Children and adolescents in Appalachia are often exposed to Adverse Childhood Experiences and may have higher levels of depression, anxiety, and aggression than youth in other areas of the United States. The unique challenges of working with youth in Appalachia and the unexpected prevalence of rap as a preferred genre are summarized in this article. Rap is a frequently requested genre with youth in Appalachian Ohio and the youth in the area frequently identify with common themes in rap such as social criticism, social empowerment, humanistic values, and negative behavior criticism. Despite success with these methods within music therapy sessions, this Caucasian music therapist has experienced internal conflict due to the potential for cultural appropriation by using rap music in music therapy with clients who are not indigenous to Hip Hop Kulture. Discussion of the implications of therapeutic application, this therapist’s self-reflections and supervision process, potential for appropriation, and personal outcomes are included.
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