From dissociation to embodied memory through voice: music therapists' perspectives on vocal music therapy with women survivors of sexualized trauma.

INTRODUCTION: Sexualized trauma is frequently accompanied by dissociation, disrupted embodiment, and loss of voice. Although somatic and arts-based approaches are increasingly integrated into trauma care, little is known about how music therapists conceptualize and implement voicework with women survivors of sexualized trauma. Drawing on expert interviews, this study explores therapists' perspectives on vocal music therapy as an embodied-relational pathway from dissociation toward integration and embodied memory. METHODOLOGY: A qualitative expert interview study employed reflexive thematic analysis. Seven experienced female music therapists (ages ~36-78) from Israel, the United States, the United Kingdom, and Belgium participated in semi-structured interviews (~120 minutes) conducted via video platform and transcribed verbatim. Analysis focused on embodied, relational, and affective dimensions of voicework. ANALYSIS: Three interrelated themes emerged: (1) Cutting the Dissociation-breath, toning, mirroring, and free-associative singing linked fragmented self-parts and mobilized dissociated affect within co-regulated holding fields. (2) Creating Memories-titrated vocal engagement fostered bodily reconnection and embodied sensory awareness, supported agency, and enabled the formation of returnable experiential traces; voicework also carried risks of evoking traumatic memories, underscoring the need for careful pacing. (3) Changing Positions within the Abuse Constellation-dynamic, vocally enacted movement among victim, perpetrator, bystander, and neglectful caregiver positions illuminated transference-countertransference processes and facilitated shifts from avoidance and symbiosis toward boundaries, including an embodied "no," and individuation. DISCUSSION: The discussion integrates three interrelated processes - cutting dissociation, creating embodied memory traces, and transforming positions within the abuse constellation - as a continuous, non-linear movement. Therapists' vocal presence functioned as a co-regulating holding field supporting clients' embodied reintegration. Vocal music therapy may ease dissociation, support embodied memory formation, and foster relational repair, while also carrying risks of retraumatization - emphasizing the need for specialized training, ethical sensitivity, and client-centered research.