that David himself did not tell me this. So what I learned is that he would take he basically cut up things from journals, things he found interesting, and kind of pieced them together in a way that created lyrics for him. And that really got me thinking about how we can do something really similar about taking these lyrics and identifying what resonates, and then piecing them together in some interesting way. And so since I've been doing that, I feel like there's one that always gets chosen. And it's, it's a little blurry how the whole thing started, which feels like it really does resonate for a lot of folks where, oftentimes, it isn't the one inciting event, but it might be a little bit of a snowball effect where something started in a benign enough way, in a harmless enough way, with even good intention behind it. That feels like it's really morphed into this thing that now we're really having to contend with.
Dr. Karen Nelson 20:43
Wow. So let's just say it's slow. It's a little blurry, how it all started.
Mandi Verstegen 20:48
It's a little blurry how the whole thing started.
Dr. Karen Nelson 20:51
Oh, it's so descriptive. I mean, no wonder it's chosen. You know, oftentimes, people are yearning for clarity of like, if I could just find the one thing, and how reassuring to hear that lyric or or see that lyric up on a board of like, it is blurry. And it doesn't mean I can't heal, and I can't move forward. It just means that someone understands that it's convoluted, it's messy sometimes.
Mandi Verstegen 21:19
Exactly. Yes. blurry, it's messy. It's not and we're so desperate to want that one thing because we really come from a collective mindset of fixing it, right? It being the one thing we've got to fix it? Well, it's really hard to identify what is right. Except saying that it the truths we know about it is that it's often complicated. And it's often messy, and it's often heaping with gray area, which can be infuriating. It's true, right? It really is true. And so for us to even grapple with the complication to acknowledge the complication. And then I think that also emphasizes the interdisciplinary approach at Melrose, which is, it is complicated. So we do need a bunch of languages to speak, we do need a bunch of entry points to this to come from it come to it in a more comprehensive way, acknowledging the complication of it and acknowledging that these things are complex.
Dr. Karen Nelson 22:22
So music therapy, can be effective. As I hear you're talking, kind of managing some of that emotion. But I think what sounds unique is you don't have to verbalize or like talk about the emotion. Right. Am I getting that?
Mandi Verstegen 22:38
Absolutely, you are absolutely getting that. And I think that's where the innate flexibility of music is so advantageous in the clinical space. If you're assessing a patient, and you're seeing what we're talking about, this is not the access point here, right. And truly, in the clinical space of Melrose, we're asked to verbally process a lot, right, patients are asked to talk through emotions, to name them to talk through solutions and skills, which is all so valuable. And music, by its definition is a combination of sound and silence. Sometimes we need the sound. And sometimes we need the space to just feel it. And so I think about music as exactly like you're saying, a way to sidestep verbal processing and be able to process in a different way or emote in a different way. Or even the word catharsis is coming to me, right in terms of releasing some of this stuff. And honestly, some of this work, the hard work that our patients are doing.
Dr. Karen Nelson 23:44
Well, oftentimes, when I'm in therapy, it's not uncommon that I may ask, you know, a variety of different questions or work to be curious, and I might start getting a lot of I don’t knows, right. And so that's indicating to me that maybe were overwhelmed or where we were pushing to a place where they're not ready to explore, would that be an appropriate place that I would maybe make a referral or or if they were impatient, they would maybe then progress to, you know, music therapy to maybe do some exploration around emotion. As I'm feeling. I don't have words to talk about it yet.
Mandi Verstegen 24:21
Oh, absolutely. I would, I would stand strongly behind that, I don't know is a pretty powerful space. And I do feel like music is I'll just use the word a non threatening medium, right? So we don't have to dig into the deep stuff immediately. There can be some almost stepping stones into deeper work. And that will depend on the patient. It will depend on the day. It does feel like it is like I said kind of a non threatening medium, a way to connect about some of these things, but not with any expectation right for letting things just be in a way that they need to. I'm even thinking about right now I've had patients learn the ukulele during their inpatient time at Melrose, which has just been so interesting. Some people really connect to it. And they'll learn introductory chords, ukulele is one of those instruments where it's pretty satisfying pretty quickly. And that's why it works in our context. And so for patients to start playing these things, and for us to check in later and say, Where were your thoughts while we were doing that, right? And oftentimes, it's like, my thoughts were this darn G chord, or my thoughts were I'm liking this or my, you know, it's generally not about what the morning’s been or what is coming tomorrow. It's these really in the moment, processes these really in the moment thoughts. And so certainly doing deeper work is possible. And sometimes we're equipping patients with a really accessible coping skill, right, that they're able to learn an instrument in this space, and then maybe use it independently in their own time.
Dr. Karen Nelson 26:14
Well, it feels so important to almost like reawaken some of those kind of internal parts for our patients, right? We talk about the numbing or, or the the disconnection that happens when I'm struggling so deeply with an eating disorder. You know, some of our patients describe it as feeling like the world's on mute, like I can't really hear it, and it's really far away. And what I hear you talking about is just really kind of investing in their creation, right of their creativity, it just feels so powerful.
Mandi Verstegen 26:50
It really is, I mean, to just say, we are capable of so much, and oftentimes there are voices, there are circumstances, there are lots of things that shut that down, right, just our sense of being capable. And I do feel like music is one of those ways that extends its hand and says, You are capable, you are enough, come on. Here we go. Exactly.
Dr. Karen Nelson 27:17
If someone is listening to this conversation, Mandy, and potentially struggling with an eating disorder, or depression or anxiety, Are there exercises that you can share that may be beneficial to them in the realm of music therapy?
Mandi Verstegen 27:34
Absolutely, yes, I would say of course, it's always you know, your first thought as a music therapist, or like, what if we worked together we could do XYZ. So even just thinking about something that's pretty accessible for someone is creating a playlist for yourself, right. And sometimes people, I mean, with technology that we have at our disposal, there are a lot of pre-made playlists. And that might be a start, right? As you start to take from premade existing things and to create something for yourself. Right, a lot of people will report that they have mood based playlists. And I think that's lovely. Again, we're talking about mood validation, emotional validation. And then talking about something that's a little bit more, there's a little bit more journey to it a little bit more traveling, where you're going to start in a specific mood or place and then you're going to consider what it would look like to move maybe to a different place that feels a little bit more fair, favorable to you. So that's certainly one way is looking at music listening is being able to use that in a way that affects emotion, right, is that you don't necessarily need me in the room to, to do that. With music listening. And really with anxiousness with depression with intrusive thoughts. Oftentimes, our brain is so ready for a task, right? It's ready for something really directed. So even taking a song, listening to a song, you could do it at random, and identifying in it lyrics that feel resonant to you. Right? So I think about there's a song by a songwriter that I absolutely love. Her name is Lynn O'Brien, and she's got a song called you will always you have always been enough. And I think even in that title, right, that feels like it suggests probably where the what the vibe of that song will be. But going into a song and listening to it, and identifying what hits and what doesn't, I think can be a helpful practice. Now, in the short term, it's helpful, helpful practice because you're giving your mind a task, right? You might be listening to a totally new song, and the muscles in your brain you're using to actively listen and try to parse out the lyrics. They're gonna let it's lighting up your brain in several pretty helpful ways that are going to demand your focus. And then can it also give you a little bit of things to consider right themes and whatnot to consider. So to take that example, she says, it's all meant to be experimental. So you cannot do it wrong, right? It's like, so lovely. And so to even just hear and, you know, folks don't need to necessarily key on key and on these beautiful thematic pieces. Sometimes it happens by accident, but that they could just start to listen actively in those moments, right, giving their brain a task. You might even as you're listening, identify musical elements, just being able to factually say I hear a guitar, I hear a drum, I hear this right. Again, giving yourself something to do some task at hand. So I would say music, listening is a beautiful entry point for folks to do things on their own, again, because of access to music, listening through streaming services, and YouTube and, and things of the like. And because they can use it in these ways that are a little open ended, right? It kind of depends on where you're at. And what you hear in that moment might be different than what you hear tomorrow, or what might be different the way you hear next week.
Dr. Karen Nelson 31:25
So that's so true. That's so true. Well, Mandi, I cannot thank you enough for this conversation. My heart is singing with joy. Thank you so much.
Mandi Verstegen 31:34
Thank you so much for having me. I feel like it's one thing to love your work. And then another thing to get to share the work that you love. So I'm so grateful for this space in the conversation with you.
Dr. Karen Nelson 31:47
That's it for today. Thanks for joining me, we've covered a lot. So I encourage you to let it settle and filter in. And as I tell my patients at the end of every session, take notice. Pay attention, and we'll take it as it comes. I'll talk to you next time. Melrose heals a conversation about eating disorders was made possible by generous donations to the park Nicolet foundation