by Karen de Kock

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Group music therapy in a South African private psychiatric hospital

“In the diverse cultural tapestry of South Africa, the significance of communal healing resonates deeply. ”


In the diverse cultural tapestry of South Africa, the significance of communal healing resonates deeply. The concept of a village as a space where individuals come together to heal, restore and find belonging, holds profound relevance in the context of a psychiatric hospital. Group Music Therapy, when applied to clients from various South African backgrounds, can offer a metaphorical journey back to the healing and holding of a village. This vignette explores how group music therapy may offer a bridge between modern psychiatric care and traditional communal healing, fostering a sense of belonging, humanity, identity and renewal, reminiscent of a village experience.


It is 3pm on a Wednesday, I have just entered the hospital foyer greeting admission staff.  From the reception area to my right comes a loud “Kaaaren, I missed you!” A young lady runs towards me with arms wide open, hugging me. Her voice is possibly too loud for the reception area and her hug may be considered too forward for some. I understand her loud voice and actions, I respect her neurodiversity. M is on the Autistism spectrum and in late adolescence, admitted annually for medication regulation and to offer her single mother some respite as primary caregiver. I have known M for many years. During her hospital stay she is referred for Music Therapy only, due to complaints of disruption in other groups. In Music Therapy M is able to participate in singing, drumming and engages in guided visualisation. M’s drum playing is sometimes erratic and yes, her singing is not always in tune and yes, M carries on singing after a song has ended. However, there are always enough participants in the sessions who understand and accommodate her. After an enthusiastic greeting, we walk to the therapy room while M tells me about her day. She opens the windows as we enter, arranging mats and cushions on the floor in preparation. M helps me unpack my instruments and goes to the restroom while I tune my guitar.

At 3:40pm there is a knock on the door. I open to find a woman unfamiliar to me, appearing lost, asking “is this Music Therapy?”. M answers loudly “Yes, Music Therapy!!”. The newcomer introduces herself as P and shares that she was admitted the day before, still trying to find her way around the hospital. Although Music Therapy sessions are offered as a series from Monday to Friday, it is not unusual for referrals to occur in the middle of the week as patients are admitted. An elder, P, shares that a back injury prevents her from sitting or lying on the mat and I find a comfortable easy chair in the passage for her. As P makes herself comfortable on the chair next to M on the mat, I notice an immediate sensitivity and awareness to M as she gently engages in Sepedi. By 4pm the room had filled up with 12 participants. All except P have attended since Monday. Ages range from 18 to 68, and there is diversity across languages and gender. It feels significant that the youngest, M, and the older, P, connected before the others entered and were situated next to each other.


As always, the session commences with a chant in isiZulu and English that speaks to feeling at home in the space. The chant is introduced on a Monday and threads through to Friday, repeated many times for familiarity. With each repetition there is a deeper immersion and engagement with the lyrics and the energy in the space becomes more grounded. After the chant, I invite each participant through turn-taking to sound their name into the space to enable newcomers to feel welcomed and included.

The Wednesday session is part of an ongoing series of guided visualisation into a natural setting, accompanied by live instruments and carefully selected songs to enhance the nature theme. Each nature-based metaphor is explored in an awakened state followed by progressive relaxation. Participants are invited to listen or to participate in singing in a relaxed state. 

To address diversity, songs are chosen from a variety of languages and genres.

As a new participant, I observe P closely from the start as I prefer to not know the reasons for referral initially unless the psychiatrist has specific concerns which they communicate beforehand. I invite the songs to co-facilitate, to offer a projective screen on which emotions can surface.

P appears relaxed after the progressive relaxation and first few songs. She bursts into tears during the fifth song themed around forgiveness. Her crying grows in intensity. I support P by repeating the song, increasing my volume to meet the intensity of her crying. The group responds and supports by singing louder as well. We repeat the song a few times as our collective singing offers a container of support for P. P’s crying gradually subsides as her breathing slows down and she becomes quiet during the remaining 5 songs.


As the group is brought back into an awakened state, each participant takes their time to emerge from lying down into sitting. M jumps up, hugging P on the chair with “Why did you cry?”. I invite participants to reflect and integrate as they feel comfortable to share. P takes a deep breath before speaking. She found the experience quite emotional and cathartic. She had been carrying a load of anger and guilt, unable to cry since her husband of 48 years passed away 6 months before. She was angry with him for leaving her, for not sharing with her that after a remission of two years, his cancer had returned. She felt guilty for not noticing the signs. During the experiential, the song on forgiveness gave her the words that she had not been able to find since his passing. The lyrics resonated with her deepest emotions. P felt a flood of emotions flowing from her body like the river metaphor that we were engaging with in the song. She could no longer hold back the tears that were stuck in her body. P thanked us for making her feel welcome and safe enough to express her difficult emotions. She felt witnessed and understood for the first time.

With each reflection, the theme of loss and grief comes up. Loss of a loved one, financial loss due to retrenchment, loss of identity due to burn out. Participants share how the natural setting offered space to breathe, to remember, to connect with places and with people. C, who has been a teacher for 20 years, shares that she went back to the family farm where she grew up, swimming in the river with her brother who passed away during Covid. They were children again, enjoying splashing each other, laughing. The experience brought her physical release from the sadness she was holding, not being able to grieve due to work demands and stress. She experienced joy again for the first time in a long time.

Everyone resonated strongly with P’s crying and felt their singing helped them to move through difficult emotions as well. The river metaphor assisted with a somatic sense of release and relief.

Q has been offering some perspectives from his traditional healing practice since attending sessions from Monday and again asks permission to offer some insights. He shares that he connected to his ancestral water beings while we were at the river. Q explains again that healing through interaction with ancestral beings is a fundamental aspect of South African traditional medicine. The belief in the ability of ancestral water beings to provide insights into disease, offer guidance for treatment and aid in the restoration of well-being is central to his practice. Q shares that he resonated deeply with the experience.

R, a minister, requests that we end the session with Amazing Grace. The group supports his request and we repeat the hymn a few times until it fades out naturally.

As the participants exit P stays behind. 

“May I hug you please. I got lost on my way to the music therapy room and almost turned around. A voice inside told me to keep on looking. When I saw M in the room with you, I knew why I had to be here today. I have a grandson like M who has experienced significant rejection in his life. Thank you for including her in your group. This is truly a healing space.”


The aim of this vignette was to offer a narrative on how the group music therapy space may emerge as a metaphor for returning to the village for healing and a sense of community within the hospital environment. Just as the traditional village serves as a sanctuary, the in-hospital therapeutic space can offer a space where individuals share their narratives, be witnessed, rediscover their roots and collectively heal.

Karen de Kock


Karen is a Music Therapist who obtained a BMus in Performance Singing and an Honours in Ethnomusicology from the University of Cape Town before studying Music Therapy at the University of Pretoria. She’s been practicing since 2004, including 15 years at an NGO for persons with cognitive and physical disabilities, working with residents and care workers. She has been offering group work in private psychiatric hospitals since 2009, focusing on the intersection between group indigenous healing practices and group music therapy. She is also a Part-Time lecturer and clinical supervisor.