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Dickey A, Blakey J. A Theoretical Intervention Model for Using Hip-Hop Therapy in Suicide Treatment for Black Males. JSP 2023; 5 (1) :23-38
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JSP
Journal of Suicide Prevention ![]()
https://isssp.ir Vol. 5. 2023. Article ID: e2023004
A Theoretical Intervention Model for Using Hip-Hop Therapy in Suicide Treatment for Black Males
Andrea Dickey1, Joan Blakey2
1-, DSW, LCSW Tulane University
2- PhD., MSW, LMSW University of Minnesota-Twin Cities
(Corresponding author) E-mail: drea.keen@gmail.com
Conflicts of interest: None
Funding: None
Cite this article as: Dickey. Andrea, L., Blakey Joan. A Theoretical Intervention Model for Using Hip-Hop Therapy in Suicide Treatment for Black Males. J Suicid Prevent. 2023 (Nov): 5: 23-38 e2023005. *This work is published under CC BY-NC-SA 3.0 license.
Table 1. A Theoretical Intervention Model for Using Hip-Hop Therapy for Suicide Treatment for Black Males Outline
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JSPJournal of Suicide Prevention
https://isssp.ir Vol. 5. 2023. Article ID: e2023004
Case Study
A Theoretical Intervention Model for Using Hip-Hop Therapy in Suicide Treatment for Black Males
Andrea Dickey1, Joan Blakey2
1-, DSW, LCSW Tulane University
2- PhD., MSW, LMSW University of Minnesota-Twin Cities
(Corresponding author) E-mail: drea.keen@gmail.com
Abstract
Background and Objectives: Suicide rates for young Black males continue to increase in the US. The young Black male population is a difficult population to engage in mental health treatment due to denial, resistance, and cultural stigma. Hip-Hop Therapy interventions use written and oral expressions for strengthening emotional regulation, building coping skills, and developing self-confidence. Suicide prevention using Hip-Hop Therapy principles can be a solution for treating suicidal behaviors for young Black males. The therapeutic intervention model discussed in this paper is a short-term intervention, but it gives the client an opportunity to seek out the clinician if additional treatment is needed. This innovative model can change the way clinicians approach treatment with young Black males. |
Keywords Hip-Hop Therapy, Suicide prevention, Hip-hop, Black men, Black youth, Suicide Received: 15/03/23 Revised: 29/08/23 Accepted: 10/10/23 |
Conflicts of interest: None
Funding: None
Cite this article as: Dickey. Andrea, L., Blakey Joan. A Theoretical Intervention Model for Using Hip-Hop Therapy in Suicide Treatment for Black Males. J Suicid Prevent. 2023 (Nov): 5: 23-38 e2023005. *This work is published under CC BY-NC-SA 3.0 license.
Introduction
In 2020, suicide rates for black men were higher than 2019. It is estimated that 7.7 out of every 100,000 Black men commit suicide annually [1]. In the United States, Black youth are dying from suicide at faster rates than any other racial or ethnic youth groups [2]. Between 1993 and 2012, the suicide rates doubled for Black youth between the ages of 5 and 11 [3]. Research indicates that between the ages of 11 and 15, Black youth are at a heightened risk for mood dysregulation, depression, and suicidal thoughts [4]. According to Talley et al. [5], suicide rates in young Black men are much higher than it appears due to non-traditional methods of suicide (methods such as victim precipitated homicide are excluded from suicide rates.) Victim precipitated homicide is when the victim of a homicide is a direct precipitator to be killed by someone else.
Depression is one of the leading illnesses for Black men [6]. About 17 million adults have had at least one major depressive episode in their lifetime [7]. Black and Indigenous populations are known to have more pervasive mental health conditions and needs than other populations in America [8]. In the United States, Black men are most vulnerable to direct trauma experiences such as discrimination, serious injury due to violence, and poverty [9]. Research has shown that Black men generally have higher rates of post-traumatic stress disorder, chronic social phobia, and depression [10-11]
Furthermore, the Black culture tends to ignore and stigmatize mental health symptomology, treatment, and suicide. Mental health issues can be dismissed as stress and perceived as something that can be easily overcome. This cultural stigma has triggered reluctance to seek outpatient mental health treatment [12]. However, the Black population is overrepresented in receiving emergency and inpatient psychiatric treatment [13]. This research indicates that the Black population seeks mental health treatment once the symptoms have become pervasive and unmanageable. The Black population typically uses religion or spirituality, talking to family and/or friends, and listening to music as alternatives to traditional outpatient treatment models [14-15].
Among Black people, Black men are more likely to ignore, minimize, or neglect their mental health needs. This requires clinicians to use more probing, prompting, and clarifying questions to clearly understand the needs of Black men. When Black men do seek mental health treatment, they are often misdiagnosed due to differences in cultural norms, presentation, expression, and reporting of symptomology [16-17]. The current treatment modalities used in practice are based on research studies in which the Black population had little to no participation in [18], which has triggered inadequate interventions and a poor cultural perception of mental health treatment [19].
According to research on Black men and mental health, there is a high prevalence of depression and suicide attempts among this population [20]. There is an urgent need for culturally appropriate suicide prevention treatment for young Black men [21]. An example of a culturally appropriate suicide intervention approach for Black men is the use of Hip-Hop in therapeutic settings. Consideration is rarely given to how the music and art that Hip-Hop artists produce can be used therapeutically to emotionally support young Black men. Hip-Hop music serves a dual therapeutic purpose for the artist and the listener for healing and coping [22-24].
Purpose of Study
Although Hip-Hop Therapy has been researched, no research has been conducted on the implementation of specific Hip-Hop songs in a therapeutic intervention. This lack of research in applying Hip-Hop songs in therapy and the development of tools for research and teaching indicates a significant need for the development of Hip-Hop Therapy treatment models [25-26]. This study will support the development of culturally sensitive interventions for young Black males, as it pertains to depression and suicide. This study will show how Hip-Hop Therapy can be used in suicide prevention treatment with young Black men by demonstrating how to apply Hip-Hop music to a therapeutic suicide treatment intervention using a suicide treatment model.
Literature Review
As early as 4000 BC, music has been known to support the healing of a variety of physiological and psychological needs [27]. Music comes in many different genres, uses various instruments, and touches people worldwide. Religious, cultural, and environmental experiences can influence musical expression. The sound waves and beats of music can trigger healing properties for a variety of ailments [28].
Music can be an effective tool to reduce the symptoms of depression and anxiety [29]. Listening to music has been found to trigger increased coping skills, orientation, and mood regulation [30]. Research has shown that music can produce emotional reactions that support stress management [31]. According to Jasemi, Aazami, & Zabihi [32], the use of music therapy decreases the intensity of depression and anxiety in cancer patients. Songwriting in music therapy has also been found to trigger happiness and support written expressions [33].
There is limited research on the use of Hip-Hop music for the purpose of decreasing symptoms of depression, anxiety, and suicide. In fact, only one study was found that looks at the impact of Hip-Hop music and suicide prevention. Niederkrotenthaler et al. (2021) researched individual responses to seek mental health treatment after a Hip-Hop song entitled “1-800-273-8255”, the national suicide hotline number, was released [34]. This study found that within a 34-day period of the release of the song “1-800-273-8255”, the suicide hotline experienced a 7% increase in calls, and suicide rates were reduced by 5.5%.
Hip-Hop as a Therapeutic Tool
Hip-Hop music emerged in the 1970s in the South Bronx, New York. This music was in response to the environmental conditions that minorities were exposed to at that time. Hip-Hop provided a psychological distraction and an outlet for self-expression. It was used as a non-violent way for Black and people of color to speak out about their experiences of poverty, inequality, and injustice in the South Bronx and beyond [35]. The lyrics of Hip-Hop music have been a powerful platform of storytelling to encourage self-confidence, empowerment, liberation, and motivation [36].
Dr. Edgar Tyson began studying the therapeutic effects of Hip-Hop music in the late 1990s. Tyson [37] found that Hip-Hop based interventions improved the therapeutic experience and outcomes of Black, Latino, and delinquent youth. The Black population struggles with emotional regulation vulnerabilities such as anxiety and depression which can likely be treated using Hip-Hop Therapy [38]. Hip-Hop based interventions are essential to increasing safe spaces and treatment options for the Black population to express their emotions unrestricted, increase coping skills, and decrease negative responses to trauma [39]. Research has shown that therapists who utilize Hip-Hop in therapy sessions appear more relatable and personable to the client [40].
The therapeutic value of Hip-Hop Therapy is more complex than a music listening session and a passive discussion of the musical lyrics. Hip-Hop Therapy is about developing a therapeutic environment that fosters comfort to share emotions and experiences through creative expressions such as music, poetry, dance, film, etc. [41-42]. Hip-Hop Therapy can help participants to address issues such as depression, poor decision making, internalized racism, instant gratification, and a lack of social support.
Hip-Hop Therapy utilizes the four basic elements of Hip-Hop culture for treatment intervention which encompasses emceeing (rapping), deejaying (music production), b-boying and b-girling (breakdancing), and graffiti (art). Emceeing is an artist rapping, talking, and/or singing over a musical arrangement. In Hip-Hop culture, the deejay or music producer plays Hip-Hop songs, composes instrumental compositions, and plays instrumentals from previously composed songs for artists to rap, talk, or sing over [43]. The structure of these elements culturally affects sensitive therapeutic interventions and enhances treatment options for the Black population. Hip-Hop Therapy can be a powerful tool for identification, clarification, representation, meditation, catharsis, and validation [44].
Intervention Models in Hip-Hop Therapy
This study focuses on the emceeing element as the primary mode of therapy. Emceeing is the verbal expression of cognitive, emotional, and behavioral thoughts to an instrumental, oral, or musical beat. Emceeing is the most popular element of Hip-Hop culture. Rapping, beatboxing, and spoken word are forms of emceeing. The interventions in Hip-Hop Therapy utilize oral and written expressions to reinforce the therapeutic process, using emceeing. Poetry in therapy, bibliotherapy, and cyphers in therapy are emceeing techniques used in Hip-Hop Therapy.
Poetry in Therapy
Poetry in therapy is the use of poetry in the forms of written and spoken words with the clinical goal of supporting healing and personal growth [45]. Furman [46] contends that the use of poetry in therapy helps to facilitate a therapeutic environment with minimal questions which reduces the client feeling interrogated or overwhelmed. Poetry in therapy uses a group approach with a three-step model in the clinical setting. The three-step model used is prescriptive, expressive creative, and ceremonial [47].
In the prescriptive step, the clinician introduces the song lyrics, poem, letter, or story is used during the session. Since this is a client-centered approach, group members are encouraged to introduce literature to the group after a few sessions [48]. The expressive creative step entails the group participants engaged in writing song lyrics, poems, letters, screenplays, or stories [49]. Group participants read aloud poetry, stories, letters, song lyrics, and screenplays during the final ceremonial step of poetry in therapy [50].
Bibliotherapy
Implementation of bibliotherapy in Hip-Hop Therapy consists of analyzing the lyrical content of music, reviewing written texts, and writing original song lyrics, poetry, or a screenplay [51]. Bibliotherapy is similar to poetry in therapy, but it eliminates the final step of reading aloud or performing literature. Bibliotherapy is a self-developing therapy that uses reading as a treatment intervention to facilitate mental health recovery [52]. This form of therapy has shown to be effective on mild to moderate depression and anxiety [53].
Traditionally, bibliotherapy has been implemented in inpatient psychiatric settings to support self-actualization, behavior modification, coping skills development, and self- regulation [54]. Bibliotherapy in Hip-Hop Therapy does not require reading literature or books, but it does encourage analyzing the words and stories of Hip-Hop music, poetry, film, and original writings [55]. This can be achieved by using auditory tools such audiobooks.
Cyphers in Therapy
A cypher in Hip-Hop refers to participants in a circle rapping improvised lyrics about thoughts, feelings, and experiences; each person typically raps between 8 to 16 music lines or “bars” [56-57]. Lee (2009) indicates that a Hip-Hop Therapy cypher is a form of a verbal duel in which participants avoid personal attacks, physical aggression, and offensive language or behavior [58]. In Hip-Hop Therapy, a cypher is used in a group setting to build self-esteem, coping skills, and social skills. The cypher participants learn how to provide emotional support to peers, mood regulation, and confidence building [48].
Intervention Framework
The conceptual framework for this paper will merge the ideas of Hip-Hop and Spoken Word Therapy (HHSWT) and the Attempted Suicide Short Intervention Program. Merging the ideas of these two frameworks helps to address suicide in Black men and youth, while effectively supporting the emotional and cultural aspects needed. The conceptual frameworks of these approaches were combined due to its applicability, they are conceptually short-term interventions, and both have a three-step approach. This concept can be used as an individual or group intervention.
Hip-Hop and Spoken Word Therapy (HHSWT) is a school counseling framework used to facilitate discussing and analyzing difficult emotional experiences [59]. The HHSWT encourages youth to write, record, and perform Hip-Hop songs about environmental stressors, unresolved issues, and difficulties in their lives [60]. Lyric writing, cyphers (group therapy), and mixtape development are activities used in HHSWT to elicit culturally appropriate expressions of emotion, build coping skills, and enhance insight on situation or circumstance [61].
Each HHSWT session includes a warm-up, main event, and cool down. The warm-up includes an activity of listening to a Hip-Hop song or watching a Hip-Hop music video based on the topic of the session or need of the client. Client lyric writing is the focus of the main event, which encourages the emotional expression of feelings, environmental stressors, trauma, etc. Typically, the cool down part of the session lasts for about five to ten minutes and focuses on self-reflection, self-improvement, and self-soothing [62].
The Attempted Suicide Short Intervention Program is a short-term, three-session intervention that was designed for individuals that have attempted suicide [63]. The intervention is broken down into three sessions: the narrative interview, review and analysis of experience, and long-term goals and planning. The Attempted Suicide Short Intervention Program requires the first session to be video recorded, and the recording is analytically reviewed in the second session [64]. The third session looks at remaining stable, establishing a crisis plan, and understanding available resources.
Methods
Design
The instrumental case study design is used to provide a more in-depth understanding of standard practices of a phenomenon [65]. This research study uses an instrumental case study design using the song ‘Let It Work Out’ by Lil Wayne to understand his detailed account of his suicide process and recovery. This design was selected because it allows the researcher to use song coding to understand the lyrical content of the song and face-to-face interviews to explain and clarify the experience. The aim of this study is to understand how to apply a Hip-Hop song to a Hip-Hop Therapy intervention.
Sample
This research study will focus on a song by a 39-year-old Hip-Hop artist, Lil Wayne, also known as, Dwayne Michael Carter Jr. He was born on September 27, 1982, in New Orleans, LA. It has been reported that his mother was in her teens at his birth and his father abandoned the family by the time he was two years old. Lil Wayne signed a record deal with Cash Money Records at the age of 11 and his career as a Hip-Hop artist has sustained over 25 years [66].
The song ‘Let It Work Out’ by Lil Wayne was selected for this study due to the description of depression, suicide attempt, and recovery shared by Lil Wayne. Lil Wayne has been quite vocal about mental health issues and has written about his personal struggles with depression and attempted suicide [67]. His descriptions of self-motivation, his suicide recovery process, mental health issues, and survival can provide inspiration in a therapeutic setting for other Black men that have had these experiences.
Data Collection
This study uses two primary data collection methods: lyrics from songs and interviews where the rapper discussed his suicide attempt. Data collection for this study took place for a period of one week between January 1 and 7, 2022. The music was downloaded from a paid music streaming service. The internet was used to collect the musical lyrics of the song, and face-to-face interviews of the Hip-Hop artist, Lil Wayne. The musical lyrics were obtained from a Google search and downloaded from the internet. Since Lil Wayne was not directly interviewed for this study, the archival information collected from his face-to-face interviews was used. Other media was gathered to clarify and understand environmental stressors, emotional distress, expression of feelings, suicide process, suicide recovery, and coping skills.
Data Analysis
To ensure accuracy and obtain an overall feeling/ mood/ tone of this song, the lyrics were reviewed while simultaneously listening to the music. The songs were placed on a datasheet for the researcher to review the song lyrics, clarify the slang terms used, and identify the themes and descriptive codes. The lyrical content of the song was coded line by line. The codes were identified based on similarity and subject matter. The identified codes were used to identify themes in the message to determine the specific patterns of the song and answer the research question. The guiding research question for this study was: How can factors identified in the song ‘Let It All Work Out’ help us to develop a suicide prevention intervention for young Black men?
Results
In March 2014, in an interview with Jimmy Kimmel, Lil Wayne jokingly talked about shooting himself by accident while listening to a song by the infamous Hip-Hop artist, Notorious B.I.G [68]. Sadly, Lil Wayne did not shoot himself by accident, he attempted suicide. In an August 2021 interview, Lil Wayne openly talked about struggling with mental health issues since he was 10 years old and attempting suicide as a teenager [69]. This conversation of depression and suicide was a stark difference to the image portrayed as a Hip-Hop artist and the narrative that was presented when Lil Wayne shot himself.
In the song ‘Let It All Work Out’ released in 2018, Lil Wayne describes his experience with attempting suicide and his suicidal process. The suicidal process ranges from self-harming ideas to an actual behavior of a suicidal act intended to complete suicide [70]. Studies have shown that individuals with a suicide process with a duration longer than 10 minutes may have an opportunity for increased planning and personalized interventions to prevent a suicide attempt [71]. ‘Let It All Work Out’ provides an opportunity to support young Black men in reducing suicidal behavior.
This study will describe how a clinician can use ‘Let It All Work Out’ in a brief short-term intervention of six to nine therapy sessions. Additionally, this model gives clinicians methods that can teach young Black men to understand how to seek help within their own suicide process so that the process can be disrupted. This intervention can be used in a group or individual Hip-Hop Therapy setting for young Black men seeking suicide prevention treatment. ‘Let It All Work Out’ describes Lil Wayne’s experience with attempting suicide including the precipitating events, his suicide process, and suicide recovery. While not a generalization, Lil Wayne’s detailed description can provide insight on how to support other Black male youth and adults with similar experiences. Song coding provides a more in-depth understanding of Lil Wayne’s experience with attempting suicide, and clinicians can use song themes to focus on the specific needs of the client. The song codes used to guide topics for the Hip-Hop Therapy sessions are discussed below.
Warm-up
The warm-up sessions are the first two to three sessions and should be used to develop a narrative of the client’s suicide experience. In these sessions, the clinician should help the client understand the client’s suicide process, suicidal ideations, suicidal thoughts, suicidal behavior, suicide attempt, and a completed suicide. By the end of the warm-up sessions, the client should be able to provide a narrative of their suicide experience through a song or poem.
Each session of the warm-up should begin with listening to the song ‘Let It All Work Out’ by Lil Wayne. Listening to the song and reviewing the song lyrics should take place simultaneously. The clinician should provide a copy of the song lyrics to the client(s). The clinician can encourage the client(s) to process the emotions presented by Lil Wayne in the song as they listen to Lil Wayne rap about his suicide attempt. Lil Wayne shares that he tried to independently manage his depressed mood, but he couldn’t and eventually attempted suicide, “I tried compromising and went kamikaze” [72]. The term kamikaze refers to an intentional suicide attempt. This feeling of being unsuccessful at managing his mental health symptoms, described by Lil Wayne, is common for Black men, as it pertains to avoiding mental health treatment.
Throughout the warm-up sessions, the clinician should focus on the first verse of the song ‘Let It All Work Out’ which explains Lil Wayne’s psychosocial stressors and triggers. The prominent themes emerged from song coding was pride, substance use, overwhelmed, family planning, fake friends, emotional distress, and strained relationships. Lil Wayne refers to the experience of strained interpersonal relationships by stating, “I never turn my back on 'em, 'Cause niggas act like they cool with ya, but a lot of these niggas be transformers” [72].
The warm-up sessions will provide the client with an opportunity to create a song or poetry about their experience with suicide. Clinicians should guide the client through this activity with mostly open-ended questions. Closed ended questions may elicit one-word answers that may not be helpful to this process. The purpose of this activity is to trigger participation. The clinician will use lyric writing to process the client’s thoughts about suicide and explore whether they have had or thought about a suicide attempt. Lyric writing will give clients an opportunity to write out their thoughts about the events and circumstances surrounding their personal suicide attempt or suicidal behavior. The song lyrics and instrumental from ‘Let It All Work Out’ can be used as an artistic motivation for the client to write their own song lyrics or poem. The client will perform their song lyrics or poem while being audio or video recorded which will be reviewed in the main event sessions.
At the end of each session, the clinician and client will focus on safety until the next session and developing a motivational Hip-Hop playlist. The clinician will ask the client to report at least one action of safety that they will incorporate after the session. If the client has a history of suicide attempts, the client should identify someone close by or someone they can call if they have suicidal ideations. Clinician should provide resources for emergency mental health services, as well.
The motivational Hip-Hop playlist will be used as a coping mechanism throughout the week for the client. Playlists are easily accessible from any mobile device, and it is a discreet way to self-soothe. Additionally, the act of creating a playlist and selecting music has a therapeutic value for mood regulation, coping, and motivation [73]. The client and clinician will select five to ten Hip-Hop songs to add to a single playlist to be used by the client throughout the week. The clinician should take some time during each session to discuss with the client the effectiveness of using a motivational Hip-Hop playlist for self-soothing and coping throughout the week.
Main Event
The main event includes the following three to four therapy sessions and should be used to review and analyze the client’s suicidal experience. In these sessions, the clinician should support the client in processing their feels about attempting suicide and identify whether the client is in the acceptance or denial stages. If the client is in the denial stage, then the clinician can support the client with moving towards the acceptance stage with the activities of the main event sessions.
Each session of the main event should begin with the clinician presenting to the client various interviews of Lil Wayne talking about his suicide attempt while in the denial and acceptance stages. Clinician should explore with the client any connections into client’s personal experience and Lil Wayne’s experience of denial and acceptance. Additionally, the clinician can guide the client in observing and comparing Lil Wayne’s body language, eye contact, and confidence in the interviews during denial and acceptance stages.
The clinician should focus on the third verse of ‘Let It All Work Out’ in which Lil Wayne shares a detailed description of his suicide process. He indicates that he had a means of attempting suicide, “I found my momma's pistol where she always hides it” [72]. He continued to have suicidal thoughts, “I cry, put it to my head and thought about it” [72]. Lil Wayne explains that during his suicide process he sought help from his aunt when he had suicidal thoughts, “Nobody was home to stop me, so I called my auntie” [72]. He then escalates to suicidal intent “Hung up, then put the gun up to my heart and pondered, too much was on my conscience to be smart about it, too torn apart about it” [72]. Lil Wayne explains that he attempted suicide, “I aim where my heart was pounding, I shot it, and I woke up with blood all around me, it’s mine” [72]. In this verse, the prominent theme emerged from song coding was gun availability, suicide letter, suicidal thoughts, call for help, suicidal behavior, and suicide attempt.
In the first session of the main event session, the clinician and client should review and process the audio or video recording from the warm-up session. While processing the audio or video recording, the clinician should focus on the non-verbal body language, tone of voice, and intensity of lyrics. This will support the client in understanding how impactful the suicidal event was to them. The clinician should encourage the client to explore their physical responses during the recording and playback of the recording.
For the main event sessions, the clinician will use lyric writing for analyzing and exploring the client’s feelings, triggers, and coping mechanisms pertaining to the client’s personal suicide process. The lyric writing exercises for these sessions should be recorded and reviewed in the following session. Supporting the client in understanding triggers and developing insight into their own suicide process will help the client identify times in that process to seek help. According to Deisenhammer (2009), individuals that have a suicide process of 10 minutes or more have an opportunity to seek help before they engage in self-injurious behaviors [74]. Clinicians should focus on safety opportunities during the client’s suicide process.
Clinicians should also explore barriers to long-term safety. An ongoing discussion on how effective the client’s safety action plan is imperative for maintaining an effective plan. The clinician will ask the client to report at least one more action of safety that they will incorporate after each main event session. If the client has a history of suicide attempts, the client should identify someone close by or someone that they can call if they begin to have suicidal ideations. During these sessions, the clinician should reiterate to the client the use of suicide hotlines and emergency mental health services when necessary.
In the main event sessions, the clinician will give the client time to develop a motivational Hip-Hop playlist for a week. In these sessions, the clinician will not be actively involved with developing the playlist but should provide support to the client. This will support client in developing the autonomy needed to create a motivational Hip-Hop playlist in their daily lives without the clinician.
Cool Down
The cool down includes three sessions that focuses on maintaining stability, understanding how and when to use the developed crisis plan, and understanding available resources. In these sessions, the clinician should support client in their suicide recovery process by developing long-term goals and safety planning. The clinician should focus on processing with client ways to maintain recovery, seek treatment, and increase coping skills.
The cool down sessions focus on ongoing safety of the client. Each session of the cool down should begin with the clinician asking the client to report at least one more action of safety that they will be incorporated after the session. Additionally, the clinician will support the client in developing a plan for the client to contact the clinician if ongoing treatment is needed for this issue when the sessions are completed.
The clinician should encourage a discussion with client about Lil Wayne’s and the client’s suicide recovery. The clinician should focus on the chorus and bridge of ‘Let It All Work Out’ in which Lil Wayne encourages survival and coping with difficult times by sharing “Let it all work out, and it all worked out” [72]. In the chorus and bridge, the prominent themes that emerged from song coding was perseverance, coping skills, encouragement, motivation, religion, and overcoming adversity.
In the cool down sessions, the clinician will use lyric writing for processing the client’s suicide recovery, coping mechanisms, and support systems. The client will perform the lyrics written during the session and process with the clinician the emotions and feelings that arise during the performance. In these sessions, clinicians will continue to explore barriers to long-term safety. The clinician will support a discussion around continuing a positive suicidal recovery.
The client should be able to independently develop a motivational Hip-Hop playlist. In the cool down, the client can elect to text, email, or share their playlist with the clinician. The clinician can process with the client the song topics of the motivational Hip-Hop playlist and its reflection on the client’s mental state.
In 2020, suicide rates for black men were higher than 2019. It is estimated that 7.7 out of every 100,000 Black men commit suicide annually [1]. In the United States, Black youth are dying from suicide at faster rates than any other racial or ethnic youth groups [2]. Between 1993 and 2012, the suicide rates doubled for Black youth between the ages of 5 and 11 [3]. Research indicates that between the ages of 11 and 15, Black youth are at a heightened risk for mood dysregulation, depression, and suicidal thoughts [4]. According to Talley et al. [5], suicide rates in young Black men are much higher than it appears due to non-traditional methods of suicide (methods such as victim precipitated homicide are excluded from suicide rates.) Victim precipitated homicide is when the victim of a homicide is a direct precipitator to be killed by someone else.
Depression is one of the leading illnesses for Black men [6]. About 17 million adults have had at least one major depressive episode in their lifetime [7]. Black and Indigenous populations are known to have more pervasive mental health conditions and needs than other populations in America [8]. In the United States, Black men are most vulnerable to direct trauma experiences such as discrimination, serious injury due to violence, and poverty [9]. Research has shown that Black men generally have higher rates of post-traumatic stress disorder, chronic social phobia, and depression [10-11]
Furthermore, the Black culture tends to ignore and stigmatize mental health symptomology, treatment, and suicide. Mental health issues can be dismissed as stress and perceived as something that can be easily overcome. This cultural stigma has triggered reluctance to seek outpatient mental health treatment [12]. However, the Black population is overrepresented in receiving emergency and inpatient psychiatric treatment [13]. This research indicates that the Black population seeks mental health treatment once the symptoms have become pervasive and unmanageable. The Black population typically uses religion or spirituality, talking to family and/or friends, and listening to music as alternatives to traditional outpatient treatment models [14-15].
Among Black people, Black men are more likely to ignore, minimize, or neglect their mental health needs. This requires clinicians to use more probing, prompting, and clarifying questions to clearly understand the needs of Black men. When Black men do seek mental health treatment, they are often misdiagnosed due to differences in cultural norms, presentation, expression, and reporting of symptomology [16-17]. The current treatment modalities used in practice are based on research studies in which the Black population had little to no participation in [18], which has triggered inadequate interventions and a poor cultural perception of mental health treatment [19].
According to research on Black men and mental health, there is a high prevalence of depression and suicide attempts among this population [20]. There is an urgent need for culturally appropriate suicide prevention treatment for young Black men [21]. An example of a culturally appropriate suicide intervention approach for Black men is the use of Hip-Hop in therapeutic settings. Consideration is rarely given to how the music and art that Hip-Hop artists produce can be used therapeutically to emotionally support young Black men. Hip-Hop music serves a dual therapeutic purpose for the artist and the listener for healing and coping [22-24].
Purpose of Study
Although Hip-Hop Therapy has been researched, no research has been conducted on the implementation of specific Hip-Hop songs in a therapeutic intervention. This lack of research in applying Hip-Hop songs in therapy and the development of tools for research and teaching indicates a significant need for the development of Hip-Hop Therapy treatment models [25-26]. This study will support the development of culturally sensitive interventions for young Black males, as it pertains to depression and suicide. This study will show how Hip-Hop Therapy can be used in suicide prevention treatment with young Black men by demonstrating how to apply Hip-Hop music to a therapeutic suicide treatment intervention using a suicide treatment model.
Literature Review
As early as 4000 BC, music has been known to support the healing of a variety of physiological and psychological needs [27]. Music comes in many different genres, uses various instruments, and touches people worldwide. Religious, cultural, and environmental experiences can influence musical expression. The sound waves and beats of music can trigger healing properties for a variety of ailments [28].
Music can be an effective tool to reduce the symptoms of depression and anxiety [29]. Listening to music has been found to trigger increased coping skills, orientation, and mood regulation [30]. Research has shown that music can produce emotional reactions that support stress management [31]. According to Jasemi, Aazami, & Zabihi [32], the use of music therapy decreases the intensity of depression and anxiety in cancer patients. Songwriting in music therapy has also been found to trigger happiness and support written expressions [33].
There is limited research on the use of Hip-Hop music for the purpose of decreasing symptoms of depression, anxiety, and suicide. In fact, only one study was found that looks at the impact of Hip-Hop music and suicide prevention. Niederkrotenthaler et al. (2021) researched individual responses to seek mental health treatment after a Hip-Hop song entitled “1-800-273-8255”, the national suicide hotline number, was released [34]. This study found that within a 34-day period of the release of the song “1-800-273-8255”, the suicide hotline experienced a 7% increase in calls, and suicide rates were reduced by 5.5%.
Hip-Hop as a Therapeutic Tool
Hip-Hop music emerged in the 1970s in the South Bronx, New York. This music was in response to the environmental conditions that minorities were exposed to at that time. Hip-Hop provided a psychological distraction and an outlet for self-expression. It was used as a non-violent way for Black and people of color to speak out about their experiences of poverty, inequality, and injustice in the South Bronx and beyond [35]. The lyrics of Hip-Hop music have been a powerful platform of storytelling to encourage self-confidence, empowerment, liberation, and motivation [36].
Dr. Edgar Tyson began studying the therapeutic effects of Hip-Hop music in the late 1990s. Tyson [37] found that Hip-Hop based interventions improved the therapeutic experience and outcomes of Black, Latino, and delinquent youth. The Black population struggles with emotional regulation vulnerabilities such as anxiety and depression which can likely be treated using Hip-Hop Therapy [38]. Hip-Hop based interventions are essential to increasing safe spaces and treatment options for the Black population to express their emotions unrestricted, increase coping skills, and decrease negative responses to trauma [39]. Research has shown that therapists who utilize Hip-Hop in therapy sessions appear more relatable and personable to the client [40].
The therapeutic value of Hip-Hop Therapy is more complex than a music listening session and a passive discussion of the musical lyrics. Hip-Hop Therapy is about developing a therapeutic environment that fosters comfort to share emotions and experiences through creative expressions such as music, poetry, dance, film, etc. [41-42]. Hip-Hop Therapy can help participants to address issues such as depression, poor decision making, internalized racism, instant gratification, and a lack of social support.
Hip-Hop Therapy utilizes the four basic elements of Hip-Hop culture for treatment intervention which encompasses emceeing (rapping), deejaying (music production), b-boying and b-girling (breakdancing), and graffiti (art). Emceeing is an artist rapping, talking, and/or singing over a musical arrangement. In Hip-Hop culture, the deejay or music producer plays Hip-Hop songs, composes instrumental compositions, and plays instrumentals from previously composed songs for artists to rap, talk, or sing over [43]. The structure of these elements culturally affects sensitive therapeutic interventions and enhances treatment options for the Black population. Hip-Hop Therapy can be a powerful tool for identification, clarification, representation, meditation, catharsis, and validation [44].
Intervention Models in Hip-Hop Therapy
This study focuses on the emceeing element as the primary mode of therapy. Emceeing is the verbal expression of cognitive, emotional, and behavioral thoughts to an instrumental, oral, or musical beat. Emceeing is the most popular element of Hip-Hop culture. Rapping, beatboxing, and spoken word are forms of emceeing. The interventions in Hip-Hop Therapy utilize oral and written expressions to reinforce the therapeutic process, using emceeing. Poetry in therapy, bibliotherapy, and cyphers in therapy are emceeing techniques used in Hip-Hop Therapy.
Poetry in Therapy
Poetry in therapy is the use of poetry in the forms of written and spoken words with the clinical goal of supporting healing and personal growth [45]. Furman [46] contends that the use of poetry in therapy helps to facilitate a therapeutic environment with minimal questions which reduces the client feeling interrogated or overwhelmed. Poetry in therapy uses a group approach with a three-step model in the clinical setting. The three-step model used is prescriptive, expressive creative, and ceremonial [47].
In the prescriptive step, the clinician introduces the song lyrics, poem, letter, or story is used during the session. Since this is a client-centered approach, group members are encouraged to introduce literature to the group after a few sessions [48]. The expressive creative step entails the group participants engaged in writing song lyrics, poems, letters, screenplays, or stories [49]. Group participants read aloud poetry, stories, letters, song lyrics, and screenplays during the final ceremonial step of poetry in therapy [50].
Bibliotherapy
Implementation of bibliotherapy in Hip-Hop Therapy consists of analyzing the lyrical content of music, reviewing written texts, and writing original song lyrics, poetry, or a screenplay [51]. Bibliotherapy is similar to poetry in therapy, but it eliminates the final step of reading aloud or performing literature. Bibliotherapy is a self-developing therapy that uses reading as a treatment intervention to facilitate mental health recovery [52]. This form of therapy has shown to be effective on mild to moderate depression and anxiety [53].
Traditionally, bibliotherapy has been implemented in inpatient psychiatric settings to support self-actualization, behavior modification, coping skills development, and self- regulation [54]. Bibliotherapy in Hip-Hop Therapy does not require reading literature or books, but it does encourage analyzing the words and stories of Hip-Hop music, poetry, film, and original writings [55]. This can be achieved by using auditory tools such audiobooks.
Cyphers in Therapy
A cypher in Hip-Hop refers to participants in a circle rapping improvised lyrics about thoughts, feelings, and experiences; each person typically raps between 8 to 16 music lines or “bars” [56-57]. Lee (2009) indicates that a Hip-Hop Therapy cypher is a form of a verbal duel in which participants avoid personal attacks, physical aggression, and offensive language or behavior [58]. In Hip-Hop Therapy, a cypher is used in a group setting to build self-esteem, coping skills, and social skills. The cypher participants learn how to provide emotional support to peers, mood regulation, and confidence building [48].
Intervention Framework
The conceptual framework for this paper will merge the ideas of Hip-Hop and Spoken Word Therapy (HHSWT) and the Attempted Suicide Short Intervention Program. Merging the ideas of these two frameworks helps to address suicide in Black men and youth, while effectively supporting the emotional and cultural aspects needed. The conceptual frameworks of these approaches were combined due to its applicability, they are conceptually short-term interventions, and both have a three-step approach. This concept can be used as an individual or group intervention.
Hip-Hop and Spoken Word Therapy (HHSWT) is a school counseling framework used to facilitate discussing and analyzing difficult emotional experiences [59]. The HHSWT encourages youth to write, record, and perform Hip-Hop songs about environmental stressors, unresolved issues, and difficulties in their lives [60]. Lyric writing, cyphers (group therapy), and mixtape development are activities used in HHSWT to elicit culturally appropriate expressions of emotion, build coping skills, and enhance insight on situation or circumstance [61].
Each HHSWT session includes a warm-up, main event, and cool down. The warm-up includes an activity of listening to a Hip-Hop song or watching a Hip-Hop music video based on the topic of the session or need of the client. Client lyric writing is the focus of the main event, which encourages the emotional expression of feelings, environmental stressors, trauma, etc. Typically, the cool down part of the session lasts for about five to ten minutes and focuses on self-reflection, self-improvement, and self-soothing [62].
The Attempted Suicide Short Intervention Program is a short-term, three-session intervention that was designed for individuals that have attempted suicide [63]. The intervention is broken down into three sessions: the narrative interview, review and analysis of experience, and long-term goals and planning. The Attempted Suicide Short Intervention Program requires the first session to be video recorded, and the recording is analytically reviewed in the second session [64]. The third session looks at remaining stable, establishing a crisis plan, and understanding available resources.
Methods
Design
The instrumental case study design is used to provide a more in-depth understanding of standard practices of a phenomenon [65]. This research study uses an instrumental case study design using the song ‘Let It Work Out’ by Lil Wayne to understand his detailed account of his suicide process and recovery. This design was selected because it allows the researcher to use song coding to understand the lyrical content of the song and face-to-face interviews to explain and clarify the experience. The aim of this study is to understand how to apply a Hip-Hop song to a Hip-Hop Therapy intervention.
Sample
This research study will focus on a song by a 39-year-old Hip-Hop artist, Lil Wayne, also known as, Dwayne Michael Carter Jr. He was born on September 27, 1982, in New Orleans, LA. It has been reported that his mother was in her teens at his birth and his father abandoned the family by the time he was two years old. Lil Wayne signed a record deal with Cash Money Records at the age of 11 and his career as a Hip-Hop artist has sustained over 25 years [66].
The song ‘Let It Work Out’ by Lil Wayne was selected for this study due to the description of depression, suicide attempt, and recovery shared by Lil Wayne. Lil Wayne has been quite vocal about mental health issues and has written about his personal struggles with depression and attempted suicide [67]. His descriptions of self-motivation, his suicide recovery process, mental health issues, and survival can provide inspiration in a therapeutic setting for other Black men that have had these experiences.
Data Collection
This study uses two primary data collection methods: lyrics from songs and interviews where the rapper discussed his suicide attempt. Data collection for this study took place for a period of one week between January 1 and 7, 2022. The music was downloaded from a paid music streaming service. The internet was used to collect the musical lyrics of the song, and face-to-face interviews of the Hip-Hop artist, Lil Wayne. The musical lyrics were obtained from a Google search and downloaded from the internet. Since Lil Wayne was not directly interviewed for this study, the archival information collected from his face-to-face interviews was used. Other media was gathered to clarify and understand environmental stressors, emotional distress, expression of feelings, suicide process, suicide recovery, and coping skills.
Data Analysis
To ensure accuracy and obtain an overall feeling/ mood/ tone of this song, the lyrics were reviewed while simultaneously listening to the music. The songs were placed on a datasheet for the researcher to review the song lyrics, clarify the slang terms used, and identify the themes and descriptive codes. The lyrical content of the song was coded line by line. The codes were identified based on similarity and subject matter. The identified codes were used to identify themes in the message to determine the specific patterns of the song and answer the research question. The guiding research question for this study was: How can factors identified in the song ‘Let It All Work Out’ help us to develop a suicide prevention intervention for young Black men?
Results
In March 2014, in an interview with Jimmy Kimmel, Lil Wayne jokingly talked about shooting himself by accident while listening to a song by the infamous Hip-Hop artist, Notorious B.I.G [68]. Sadly, Lil Wayne did not shoot himself by accident, he attempted suicide. In an August 2021 interview, Lil Wayne openly talked about struggling with mental health issues since he was 10 years old and attempting suicide as a teenager [69]. This conversation of depression and suicide was a stark difference to the image portrayed as a Hip-Hop artist and the narrative that was presented when Lil Wayne shot himself.
In the song ‘Let It All Work Out’ released in 2018, Lil Wayne describes his experience with attempting suicide and his suicidal process. The suicidal process ranges from self-harming ideas to an actual behavior of a suicidal act intended to complete suicide [70]. Studies have shown that individuals with a suicide process with a duration longer than 10 minutes may have an opportunity for increased planning and personalized interventions to prevent a suicide attempt [71]. ‘Let It All Work Out’ provides an opportunity to support young Black men in reducing suicidal behavior.
This study will describe how a clinician can use ‘Let It All Work Out’ in a brief short-term intervention of six to nine therapy sessions. Additionally, this model gives clinicians methods that can teach young Black men to understand how to seek help within their own suicide process so that the process can be disrupted. This intervention can be used in a group or individual Hip-Hop Therapy setting for young Black men seeking suicide prevention treatment. ‘Let It All Work Out’ describes Lil Wayne’s experience with attempting suicide including the precipitating events, his suicide process, and suicide recovery. While not a generalization, Lil Wayne’s detailed description can provide insight on how to support other Black male youth and adults with similar experiences. Song coding provides a more in-depth understanding of Lil Wayne’s experience with attempting suicide, and clinicians can use song themes to focus on the specific needs of the client. The song codes used to guide topics for the Hip-Hop Therapy sessions are discussed below.
Warm-up
The warm-up sessions are the first two to three sessions and should be used to develop a narrative of the client’s suicide experience. In these sessions, the clinician should help the client understand the client’s suicide process, suicidal ideations, suicidal thoughts, suicidal behavior, suicide attempt, and a completed suicide. By the end of the warm-up sessions, the client should be able to provide a narrative of their suicide experience through a song or poem.
Each session of the warm-up should begin with listening to the song ‘Let It All Work Out’ by Lil Wayne. Listening to the song and reviewing the song lyrics should take place simultaneously. The clinician should provide a copy of the song lyrics to the client(s). The clinician can encourage the client(s) to process the emotions presented by Lil Wayne in the song as they listen to Lil Wayne rap about his suicide attempt. Lil Wayne shares that he tried to independently manage his depressed mood, but he couldn’t and eventually attempted suicide, “I tried compromising and went kamikaze” [72]. The term kamikaze refers to an intentional suicide attempt. This feeling of being unsuccessful at managing his mental health symptoms, described by Lil Wayne, is common for Black men, as it pertains to avoiding mental health treatment.
Throughout the warm-up sessions, the clinician should focus on the first verse of the song ‘Let It All Work Out’ which explains Lil Wayne’s psychosocial stressors and triggers. The prominent themes emerged from song coding was pride, substance use, overwhelmed, family planning, fake friends, emotional distress, and strained relationships. Lil Wayne refers to the experience of strained interpersonal relationships by stating, “I never turn my back on 'em, 'Cause niggas act like they cool with ya, but a lot of these niggas be transformers” [72].
The warm-up sessions will provide the client with an opportunity to create a song or poetry about their experience with suicide. Clinicians should guide the client through this activity with mostly open-ended questions. Closed ended questions may elicit one-word answers that may not be helpful to this process. The purpose of this activity is to trigger participation. The clinician will use lyric writing to process the client’s thoughts about suicide and explore whether they have had or thought about a suicide attempt. Lyric writing will give clients an opportunity to write out their thoughts about the events and circumstances surrounding their personal suicide attempt or suicidal behavior. The song lyrics and instrumental from ‘Let It All Work Out’ can be used as an artistic motivation for the client to write their own song lyrics or poem. The client will perform their song lyrics or poem while being audio or video recorded which will be reviewed in the main event sessions.
At the end of each session, the clinician and client will focus on safety until the next session and developing a motivational Hip-Hop playlist. The clinician will ask the client to report at least one action of safety that they will incorporate after the session. If the client has a history of suicide attempts, the client should identify someone close by or someone they can call if they have suicidal ideations. Clinician should provide resources for emergency mental health services, as well.
The motivational Hip-Hop playlist will be used as a coping mechanism throughout the week for the client. Playlists are easily accessible from any mobile device, and it is a discreet way to self-soothe. Additionally, the act of creating a playlist and selecting music has a therapeutic value for mood regulation, coping, and motivation [73]. The client and clinician will select five to ten Hip-Hop songs to add to a single playlist to be used by the client throughout the week. The clinician should take some time during each session to discuss with the client the effectiveness of using a motivational Hip-Hop playlist for self-soothing and coping throughout the week.
Main Event
The main event includes the following three to four therapy sessions and should be used to review and analyze the client’s suicidal experience. In these sessions, the clinician should support the client in processing their feels about attempting suicide and identify whether the client is in the acceptance or denial stages. If the client is in the denial stage, then the clinician can support the client with moving towards the acceptance stage with the activities of the main event sessions.
Each session of the main event should begin with the clinician presenting to the client various interviews of Lil Wayne talking about his suicide attempt while in the denial and acceptance stages. Clinician should explore with the client any connections into client’s personal experience and Lil Wayne’s experience of denial and acceptance. Additionally, the clinician can guide the client in observing and comparing Lil Wayne’s body language, eye contact, and confidence in the interviews during denial and acceptance stages.
The clinician should focus on the third verse of ‘Let It All Work Out’ in which Lil Wayne shares a detailed description of his suicide process. He indicates that he had a means of attempting suicide, “I found my momma's pistol where she always hides it” [72]. He continued to have suicidal thoughts, “I cry, put it to my head and thought about it” [72]. Lil Wayne explains that during his suicide process he sought help from his aunt when he had suicidal thoughts, “Nobody was home to stop me, so I called my auntie” [72]. He then escalates to suicidal intent “Hung up, then put the gun up to my heart and pondered, too much was on my conscience to be smart about it, too torn apart about it” [72]. Lil Wayne explains that he attempted suicide, “I aim where my heart was pounding, I shot it, and I woke up with blood all around me, it’s mine” [72]. In this verse, the prominent theme emerged from song coding was gun availability, suicide letter, suicidal thoughts, call for help, suicidal behavior, and suicide attempt.
In the first session of the main event session, the clinician and client should review and process the audio or video recording from the warm-up session. While processing the audio or video recording, the clinician should focus on the non-verbal body language, tone of voice, and intensity of lyrics. This will support the client in understanding how impactful the suicidal event was to them. The clinician should encourage the client to explore their physical responses during the recording and playback of the recording.
For the main event sessions, the clinician will use lyric writing for analyzing and exploring the client’s feelings, triggers, and coping mechanisms pertaining to the client’s personal suicide process. The lyric writing exercises for these sessions should be recorded and reviewed in the following session. Supporting the client in understanding triggers and developing insight into their own suicide process will help the client identify times in that process to seek help. According to Deisenhammer (2009), individuals that have a suicide process of 10 minutes or more have an opportunity to seek help before they engage in self-injurious behaviors [74]. Clinicians should focus on safety opportunities during the client’s suicide process.
Clinicians should also explore barriers to long-term safety. An ongoing discussion on how effective the client’s safety action plan is imperative for maintaining an effective plan. The clinician will ask the client to report at least one more action of safety that they will incorporate after each main event session. If the client has a history of suicide attempts, the client should identify someone close by or someone that they can call if they begin to have suicidal ideations. During these sessions, the clinician should reiterate to the client the use of suicide hotlines and emergency mental health services when necessary.
In the main event sessions, the clinician will give the client time to develop a motivational Hip-Hop playlist for a week. In these sessions, the clinician will not be actively involved with developing the playlist but should provide support to the client. This will support client in developing the autonomy needed to create a motivational Hip-Hop playlist in their daily lives without the clinician.
Cool Down
The cool down includes three sessions that focuses on maintaining stability, understanding how and when to use the developed crisis plan, and understanding available resources. In these sessions, the clinician should support client in their suicide recovery process by developing long-term goals and safety planning. The clinician should focus on processing with client ways to maintain recovery, seek treatment, and increase coping skills.
The cool down sessions focus on ongoing safety of the client. Each session of the cool down should begin with the clinician asking the client to report at least one more action of safety that they will be incorporated after the session. Additionally, the clinician will support the client in developing a plan for the client to contact the clinician if ongoing treatment is needed for this issue when the sessions are completed.
The clinician should encourage a discussion with client about Lil Wayne’s and the client’s suicide recovery. The clinician should focus on the chorus and bridge of ‘Let It All Work Out’ in which Lil Wayne encourages survival and coping with difficult times by sharing “Let it all work out, and it all worked out” [72]. In the chorus and bridge, the prominent themes that emerged from song coding was perseverance, coping skills, encouragement, motivation, religion, and overcoming adversity.
In the cool down sessions, the clinician will use lyric writing for processing the client’s suicide recovery, coping mechanisms, and support systems. The client will perform the lyrics written during the session and process with the clinician the emotions and feelings that arise during the performance. In these sessions, clinicians will continue to explore barriers to long-term safety. The clinician will support a discussion around continuing a positive suicidal recovery.
The client should be able to independently develop a motivational Hip-Hop playlist. In the cool down, the client can elect to text, email, or share their playlist with the clinician. The clinician can process with the client the song topics of the motivational Hip-Hop playlist and its reflection on the client’s mental state.
Table 1. A Theoretical Intervention Model for Using Hip-Hop Therapy for Suicide Treatment for Black Males Outline
| Intervention Session Description | Number of Sessions | Song Verse to Focus on | Safety Focus | Activities |
| Warm-Up - Helping clients develop a narrative of the client’s suicide experience |
Two to three sessions (based on necessity) | First verse | - Developing a playlist with the clinician support - Reviewing effectiveness of the playlist |
- Creating a song or poem about suicide experience - Listening to Hip-Hop song, watching video, and reviewing song lyrics -Performing the song/ poem written by the client with video/audio recording |
| Main Event - Identifying the client’s stage of acceptance -Reviewing and analyzing the client’s suicidal experience - Identifying safety opportunities in the client suicide process |
Three to four sessions (based on necessity) | Third verse | - Exploring barriers to long-term safety - Fostering the client’s autonomy with playlist development -Developing crisis plan - Reporting at least one action of safety for plan by the client in each session |
-Reviewing interviews of personal stories of the suicide survival -Reviewing the video/audio recording of the client’s song performing |
| Cool Down - Focusing on maintaining stability, understanding how and when to use the developed crisis plan, and understanding available resources -Termination of the client |
Three sessions | Chorus and Bridge | - Electing to text, email, or share their playlist with the clinician by the client -Processing with the client the song topics of the playlist |
- Using lyric writing for processing the client’s suicide recovery, coping skills, and support systems - Processing emotions and feelings that arise during the performance of song/poem written by the client |
Discussion
Critics of Hip-Hop music have focused on some of the negative content, ignoring the healing properties of this music. This criticism is contrary to the intent of Hip-Hop music, as it was developed to help a culture heal. Hip-Hop Therapy embraces the cultural benefits of Hip-Hop culture in mental health treatment. It is essential that culturally sensitive interventions are developed and implemented to address the mental health needs in young Black men. Similar interventions to the model discussed in this paper are needed.
Black men avoid mental health treatment by using and seeking culturally acceptable ways to cope with mental illness and suicidal thoughts. Short-term treatment with the ability to reach out for support may benefit this population, just as in the model discussed in this paper. This model gives clients the autonomy to seek treatment on a short-term basis and as needed, which can reduce the stigma of mental health treatment and incorporate flexibility to the treatment process for young Black men.
Limitations of the Study
Hip-Hop Therapy is not a widely used intervention, and research on this topic is not extensive. The limitation of this study is that it does not use actual participants in a therapeutic intervention, which does not provide the client’s perspective. This study uses one song from one Hip-Hop artist, as an example, for a therapeutic intervention in Hip-Hop Therapy. Understanding the client’s experience can provide a more robust interpretation of the therapeutic model presented.
Conclusion
According to Levy et al. (2018), the youth and adults engaged in Hip-Hop culture represent a population that face multiple barriers to accessing mental health treatment and often deal with ongoing emotional distress and trauma with limited resources and treatment options [75]. Developing Hip-Hop Therapy interventions with sensible emotional support can begin the culturally sensitive process of the clinicians engaging young Black men [76]. Hip-Hop Therapy can support young Black men in developing and maintaining positive coping skills and building trust in mental health treatment.
Traditional treatment models have proven to be less effective and unreliable than non-traditional treatment models such as Hip-Hop Therapy. The development of culturally engaging treatment models for young Black men would likely trigger increased engagement in mental health treatment by this population. It is essential that more culturally sensitive models are developed to support the emotional needs of young Black men. Young Black men need a treatment that is affirming, fosters resiliency, and enhances positive coping skills.
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[35] Levy I, Keum B. Hip-hop emotional exploration in men. Journal of Poetry Therapy. 2014; 27 (4): 217–223. doi.org/10.1080/08893675.2014.949528
[36] Chang J. Can’t Stop Won’t Stop: A History of the Hip-Hop Generation. 2005. New York: St. Martin’s Press.
[37] Tyson E. Rap Music in Social Work Practice with African American and Latino Youth: A Conceptual Model with Practical Applications. Journal of Human Behavior in the Social Environment. 2004; 8 (4): 1–21. doi.org/10.1300/J137 v08n04_01
[38] Levy I., Emdin C, Adjapong E. Lyric writing as an emotion processing intervention for school counselors: Hip-Hop Spoken Word Therapy and Motivational Interviewing. Journal of Poetry Therapy. 2021; 35 (2). DOI: 10.1080/08893675.2021.2004372
[39] Tyson E. Hip hop therapy: An exploratory study of a rap music intervention with at-risk and delinquent youth. Journal of Poetry Therapy. 2002; 15: 131–144.
[40] Kobin C, Tyson E. Thematic analysis of hip-hop music: Can hip-hop in therapy facilitate empathic connections when working with clients in urban settings?. The Arts in Psychotherapy. 2006; 33 (4): 343–356. doi.org/10.1016/j.aip. 2006.05.001
[41] Levy I. Hip hop and spoken word therapy with urban youth. Journal of Poetry Therapy. 2012; 25 (4): 219–224. doi.org/10.1080/08893675.2012.736182
[42] Tyson E. Rap-music Attitude and Perception Scale: A Validation Study. Research on Social Work Practice. 2006; 16 (2): 211–223. doi.org/10.1177/1049731505281447
[43] Williams J. Hip-Hop Turntablism, Creativity and Collaboration by Sophy Smith, and: Groove Music: The Art and Culture of the Hip-Hop DJ by Mark Katz (review). Music & Letters. 2013; 94 (3): 554–557. doi.org/10.1093/ml/gct091
[44] Hausig A. Therapeutic uses of rap and hip-hop. Music Therapy Perspectives. 2012; 30 (2): 204.
[45] Maanmieli K, Ihanus J. Therapeutic metaphors and personal meanings in group poetry therapy for people with schizophrenia. Journal of Poetry Therapy. 2021; 34 (4): 213–222. doi.org/10.1080/08893675.2021.1951900
[46] Furman R. The role of the question in writing the self: implications for poetry therapy. Journal of Poetry Therapy. 2020; 33 (3): 194–202. doi.org/10.1080/08893675.2020. 1776973
[47] Mazza N, Hayton C. Poetry therapy: An investigation of a multidimensional clinical model. The Arts in Psychotherapy. 2013; 40: 53–60.
[48] Olson-McBride L, Page T. Song to Self: Promoting a Therapeutic Dialogue with High-Risk Youths Through Poetry and Popular Music. Social Work with Groups. 2012; 35 (2): 124–137. doi.org/10.1080/01609513.2011.603117
[49] Dubrasky D, Sorensen S, Donovan A, Corser G. “Discovering inner strengths”: a co-facilitative poetry therapy curriculum for groups. Journal of Poetry Therapy. 2019; 32 (1): 1–10. doi.org/10.1080/08893675.2019.1548924
[50] Longo P. Poetry therapy: theory and practice (2nd edition). Journal of Poetry Therapy. 2017, 30 (2): 129–132. doi.org/10.1080/08893675.2017.1303967
[51] Love B. Complex personhood of hip hop & the sensibilities of the culture that Fosters knowledge of self & self-determination. Equity & Excellence in Education. 2016; 49 (4): 414–427. doi.org/10.1080/10665684.2016.1227223
[52] Stip E, Östlundh L, Aziz K. Bibliotherapy: Reading OVID During COVID. Frontiers in Psychiatry. 2020; 11: 567539. doi.org/10.3389/fpsyt.2020.567539
[53] Eddy C, Herman K, Huang F, Reinke W. Evaluation of a bibliotherapy-based stress intervention for teachers. Teaching and Teacher Education. 2022; 109: 103543. doi.org/10.1016/ j.tate.2021.103543
[54] Jack S, Ronan K. Bibliotherapy: Practice and Research. School Psychology International. 2008; 29 (2): 161–182. doi.org/10.1177/0143034308090058
[55] Urbanek A, Kamiński A, Chatzipentidis K. Original hip-hop lyrics in pedagogical therapy of adolescents with socialization deficits. Journal of Poetry Therapy. 2021; 34 (2): 118-130. DOI: 10.1080/08893675.2021.1899633
[56] Newman M. Rap as literacy: A genre analysis of Hip-Hop ciphers. Interdisciplinary Journal for the Study of Discourse. 2005; 25 (3): 399–436. doi.org/10.1515/text.2005.25.3.399
[57] Watkins P, Caines R. Cyphers: Hip-Hop and Improvisation. Critical Studies in Improvisation. 2015; 10 (1): doi.org/10.21083/csieci.v10i1.3518
[58] Lee J. Escaping Embarrassment: Face-work in the Rap Cipher. Social Psychology Quarterly. 2009; 72 (4): 306–324. doi.org/10.1177/019027250907200405
[59] Levy I, Lemberger-Truelove M. Supporting Practicing School Counselor’s Skill Development: A Hip Hop and Spoken Word Professional Development Intervention. The Journal of Counselor Preparation and Supervision. 2021; 14 (1).
[60] Levy I. Hip-Hop and Spoken Word Therapy in urban school counseling. Professional School Counseling. 2019; 22 (1b): 1–11. doi.org/10.1177/2156759X19834436
[61] Levy I. “Real Recognize Real”: Hip‐Hop Spoken Word Therapy and Humanistic Practice. Journal of Humanistic Counseling. 2020; 59 (1): 38–53. doi.org/10.1002/johc.12128
[62] Levy I, Hess C, Elber A, Hayden L. A Community-Based Intervention: A Hip Hop Framework Toward Decolonizing Counseling Spaces. Journal of Creativity in Mental Health. 2021; 16 (2): 212–230. doi.org/10.1080/15401383.2020. 1762816
[63] Gysin-Maillart A, Soravia L, Schwab S. Attempted suicide short intervention program influences coping among patients with a history of attempted suicide. Journal of Affective Disorders. 2020; 264: 393–399. doi.org/10.1016/j.jad.2019. 11.059
[64] Conner K, Kearns J, Esposito E, Pizzarello E, Wiegand T, Britton P, et al. Pilot RCT of the Attempted Suicide Short Intervention Program (ASSIP) adapted for rapid delivery during hospitalization to adult suicide attempt patients with substance use problems. General Hospital Psychiatry. 2021; 72: 66–72. doi.org/10.1016/j.genhosppsych.2021.07.002
[65] Merriam S, Tisdell E. Qualitative research: A guide to design and implementation (4th ed.) 2015. Jossey-Bass: San Francisco, CA.
[66] Wittekind E. Lil Wayne: Grammy-winning hip-hop artist. 2014. ABDO Publishing Company.
[67] Francis D. “Twitter is Really Therapeutic at Times”: Examination of Black Men’s Twitter Conversations Following Hip-Hop Artist Kid Cudi’s Depression Disclosure. Health Communication. 2021; 36 (4): 448–456. doi.org/10. 1080/10410236.2019.1700436
[68] Fisher, A (Director). Rapper Lil’Wayne; Willie Nelson performs; Los Lonely Boys sit in with Cleto and Cletones (Season 12, Episode 41) [Talk Show]. In J. Kimmel, J. Schrift (Executive Producer), Jimmy Kimmel Live. 2014, March 14. ABC Signature, Jackhole Productions; Disney-ABC Domestic Television.
[69] Acho E. Mental Health Doesn't Discriminate feat. Lil Wayne [Video podcast]. (2021, August 15). Uncomfortable Conversations with Emmanuel Acho. www.youtube.com/ watch?v=H_iKNketUXI&t=107s
[70] Benson O, Gibson S, Boden Z, Owen G. Exhausted without trust and inherent worth: A model of the suicide process based on experiential accounts. Social Science & Medicine. 2016; 163: 126–134. doi.org/10.1016/j.socscimed.2016.06.045
[71] Kattimani S, Sarkar S, Menon V, Muthuramalingam A, Nancy P. Duration of suicide process among suicide attempters and characteristics of those providing window of opportunity for intervention. Journal of Neurosciences in Rural Practice. 2016; 7 (4): 566–570. doi.org/10.4103/0976-3147.185505
[72] Carter D. Tha Carter V [Album] 2018. Young Money Records.
[73] Krause A, North A. Playlists and time perspective. Psychology of Music. 2016; 44 (5): 1209–1218.
[74] Deisenhammer E, Ing C, Strauss R, Kemmler G, Hinterhuber H, Weiss E. The duration of the suicidal process: How much time is left for intervention between consideration and accomplishment of a suicide attempt?. Journal of Clinical Psychiatry. 2009; 70:19-24.
[75] Levy I, Cook A, Emdin C. Remixing the School Counselor’s Tool Kit. Professional School Counseling. 2018; 22 (1). doi.org/10.1177/2156759X18800285
[76] Williams M, Winley J, Causey J. For the Dead Homie: Black Male Rappers, Homicide Survivorship Bereavement, and the Rap Tribute of Nipsey Hussle. Journal of Hip Hop Studies. 2021; 8 (1): 89 – 126. doi.org/10.34718/x4j2-vq30
Critics of Hip-Hop music have focused on some of the negative content, ignoring the healing properties of this music. This criticism is contrary to the intent of Hip-Hop music, as it was developed to help a culture heal. Hip-Hop Therapy embraces the cultural benefits of Hip-Hop culture in mental health treatment. It is essential that culturally sensitive interventions are developed and implemented to address the mental health needs in young Black men. Similar interventions to the model discussed in this paper are needed.
Black men avoid mental health treatment by using and seeking culturally acceptable ways to cope with mental illness and suicidal thoughts. Short-term treatment with the ability to reach out for support may benefit this population, just as in the model discussed in this paper. This model gives clients the autonomy to seek treatment on a short-term basis and as needed, which can reduce the stigma of mental health treatment and incorporate flexibility to the treatment process for young Black men.
Limitations of the Study
Hip-Hop Therapy is not a widely used intervention, and research on this topic is not extensive. The limitation of this study is that it does not use actual participants in a therapeutic intervention, which does not provide the client’s perspective. This study uses one song from one Hip-Hop artist, as an example, for a therapeutic intervention in Hip-Hop Therapy. Understanding the client’s experience can provide a more robust interpretation of the therapeutic model presented.
Conclusion
According to Levy et al. (2018), the youth and adults engaged in Hip-Hop culture represent a population that face multiple barriers to accessing mental health treatment and often deal with ongoing emotional distress and trauma with limited resources and treatment options [75]. Developing Hip-Hop Therapy interventions with sensible emotional support can begin the culturally sensitive process of the clinicians engaging young Black men [76]. Hip-Hop Therapy can support young Black men in developing and maintaining positive coping skills and building trust in mental health treatment.
Traditional treatment models have proven to be less effective and unreliable than non-traditional treatment models such as Hip-Hop Therapy. The development of culturally engaging treatment models for young Black men would likely trigger increased engagement in mental health treatment by this population. It is essential that more culturally sensitive models are developed to support the emotional needs of young Black men. Young Black men need a treatment that is affirming, fosters resiliency, and enhances positive coping skills.
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[41] Levy I. Hip hop and spoken word therapy with urban youth. Journal of Poetry Therapy. 2012; 25 (4): 219–224. doi.org/10.1080/08893675.2012.736182
[42] Tyson E. Rap-music Attitude and Perception Scale: A Validation Study. Research on Social Work Practice. 2006; 16 (2): 211–223. doi.org/10.1177/1049731505281447
[43] Williams J. Hip-Hop Turntablism, Creativity and Collaboration by Sophy Smith, and: Groove Music: The Art and Culture of the Hip-Hop DJ by Mark Katz (review). Music & Letters. 2013; 94 (3): 554–557. doi.org/10.1093/ml/gct091
[44] Hausig A. Therapeutic uses of rap and hip-hop. Music Therapy Perspectives. 2012; 30 (2): 204.
[45] Maanmieli K, Ihanus J. Therapeutic metaphors and personal meanings in group poetry therapy for people with schizophrenia. Journal of Poetry Therapy. 2021; 34 (4): 213–222. doi.org/10.1080/08893675.2021.1951900
[46] Furman R. The role of the question in writing the self: implications for poetry therapy. Journal of Poetry Therapy. 2020; 33 (3): 194–202. doi.org/10.1080/08893675.2020. 1776973
[47] Mazza N, Hayton C. Poetry therapy: An investigation of a multidimensional clinical model. The Arts in Psychotherapy. 2013; 40: 53–60.
[48] Olson-McBride L, Page T. Song to Self: Promoting a Therapeutic Dialogue with High-Risk Youths Through Poetry and Popular Music. Social Work with Groups. 2012; 35 (2): 124–137. doi.org/10.1080/01609513.2011.603117
[49] Dubrasky D, Sorensen S, Donovan A, Corser G. “Discovering inner strengths”: a co-facilitative poetry therapy curriculum for groups. Journal of Poetry Therapy. 2019; 32 (1): 1–10. doi.org/10.1080/08893675.2019.1548924
[50] Longo P. Poetry therapy: theory and practice (2nd edition). Journal of Poetry Therapy. 2017, 30 (2): 129–132. doi.org/10.1080/08893675.2017.1303967
[51] Love B. Complex personhood of hip hop & the sensibilities of the culture that Fosters knowledge of self & self-determination. Equity & Excellence in Education. 2016; 49 (4): 414–427. doi.org/10.1080/10665684.2016.1227223
[52] Stip E, Östlundh L, Aziz K. Bibliotherapy: Reading OVID During COVID. Frontiers in Psychiatry. 2020; 11: 567539. doi.org/10.3389/fpsyt.2020.567539
[53] Eddy C, Herman K, Huang F, Reinke W. Evaluation of a bibliotherapy-based stress intervention for teachers. Teaching and Teacher Education. 2022; 109: 103543. doi.org/10.1016/ j.tate.2021.103543
[54] Jack S, Ronan K. Bibliotherapy: Practice and Research. School Psychology International. 2008; 29 (2): 161–182. doi.org/10.1177/0143034308090058
[55] Urbanek A, Kamiński A, Chatzipentidis K. Original hip-hop lyrics in pedagogical therapy of adolescents with socialization deficits. Journal of Poetry Therapy. 2021; 34 (2): 118-130. DOI: 10.1080/08893675.2021.1899633
[56] Newman M. Rap as literacy: A genre analysis of Hip-Hop ciphers. Interdisciplinary Journal for the Study of Discourse. 2005; 25 (3): 399–436. doi.org/10.1515/text.2005.25.3.399
[57] Watkins P, Caines R. Cyphers: Hip-Hop and Improvisation. Critical Studies in Improvisation. 2015; 10 (1): doi.org/10.21083/csieci.v10i1.3518
[58] Lee J. Escaping Embarrassment: Face-work in the Rap Cipher. Social Psychology Quarterly. 2009; 72 (4): 306–324. doi.org/10.1177/019027250907200405
[59] Levy I, Lemberger-Truelove M. Supporting Practicing School Counselor’s Skill Development: A Hip Hop and Spoken Word Professional Development Intervention. The Journal of Counselor Preparation and Supervision. 2021; 14 (1).
[60] Levy I. Hip-Hop and Spoken Word Therapy in urban school counseling. Professional School Counseling. 2019; 22 (1b): 1–11. doi.org/10.1177/2156759X19834436
[61] Levy I. “Real Recognize Real”: Hip‐Hop Spoken Word Therapy and Humanistic Practice. Journal of Humanistic Counseling. 2020; 59 (1): 38–53. doi.org/10.1002/johc.12128
[62] Levy I, Hess C, Elber A, Hayden L. A Community-Based Intervention: A Hip Hop Framework Toward Decolonizing Counseling Spaces. Journal of Creativity in Mental Health. 2021; 16 (2): 212–230. doi.org/10.1080/15401383.2020. 1762816
[63] Gysin-Maillart A, Soravia L, Schwab S. Attempted suicide short intervention program influences coping among patients with a history of attempted suicide. Journal of Affective Disorders. 2020; 264: 393–399. doi.org/10.1016/j.jad.2019. 11.059
[64] Conner K, Kearns J, Esposito E, Pizzarello E, Wiegand T, Britton P, et al. Pilot RCT of the Attempted Suicide Short Intervention Program (ASSIP) adapted for rapid delivery during hospitalization to adult suicide attempt patients with substance use problems. General Hospital Psychiatry. 2021; 72: 66–72. doi.org/10.1016/j.genhosppsych.2021.07.002
[65] Merriam S, Tisdell E. Qualitative research: A guide to design and implementation (4th ed.) 2015. Jossey-Bass: San Francisco, CA.
[66] Wittekind E. Lil Wayne: Grammy-winning hip-hop artist. 2014. ABDO Publishing Company.
[67] Francis D. “Twitter is Really Therapeutic at Times”: Examination of Black Men’s Twitter Conversations Following Hip-Hop Artist Kid Cudi’s Depression Disclosure. Health Communication. 2021; 36 (4): 448–456. doi.org/10. 1080/10410236.2019.1700436
[68] Fisher, A (Director). Rapper Lil’Wayne; Willie Nelson performs; Los Lonely Boys sit in with Cleto and Cletones (Season 12, Episode 41) [Talk Show]. In J. Kimmel, J. Schrift (Executive Producer), Jimmy Kimmel Live. 2014, March 14. ABC Signature, Jackhole Productions; Disney-ABC Domestic Television.
[69] Acho E. Mental Health Doesn't Discriminate feat. Lil Wayne [Video podcast]. (2021, August 15). Uncomfortable Conversations with Emmanuel Acho. www.youtube.com/ watch?v=H_iKNketUXI&t=107s
[70] Benson O, Gibson S, Boden Z, Owen G. Exhausted without trust and inherent worth: A model of the suicide process based on experiential accounts. Social Science & Medicine. 2016; 163: 126–134. doi.org/10.1016/j.socscimed.2016.06.045
[71] Kattimani S, Sarkar S, Menon V, Muthuramalingam A, Nancy P. Duration of suicide process among suicide attempters and characteristics of those providing window of opportunity for intervention. Journal of Neurosciences in Rural Practice. 2016; 7 (4): 566–570. doi.org/10.4103/0976-3147.185505
[72] Carter D. Tha Carter V [Album] 2018. Young Money Records.
[73] Krause A, North A. Playlists and time perspective. Psychology of Music. 2016; 44 (5): 1209–1218.
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Received: 2023/10/31 | Accepted: 2023/03/1 | Published: 2023/03/1
Received: 2023/10/31 | Accepted: 2023/03/1 | Published: 2023/03/1
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