How Hip-Hop Therapy Breaks Traditional Barriers to Healing

I make big money, I drive big cars/
Everybody know me; it's like I'm a movie star/
But late at night, somethin' ain't right/
I feel I'm bein' tailed by the same sucker's headlights/

In 1991, the Geto Boys — a Houston-based rap group of members Willie D., Scarface and Bushwick Bill — released a song called “Mind Playing Tricks on Me.” The track, which helped launch the horrorcore subgenre of hip-hop, portrayed the inner paranoid thoughts of a man caught in the nerve-wracking realities of street life. Although horrorcore and other explicit storytelling formats of rap were criticized for vulgarity, these songs were among the first to bring often tabooed mental health topics to the forefront in hip-hop.

Hip-hop music has been an outlet with a history of detailing emotional and mental strife like PTSD, anxiety and depression since the genre's earliest days. At the root of rap is the pillar of MC’ing, which evokes essential elements of storytelling, spoken word and self-expression. Because of this, rap and the other five principles of hip-hop — aural, physical and visual— make fitting tools for self-reflection and healing. Thanks to the groundbreaking work of a growing community of therapists and social workers, hip-hop is helping to unlock the gates around the often stigmatized world of mental health.

Therapy that Doesn’t Erase Nuance

In 1998, a psychotherapist named Dr. Edgar Tyson coined the term hip-hop therapy (HHT) after spending two years working with at-risk youth at a facility in Miami-Dade, Florida. Dr. Tyson noted a significant impact on the teenagers who attended music therapy sessions that centered on the use of hip-hop when compared to those who attended traditional therapy sessions. In 2002, Dr. Tyson published his findings in the Journal of Poetry Therapy in an article called "Hip Hop Therapy: An Exploratory Study of a Rap Music Intervention with At-Risk and Delinquent Youth."

The process of HHT, as set forth by Dr. Tyson’s study, begins with an open discussion about music therapy and the history of rap music, followed by listening to a selection of songs and discussing them as a group. Dr. Tyson found that the best way to reach the kids in the group therapy sessions, was to use the music that they related to open topics that would otherwise be off-limits. What might have been most radical about Tyson’s study was that, at the time, rap was under fire as a musical abomination that spewed violence, and misogyny and encouraged criminal activity. In the conclusion of his article, Tyson encouraged further study and exploration of HHT despite the overwhelming opinion that rap music was inherently problematic.

“The field of social work and related mental health fields would benefit from a more balanced literature on rap music,” wrote Tyson, “It is possible that when social workers, counselors, and other practitioners shift their paradigm on rap music and utilize this resource as an engagement tool, greater success might be gained with youth.”

Dr. Tyson’s pioneering work prompted a quiet shift in social work, especially for those working with individuals whose lived experiences felt erased from traditional therapy. While pursuing his master's in social work at the Fordham Graduate School of Social Services, J.C. Hall LCSW, EXAT. was mentored by Dr. Tyson and later implemented HHT as a social worker and therapist.

Hall, himself a hip-hop artist, was featured in the Porsche documentary Back to the Tape 3 and Kyle Morrison's award-winning short film, Mott Haven, which follows Hall and a group of students at Mott Haven Transfer School in the South Bronx. The “second chance” school, stands on hallowed ground and was once the site of a technical trade school where Grandmaster Flash cut his teeth on electrical equipment repair. This history serves as the backdrop for Hall's innovative use of expressive therapy.

"Much of my work revolves around processing trauma, which can be a very wide range of experiences from neglect, physical and sexual abuse, incest, incarceration, gang and gun violence, to police brutality and other forms of racial injustice," Hall told Okayplayer. In his work at Mott Haven, Hall utilizes the practice of his model of HHT called HEAT, which stands for Hip-Hop Expressive Arts Therapy. Hall’s work involves listening to and discussing rap lyrics and creating and performing music. Hall says that adding expression and performance elements to HHT expands the impact of therapy by fostering a connection with the community.

The Power of Self-Expression

HEAT also differs from Tyson’s original study by veering away from a more controlled, predetermined list of rap music to analyze. Dr. Tyson suggested using “positive rap,” which his article defines as “rap that depicts solutions and self-protective concepts and skills, as well as inspires to improve unwanted conditions.” Among the music included in Dr. Tyson’s study were “Free” by Goodie Mob, Outkast’s “Babylon” and Tupac’s “Dear Mama.”

But, Hall finds the best outcome in his HEAT practice when he allows his clients or students to introduce their own musical preferences. “I may have never heard the song before and have to be willing to spontaneously interact with the content, asking [them] questions about what is being portrayed and what about it they like or identify with,” said Hall, “In that moment, it is their time to be the expert.”

Because the HEAT method dictates expression, Hall advocated for a studio space at Mott Haven, complete with Macbooks, mixing boards and drum pads. In Mott Haven, Hall’s student group makes beats to the lyrics they write and later perform for their school. In one scene, a student nicknamed Biggie recites a rhyme she wrote after a classmate, Josh, was murdered in a fight outside the school.

Before he graduated, n****s had to take his life/
Tryna make himself some money, p***y stabbed him with a knife/
Haters always wanna fight. They think killin’ n****s is right/

Later in the film, Biggie explains that music was her only outlet to be vulnerable. “I don't really like showing people my emotions,” she told the camera, “Like, me, my soft part. I don't like that. 'Cause I feel like people's gonna end up walking over me.”

To the naked eye, what Hall and the Mott Haven students are doing looks pretty similar to what artists and producers do in every recording studio in the world. But the intentionality matters, according to Hall. “Both hip-hop and therapy are expressive practices that serve as a form of expression and connection,” he told Okayplayer, “The cypher looks a lot like group work, rooted in interpersonal communication and the curative capacity of connecting to a community.”

Hip-Hop Therapy for Everyone

Given its slow introduction into mainstream therapy modalities, Hall is well aware that HHT is still a long way away from general consumption. For example, HEAT requires the presence of a clinician who is also an artist, producer and engineer. “These roles can always be separated but that comes at the cost of things slipping through the cracks,” Hall said. “A teaching artist will not have the lens of a clinician, and a therapist will not have the expertise of an artist.”

Since hip-hop therapy’s mid-nineties birth there have been offshoots by other practitioners. Adia "Dr. Dia" Winfrey is a psychologist and another pioneer in HHT who facilitates training for therapists and educators who want to offer hip-hop as a therapeutic or learning tool. Dr. Dia’s 12-part curriculum studies 50 songs spanning the mid-1980s to 2020 and includes 21 Savage's "Letter 2 My Momma" and "Sojourner'' by Rapsody.

Dr. Dia shared her optimism for HHT’s expansion, noting the impact of transparent storytelling as its superpower. “Over the last 20 years, HHT has grown exponentially. Mental health practitioners and scholars have presented HHT at a number of professional conferences, and the field continues to expand,” she tells Okayplayer, “At the most basic level, rap songs that address sensitive subjects can be used to stimulate hard conversations and introspection.”

Therapy is still a sticky subject in the Black community thanks to barriers like stigma and an overall lack of access. The CDC has reported as recently as 2021 that although there is a steady incline of Black people seeking and going to therapy, the rate of treatment is less than 15% for individuals between 18 and 44. This glaring disparity persists despite statistically higher rates of psychological distress, depression and suicide among Black people — this therapy barrier is life-threatening.

Hall strongly suggests finding a therapist willing to adopt HHT into their practice if one who already specializes in it isn’t available. “My personal recommendation to individuals is always to inquire into a therapist's knowledge of hip-hop culture when shopping around, and if they find one, to ask if they are familiar with or willing to learn about HHT.”

Given the already grueling process of finding a therapist who accepts the right insurance and is available on suitable days, it might be daunting to add another requisite to the process. Still, Hall encourages self-advocacy and open-mindedness in pursuing healing spaces willing to cater to specific needs. “[It won’t be] the same as working with someone who has years of experience studying and implementing the approach,” Hall admitted, “but it is a starting point where both therapist and client could potentially practice and grow together.

HHT: Do Try This at Home

With or without a skilled or willing practitioner, the therapeutic benefits of hip-hop can be accessed and utilized by anyone through a self-tailored practice. “From the standpoint of self-care, listening to and creating the music in and of itself can be tremendously therapeutic,” Hall said that because of its inherent therapeutic nature, it’s important to note that the simple and unmanaged act of enjoying music stimulates healing. He also encourages individuals who want to bring hip-hop or music into their care routine to try a few exercises and suggests two options to jump things off.

Make a playlist.

Add songs with a collective theme around the emotions they evoke — like joy or inspiration. “Have [it] on standby for when you find yourself in a particular mood or mindset that you want to change,” said Hall.

Write to a beat.

“Find or create beats that resonate deeply within you,” Hall explained. “When you do, see what lyrics they draw out of you.” He offered these writing prompts to inspire the writing process:

• Write a rap to a loved one, someone alive, or who you’ve lost.
• Write to someone you have a resentment towards. To take it a level deeper and explore your part in the dispute.
• Write a song to a younger version of yourself or your inner child.
• Write something from the perspective of different parts of yourself.
• Write about your deepest, darkest secret without intending to show anyone.

Hall further challenges this self-work by sharing with a group, which in the digital and social media era is easier than ever. “Record those songs and perform them at an open mic. Release your music and get feedback from your community. The art will take on a new life with new chances for healing once it is brought beyond the individual.”

Whether casually listening to a song that sparks calm or journaling the complex feelings that arise from a hand-written verse, the very nature of hip-hop as a self-reflective art begs to be unraveled and explored. The sheer availability of a healing tool on everyone’s phone disrupts the notion that therapy only comes with a hefty price tag or a dizzying waitlist. Hal, who has himself used hip-hop to write about and express his pain, continues to evangelize the use of hip-hop therapy and self-expressed art in his work. He insists, "Writing, producing, recording, performing – these are all inherently cathartic experiences."