Saturday, March 31, 2012

An Anniversary... of sorts.

Yesterday I welcomed my new intern into the music therapy program. I started counting up interns and discovered that this one is #20! Therefore, I am going to count this as an anniversary!

I, as a part of this anniversary and new intern thing, have been thinking about the interns that have been at my facility over the past 13 years. They have been the source of great joy, frustration, and challenge over the years. I enjoy this aspect of my clinical life, and I hope to continue over the years as an Internship Director (ID).

10 Things I Have Learned About Being an ID
  • Being an ID is always interesting.
  • There will be days when you are thrilled about your intern's growth and competence.
  • Sometimes an intern has to be "deserted" in order to grow as a therapist.
  • Interns are creative people, offering great ideas to your setting. Remember to give them credit for their work.
  • There will be times when your intern challenges your own clinical skill development. This is good. 
  • There will be days when you do not want to be the supervisor.
  • Even the most challenging intern will offer good learning opportunities for you - what to do, what not to do, how to keep your professional attitude, and how to screen potential applicants more carefully next time!
  • Misunderstandings happen. Apologize if you are wrong. Stand firm if you are not wrong.
  • Use your internship agreement very carefully.
  • Take a break if you need to get away from the job of the internship director. There are times when I just need to be "therapist" rather than "supervisor."
I would like to thank the 20 young women who have agreed to be an intern at my facility since 1999. They have taught me so much about being an ID, about being a teacher, and about being a therapist. Each intern has challenged my competence in vastly different ways. I can honestly say that I have enjoyed each experience and each person. 

I have learned so much from you all.


Thank you.

Monday, March 26, 2012

Improvisation

I enjoy improvisation with my clients. My attitude towards improvisation was not always positive but was extremely negative while I was a teenager. My jazz band director always expected us to improvise. As soon as it was my turn, my mind, usually full of notes, scales, and modes, would turn to absolute mush!!

I had an improvisation block for many, MANY years.

My turning point was during my internship. My very wise Internship Director, Sheryl Kelly, at the Center for Neurodevelopmental Studies in Phoenix, AZ, stated that improvisation was merely reflecting the behaviors of my clients in my musical interactions.

Simple as that, I was no longer blocked when it came to improvisation.

Today's improvisation came in the form of a serendipitous happenstance. I had a group of teenagers with diagnoses on the intellectual and psychiatric spectra who have varying levels of communication skill as well as varying levels of involvement. I had taken out my Five Senses visual aids - simple cards with sense organ drawings. I had completed most of what I had on my session strategy and was at a loss about what to do next.

I placed the cards on the floor where everyone could see them easily and started to sing a simple song. 

"When we see we use our eyes, use our eyes, use our eyes. When we see, we use our eyes. That is how we see."

This simple improvised song turned into a lyric completion experience, a game where one student picked a card and started the song. The other students then had to complete the sentence. This group of students sang along with me and engaged with each other without difficulty. I hope I remember the song tomorrow when I have some time to set it down on paper...

I encourage you to throw yourself into the music making that happens in your sessions. Change things around, try different timbres, instrumentations, and modes in your improvisation. Revel in the moment.

Sunday, March 25, 2012

Community...again!

Every time I spend some time around other music therapists, I recognize the importance of being part of a community of like-minded professionals. So... I tend to write about it during and after the conference.

I am currently attending the Southwestern regional conference of the American Music Therapy Association. Now, I do not live in this region, but I know lots of folks here, thanks to my conference roommate, Christine. Now, the Texans are a pretty tight-knit group, but they have always been very welcoming to me. I have a bit of an "in" since I was born in the great state of Texas, but left in the midst of my childhood.

I digress. Sorry.

Anyway, I started this discussion thinking about the importance of community and will get back to that topic right now.

I sat in two sessions today focusing on the development of students as they move from one area of professional interaction to another. I enjoyed the presentations as both were focused on children and adolescents with developmental disabilities (my population of choice) and how to increase the variety of things that we can do with our clients. It was wonderful to hear presentations from experienced professionals about the same things that I struggle and exalt with during my day as a therapist.

 My sense of community increased as I was greeted by music therapists that I know from many different settings and situations... the online conference for music therapy, the Association Internship Approval Committee, presentations over the years. I got hugged. I laughed with friends, old and new. If I had to do some work-related things over Spring Break, the conference for the Southwestern region of the American Music Therapy Association was a great place to start!

I encourage you to find your community within the larger profession of music therapy. Link to your community as much as you can. Use your social media but also remember to interact face-to-face as much as possible.


Connect.

Tuesday, March 20, 2012

A Flash!

I am very interested in how music therapists get ideas for what to do with their clients.

How do you figure out what to do with your clients? Do you use ideas from other people all the time? Do you develop your own songs and experiences? Do you enter a session with a scripted plan, or do you improvise everything?

I tend to do a combination of the questions above. I often have a sketch of a session plan in my head, along with all of my previous experiences, improvisation formats, and my equipment. I go where my clients take me, wherever that may be.

My ideas for Therapeutic Music Experiences (or TMEs as I will refer to them from now on) often come to me in a flash of creativity. The flash comes and goes, and I have learned, the hard way, that if I don't capture that flash immediately, it is just plain old gone.

The flash is an elusive thing. Sometimes I wake up in the morning singing a fully formed song - everything falls into place without effort. Other times, I get stuck in a rut, singing old songs over and over until I finally force myself to break out. I use several techniques to get my creativity going, including writing songs within very strict structures and rules, using modes, limiting the kinds of notes that I can use, and many other tricks that I have developed for my use over the years. Every time I get a flash, I try to capture it as quickly as I can. Sometimes it works, sometimes it doesn't.

I have a box and a data file of all of the TMEs that I have collected and developed over the years. The ideas that have survived the first flash have made it into my TME file and have been used with generations of clients. Some of those ideas are wonderful - clients appear to enjoy them, ask for them by name, and engage in them exactly as I planned from the very beginning. Others are flops from the start. I never throw anything away, though. You never know when a flop of an idea will become fully formed and make a transition from flop to hit.

I occasionally post some of my TMEs on my website, www.musictherapyworks.com. I make sure that I only use my own original ideas and music on those posts, and you are welcome to access them at any time. 

Monday, March 19, 2012

The Power of Making Music in a Group

Yesterday, I was leading music at my church job. I have been a church music director for many years now and am always interested in how the members of the congregation make music.

If asked to join the choir, many of the members of the congregation refuse stating something along the lines of "You wouldn't want my voice in the choir. I'm not a good singer." No matter how many times I reassure them that singing in the choir is not about individual voices but the group as a whole, they appear to worry that their singing will bring the group's musical prowess down. In the many years that I have been the leader of the music at this church, all of the folks outside the choir still focus on the product of our singing rather than the process of singing.

As a music therapist, I focus on the process of music making rather than on the product. Now, that's not to say that I am not excited when my choir members conquer a particular passage or piece, but I am more interested that the members of the choir enjoy their time singing and that the congregation finds their worship experience enriched by the music presented during the service than perfection. If we miss a note or two, that is fine with me. The composers are not present in our worship services so they don't know we are butchering specific passages. Some days we just simply get through our selected piece. I do not believe that this diminishes our participation in the worship setting, but rather enhances it.

I am a big fan of William W. Sears' chapter in Music in Therapy entitled Processes in Music Therapy (Sears, 1968). As an honorary "grand-baby" in music therapy of Gaston and Sears (raised in music therapy by a therapist/professor who learned the profession from both of those men), I have read and reread the introductory chapters of Music In Therapy many times.

The chapter authored by Dr. Sears outlines "theoretical understanding of the function of music in therapy (p.30)." Sears presents three different classifications for music within the domain of therapy: experience within structure; experience in self-organization; and experience in relating to others (p. 33). Under each of these classifications, Sears delineates several functions of music. If you haven't read this chapter, I suggest that you do so. I believe that Sears made an excellent case for the value of music as a therapeutic medium, and all music therapists need to know these functions when placed in situations where we must justify our profession to others.

I'm going to focus one part of the last classification, experience in relating to others. Sears states that "music provides means by which self-expression is socially acceptable (33-34)." My congregation members who refuse to sing in the choir due to their views of their voices and talents can sing within the structure of a hymn in a church. They can bellow, slide, warble, or wobble when they are singing with many other people. The joy of making music their way is greater than their individual hangups about their vocal quality. In the group setting, they feel comfortable singing. In the choir, not so much. There is a bit of anonymity when you are part of a group of 70 people.


As a part of my training as a music therapist, I ensure that members of the congregation have ample opportunities to make music as a group. We sing old, familiar hymns and new praise songs. We use our bodies, our breath, our words to share a common experience - that of worship in our particular faith community. The power of that experience appears to enrich our sense of community as well as enriching our cohesion as a group.


Long story short - sing. One of my favorite songs states it best.

Don't worry that it's not good enough for anyone else to hear.
Just sing, sing a song. (Raposo, 1970).


Gaston, E. T. (Ed.). (1968). Music in therapy. New York: Macmillan.

Raposo, J. (1970). Sing [Recorded by Sesame Street Cast Members]. On Sesame Street Episode 0273. New York: Jonico Music, Inc.

Sears, W. W. (1968). Processes in music therapy. In E. T. Gaston (Ed.), Music in therapy. New York: Macmillan.






Sunday, March 18, 2012

When Life Intrudes

I woke up this morning to find a flood in my guest bathroom.

Don't you love it when you find things happening that were unplanned, unexpected, and that interrupt your plans? I am being very sarcastic right now.

One of the things that I have been talking to my current intern about is how to be a therapist - self-actualized, confident, healthy, and giving without giving it all away. We discussed that being a therapist does not mean that you have to completely give up on a personal life, but that it does mean you have to be able to compartmentalize many of your personal issues. When you can't compartmentalize, it is time to take some time away from the clinic.

There are times when I am unable to focus on being a therapist. I have other things that are running through my head instead of what the client is doing during our musical interaction. On days like today,with a flooded bathroom, I would be wondering about the maintenance call, about the cat and whether she was being nice, about the mess that I had to clean up, about any number of things unrelated to music therapy. That therapist is not the best therapist that I can be.


The best therapist I can be and strive to be everyday is one that is able to focus on the client and the music we make together without being overly distracted by other things in my life. I feel it is my responsibility to leave my own concerns outside of the music therapy session. If there are things that distract me too much, I owe it to myself and to my client to take care of those things.

My plan for today is to clean up the flood, put in a call to the maintenance department, clean the apartment so the maintenance folks can come in and fix things, and go to work. I do not have to be at work next week (it is Spring Break), so I can focus on this rather than trying to focus on this and my clients.

Life happens.

Tuesday, March 13, 2012

Strange Things are Happening to Me

I have always loved the song from Toy Story when Woody notices that things are changing around him. He is happy with the status quo and cannot really seem to understand that change leads to growth. I am in the midst of lots of changing situations right now, and this song seems to be the best descriptor of what is going on.

I beg your indulgence as I elaborate.

For me, personally, my changes are not earth shattering but there nonetheless. I am getting ready to host my first webinar on Thursday. I am getting more proactive at work, and I am getting ready to add another intern to my music therapy clinic. These changes are not large, but they change everything in my world pretty significantly. There are other things happening right now for me as well.

The culture of music therapy as a health profession is changing. This past year brought several examples of music therapy in the media, increasing our visibility in both the public eye and in the health care industry. Music therapy is starting to be a household name. This is a good thing.

As the profession is getting more well-known, we, as a profession, are on the brink of some major decisions. I am on the AMTA Education and Training Advisory Board (also known as ETAB). Over the past two years, we have been discussing, debating, researching, and writing about the concept of a change in the entry-level to the profession of music therapy.

ETAB has written two papers recommending a change from an entry into the profession after completing a Bachelor's degree to a Master's level entry. These papers have started a discussion that will continue throughout March and April with members of ETAB attending all regional conferences to collect questions and comments.

This change is a big one for the profession. I bet there are lots of therapists out there who feel like things are out of their control with this proposal. That is one of the reasons that ETAB folks are going to meetings. We want to talk about this and about the history of this conversation to the people who need to know.


I am a bit nervous about going to regional conferences to talk about this process. I hope that we, as a group, will be able to calmly discuss this issue and come to a decision. See some of you soon!


Saturday, March 10, 2012

Improvisation

I like to call what I do in sessions, Therapeutic Music Experiences or TMEs. I got this highfaluting series of words from an intern I supervised a long time ago, and it really seems to fit with what I think I do. The other words that I have used over the years included activities, applications, and interventions, but none of these terms ever really seemed to encapsulate the purpose of music in a therapy session the way TME does.

I use specific TMEs as parts of larger music therapy interventions. The experiences are designed carefully to address multiple goal areas at the same time. If we are addressing impulse control as a common goal for all group members, I ensure that every TME has an element of impulse control to fit within the use of music therapy as an intervention. Within one single TME, however, many different goal areas can be addressed.

This week I used a simple Orff improvisation with a group of students with diagnoses on the severe end of the Autism spectrum. These students have severe symptoms associated with their concurrent psychiatric disorders, their diagnoses of Autism Spectrum Disorders, and their patterns of behavior which include screaming, aggression, and difficulty remaining engaged in any experience for more than a minute. Their common goals are to increase impulse control, increase use of communication systems to indicate wants/needs, and to remain in the designated area.

I didn't have much hope for this TME - it was originally supposed to be a choice making experience. I gave each child a field of pictures of instruments and sang a short directive song asking them to choose one picture. As soon as they chose a picture, I provided them with the instrument they indicated and encouraged them to play. They started to play, gradually adding layers and layers of music until we were all playing together. Once I was finished passing out instruments, I picked up the guitar and started a strum along with their group pattern and play. I improvised a narrative song and decided to see how long we could sustain the experience.

They improvised together for 20 minutes.

Now what do I think went on? They first had an opportunity to make choices. They were supported in the choices that they had made by gaining the instrument that they selected. Once they had their desired instrument, they were encouraged to play how they wanted. Then, they started to hear their sounds as a part of a musical whole - that was something that became interesting to group members (I believe, however, this is a completely subjective assumption). We became a group, an ensemble, a society of musicians in this experience.

My simple plan morphed into so much more - went from one therapeutic focus to a completely different focus in the blink of an eye - and became so much more than the plan.

The power of music.

Friday, March 02, 2012

Anyone want to make some mallets?

I am going to try something this month that I have never tried before. I am going to offer a webinar through a program called Meeting Burner. The webinar is NOT CBMT-related and will not be eligible for CMTE credits for those of us certified through the Certification Board for Music Therapy. It will, however, show you a technique for making mallets.


Now, I am sure that many folks out there are perfectly fine with purchasing mallets, but I have always been someone who prefers to make my own materials, so I was thrilled to learn how to make mallets that look and feel like the ones I can purchase. If you are interested in learning how to make mallets, please register using the following link: http://MJ.enterthemeeting.com/m/4ESCNYYB . This meeting is limited to 10 participants. After you register for the webinar, you will receive a materials list and a bonus tool!

Thanks for considering it!!

See you on the 15th of March from 7pm to about 8:30pm Central Standard Time (or GMT -6 for you international folks!). Bring your yarn, dowels, and I'll show you how to make your own mallets! 

Oh, did I mention that this webinar is free?? 

Thursday, March 01, 2012

Manipulation

Today, I was manipulated by a master. I must admit that he took me in, spun me around, and got exactly what he wanted. Shame on me!!!

This young man is 11 years old and has a diagnosis on the severe side of the autism spectrum. He has never been an individual client of mine, but has been in group music therapy for quite a time now. He was on my list of students to start in individual therapy and then was discharged from the facility. He returned after approximately a month at home. Today was the first time we were going to the music room for individual music therapy.

I handed "P" his name card and directed him to get his PECS icon off of his schedule. He grabbed the music card and threw himself on the floor, screaming, "No music! No music!" He attempted putting his card back on his schedule. I persisted and made him get his music card again. I finally persuaded him to move towards the door, ushered him out where he appeared to revel in the wonderfully live acoustics of the classroom building hallway. He kept screaming, and I kept up my mantra. " 'P' doesn't get what he wants when he screams." He kept going.

The manipulation part of this scenario occurred soon after moving into the hallway. I told him, "When you get to the music room, we will sing 'MJ Don' 'Low." (His favorite song - he requests it during every group session.)

The little stinker smiled at me, said, "Okay," and popped up, walked down to the music room, and participated in 15 minutes of music therapy without a complaint.

Sigh.