Saturday, January 29, 2011

Focusing on What Makes Music Therapy Unique

Well, duh, music.

There are many things that music therapists do well. We help clients, patients, residents, persons-served, whomever to reach their goals using music as the primary treatment modality. We often do not let folks know the effect of music on human development in a way that makes sense to our audience.

It is not just enough to say that music works well.

We have to be able to talk about the effect of music on the human being in terminology that is familiar to our audience. In order to do that, we, music therapists, must know what neurologists, music psychologists, and behavioral psychiatrists are finding out about what happens inside the brain when music is in the environment. We know how folks respond on the outside, but the specific reactions occurring in the brain are not often visible or accessible to the average music therapists.

In the past week, the music therapy listserv has been in an uproar due to the coverage of music therapy in relation to the rehabilitation of one of the members of Congress. The mere mention of music and treatment accompanied by music has sent several of us into tizzies!

In my opinion, music therapy has been treated well in relation to other therapies offered to this particular client. We have had several articles about music as a treatment modality. These articles have not always mentioned music therapy or specific music therapists, but several of them have not only mentioned music therapy, but have featured music therapists doing therapy with clients. This is a good sign. I personally feel that music therapy has been represented pretty well during this time, but we still have a long way to go as a professional body.

We need to remember that, while we are great, people still don't know much about our profession. We need to continue to use our greatest strength...our music.

Sunday, January 23, 2011

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??

Tuesday, January 18, 2011

Melody

The complexities of music abound. There are many things that happen during a musical piece that exist in time and relationship with the other things. One of those things is melody.

I work with children and adolescents with developmental and psychiatric disorders aged 5-22 years. My primary instrument is voice with additional forays into trumpet and guitar. I have functional skills on the piano and am getting better with playing in front of people.

I write MANY songs for my clients during my job. The particular songs I write are often concerned with simple topics, have simple lyrics and rhythms, and have catchy melodies (if I say so myself). When I am reading songbooks written for my population, I often find that the songs are too long or too complex for many of my students. As a result, I write my own songs.

Melodies, for my students, are often more successful when they are repetitive in nature, follow scalar patterns rather than incorporating skips, and are quick. When a melody is difficult to replicate, my students do not spend much time singing.

I want them to sing.

There is a difference between a melody that is engaging and one that is difficult. An engaging melody stays in your head. It is easily replicated and starts to take over part of your mind when you mention the words or the song title. It comes out of your mouth in situations other than the music situation where you first heard the melody. You find yourself singing the melody all the time (good and bad).

My current melodic obsession is Beautiful sung by Christina Aguilera. One of my interns had led a brief lyric experience with the song, and I have not been able to finish the song in my head. I have tried all of the tricks that I know to get rid of earworms, but have not been able to exorcise the melody.

A bad melody is difficult to recall, sing, or even listen to.

I have written MANY bad melodies. Songs that did not flow easily into my memory, even after trying to memorize the songs. Songs that have been incomplete in some way - missing a phrase or a resolution or a rhyme - all things that are not really melodic in nature but other elements. When the melody flows, the other elements flow as well.

Tips for writing melodies (that have helped me over the years)
  • Know your target audience
  • Keep it simple - scalar melodies are often easier for folks to remember than melodies with large skips
  • Sing them to yourself until they are easy to recall

Saturday, January 08, 2011

Therapeutic Elements of Music

How many of us think through how and why we use the music that we use in sessions? I do not often think through the therapeutic elements of the music that I use other than I try new things to engage my clients. When asked why I pick the musical interventions that I use, I am often unable to explain the exact reasons why I felt that changes were necessary. I often follow instinct.

This is a problem.

I am a music therapist who never really learned how to explain the effect of music on humans. Now, I took and passed all my coursework on the physiological effects of music on behavior, I have done some additional reading on this topic, and I think that we all (music therapists, I mean) know that music works, but do not really know why music works the way it does.

There are many difficulties with trying to examine the therapeutic elements of music and their effect on human behavior. Music causes different reactions in every person who is within range. It is difficult to predict how a person will react to any part of the music presented, much less to separate one element of the musical experience as the focus of a study. How can you separate melody from duration, pitch from harmony? You cannot.

It is going to be my quest this year to focus on the therapeutic elements of music.

Monday, January 03, 2011

2011

The new year is here, and I, like everyone else in the world, have made some resolutions. I beg your indulgence as I list them here.

  1. Become more articulate when discussing the therapeutic effect of music on behavior
  2. Assert music therapy to the teachers, clinicians, administrators, and clients at my facility, and, if not possible, find a new position where music therapy realities match my expectations
  3. FINISH MY DEGREE PROGRAM!!!
I am also going to try to focus more on the purpose of this blog as reflected in its title. I often focus on the "me" element more than the other two elements of the title. That will not happen anymore (but, probably not any less either ;-) ).