ABOUT THE AUTHOR

Dr Kay Capaldi () is a BACP-registered integrative psychotherapist, researcher, and university lecturer with extensive experience supporting performers. She is listed in the BAPAM Directory and specialises in the self-relationship, negative self-treatment (NTS), and social anxiety—areas she continues to explore through both research and clinical practice.

Drawing on these insights, Dr Capaldi developed the Self-Relationship Training® programme, which helps people develop awareness of unhelpful patterns, cultivate self-compassion, and build a healthier, more supportive relationship with themselves.

In this guest blog for BAPAM, Dr Capaldi examines the links between performance anxiety, social anxiety, and the self-relationship, and explains how these insights have shaped the Self-Relationship Training® programme.

BAPAM readers are invited to join a pilot weekend of the programme in central/South West London—an opportunity to experience the approach first-hand, provide feedback, and help shape its future. The pilot will be offered at a reduced rate of £95, with a Pay-What-You-Can option available for those in the performing arts community who may need additional support.

Participants will be invited to share their feedback, which will directly inform the next stage of the programme’s development. The exact date is yet to be confirmed, with the pilot planned for early 2026.

This programme is suitable for anyone experiencing challenges in their self-relationship, such as self-criticism, low self-worth, or harsh self-judgement. Places are limited, and participants will be selected based on suitability criteria. If you are unsure whether this pilot is right for you, please contact Dr Capaldi for a confidential discussion.

To register your interest or find out more:
Email: kay@drkaycapaldi.com

Please note that the Self-Relationship Training® programme and pilot are organised independently of BAPAM.

Introduction: Typical Nerves or a Clinical Concern?

Performance anxiety – often referred to as stage fright – sits on a spectrum. Whether it is a clinical concern or simply part of the typical experience of performing depends on its intensity, frequency, and impact on everyday life.

For many performers, some level of anxiety is expected. It often shows up as nerves, butterflies, or physical changes such as increased heart rate, sweating, or trembling before or during performance. Usually situational and mild to moderate, this form of anxiety rarely prevents performance. In fact, it can be adaptive, sharpening focus and enhancing preparation.

However, performance anxiety can escalate into a clinical condition when nervousness becomes intense, persistent, and disruptive. In such cases, it may meet the criteria for a formal anxiety difficulty, most often classified as the performance-only subtype of Social Anxiety Disorder (SAD). Severe physical symptoms such as trembling, nausea, or panic attacks are common, and avoidance of auditions, performances, or evaluative situations may follow. While performance anxiety and SAD overlap, they are not identical. The American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (known as the DSM-5) recognises a performance-only specifier for SAD, where anxiety is confined to public speaking or performance contexts, reflecting both the shared mechanisms and the distinct features of performance anxiety (American Psychiatric Association, 2013).

Differentiating Typical and Clinical Anxiety

Performance anxiety can be understood by looking at its context, intensity, persistence, and impact (Hofmann et al., 2004):

• Context and triggers: Typical anxiety is situational and proportionate; clinical anxiety may arise even in minor or imagined performance scenarios.
• Intensity and symptoms: Typical nerves are mild to moderate; clinical anxiety can provoke severe, panic-like symptoms.
• Behavioural impact: Typical anxiety allows performance with coping strategies; clinical anxiety can lead to avoidance and lost opportunities.
• Duration and persistence: Clinical anxiety persists across many performances, often lasting six months or more.
• Cognitive patterns: Typical worry is realistic; clinical anxiety involves excessive, intrusive thoughts disproportionate to actual risks.
• Functional impairment: Typical nerves have minimal impact on life or career; clinical anxiety can significantly disrupt functioning.

Shared Mechanisms in Social and Performance Anxiety

Both SAD and performance anxiety share underlying mechanisms: fear of negative evaluation, self-focused attention, and heightened physiological arousal such as a rapid heartbeat and trembling (Hofmann et al., 2004).

These similarities explain why treatments developed for SAD – including cognitive-behavioural therapy (CBT), exposure-based interventions, and emotion-focused therapy (EFT; Elliott & Shahar, 2017) – are also effective for performance anxiety (Hofmann & Smits, 2008).

Key Differences

SAD tends to appear across a wide range of social situations, while performance anxiety is more specific to contexts where identity and ability feel on the line (Niering et al., 2023). Both are rooted in heightened self-consciousness and fear of judgement, underpinned by self-critical beliefs and a tendency to interpret situations as threatening.

Importantly, even socially confident individuals can experience performance anxiety. This is often seen in situations such as public speaking, which may be viewed as a specific form of social anxiety characterised by fear of negative evaluation (Bodie, 2010). Clarifying these distinctions enables clinicians to determine whether performance anxiety occurs as part of a broader diagnosis of social anxiety disorder (SAD) or represents a separate concern requiring targeted intervention.

Beyond Symptoms: The Self-Relationship

Research shows that both SAD and performance anxiety are maintained not only by external fears of judgement but also by how individuals relate to themselves in stressful situations. Many worry about revealing perceived flaws or inadequacies, reinforcing avoidance and distress (Moscovitch, 2009).

Traits such as self-criticism, perfectionism, and internalised shame intensify physiological arousal and avoidance, creating a self-perpetuating cycle (Capaldi & Elliott, 2023). Internal self-criticism, rather than fear of external evaluation alone, often plays the central role in maintaining anxiety.

Approaches that focus on the self-relationship (Capaldi, 2024) complement standard treatments by fostering self-compassion, non-judgemental awareness, and supportive self-talk. This shift helps to reduce anxiety in the moment and build resilience over the long term.

The Self-Relationship: An Internal Mirror

The self-relationship reflects how we think, feel, and behave towards ourselves, encompassing our beliefs about our abilities, emotions, and responses under pressure. This relationship can take several forms, including:

• Inner critic – attacking, rejecting, shaming, or comparing ourselves to others.
• Neglectful self – overlooking our physical, emotional or psychological needs.
• Controlling self – striving for perfection, pressuring ourselves, or overly monitoring our thoughts and actions.
• Isolating self – withdrawing to avoid vulnerability.
• Compassionate self – nurturing, validating, respecting, and accepting ourselves.

In social and performance anxiety, the inner critic often dominates, predicting failure and fuelling fears of inadequacy. Capaldi and Elliott (2023) describe this as Negative Treatment of Self (NTS), a pattern of harsh self-derogation, rigid perfectionism, self-neglect and withdrawal. These patterns often originate in earlier relational experiences where emotional safety was lacking.

A Model for Healing: Self-Relationship Training®

Self-Relationship Training® (SRT), developed by Dr Kay Capaldi, offers a structured framework for rebuilding this sense of internal safety and addressing unhelpful self-relationship dynamics:

1. Recognise: Identify patterns of negative self-treatment such as self-criticism or neglect.
2. Externalise and process: Use reflective and experiential methods to bring patterns and emotions such as shame, fear, or sadness into awareness.
3. Develop a compassionate inner voice: Practise self-soothing, boundary-setting, and nurturing responses to balance the inner critic.
4. Integrate: Apply journalling, mindfulness, and other practices to embed awareness and encourage emotional growth.

By shifting from adversarial self-monitoring and criticism to supportive self-regulation, SRT aims to address the root of anxiety rather than just its symptoms.

Why This Matters

SRT and related approaches offer more than mere symptom relief; they promote lasting change by transforming the performer’s relationship with themselves. Through this process, individuals are able to:

• Rely less on external validation for their sense of self-worth and confidence, cultivating an internal sense of assurance.
• Strengthen resilience to rejection, whether it is real or perceived, allowing setbacks to be met with greater composure.
• Develop a secure, supportive inner foundation, creating a stable base from which to thrive both personally and professionally.

By shifting the focus inward, these approaches equip performers with tools that extend far beyond performance contexts, enhancing overall well-being and self-reliance.

Conclusion: You Deserve to Be on Your Own Side

Recovery from clinical anxiety is not simply about acquiring coping techniques – it is about cultivating a deeper sense of allegiance to yourself. When the inner critic is met with compassion, acceptance, and clarity, its intensity begins to soften. This inward journey is less about eliminating nerves entirely and more about reshaping your relationship with them. In doing so, performers discover a path to resilience, allowing them to move forward with greater confidence, authenticity, and ease.

Acknowledgement: AI-based tools (OpenAI, 2023) were used to support background research and language editing. All interpretations, analysis, and conclusions in this blog remain the author’s own.

References

• American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). American Psychiatric Publishing.
• Bodie, G. D. (2010). A racing heart, rattling knees, and ruminative thoughts: Defining, explaining, and treating public speaking anxiety. Communication Education, 59(1), 70–105.
• Capaldi, K. (2024). The power of Self-Relationship Training [Blog series].
• Capaldi, K., & Elliott, R. (2023). Negative treatment of self in socially anxious clients. Person-Centered and Experiential Psychotherapies, 23(1), 101–121.
• Elliott, R., & Shahar, B. (2017). Emotion-focused therapy for social anxiety (EFT-SA). Person-Centered & Experiential Psychotherapies, 16(2), 140–158.
• Hofmann, S. G., Heinrichs, N., & Moscovitch, D. A. (2004). The nature and expression of social phobia: Toward a new classification. Clinical Psychology Review, 24(7), 769–797.
• Hofmann, S. G., & Smits, J. A. J. (2008). Cognitive-behavioural therapy for adult anxiety disorders: A meta-analysis of randomised placebo-controlled trials. Journal of Clinical Psychiatry, 69(4), 621–632.
• Moscovitch, D. A. (2009). What is the core fear in social phobia? A new model to facilitate individualised case conceptualisation and treatment. Cognitive and Behavioral Practice, 16(2), 123–134.
• Niering, M., Monsberger, T., Seifert, J., & Muehlbauer, T. (2023). Effects of psychological interventions on performance anxiety in performing artists and athletes: A systematic review with meta-analysis. Behavioural Sciences, 13, 910.
• OpenAI. (2023). ChatGPT (GPT-5) [Large language model]. Used for background research and language editing.

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When I sat down to write this blog about men’s mental health in the performing arts, I spent far too long searching for a clever angle, something new, or interesting to say. Yet, I kept circling back to the same familiar themes: low self-esteem, addiction, violence, and the ongoing uncertainty about what it even means to be a man today.

These issues are well-known, but they persist because they continue to shape the emotional landscape of many men, that I support.

This morning, on International Men’s Day, I heard Tim Stanley’s, “Thought for the Day” on the radio. He admitted he was “very suspicious” of the concept of even having such a day. He also pointed out that many men remain resistant to therapy and that the self-pitying man, can be almost as unattractive, as the muscle-bound man shouting at us on social media to drink protein shakes.

That line captured my attention, because it reflects two extremes that countless men feel caught between.

As a performance psychologist, my work is centred on understanding each person I meet as an individual. Gender does not define the relationship, humanity does. My aim, is to understand the unique mind in front of me, how it works, where it struggles and how to help that person perform at their best, while remaining grounded and healthy.

And it suddenly became obvious to me: perhaps the real tension many men feel lies in the polarisation itself. On one side, the “self-pitying man” who seeks help. On the other, the hyper-masculine figure selling strength, certainty and protein drinks.

In a world that amplifies these extremes, it’s easy to forget something simple and profoundly grounding:

You are a human being first.

Before performance.  Before masculinity.  Before expectation.  Before comparison.

Recognising this is a powerful starting point. Being human means having needs, vulnerabilities and limits. And understanding this allows men to approach themselves with self-compassion, rather than criticism.

Visibility Matters: Why Performers Opening Up Helps Everyone

Many leading performers, such as Lewis Capaldi, have begun openly sharing their mental health experiences with fans and the wider world. Their honesty is reshaping the conversation.

“Therapy has been such a massive part of my… last two years, a massive part of the reason that I’m able to be a musician again.”
— Lewis Capaldi (The Scotsman)

This openness is invaluable, not only for other performers, but for people in all walks of life. It allows audiences to vicariously experience the reality behind the curtain: the struggle, the seeking of help, the gradual rebuilding and ultimately the return to performing with renewed strength.

Celebrities who speak openly about their mental health journey, use their platform to reach millions. They can help the public understand that mental illness is common, treatable and nothing to be ashamed of. Importantly, they encourage those who are struggling to seek help, rather than suffer in silence.

Returning to Our Humanity

When performers and men more broadly feel torn between cultural caricatures of masculinity, returning to the simple truth of our shared humanity can be deeply grounding.

• Being human means needing support.
• It means learning to show yourself self-compassion.
• And it means recognising that asking for help is not an act of self-pity, but an act of courage.

Here are 3 tools you could do today to build your self compassion:

1. Approach yourself as you would a friend

During challenging times, pause and ask:

1. What supportive words would I say to my friend in this situation?
2. Would I use the same tone I’m using on myself right now?

This instantly shifts your inner dialogue from criticism to support, which reduces stress and improves focus.

2. Build a 30 second refocus plan after mistakes

Self-compassion is not only emotional, it’s also behavioural.  If you make a mistake rehearsing or performing, have a routine to help you get back into your performance.  A simple reset could include:

1. One deep, slow breath
2. Rolling and relaxing your shoulders
3. Saying a grounding phrase like ‘focus’ ‘calm’, or ‘ready’

This tiny habit trains your nervous system to recover faster and with more kindness.

3. It’s important to separate your self-worth from your performance.
   Your value as a person is not defined by how well you play, act, dance, or sing. Instead, anchor your self-worth in your values and in all the areas of your life, your relationships, your character, your efforts, and the way you show up as a human being, not just as a performer.

November being Men’s Mental Health Awareness month, perhaps the most meaningful starting is, remembering that you are allowed to be human.

The post Men’s Mental Health in the Performing Arts: Remembering Our Humanity appeared first on BAPAM.

“I’ve always approached things with hunger and just enough fear. Plenty of confidence, you know, but just enough fear to work extra hard.” Queen Latifah

This quote from Queen Latifah brilliantly highlights the essence of what is needed to prepare for your next audition.  It captures the hunger, the desire to do well and celebrates that fear is not something to be afraid of, but something you can use to help you work hard and channel it into delivering your best performance, when you need to.

Mindset Matters: Confidence Is a Skill

Your mindset can make, or break your audition. Staying composed under pressure and maintaining a healthy perspective is key. Confidence isn’t something you’re born with, it’s something you build. Performance psychology teaches us that confidence stems from self-efficacy, your belief in your ability to succeed in specific situations.

Confidence is quiet. It’s not arrogance. It’s the calm inner belief that you’re prepared, capable, and worthy of the opportunity. When you walk into the audition room with that mindset, you don’t just perform, you perform at your best.

Shift Your Mindset: From Proving to Growing

Auditions often feel like pressure tests of whether you’re “good enough.” But adopting a growth mindset, one that embraces the fact that skills and talent can be developed through effort, can transform your approach and reduce anxiety.

Try These Growth Mindset Habits:

• Embrace challenges: See auditions as learning opportunities, not final judgments.
• Learn from mistakes: Treat errors as feedback, not failure.  Review and learn.
• Celebrate progress: Every small success builds mastery and confidence.
• Stay curious: Keep exploring new techniques, styles, and roles

Control What You Can — Let Go of the Rest

Uncertainty fuels anxiety. As soon as your audition is booked, gather all the practical details you need.  This allows you to focus on your preparation and not be distracted worrying about how things might be.

Prep Checklist:

• Time, date, and location — how long will travel take?
• Format — live, recorded, or self-tape?
• Will it be screened?
• Are there call backs, or multiple rounds?
• What materials do you need?
• What’s the technical setup?
• Who’s on the panel?
• Dress code?
• Food and drink needs?

Focus on what’s within your control, like your preparation, your mindset, your effort. Let go of what’s not, the panel’s opinions, other performers, and final outcomes.

Brainstorm Your Worries

Before your audition, take a moment to check in with yourself. What fears, or thoughts are running through your mind? Common ones include:

• “What if I mess up?”
• “What if I don’t get the role?”
• “Everyone else is better than me.”

Use cognitive restructuring to change these beliefs into more helpful ones, like “I am well prepared and I trust myself to perform at my best”, or “If this one doesn’t work out, another opportunity will come, I’m building momentum.”

Practice Under Pressure: Simulation Training

Rehearse under realistic conditions. If it’s a screened audition, practice with a screen.  It’s amazing how many performers forget to practise in front of a screen and feel overwhelmed in the audition.  Record yourself, or rehearse behind a curtain to simulate the experience.

Wear the clothes you’ll wear. Say what you’ll say to the panel. Record yourself, or perform for a trusted friend. The more familiar the setup, the less intimidating the real thing will feel.

Create Your Pre-Audition Mental Warm-Up

Before you walk into the room, take a few minutes to center yourself:

• Take a couple of deep breaths.
• Visualize a confident, focused performance.
• Repeat affirmations like “I am prepared” and “I bring something unique.”
• Connect to your love of performing and the joy of sharing it.

Make Practice Sessions Count

When you’re busy it is easy to just wing it, in practise sessions. Structure your practice like a training session.

Practice Tips:

• Plan what you want to focus on each session.
• Evaluate what went well, what needs work and points for next session.
• Keep sessions short — 30 to 60 minutes max.
• Warm up and cool down mentally and physically.
• Use a journal, or app to track progress and stay focused.

Channel Your Energy

Some performers find that light exercise, like a run or walk, a couple of hours before an audition helps regulate nerves. Try it in advance and see what works for you.

Post-Audition Reflection

After your audition, take time to review:

• What went well?
• What could be improved?
• What did you learn?  How can you be better prepared next time?

Bonus Tips:

• Record and review your practice sessions.
• Mistakes aren’t catastrophes. They’re information. Learn from them and move forward.
• Seek feedback from trusted friends, mentors, or coaches as you prepare.

“I give myself homework when I have an audition. I give myself goals, and that’s how I check how I’m doing. It’s not about booking the job or not. It’s about what I learned as an actor about that character.” Lupita Nyong’o

Read more posts in this series: Performance Psychology articles by Dr Anna Waters

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A new study led by researcher Jeordie Shenton at the University of Portsmouth is investigating the prevalence and contributory factors of substance use amongst working musicians. As part of the study, people who earn money from playing, creating and/or performing music (either regularly or sporadically) are invited to complete a survey by answering questions about their use of alcohol, nicotine and caffeine products; prescription and/or over-the-counter medicines; and other substances (including recreational drug use). This survey is open internationally to all working musicians, including instrumentalists, vocalists, DJs, composers, songwriters and producers, from any genre or industry.

Participant information and survey:

This study has research ethics committee approval from the University of Portsmouth.

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After nailing your audition and landing a fantastic role, do you ever get that sinking feeling?

That now you have to deliver?

Do you start to think that everyone else would be better at this role than you?  Why did they pick you?  You must have just been lucky this time and soon they will find out that you are not good enough.

Fast forward to the first day of rehearsals … You start to feel like you just don’t fit in, that you don’t deserve to be there in the room with all these other performers, who clearly know what they are doing.  Everyone around you seems to be better than you and confident.  As the first night approaches, you begin to worry about living up to expectations?

Do some, or all of these thoughts resonate with you? If so, they could be your imposter syndrome talking.

Imposter syndrome (IS) is really common, with research suggesting that about 80% of people (Bravata et al., 2020), experience feelings of Imposter Syndrome at some point in their life. It seems to be especially widespread amongst those performing on stage and is something performers are always coming to see me to work on.

What is Imposter Syndrome?

Imposter Syndrome is a pattern of behaviour, rather than a clinical condition and was first coined in the late 1970s.  It exists on a spectrum with some performers having very few experiences of it and others feeling almost crippled by it.  It is often characterised by doubting one’s abilities, downplaying achievements and worrying about being found out as a fraud.

It is most common in very ambitious, high achieving people and especially among those who are prone to perfectionism.  These traits are commonly found in those performing on stage, which could be why it is so prevalent in the world of performing arts.

Imposter syndrome as a double-edged sword

In my work as a performance psychologist, I have noticed that while preparing for a performance, many performers’ patterns of thinking and beliefs align with the patterns of thinking associated with Imposter Syndrome.

Let’s use an example to bring this to life. Imagine you get a call to say you have an audition/important performance in a week’s time.

Would any of these ring true for you around your preparation?

• Aiming for the perfect performance
• Obsessing over minor details
• Expecting consistently flawless performances
• Avoidance of trying new things for fear it won’t be perfect
• Not acknowledging and celebrating success, as always moving on to the next performance

Do any of these resonate with you?

If so, the same things that may be pushing you to be ambitious and successful, may leave you struggling with Imposter Syndrome.

This is because you are aiming for the impossible, leading you to feel like you never achieve what you are striving for.

The thing is, nothing is ever perfect. No one is able to deliver consistently flawless performances.

Confidence

Confidence is built through demonstrating that we can perform, or master something. If you never feel like you are performing successfully because you are constantly striving for perfection, you will not be truly  building your underlying confidence. Your confidence will fluctuate depending on how you feel that day.

Many high-profile performers have opened up about their experiences of Imposter Syndrome including Olivia Coleman, Lupita Nyong’o, David Tennant, Ellie Goulding, Antonio Pappano and Vilde Frang.

Tom Hanks, highlighted how it feels perfectly:

No matter what we’ve done, there comes a point where you think, “How did I get here? When are they going to discover that I am, in fact, a fraud and take everything away from me?”

As we can see, many hugely successful performers still feel worthless despite their success.

For me, it is important to think about how to harness the positive aspects of imposter patterns of thinking and behaviour. To manage them more effectively and so, be able to deliver your best performance.

At the same time, it is imperative as a performer that you build value in yourself, building your self-esteem and your confidence so that even when a performance isn’t perfect, you know that you are where you should be.

Here are a few suggestions you can try to combat Imposter Syndrome:

1. Recognise Imposter Syndrome is happening – and choose to do something about it.

2. Develop a sense of feeling valuable now – just as you are.  This instantly gives you power.

3. Be proud of yourself when you do your best, even if you made a mistake.

4. Reach out to others – making a connection can help manage feelings of isolation.

5. Notice if you are engaging in safety behaviours – Safety behaviours are used consciously, or unconsciously, as we attempt to prevent fears from coming true and to feel more comfortable in situations we are anxious about.  Some common safety behaviours and how to deal with them are:

• Over practice – acknowledge it when it happens and take time to rationally plan your practice and preparation.  Challenge any beliefs around needing to practice more than others.
• Procrastination – notice if you are procrastinating  and explore your motivations for not starting. Do you fear it will not be perfect because you do not know how to practice effectively? Or because the practice will be hard work? Or is it something else entirely?  Be ready to manage the usual distracting thoughts that are likely to pop into your head, before you start to practice. Make things easy on yourself. Have a really easy first step and just get started.

6. Part of the Imposter Syndrome model (Clance & O’Toole, 1988) suggests following a performance, performers can be quick to discount positive feedback. These suggestions can help:

• Celebrate your success. Write it down and make it visible.
• Do a post-performance review after each performance. Note down a couple of things you were happy with, a couple that didn’t go so well and your key learning point to take into your next performance.  Then draw a line under the it and move on, taking confidence from what went well.

7. Accept trust and support from those who truly care about you.

Read more posts in this series: Performance Psychology articles by Dr Anna Waters

References

Bravata, D. M., Watts, S. A., Keefer, A. L., Madhusudhan, D. K., Taylor, K. T., Clark, D. M., Nelson, R. S.,  Cokley, K. O., & Hagg, H. K. (2020). Prevalence, predictors, and treatment of impostor syndrome: A systematic review. Journal of General Internal Medicine, 35(4), 1252–1275

Clance, P. R. and O’Toole, M. A. (1988). The imposter phenomenon: An internal barrier to empowerment and achievement. In E. D. Rothblum and E. Cole (Eds.), Treating Women’s Fear of Failure. New York: Haworth Press.

Dr Anna Waters

With over 20 years expertise supporting the performance and mental health of performing artists and athletes,  has been fortunate to work with prominent classical musicians, opera singers, ballet dancers, recording artists, stand-up comedians and actors. She has enjoyed working with national music conservatories, ballet companies and television companies.

Anna loves drawing on her experience of both the performing arts and sporting worlds to help facilitate her work with her clients. She believes that there are many similarities between both arenas, with performers being talented and ambitious people, whose lives are spent working towards big events. Where each day is filled with training, practice, and preparation for the next big event, where they are required to consistently deliver their best performance under the scrutiny of the world.

With a strong academic background, including a PhD in applied sport psychology, Anna spent seven years working alongside Professor Steve Peters sharing The Chimp Model ideologies. This combined with her sport psychology backgrounds forms foundations to her work.

Anna is a Chartered member and Associate Fellow of the British Psychological Society and is registered as a practitioner with Ģ��tv (BAPAM).

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Janine is a fully qualified integrative psychotherapeutic counsellor providing therapy face-to-face and online to adults and young people over 18 years old. She holds a Masters with Distinction in Integrative Counselling and is a registered member of the British Association of Counselling and Psychotherapy, adhering to their ethical code of conduct. As well as working in private practice, Janine volunteers as a relationship counsellor for Relate Bradford & Leeds and is currently in training as a couples therapist. She is a member of the Music Industry Therapist Collective (MITC) and a registered practitioner for BAPAM. Before training as a psychotherapist, Janine worked in the Music Industry for 20 years. 

Janine Ellis MA, MBACP (Reg)
Psychotherapeutic Counsellor

People working in the music industry are three times more likely to suffer from anxiety and depression than the general population – both of which are highest amongst females, who attribute this to the added pressures of being a woman in the industry (Gross and Musgrave, 2016). In January 2024, as part of a Masters research project in Integrative Counselling, a phenomenological study was undertaken that explored the experiences of therapists working in the music industry with clients who had faced issues relating to institutional or interpersonal sexism or misogyny through their work. The study was idiographic and qualitative in its approach and central to it was looking at therapists’ accounts of how sexism or misogyny came about through their clients’ presentations in the therapy room, alongside therapists’ own perspectives on the issues raised and the approaches, techniques and interventions they used to facilitate change for their clients. Semi-structured interviews were conducted over MS Teams with 3 female and 1 male therapist from differing therapeutic modalities, and the transcripts analysed. The study has provided some necessary implications for future counselling practice in the music industry.

The study by Gross and Musgrave titled Can Music Make You Sick? (2016) and the recent parliamentary report into Misogyny in Music (2024) both pointed to a clear need for more culturally aware and individualised therapeutic approaches to women and other non-dominant people in the music industry. Other recent studies (Visser et al., 2022) have explored how the music community is comprised of a distinct group of individuals with unique needs, challenges, and strengths – characteristics that signal a clear need for tailored and affordable access to therapy. These challenges are amplified further as a woman in the industry, especially as a professional musician or when working for smaller companies who have been reported to lack diversity hiring practices (Newman, 2017; Bennett, 2018).

The aims and contributions of this piece of research were therefore as follows:

• To contribute to industry change regarding mental health and issues regarding sexism.
• To improve practice by considering the usefulness of various approaches and interventions with this client group.
• To liberate and empower through the promotion of feminist counselling practices.
• To generate further research into sexism and misogyny in the music industry from multiple perspectives to aid the development of a more detailed and multifaceted account of issues raised.

The Findings

It is salient to acknowledge that all participants conceded to have experiences of working with clients affected by sexism or misogyny in the music industry in different capacities and to varying degrees. These appeared to be institutional or interpersonal experiences that presented overtly though systemic dimensions and/or interpersonally through relationship issues. These presented themselves covertly through other psychological difficulties, some pre-existing and others exacerbated by the pressure of working in the music industry.

Table 1 – Participant demographics table

Table 2 – Master summary table of themes

Conclusion

The aim of the study was to explore the experiences of music industry therapists working with clients affected by sexism and misogyny looking at how these issues emerge during the therapeutic experience. Furthermore, how this informs the therapeutic approach used. Capturing this process was not easy due to the covert and nuanced nature of issues discussed. Employing a phenomenological approach to examine each participant’s account through a feminist lens also called into question the influence of researcher subjectivity. However, the idiographic approach proved valuable in its ability to capture the voice of each participant, and this was compatible with the feminist approach.

All participants described stress, anxiety and depression as the most common presenting issues for clients. Relationship issues, burnout/exhaustion, eating disorders and self-harm were all reported by half the participants. All participants described their clients as having childhood issues, trauma, a lack of safety in their working environment and the age of the client playing a role in the issues coming up. Sexual assault and misconduct were reported by two participants and racism played a major role in the experiences of participant 4’s clients. The therapeutic approaches were informed by their modalities –integrative, incorporating psychodynamic, creative and intuitive approaches with the person-centred model. Participant 1 spoke highly of acceptance and commitment therapy and moving more towards this approach.  P3’s focus was on the relational and dialectical in his integrative approach whilst participant two was solely person-centred. All participants spoke of the importance of psychoeducation with two emphasising the importance of clinical supervision. The negative feelings associated with the pervasive nature of sexism and misogyny in the music industry was apparent throughout. Admittedly, these findings presented a difficulty knowing the specific reasons for clients’ myriads of issues, yet the covert insidiousness of sexism in the music industry was evident throughout. Their shared expression of anger, sadness and a sense of resignation towards the experiences witnessed in their clients was palpable. This was even more pronounced in participant 4’s accounts of difference and how racism and a lack of safety may manifest, especially for her intersectional clients.

More positive notions of progress regarding these issues and around mental health awareness in the industry were also exhibited. The solutions and initiatives discussed point to the findings of Ficek (2023) who suggests in his study that there is too much emphasis on the negative aspects within musicking research and that the literature pays little attention to the positive feelings associated with a career in music. However, returning to the principal study by Gross and Musgrave into music and mental health (2017), music may be therapeutic but a career in music can be traumatic which this study further illustrates. Therefore, the strength of this research lies in its ability to respond to that previous statement attesting to finding it traumatic whilst also giving a voice to those in the industry who have been under-represented in previous studies to date. Crucially, this study explored what is therapeutically significant when working with clients affected by issues relating to sexism and misogyny, suggesting that more trauma informed, feminist interventions are appropriate for this client group.

Recommendations For Practice

Recommendations for counselling practice within the music industry include wider integration of trauma informed interventions and to integrate feminist therapy techniques such as consciousness raising, social and gender-role analysis, resocialization and social activism (Israeli and Santor, 2000). Industry recommendations echo the bold sentiments of Chappell Roan at this year’s Grammy Awards and signal for stakeholders such as artist management companies, booking agencies, promoters and record labels to invest in feminist, trauma informed mental healthcare for employees and artist rosters. This will create a healthier working environment throughout all sectors of the music industry. The findings from this study will be presented at this year’s BACP Conference in May.

References

Bennett, T. (2018) ‘The whole feminist taking-your-clothes-off-thing’: Negotiating the Critique of Gender Inequality in UK Music Industries. The International Association for the Study of Popular Music, 8(1), pp. 1–18.

Ficek, A. (2023) Professional popular musicians’ experiences of pride, insecurity and pressure in their musicking environment, International Journal of Music, Health, and Wellbeing [Online]. Available from:

Gross, S. A. and Musgrave, G. (2016) Can music make you sick? [Online]. Available from:

Gross, S. A. and Musgrave, G. (2017) Can music make you sick? [Online]. Available from:

Israeli, A. L., and Santor, D. A. (2000) Reviewing effective components of feminist therapy. Counselling Psychology Quarterly, 13(3), pp. 233–247.

Newman, M. (2017) #Metoo’s chilling effect, Billboard, 129(29) December, p. 12.

UK Parliament (2024) Misogyny in music [Online]. Available from: <>

Visser, A., Lee, M., Barringham, T. and Salehi, N. (2022) Out of tune: perceptions of engagement with, and responses to mental health interventions by professional popular musicians – a scoping review, Psychology of Music, 50(3) May, pp. 814-829.

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Forthcoming BAPAM CPD: Psychological Trauma in the Performing Arts 

Our online CPD session on 28 May explores trauma presentations and strategies for supporting clients in the performing arts. BAPAM CPD is suitable for all practitioners working with performing arts clients and patients. Our presenters are expert Clinical Psychologists, Dr Anna Colton, and Dr Sam Thompson, who will cover how trauma is managed within mental health services delivered by BAPAM, as well as the wider context within health provision and the creative sector.

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