Therapeutic Elements of Music - Tempo


My next element of therapeutic influence and thought is tempo. This element is probably the most important for me as a therapist. I have found that the "right" tempo makes for exemplary sessions.

The first session that really illustrated this to me was with a woman with advanced dementia. She appeared to enjoy music and responded sporadically to the student music therapist's interventions. At times, she would use phrases to communicate. At other times, she would sit in her chair with her head down not responding to any intervention. I had the luxury of observing the interactions within the small room, but had the responsibility of not intervening as the therapist. The student was using a small keyboard to accompany singing, using songs that the client had responded to at different times during the semester. The student adjusted the tempo that she was using as a background figure rather than the primary musical instrument, and the client sat up, looked at her in the eye, and started to sing along. The tempo was adjusted again, and the client fell back into her withdrawn posture. I asked the student if I could try some things while she continued the session. She graciously gave her permission, and I started to experiment with the tempo. I found that the client would interact when the base tempo was 80 beats per minute. She would be back into her withdrawn posture at 75 beats and at 85 beats. She responded at 80 beats per minute. Once we found that "golden tempo," we were able to interact with the client in ways that she had not been able to interact for years.

This session with a person with a diagnosis that was not within my typical realm of practice helped to cement the idea that most clients have a "golden tempo," a metronome marking that elicits attention behaviors and sustains attention. I had observed this in countless sessions with children and adolescents with autism spectrum disorders, but my older client really made the concept completely clear to me.

My second experience with a "golden tempo" actually happened before the previous example, but I did not have the opportunity to really understand what was happening in the session. My client was a 17 year old young woman with a diagnosis of severe autism, intellectual disability, and Post Traumatic Shock Disorder due to previous abuse. She was nonverbal, ambulatory, and initiated occasional communication with others through leading people to desired objects. She was chosen for music therapy due to her signs of enjoyment in group sessions and due to her preferred experience of running around the room. Individual sessions were designed to encourage dancing, entrainment, communication with the therapist, and to provide sensory input in the vestibular and proprioceptive domains.

Her typical session would include leading the therapist to the music therapy room, pointing to the stereo, and then jumping or galloping around the room when the music started. At times, she would stop, walk up to the therapist, and establish eye contact. She would communicate through facial expressions and using Picture Exchange Communication Symbols. These episodes were often brief, but appeared meaningful to her. They were very meaningful to the therapist.

One day, the therapist wrote down all of the music played on the stereo and started to analyze the music as well as the client's reaction to each song. A pattern emerged where the communicative behaviors occurred when the music was primarily at 88 beats per minute. Changes in the tempo changed the behaviors of the client. Using this information, the therapist started to use a metronome in all sessions, targeting all music to 88 beats per minute. For the first time, the client was able to complete all experiences with limited need for assistance or redirection. Staff members remarked on the change in the client's behavior.

Many of the sessions that I run are group sessions. Ten students, three staff members, and one therapist in one room makes for a large group. Each individual, if the theory of a "golden tempo" is correct, has their own tempo. How can you accommodate each person during every experience? I do not think that you can, but you can certainly attempt to reach each client for a portion of the time.

In the past years, I have moved away from the concept of the "golden tempo." (By the way, this term was used in an obscure text from the 1800's that I have to find each time I think about the concept.) I will be returning to that concept as I am transitioning back into the role of therapist rather than internship supervisor (it's time for a break), attempting to find the "golden tempo" of many of my clients and using that temporal stimulus to increase the attentive behaviors of my students.

Thoughts??

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