Sunday, October 30, 2011

Conflict Resolution

Have you ever been in the middle of a sticky situation that you are unable to get out of?

How do you get yourself out of the situation?

I have spent many hours in conflict resolution training as part of my various jobs as a music therapist. This has gone along with training on workplace violence, blood-borne pathogens, and many other topics. Of all the training that I have had over my 18 years of music therapy, I think that conflict resolution training has been the most valuable of them all.

I work with children and adolescents that are under-served, unserved, or difficult to serve. They often show up at our facility in full combat mode - fighting over everything. Any question you ask is answered with a resounding "NO!" There is a conflict with any suggestion, any experience, anything that is perceived to be something that will lead to a fight.

In my music therapy sessions, clients are allowed to refuse to participate. I do not mind.

I know that music is not always a happy experience for my students, so I expect that they stay awake and respect others as they participate, but no one is forced to do more than they want to do. I refuse to make participation a conflict situation. If someone wants to participate, fine. If not, fine.

I am also a good manipulator. I say that with a bit of shame and lots of pride. I offer my clients the opportunity to refuse to participate, but I also try to make my interventions so interesting and engaging that they will participate. It is rare that a client will spend all of the time refusing to participate or trying to engage me in a conflict.

I can do these things with my clients, but I find it much more difficult to do with my co-workers. I am currently practicing for a confrontation with a co-worker who does not appear to understand me or my level of professionalism at all. I have brought my supervisor into the discussion since I do not feel comfortable with the conflict or with my co-worker. I have been practicing my "I-statements." The discussion will occur this week, and I think I am ready.

Why is it that I am able to do the things that I have learned with my clients, but not with this co-worker??? Sigh. More practice with my conflict resolution skills to come.

Thursday, October 20, 2011

Getting Ready for the AMTA Conference

It is October.

This month of Halloween is also the month before the annual American Music Therapy Association national conference. I am a habitual presenter and now, as a member of two committees, I always have to get ready for the conference this month as well. 

I always have this realization that time is running out at about this time of year.

This year, music therapists from the United States and other countries around the world will be converging on Atlanta. This is the second time in my career that we will visit the state of Georgia, and I am looking forward to both the conference and the opportunity to visit my family members in the greater Atlanta area.

I highly recommend that music therapists attend the national conference. It is an opportunity to meet many like-minded people - all interested in the use of music to affect change in the lives of others - and it is an opportunity to remember that we are not alone in our ideas, interests, and professional lives. I am always overwhelmed with the information that I learn during the conference. I also enjoy being a presenter and sharing the information that I have discovered over the years.

So, I am off to finish my electronic presentation, my CMTE notes, my meeting agenda, and my schedule. I hope to see you in Atlanta!

Sunday, October 16, 2011

The Journey of Therapy

This is a picture of the San Francisco Peaks by Flagstaff, Arizona from the Meteor Crater Complex outside of Winslow, Arizona. It is one of my favorite pictures because of the winding road that took me from the interstate all the way to the crater itself. The landscape is the desert (another place I love!) and looks so barren.

I like to think of this picture as a representation of the journey that we therapists take with our clients.

We start from a place where we are comfortable (the buildings in this picture). We know where we are, and we know where we are heading (the mountains). The path between the two is often winding, sometimes treacherous, and sometimes not clearly defined. While the way to the goal is not always clear, when you reach the goal, you can see where you have been.

I closed the therapeutic relationship with a client this week. He was a young man with a tragic history of physical abuse and neglect who came to our facility about 11 months ago. He really started to bloom in music therapy and gave me a clear indication of where he wanted to go. We played through music. We communicated through music, and he generalized that skill into other environments. He left on Friday to go to a foster placement - a wonderful step for him. I am trudging back to my starting place without him...a very sad journey for me, but one that is also joyful.

It is the role of the therapist to put him or herself out of a job.

Think about that statement for a bit. 

It is our ultimate goal to supply our clients with the provisions that they need to continue their journey without us. It is my job to guide my clients to the mountain, but they are going to go past the mountain without me. I return to my base and start the journey with another person, trusting that those who have made it to the mountain have gone on to bigger and better things. Things I will never see.

Thank you for letting me be your guide for a little while. I enjoyed the journey. God speed.

Friday, October 14, 2011

Closing the Therapeutic Relationship

Today, I will have to say "Good-bye" to a client who has blossomed in music therapy. "Q" is leaving today after about a year of time at our facility. "Q" is a young man who has a horrible history of neglect and physical abuse. He arrived with no communication or social skills and is leaving a young man who can indicate what he needs without biting or screaming. He is truly a success story for the people who work at my place of employment.

"Q" has been featured in several of my previous blog posts. He interacted with me through the music way before he interacted with others. He responded to music in ways different than any other stimulus. He is a young man who deserves music in his education because he truly does perform his educational objectives more when music therapy is the primary form of intervention.

Did I ever mention that "Q" has gigantic blue eyes?

Today I have to say "Good-bye" to "Q."

Ending a therapeutic relationship is never an easy situation, but it is a part of every relationship. In this case, I am not part of the termination/discharge decision, and that makes it a bit more difficult to accomplish. In my facility, the state department of mental health determines when clients leave (primarily due to funding issues), and the direct care staff do not have input. Children arrive and leave at the whims of outside social workers.

"Q" has made such remarkable progress with us that he has been determined to be ready for foster care. I know, with my head, that this step is due to his growth and really is the best things for him, but my heart wants to keep him around longer. I don't feel that it is time to close the therapeutic relationship, but I have no choice. I hope that "Q" will continue to be involved in music therapy, but I don't think it will happen. I will wave to him as he leaves for his new adventures, suppress a tear, and meet the new students arriving for treatment.

Good-bye, "Q." I'll miss our Wednesday afternoon sessions. 

Thursday, October 13, 2011

Boomwhacker Aftermath

So, with the experience of the Boomwhacker party resonating in my head all night, I awoke to several new ideas. Most of these are not Boomwhacker ideas, but what the hey - I thought I'd share...

My clients have developmental and psychiatric diagnoses, so many of the things that I saw last night were not things my clients can access easily. The chants, the songs, and the organization skills were valuable, so I will use them (with LOTS of adaptations) with my students.

Now, on to my ideas.

With the upcoming Halloween event arriving, I suggest using the Boomwhackers in minor keys. A and C, E and B, D and F are all minor tonalities that can be used as the format for "spooky" songs using the Diatonic set. I often use the exact same songs that I use during the rest of the year on Halloween, but I change all of my major tonalities to minor tonalities. The change of mode increases the eeriness of the music and really makes me think about my melodies and pitches as well. It's a great exercise - try it sometime. Any song can be "mode-ified." It makes for some strange sounding melodies, but it is fun for a music theory nerd like myself. Don't forget Lydian, Lochrian, and the other modes...

Boomwhackers Faster Than the Speed of Sound (well, maybe not, but we'll try...)

My kids are fascinated by speed. They seem to think that faster is better and often refuse to slow down. We sit in a circle and pass the sound around the circle. If you are fortunate enough to have a plethora of Boomwhackers, you can arrange them into a melody or phrase. (For example, each kid has one Boomwhacker and sit in the following order: C - C - G - G - A - A- G.) Challenge the students to play the notes in the correct order as well as to identify the song phrase. Once the clients have done both tasks, speed up the playing around the circle until they can play as fast as they can.

Gonna Carve a Pumpkin to Match My Mood

Emotion recognition is often not something that my clients come by naturally. They do not seem to realize that other people have emotions or that emotions are part of relationships. I am constantly trying to develop interventions that challenge them to evaluate their emotions and the emotions of others. This idea started last year right after Halloween, and I am looking forward to trying it out this next week.

Every student receives a pumpkin blank and velcroed facial features. We sing the song, and they place the features that they want on the pumpkin. I ask them to tell me what mood they were making. We then sing the song again, using the modal changes that I talked about in the first idea, identifying if the music sounds like the emotion. This is often a difficult concept for my students, but they can choose the mode that sounds best to them (There are no wrong answers).

Interested in more ideas?

Let me know...

Wednesday, October 12, 2011

Boomwhacker Party?? What??

I just finished a webinar with Kat Fulton, electronic media guru! She sent out an invitation for anyone who was interested to attend an online Boomwhacker Party. I thought, "Why not?" and signed up.

Now, I am very interested in offering online CMTE courses for music therapists who share my interests in persons with developmental disabilities, persons with psychiatric diagnoses, and music therapy interns. I am always interested in how others offer information online, so I signed up for both the Boomwhacker ideas and to see Kat in action.

I was not disappointed.

We used an online conference meeting platform called MeetingBurner. I logged in and waited for the others to arrive. The platform did not allow us to see each other, but we could see Kat and see her powerpoint presentation. It was a bit difficult to contact Kat while she was presenting, but we chatted amongst ourselves without an issue.

Now, the boomwhacker ideas were things that I would have to adapt quite a bit for my students, but Kat offered many ideas in a short amount of time. I will be waiting expectantly for the information that she will be sending to us later on.

How can we, as therapists, use the everchanging electronic media available to us to be better facilitators for our clients?

The first thought is to participate in information sharing opportunities such as the webinar that I attended 10 minutes ago. We can now communicate with each other at the speed of light, so why not?

Secondly, of course, we can use the internet to find out the most recent research in our field and in related fields. I had a wonderful "A-ha" moment yesterday when I started parsing the information in Dr. Patel's article from Nature Neuroscience in 2003 about syntax. There will be more about this when I get it all figured out.

Third, we can interact with clients in real time, but not in real space. Now, I admit that I would always rather be in real space with a client, but it is nice to know that I could participate in therapy from a distance, if necessary. This is especially nice to know now that online K-12 schools are becoming more prevalent and that the number of certified music therapists does not change very much or very often. With more kids that could be reached in an electronic format, music therapists can provide some services to areas that do not have a music therapist locally.

This was an exciting experience for me, and I heartily thank Kat Fulton for offering the opportunity! Keep an eye out for some opportunities from me coming soon!

Sunday, October 09, 2011

Seeing the Entire Picture - Part 2

Working as a music therapist often means that you have the privilege of seeing clients in a different way than other professionals.

In my music therapy room, kids are often engaged, looking happy, and participating actively in the therapeutic experiences. They will stop screaming when they know that it is almost time to sing, dance, and play. They will hold their behavior in the "acceptable" range for the duration of the session and, many times, for well after the closing song.

Why is this the case?

We know that music affects the brain differently than other stimuli. There are many researchers who study the effect of music on the brain, and there is lots of research that helps us, as therapists, to explain the mechanisms that occur in the brains of our clients.

Now, I don't know exactly what goes on in the brains of my clients since I don't have a fMRI machine or a PET Scan machine. I can only see their faces, their movements, their responses to music and therapeutic musical experiences.

In the past several days, there has been a discussion about music therapy and fun. Some folks have stated that we do not do music therapy just so a client has fun - fun and enjoyment is irrelevant to music therapy as a modality. These folks appear to be very research-based and brain-based. The other camp seems to think that without fun, music therapy cannot be accomplished.

I think that both groups are correct.

How is that for staying neutral?? (Sarcasm intended.)

Music therapists do themselves an injustice if they are not aware of the physiological changes in the brain and body when music is played. They do themselves a much larger injustice if they believe that music therapy is only centered around fun. We have to start to assimilate the information given to us by folks that study the effect of music on human beings into the rationales that we develop when planning music therapy interventions.

Who is going to assimilate this information? 

I gotta tell you, I don't think that music therapy researchers have much time to do this task. They are busy studying specific effects of music on therapeutic outcomes. They do not often have the luxury of developing a therapeutic relationship with their subjects. I think this task falls to those of us in the trenches of clinical work.

I have the advantage of working with a relatively stable population of clients. I get to know them pretty well, and I am able to observe their responses to music over time and over mood shifts. I can see what different forms of music do when presented to my mercurial clients. I do not know exactly what is going on in their brains, but I can start to make some guesses if I take the time to read the research of other professionals. This helps me to see the entire picture of music and the role music takes for my kids.

For the next several weeks, I am going to use Google Scholar to start to read some of the non-Music Therapy research out there that examines the effect of music on the brain. I will see if I can start to assimilate that information into my therapeutic planning. I will also try to share some of that information here.

Last year, in Cleveland, Dr. Ani Patel shared some of the research results that he had found, and he also told us that we needed to step up and provide the other side of the story. He emphasized that researchers could give us the glimpse into the brain, but that we needed to tell them about the rest of the picture.

Let's do that.

(By the way, the picture at the top of this post was taken on the campus of the University of Chicago in 2005.)

Thursday, October 06, 2011

My Life as a Musical Sherlock Holmes

Today's last session was one where I was at a loss.

My child is 9 years old, diagnosed with autism spectrum disorder in the pervasive level of involvement and with various and sundry psychiatric diagnoses. When I entered his classroom, he was curled up on the floor, screaming. I offered him his schedule card, and he walked with me, screaming all the way. We successfully retrieved his music card and headed towards the classroom door.

Once outside, he tried to pull me the opposite direction. When I told him we were going to the music room, he threw himself on the floor and kept screaming. He hit his head on the floor until I placed my foot between the floor and his scalp...then, he hit my foot a couple more times.

Eventually, he stood up and walked with me to the music room, still crying and screaming.

Once inside the room, he and I walked over to the window in the corner. I offered him the gathering drum (which he likes to sit on), and he sat. The screaming continued.

I pulled out my ocean drums and started echoing his sounds. He responded by pulling my hair. I stopped echoing and just kept going with the ocean drum. He laid his head on the drum and alternated between hitting the drum with his head and his hands. He started to calm.

He engaged in moving the ocean drum, occasionally hiccuping and crying. I considered this progress as we were no longer screaming. We got to the point where he calmed enough for me to sing questions.

"Do you hurt?"


"Where do you hurt?"

Pulled my hands to his head. This is his typical movement, but I thought I would try some deep pressure. I squeezed his head, shoulders, arms, and hands. He took a deep breath.

"Does your head hurt?"

He pulled my hands back. We sat with my hands on his head for about 5 minutes, just breathing and occasionally singing more questions. We walked back to class where he started screaming again. I passed on the message that he may have a headache (who wouldn't after head-banging on the floor?) and transitioned him back to his schedule. His crying was less than when I took him to the music room.

I often find myself in a place where I have to find out something about a person who uses alternate forms of communication. Many of my students are nonverbal and have learned to use off-putting behaviors to gain what they want. That is not allowed with me. You can scream as much as you can, but until you use your words, you will not get what you want. As soon as you start to communicate appropriately, you can gain what you need.

To find out information that I need to know and use in sessions, I often try sounds rather than words. With my child today, echoing his sounds was not what he needed. He needed less sound from me and more from the ocean drum. I offer sounds and look for changes in responses. I file those responses away in my brain file for future reference. Does the student appear to like this sound? Dislike it? Seem indifferent? Did this work before but isn't working now? Why or why not?

I have to be open to all possibilities, including the possibility that music is not the best way to interact.

I keep looking for the way into communication and relationship building with my students. Keep looking for the cues and clues that your clients show to you.

Monday, October 03, 2011

Therapeutic Music Intervention Planning

I am getting my head ready for session planning for the upcoming week. I have two different types of sessions - kids with severe involvement and kids with less severe involvement. I see every student in the facility for group treatment - 50 minutes per week - and about 30 of them in individual or small group treatment. In addition, each child receives 60 minutes of multidisciplinary educational enhancement services on Friday (themed discovery learning and problem-solving experiences that involve LOTS of movement).

My session planning is very different from what I was taught as an undergraduate music therapy student. When I was a fledgling, I was required to plan sessions, memorize those plans, and follow my script perfectly. This was a difficult thing for me to do as I have always been more willing to follow where a client leads me than to make a client do what I say. I had supervisors who would check off when I would say what was on my plan, and they would challenge my decisions when I deviated from the plan. I learned quickly to have a reason why I changed the order of my interventions. Most of the time, it was because I didn't feel that the 3-year old that I was working with was ready to sit and complete academic work. He needed to wiggle a bit more.

These days, session planning is more of a strategy planning session. I always have at least one experience/intervention that all of my "blue" groups (kids with severe involvement) and my "purple" groups (the other kids) go through. These are often elements of music education or therapy games that require special materials. After that, I often "play it off the cuff."

I firmly believe that the most effective therapists are client-directed as well as led by clients through musical interventions that are meaningful to the client. Therapists MUST be able to recognize signs and symptoms of avoidance, boredom, disinterest, and excitement in their clientele in order to design and develop meaningful interventions. If you make a concerted effort to use a client's interests, the client is more likely to engage in the intervention. If you insist that a client complete your plan without thinking about the client's interests, there will come a time when the client will refuse to participate. Therapy becomes a chore rather than a learning or healing process.

I write all of my therapeutic musical experience/intervention ideas down. I am starting to delineate the role of music in the intervention as I do so. This process allows me to be more strategy-driven rather than activity-driven within my sessions. I also brainstorm every goal area addressed by each TME and write those down as well. When a TME is changed, adapted, or extended in some way, I write that down. All of these habits have helped me be more strategy-minded and more client responsive.

This week, I think we will look at my woodwind instruments. I haven't taken the clarinet or the saxophone to work with me before, so the new instruments will probably cause quite a stir. After we look at those instruments, I will attempt to make a sound on them both. That will be amusing since I am NOT a woodwind musician but a mighty BRASS musician. Then, we will sing some songs about social interaction, play some instruments, and maybe even play a few games. Who knows?