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（这是高天教授于2008年11月21日在美国音乐治疗年会上的发言提要）
Music Therapy and Crisis Intervention with Survivors of the China Earthquake of May 12, 2008
         Prof. Tian Gao
   Central Conservatory of Music
   Music Therapy Research Center
   Beijing, 100031, China
        tiangao@263.net
        86-10-66415880
1. In May 12, 2008, an earthquake the magnitude of 8 occurred in the Sichuan province China. This was the most serious earthquake in more than one thousand years in China, resulting in 90,000 deaths and 370,000 wounded.
2. More than a thousand psychologists went to the regions of the earthquake to offer help, but they soon realized that traditional approaches, including crisis intervention techniques, were ineffective in this catastrophic situation. They felt themselve powerless and very frustrated.
3. In traditional psychotherapy, therapists meet clients in their offices, get data by asking clients to answer questionnaires, then discuss the traumatic event with their clients. Usually, the clients are cooperative and follow the direction of the therapist.
4. After the earthquake, people were still in a state of panic. They had difficulty expressing their feelings. Some of them refused to talk, some of them lost their memories of the traumatic events, and others chattered constantly about their trauma without any movement toward resolution of their traumatic memories. Cognitively, confusion was prevalent, strongly impacting rational thought.  
5. There were also many psychotherapists using the debriefing technique in an attempt to work with people’s traumatic feelings.  They asked people questions about their experiences during the earthquake, and their losses, including lost family members, lost bodies parts, and lost homes, etc.. Those therapists believed that the survivors should not repress any feelings or memories, the goal being to release the negative emotions and feelings, which would result in healing. However, the discussions of the traumatic events caused the survivors to be traumatized again and again, and for many, their symptoms worsened.  Actually, the survivors of the earthquake called these psychotherapists “psycho-harassing people”, and eventually refused to talk with them.
6. The treatment of post trauma stress disorder (PTSD) includes three phases: (1) stabilization, (2) processing and grieving of traumatic memories, and (3) reconnection/reintegration with the world. (Luxenberg et.al.2001). In a massive natural disaster situation, phase one, stabilization, is a very important part of crisis intervention, and it may last as long as several months or even more. During this phase of treatment, the focus should be on physical needs, trust, safety, self-soothing, and the building of support networks, not the trauma it self. “In a very real sense, patients do not have the tools they need at this stage to tolerate trauma focused work; forcing patients to do such work before they are ready risks symptom exacerbation, escalated self-injury and suicide attempts, premature termination of treatment, and re-traumatization (Lusenberg et.al. 2001).
7. How about music therapy? In the situation of severe natural disaster, like an earthquake, music therapy can be extremely effective.  Designed music activities and client-preferred, familiar songs can quickly and effectively change and improve survivors’ emotions and feelings, reestablish the sense of safety, and remotivate life energy and hope for the future.  The most important function of music is helping therapists to establish a good working relationship with the survivors in a short time period. On the contrary, therapists who use “talk” as their primary tool found themselves in a difficult situation, unable to establish good relationships with survivors.
8. Two weeks after the earthquake, our first music therapy team arrived in the regions of earthquake. Our work places were shelters and schools, and our teams  worked in those places for three months.  Our therapeutic strategy included three phases: (1) performance, (2) group music activities, (3) and individual crisis intervention. The focus of phase one and phase two is stabilization. Instead of trying to talk with the survivors about the negative experience, feelings and memories related to trauma, our works were concentrated on prompting positive emotions and life energy through various music activities.
9. We started our intervention with music performances, such as singing songs and playing music games with large audiences. The therapeutic goal of performance was to establish a good relationship. The repertoires of the performances included primarily popular songs preferred by various populations and age groups.   As we expected, our music therapy team members became the most welcomed people in the settings, and the preliminary relationship with the survivors began to build with the performances.
10. Phase two was the most important part of stabilization during crisis intervention, and it took the longest time, usually two of the three months. During this phase, many groups had been established, including sing along groups, dance groups, music game groups, music performance groups, song discussion groups and instrument playing groups. Those groups also divided according to difference of age. The therapeutic goals were:
（1） improving positive emotions and feelings
（2） prompting life energy
（3） reestablishing sense of safety
（4） facilitating hope for future
（5） remotivation for coping and confronting current life difficulties
（6） developing relationships with residents and students
（7） observing and assessing and identifying individuals who suffered from PTSD symptoms and required further trauma treatment
11      Before our music interventions, survivors and students were depressed, grieved, and restless. They were withdrawing from others, refusing to talk to people who were providing help. As soon as our music activities started, more and more survivors began to participate and smile. As they became more involved in music activities, they were increasingly willing to associate and communicate with others, and less immersed in sadness and grief.   A TV reporter told me excitedly when observing our session: “This is the first time I see people laughing since I came to the disaster area. Only music can make survivors laugh.” An administration officer of shelter told me that before the music therapy team came here, the survivors had quarrels and conflicts all the time. However, since the music therapy teams arrived, there were no quarrels and conflicts at all. In the school settings, the students enjoyed music activities so much that the administration of the school asked us to give “music classes” as often as possible, and all the regular courses gave up time so “music courses” could be held.  The students were very excited in our music classes, and sang the songs so loud that they sounded like yelling and many times were out of the tune. Their energy level was built to a climax.
12. The approaches of traditional psychotherapy could be classified as “problem orientation” such as debriefing. They focus on problems, symptoms, and the causes of problems. However, in severe natural disasters, another approach, “resource orientation” is much more successful in helping people survive difficult situations.  We believe that the most survivors could heal and recover by themselves without professional psychotherapy treatment if their life energy can be renewed and their positive emotions improved.  Only a very small percentage of the survivor population needs deeper traumatic therapy.  In phase one and phase two of the  trauma intervention process, activities which are designed for positive experiences based on resource orientation should be the most important techniques to be considered.  No trauma exposure should be used in those phases.
13. In phase three, trauma exposure and debriefing treatment could be involved. The individuals who were assessed during phase two as needing deeper trauma intervention are identified. Also, we make sure that he/she is stable enough emotionally, and his/her ego is strong enough to confront trauma exposure.   The method I developed and use in this phase is called Music Entrainment Desensitization and Reprocessing (MEDR). The basic premise is that music can significantly influence individuals’ experiences of a visual image of memory.  For example, usually a horror movie is accompanied by horrific music to produce a horrible atmosphere, but if the music is changed to relaxing or peaceful one, the atmosphere will be totally changed .  In the process of MEDR, I ask the victims of trauma, in this situation an earthquake survivor, to recall the worst picture of his/her experiences during the disaster repeatedly while music is used as a background.  Each time I change the music from scary or sad, to peaceful, relaxing, and beautiful. Gradually, the survivor’s experience with the trauma memory will be changed following with the music. Eventually, survivors will create rich and positive images to reconstruct his/her inner picture of the trauma memory with the help of beautiful music.  
14. Example case:
Lee, a 12 year old boy, is in a severe depression because his mother died in the earthquake of May 12, 2008.  When the earthquake occurred, he was in his school.  He escaped from the class room building safely, and started to worry about his mother. He wanted to go back home looking for his mother, but the road had been closed by soldiers and no one was permitted to proceed to his home.  Three days later, he got a chance to return home, and found that his mother was dead under the collapsed building.
The horrific picture of mother’s body with blood always intruded his mind and some times his dreams and nightmares.  He blamed himself for not being able to go back to rescue his mother in the first place, and took responsibility for her death. In his school, he looked very grieved, and refused to communicate with peers and teachers. He lost all his concentration and his school work suffered.
In the MEDR process, three sessions were provided. At the beginning, I played Bach’s Komm susser Tod (in Stokowski’s symphonic Bach CD) which expresses deep sadness and grief.  Lee re-experienced the moment he found his mother’s body under the building. He started crying loudly.  As the process continued, he reported the fourth time the same picture with the music of Beethoven’s Violin Concerto (Larghetto), he saw his mother laying down on the ground with pretty clothing, no wound, no blood, just like she might appear in sleep. By the eighth time recalling the same moment, with the music of Massenet, 7th orchestral suite, Sous les tilleuls, he reported that he placed his mother in the beautiful heaven, and said goodbye to her.  In the 12th time of recalling, while Wagner’s Lohengrin (Prelude to Act I ) was playing, he reported that his mother was watching him with a sweet smile from heaven, and told him that she would like to see him to go to a college. He promised his mother that he will study hard.
Lee reported that he has moved through the grief, and has decided to study hard on his school work. “I know my mother is watching me from the heaven all the time, and I will not disappoint her.”
15. Conclusion:
(1) In a severe natural disaster situation, the resource orientation activities and positive experiences should be the most important work to be applied in the crisis intervention.
(2) We believe that most survivors have the abilities of self-healing and recovering if the work of stabilization has been well done.  Only a small proportion of them need further individual deep intervention such as debriefing and trauma exposure.
(3) Music therapy is the most effective crisis intervention compared to traditional verbal therapy. It can change and improve people’s emotions and feelings rapidly.
(4) Newly developed music trauma treatment, MEDR, is a very effective method to treat survivors of severe natural disaster.