Music therapy, adolescence, and anorexia nervosa: An integrative songwriting protocol to support self-narration and emotional expression

During the acute phase of anorexia nervosa (AN), when adolescents require full-time hospitalization, opportunities for psychotherapy are often limited by the absence of an explicitly expressed need for psychological support, the predominance of symptom-focused concerns, and the cognitive and emotional consequences of malnutrition. These factors may weaken the therapeutic alliance, reduce motivation for change, and hinder psychological engagement. This exploratory multiple-case study aimed to develop and clinically illustrate the SDiR 2 (Songwriting, Development of Emotional and Cognitive Identification and Expression, Audio Recording, and Clinical Research) protocol, a form of “Narrative Music (Psycho)therapy”, an original narrative music therapy approach designed for adolescents hospitalized with AN. The protocol was implemented with five adolescent girls at different stages of hospitalization (full-time and day hospital), at different points in their psychotherapeutic trajectory (before, during, or after psychotherapy), and over varying durations (1 to 10 sessions). Across 25 sessions, participants produced 32 original songs. Clinical examination of the lyrics and therapeutic material focuses on the experience of AN, identity construction, interpersonal relationships, emotional expression, and self-narration. The cases suggest that SDiR 2 may facilitate emotional expression, support continuity of the Self, and promote therapeutic engagement by combining songwriting, live musical improvisation, recording, and self-listening within a flexible clinical framework. Despite methodological limitations related to case heterogeneity and variations in protocol implementation (exploratory multiple-case design, clinician-researcher bias, limited generalizability, heterogeneous application of the protocol, and limited qualitative analytic procedures), the findings suggest that the SDiR² protocol may hold clinical value and warrant further qualitative and mixed-methods research to evaluate and refine the protocol.