Thursday, September 29, 2011

What A Difference A Week Makes...

Last week stunk. There is no other word for the funk that I was in that was caused by work, or by the aspartame, or by the moon, or...

Anyway, this week is MUCH better!

I stopped drinking the Crystal Light. I made an effort to avoid the people who drive me crazy (A.S.P. - my new campaign...I may post about this at some point), and I tried to think positive thoughts all the time.

Aaah, the power of the positive thought.

I think positive thinking is often highly underrated. There is power to thinking about the good in things. The recession...it is forcing me to budget more carefully. The allergies...the medication makes me feel sleepy so I am sleeping well. Co-workers' conflict...an opportunity to focus on my role in the facility. Broken guitar...an opportunity to challenge myself with my piano skill development.

There.

Go out and think positively. It made a world of difference for me.

Friday, September 23, 2011

Leaving It All Behind

The work week is over. Thank all that is good in this world that the week is over.

This week presented me with many challenges.

First, a teacher didn't bother to communicate with me that his class would be 20 minutes late to music therapy. I waited and left because they weren't where they were supposed to be. He arrived a bit later and announced that they were NOW ready for me. I told him that I cleaned up and left because they hadn't arrived. He started yelling at me that I was denying his students their IEP-based right to music therapy. He didn't like it a bit when I informed him that music therapy is not on any student's IEP at my facility. He stormed off to tell the principal.

Second...the principal.

There aren't many people that I just cannot work with, but unfortunately, she is one of these people. She informed me that I needed to "give the teacher his planning time." I couldn't believe that her concern was not for the students but for the teacher! This just irked me no end!

Third, my body is not cooperating. It is allergy season here in Kansas (...for everyone now. I am no longer alone in my chronic allergy suffering!) I missed a dose of medication and had to go through the side effects yesterday. I woke up extremely drowsy and dizzy and decided that I would take a sick day. I felt that my combination of absolute disgust and difficulty staying awake would not be conducive to driving an hour to the facility.

So, I stayed home yesterday. I slept and got over my irksome tendency to feel put upon.

This morning I was calmer, cooler, pretty much over myself, and ready to go back to work. I went to the school and prepared for MMARS (Music, Movement, Art and Rhythmic Sensations). We spent the day playing game show-type games with an educational and problem-solving focus. The day went well. Nothing was unusual in the way kids played or staff members reacted to the experiences presented. The day ended the way it needed to...on a good note.

I feel that I often have difficulty leaving things at work that have no business being in my home environment. After 19 years of offering therapy, I have developed a transition routine that works well (for me.). This routine allows me to leave most of my work-related issues behind at work. Here is my "Leave work at work" routine:

  1. I get into my car and put my work keys into a cup holder.
  2. I take off my watch and put it in the cup holder. (My watch NEVER goes into my house as I have no need for it there - there are clocks EVERYWHERE in my house!)
  3. I have the hour-long commute to rant, rave, cry, laugh, create, or do anything that I feel I need to do. I often make lists of things that I want to try to do at work on Super-Sticky Post-It Notes (love them!!) and stick the notes on my dashboard.
  4. Once I get home, I try to leave everything else in the car.
Today I felt the week evaporate when I took off my watch.

I am finished and will get ready for work when I get into my car on Monday morning.

Happy weekend, everyone!
 

Thursday, September 22, 2011

Seeing the Entire Picture

Things are not often what they seem at first glance.

This thought is just as true in the therapy setting as it is in any other situation or circumstance.

This week has been an example of looking deeper into situations that are one thing at first glance, but are something else entirely at the second glance.

I have the privilege of being a music therapist at a psychiatric residential treatment facility for children and adolescents ages 5-22. It is part of a larger program that offers educational and residential services for persons with developmental delays and disabilities from infancy to age 3 and ages 5 to end-of-life. (We do not serve kids from 3-5 due to an educational mandate in our state.)

Kids come to my music therapy room with a variety of letters put very carefully into Axis boxes. Axis I diagnoses are often from the world of psychiatry. Axis II diagnoses are often developmental in nature, and Axis III diagnoses are other health diagnoses. It is not uncommon for a seven year old child to arrive at the facility with strings of letters indicating different diagnoses - ADHD, OCD, ODD, RAD, ID/MR, ASD, PDD-NOS, the list goes on and on.

When you start to look at these letters, you often get one picture of the child. This is not the entire picture.

The trick to seeing past the initials to the child is to stop looking at the initials first.

When I receive an admission notice for a student, I scan it, looking for any and all references to music. (These are often in the section entitled, "Successful Calming Strategies," and are never more than just, "listening to music.") After that, I stop reading.

My students attend group music therapy once per week for a standard group session. We start with an opening therapeutic music experience (TME) which I use as an assessment time. We then move into other TMEs designed to address such goals as impulse control, social interaction, and expressing emotion in an appropriate manner. When I first meet a student, I pay close attention to that student during the first session. I am looking to see if the student connects with me through the musical intervention. This very tenuous description of "connection" is not easily observed unless you know what you are looking for. For some of my kids, connection is simply eye contact. For others, it is volunteering for a turn during the opening TME. For yet others, it is singing along with me to songs that are original to me and to Lakemary.

This initial session gives me lots of information about the child as a human being, not just a series of diagnoses and initials.

There is more to each person than ever meets the eye, or the paperwork.

(By the way, the picture at the beginning of this entry is a shot of the roof of the opera house in Sydney, Australia. If you look to the left, you can see the heads of the school children that were there when my sister and I visited after the 2005 World Congress of Music Therapy. Doesn't much look like a roof, does it?) 

Saturday, September 17, 2011

Finding Your Way

This weekend I have been contemplating my choice of population. I have been remembering the path that I took during my 19 years of music therapy practice to the people that I serve.

I was always a person who people were drawn to. I spent lots of time with my mother when I was little in her role as an Occupational Therapist. I spent time in nursing homes, in schools for children with physical disabilities, and around folks with exceptionalities. Children with developmental disabilities would find me in large crowds of people and would follow me around. I was destined to be a therapist, right?

Now, as I was growing up, I knew I would be in a helping profession. I enjoyed being a Sunday School teacher, a Girl Scout, a camp counselor, a babysitter, a teacher's aide, you name it. If it involved children or volunteering to be around people, I was there. I met kids in the special education classes in my junior high, I played with a little boy with Down Syndrome at a pool party, and one of my best friends growing up had what I now suspect was Aspergers.

With a mother who was in the forefront of my development who was also an OT, I knew that there were therapy professions out there, but I did not want to be the same as my mom. OT was an idea, but just did not zing for me the same way that Music Therapy did. (At another time, I will regale you with my discovery of music therapy story...I think it's a good one ;-).) I entered my university program knowing that I would be a music therapist that worked with persons with autism.

Fast forward three months, and I was in my first music therapy experience as an observer. Three of us newbies were observing the MT supervisor and three MT students lead sessions with 12 clients from a group home company. The first week, I entered the room with the other two observers, and the female clients entered. They walked up to me and introduced themselves. They did not interact with any of the other therapists in the room. I didn't think much about it. The male clients did the same thing. They all entered the room and walked up to me, introducing themselves and shaking my hand.

The MT asked us all to sit in a circle for the opening. We stated what we liked to do. The responses were pretty typical. "I like chocolate." "I like making friends." This continued until we got to the man sitting immediately to my left. He mumbled, "I like her." The therapist asked him to repeat what he had said, and he pointed to me and said, "I like THAT woman RIGHT THERE!" The therapist, a bit in shock, mumbled something about liking to make new friends and moved on.


When it was time to dance, the man walked right up to me and grabbed my hand. For the rest of the evening, he was my shadow. That was fine with me, but I felt that the attention was a bit weird.


The next week, we were again sitting in the circle, waiting for the men's group to arrive. We heard their footsteps on the ground floor above us, and then we heard something else. All of a sudden, there was a voice from above yelling, "Here I come, MJ-Baby. I love you, Baby. Oh, Baby, Baby. Here I come, MJ!" This was definitely directed toward me. I panicked. The therapist intervened and intercepted him before he got to me.


For the rest of the semester, I was the target of this gentleman's amorous attentions. I felt a bit stalked and decided that I would never be able to work with people with developmental disabilities because of the discomfort that I felt when he made it obvious that he REALLY liked me. He was the star of the performance that we had at the end of the semester, singing and playing the guitar to Nine to Five.



I found out a couple of years after my initial experience that the young man who had very verbally expressed his love for me had never spoken in music therapy previously, much less performed entire songs.


I did eventually figure out that the response that he had to me was not a bad thing, and it did not keep me from pursuing my career. I have worked with persons with developmental disabilities of all ages, shapes, sizes, and levels of intervention and will continue to do so for as long as I can. Thank goodness I found my path.


Finding the place you need to be is not always easy. Often, there are detours, speed limits, roadblocks, or roadside attractions that demand attention. I can only say that, if you keep moving forward, you will find your destination. You can also always turn around and go back to someplace familiar. Just keep moving...

Sunday, September 11, 2011

Paying Attention

Today, September 11, 2011, is the tenth anniversary of the world trade center bombings. There has been absolutely NO WAY you could escape that fact here in the States. This has been a good thing and a bad thing. 

I remember where I was when I heard about the incidents that happened on September 11th. I was in my old music therapy room at my current facility when the school secretary entered the room in a flurry. She told me that the world trade center had been bombed. (Information was a bit spotty in a place with limited internet exposure and no television access - she got her information from the country music station that she could listen to in her room. My room did not pick up many radio stations.) My first response was a simple thought of "again?" The world trade center had been bombed before.

As I heard more about what had happened, my thoughts were varied. I went through dismay, surprise, fear, anger, and disgust. (The disgust was from all of the people here in Kansas who panicked, convinced that we were the next targets that they all had to go to the gas station, waiting in line for 5 hours, and go pick up their children so they would be safe. By the time we started to hear the actual details of the situation, all flights were grounded and there was no way that someone would be able to fly over Kansas to crash into our... what? corn fields??)

My reactions were somewhat different from the reactions of the people that I worked with at that time. My clients (children and adolescents with developmental disabilities and psychiatric disorders) were mainly oblivious to the ramifications of the situation. They did not seem to know what was happening, but their fear was very real. We spent lots of time talking about being safe. We spent time talking about how to contact people if something happened. We acknowledged all feelings and then emphasized the safety of us provided by the airline shut-down and the increased presence of the military. I spent about as much time with my co-workers, calming them down. 

A lesson I learned during this whole time is that panic is something that has to be acknowledged, but it really cannot be fixed.

There is no way to fix a person's panic. You have to pay attention to their fears, whether you think they are valid or not. Once you have heard their fears, you can start to help them think through their fears. They have to be the leaders in this process as the only person that can calm a fear is the person him or herself. 

I am a therapist which means that I am a helper. I remember the lesson that I learned on September 11, 2001 each and every time that I start to work with a person by addressing fear. I remember that every time I start to develop my own panics and fears.

We sing a song that I learned from John Lithgow's Singing In the Bathtub album. The song is called, Big Kids. The song talks about a small child who is scared by the big kids that he sees at school. He moves through a process where he meets a smaller child who is scared of him. The "A-ha" moment occurs and all of a sudden, the fear is understood. We substitute our own fears into the song, and then develop strategies to help us in the middle of our panic. I always lead the way with my fear of tornadoes. My kids (all mid-westerners at this time) scoff at this fear, but it is very real to me. They help me with my strategy and then we progress into their fears. We pay attention to each other and help each other through situations.

Lesson learned.

Friday, September 09, 2011

Thoughts

This week has been a week of thinking. Now, just to warn you, my thoughts are not always nicely organized, but they are what they are. Be prepared for a bunch of randomness as ideas bubble to the surface of my brain and out onto the blog...

Abstract concepts are difficult to teach to persons with developmental disabilities. I don't know how many times interns have done the "Play how you feel" therapeutic musical experience just to see it crash and burn as clients play the same way for all emotions. I wish we (we being all of us teachers and supervisors) would stop using this as an example of something to do with adolescents. NOT ALL ADOLESCENTS GET IT! There are SOOO many other good things that adolescents can and will do. Let's stop beating the emotion horse in this particular manner...

I watched The King's Speech last night. I know I am one of the few people who didn't watch it in the theater, but I am glad that I didn't go to the theater to watch it. I cried like a baby throughout the movie. I was a stutterer at age 6. No one knew why I was stuttering until my mom was playing kickball with me in the backyard. I kept backing up and trying to kick the ball with my right foot. Now, I am a STRONGLY left-side dominant person. My mother, who is also left-handed, asked me why I was stopping and kicking with the other foot. I told her I had to since I was getting yelled at school for using my left foot. Apparently the PE teacher was trying to "fix" me by making my use my right side. This was scrambling my oral motor development, and I was stuttering. My mother, a fierce advocate for her children at any time but VERY adamant that their development NOT be messed with (an Occupational Therapist), marched herself down there and ripped the PE teacher a new one. I was allowed to use my left foot, and BEHOLD, the stuttering disappeared (mostly).

Watching the movie, it was amazing to hear of King George VI's "conversion" from lefty to righty as well as the expectations that were placed on him as well as the emotional abuse that he suffered. I was thankful that my mom went as crazy as she did on my behalf. I cannot imagine what my life would have been like as the new kid in school who stuttered. Being the new kid in school 4 times was bad enough.

I am getting ready for a new intern. This intern does not start until January, but I am still getting ready. I do this every time I accept a new one into my program. At this time, I am working on an internship handbook to use with my intern. I am also working on a different handbook that is more general for use in many different National Roster Internship programs. Just a little something to keep myself engaged.

I will be enjoying the sunrise this morning on my way to work.

Random.

I wish that Netflix would post more seasons of television shows to watch instantly. I would watch them, I promise!

Gotta go to work...

Tuesday, September 06, 2011

Today in my Music Therapy Room...

This morning started off with a typical first-day-of-the-week thought..."What am I going to do with my students today?"

When I left home to go to the car for my commute, the weather was crisp and cool - a typical autumn day here in Kansas. Inspiration struck! An autumn song would be just the thing!

So, then I spent the commuting time thinking about how and what an autumn song would be.

I finally decided that we would do an Orff improvisation using fall words.

Now, here are the things that I had to consider this morning.

Tuesday's clients are mainly verbal, ambulatory, and more involved on the psychiatric spectrum than on the developmental spectrum. They, as a large group, have difficulties with abstract concepts, so starting an improvisation based on words is not often a successful idea. Today it worked.

I started the session with the opening song that I use often and then asked clients to choose Orff instruments. They then had to assemble the instrument - this is ALWAYS a bit of a tumultuous time for most of the students, even though we do not change the process or the instrument ever. Instruments assembled, we tried them out for a short time before focusing on the word/concept portion of the session.

After a 5-count cut-off, we placed the mallets in their storage places and then started brainstorming words about autumn.

We chose a word and then decided on one characteristic of our music that would help us musically illustrate the word. We played. Repeat with word #2 and #3, but we talked about changing the music somehow to illustrate that we had 3 different concepts. 

FOR THE FIRST TIME, MY CLIENTS WERE ABLE TO DO THIS AS A GROUP!!!!!!!!

I sat in awe, listening to the musical products that these students were producing. They were able to change their music with prompts from me. They all seemed to remember how to alter their playing to illustrate the words they had chosen.

I found myself thinking about improvisation while I was driving home. My students often have difficulty with improvising.

While I was driving home, I heard an article about a cello player, Zoe Keating.

http://www.npr.org/2011/09/06/140069246/zoe-keating-a-symphony-unto-herself 

The article shared how Ms. Keating had difficulty with stagefright and trying to be perfect when performing. She started to speak about how she felt less pressure to be perfect when she was improvising and has now made an entire recording career out of her music.

Lightbulb! My students often refuse to do things and share that they don't want to do things wrong. A messed up worksheet often causes tantrums and destruction.

In music, I often have the most success with client improvisation when I tell them that there is no wrong. There is no wrong way to play. There is no wrong way to color. There is no wrong way to make choices. This often frees the client to try things. It also is freeing for me.

I try to live what I tell others...

Sunday, September 04, 2011

Updates...

I spent a bunch of time in a medication haze this week, so things kinda got away from me. Here are some updates to what happened in my music therapy room this week...

This week we used novelty instruments. These are the instruments that I keep in the far back reaches of my cabinets. They are assorted shakers, loud obnoxious instruments, and things that are not easily replaced. I bring them out infrequently since one instrument gets broken every session. We played these instruments, tried everything out, checked long-term memory with Kim's Game, and practiced our social skills when it was time to trade.

My individual sessions were very good this week. I had to discontinue treatment for one young woman who no longer participates in music therapy interventions. She has decided that music is a time to engage in inappropriate sexual stimulation. I can now use her time for a student who will participate. All of my other individuals really started to click this week. I had approached the week with some trepidation due to the fact that several of my clients did not appear to be interested in music therapy last week. This week, all of those folks started to interact with me through the music.

"Q" took over the fast/slow playing that I had modeled in the previous session. He played, and I moved this week. We giggled and communicated. Other students started playing instruments in lessons, started songwriting, and started to make a music video starring themselves! Things are hopping down in the music therapy room.

This was a week that reinforced the importance of music as a therapeutic medium for children and adolescents with developmental disorders and concurrent psychiatric concerns. Even when I was bit by a client (who REALLY did not want to leave the music therapy room), I still felt that the benefit of the music therapy session outweighed the big old bruise on my forearm. 

It was also a good week for music therapy advocacy in my facility. I had visits from school district representatives and my own administrators during sessions. I received an email from my principal about my work with our students - it was complimentary which was unusual.

What a good week.