Monday, September 30, 2013

Surprise! Kids Like Music

So, I wrote about my youngster who was absolutely out-of-control in a session on Friday. Today, I found out that the behavior I was seeing was de riguer for him in every other setting, but not music. In fact, the social worker who was observing the session thought that he was doing extremely well! I, on the other hand, felt that he was completely wild and having some medication side effects. Silly me!

Apparently he enjoys music and is able to keep himself under control most of the time - he was able to do so today when I arrived for his usual music therapy session. It's a shame that the social workers weren't around for that session. They would have been absolutely staggered to see him sit quietly, request materials appropriately, and engage with peers in an appropriate manner.

What an interesting situation. I wonder what happened right before Friday's session that set him off.

Several other kids were mentioned as having difficulties during their music therapy times - "She always have problems from 9-10 in the morning." Me: "Not on Wednesdays during music. She is fine." "Oh."

It brought to mind that the team that I work with really has no clue how music therapy works.

I guess I could always try to re-educate them again (after 17 years of inviting them to sessions, asking them to come to sessions, and letting them know about what I try to do during sessions). It has never happened that they arrive to observe...

I think they heard my message today. Kids display completely different behavior in music therapy than they do in other settings.

Surprise!

Saturday, September 28, 2013

Thinking More About Manipulating Music for Therapeutic Ends

Yesterday was another music therapy moment. The same group of kids as the last one with several significant differences...

One student was entirely out of control. He was showing signs and symptoms of tardive dyskinesia - strange facial expressions, uncontrollable behavior, physical twitches and tics, loud speech, and random comments. I asked if there had been any changes in his medication, and, yes indeed there had been. He was wild - not aggressive, but not able to focus on anything! This is the same kid who has been sitting with his head down when he feels that he is not getting what everyone else is getting. Everyone else was behaving in a typical way, but they couldn't really engage in a normal manner since this kid was so out of control.

So, what to do?

I went to my go-to elements of music, rhythm and tempo! The first song seemed to work in a mediocre manner, but the second was the one that changed the group dynamic.

On Fridays, I do theme-based sessions that aren't as specifically music therapy focused as the other sessions. That, of course, doesn't mean that all of my music therapy training goes out the window, but it means that I get to do things that are outside of my therapeutic mandate. So, yesterday, we were talking about professions and Labor Day.

The first song was about our own choices. The kid (I'll call him "L" for convenience sake) could not sit still. I sat him next to me for the express purpose of watching him and using my body to block him from accessing anyone else. He was talking constantly. L kept twitching and then yelling at me for yelling at him. (I wasn't.) He accused his peers of sticking out their tongues at him. (They may have been, but I didn't see it, unfortunately.) He could not settle into the music experience.

So, I switched the experience. I started a patsch, patsch, clap pattern. It took some time to get L to entrain, but with some manipulation of the tempo, he was able to coordinate himself to complete the pattern. His movements were jerky, but he was able to get it done. I paired that motor pattern with an unfamiliar song that we repeated over and over and over again. Twenty minutes of patsch, patsch, clap and singing one of my mother's favorite songs. By the end of the experience, L was sitting quietly with less twitching. Everyone else had contributed to the song through motor patterns and body percussion or singing.

By the end of the hour, the classroom was quieter than it had been when my intern and I entered. Everyone seemed to breathe easier. L certainly was sitting more quietly than he had started off...

Rhythm and tempo. My favorite therapeutic musical elements to manipulate during music therapy.



**On L - I reported the changes of behavior and my concerns about tardive dyskinesia to the liaison between me and the psychiatrist. Hopefully the kid will get some things changed with his medications so he can concentrate on things again.

 

Tuesday, September 24, 2013

A Music Therapy Moment

Yesterday, I was privileged to share in a music therapy moment. If you're a therapist, you know what I mean, one of those moments when everything clicks together and just works. Let me set the scene...

This was the last group of the afternoon. There were ten kids with a variety of diagnoses and interests, two staff members, my intern, and myself in the room. This group of kids is extremely diverse - some kids speak, some do not, some kids are working on academic goals, some kids are working on preacademic goals. Their goals are to improve impulse control, engage in appropriate social interactions, and increase communication skill. It was mid-afternoon, and we started the session the way we usually do - with an opening song.

Some kids sang, some sat, others just rocked during the opening song. I felt that what I had planned next wasn't quite right for us, so I changed my plan. I started with a strong alternate bass pattern on the guitar. I played the 12-bar blues progression through once and then starting singing. The words (the actual lyrics are lost forever as all improvisations tend to happen for me) were something like, "find the beat and put it in your head." Kids started to entrain to the song as indicated by moving to the beat. We spent several verses with movement and with me singing directive lyrics of thing to do. The last directive lyric was for group members to make a sound to the beat.

We started to meld into a unique musical experience. Some kids moved to the beat, sitting quietly. Some kids made sounds - one kid made an obnoxious sound and then looked at me and stated, "I'm a fire alarm!" Others sang the bass line. One young man scatted in a way that indicated to me that he had scatted before - lots of syllables and variations. Some clapped their hands.

For the next 5 minutes, we engaged, entrained, interacted, communicated, and allowed each other to be musical. 

Once we had finished our improvisation, the group seemed to be ready to move on, so we did.

Sunday, September 22, 2013

Talking About Therapeutic Music Experiences

This week, I had a conversation with my current intern about Therapeutic Music Experiences (TMEs). We were going over the different parts of my required paperwork including how to write procedures and goals.

The question I get all the time is, "how do you think up ideas for sessions?" My answer is, "I play around and write everything down as soon as I can." A simple answer for a complex question. I guess not everyone is able to brainstorm therapeutic uses for materials and instruments.

I blame my mother.

My mom, an Occupational Therapist, is an extremely creative person. She sees possibilities every where. She looks at Lunchable trays and can come up with 101 ways to use them in her therapy practice. She taught all three of us to do the same thing.

I led my intern through a decision tree that started with an instrument. She and I brainstormed all of the sensory information that we get from the instrument. We talked about what the instrument looked like, sounded like, felt like, and how we played the instrument. This led to a list of goal areas that we could use during therapy.

Then we started to improvise a song about the instrument. We started by talking about what we usually did with the spoons (the instrument of choice), and then I asked her what we didn't usually do with spoons. That seemed to be a difficult concept, but we eventually started to brainstorm. That led to more goal identification and almost an entire TME plan. 

I use my TME plan to help me organize my thoughts and ideas into fully-imaged music therapy interventions.The plan includes places to write down lots of information about the experience itself so anyone can use the experience later on. I write down the goals and objectives that I see, the original source of the music, and where group members or clients need to be during the experience. Then the plan includes music and a procedure for running the TME including cues and prompts, assessment information, and opportunities for reinforcement. All of this information helps me to organize the reasons why I do what I do with my clients. It also helps me figure out how to explain what I do as a music therapist that makes me different from any other musician who comes into my facility.

I think that this idea of identifying what makes music therapists unique in their use of music with clients is something that we don't do very well. That is why we have such a difficult time convincing people in charge that we are worth the extra money and the extra time. 

This is something that I've been contemplating for a very long time. I am astounded how little we therapists actually can talk about our medium. How, exactly, does music work to affect therapeutic change? It is the recognition of the elements of music and our manipulation of the elements that makes us effective. 

Therapists who understand how to use the elements of music are good therapists. Therapists who do not, are not. 

For me, it comes down to that statement. If you do not know how to use your medium to affect the changes that your client needs, you are not a therapist.

I am starting a webinar series for folks who are interested in learning more about these elements of music. Check out the website at http://www.musictherapyworks.com/webinarsandcourses.html for information on how to register and attend.

Wednesday, September 18, 2013

It's Been a While Now

Whew. Lots of things have been going on, and I keep sitting down to write something, but I head down a tangent that is not really blog-worthy, and then I delete things. So, here we are.

So, life. Hmm.

In the past several weeks, my facility has gone through another upheaval caused by the defection of a long-time teacher and seven of our students. We've closed one classroom, added another classroom, rearranged all of the other classrooms and basically stirred up all sorts of things. Administrators are mumbling about dress codes and "teachers should be teaching" - themes that are near and dear to my heart, but that have been ignored for several years now. I almost started to laugh in the meeting, but managed to restrain myself.

Right now, I am continuing to move through my current schedule and am trying to fill up the rest of my time with music therapy sessions. I managed to secure a music therapy room for group sessions - this should get teachers off my back for being "too loud" during music therapy. Ugh. I have to make music - that's part of my title and each and every teacher that I work with know that. 

Aargh! This is what I've been battling the past several days. I've just been moving down the wrong thought paths and can't seem to turn around.

Reverse.

Tomorrow is CPR/First Aid so I am deserting my intern to run three groups. She has explicit instructions to lead her portions and then start the groups down the non-music therapy experience paths that I've decided on. She seems a bit hesitant, but it can't be helped. While I am listening to the trainer drone on and on about CPR/First Aid, I'm going to work on my schedule and my vision for music therapy at the facility. I hope to have a vision board complete at the end of training...

Maybe once I have a vision, I'll be able to move forward and not be sucked into the thought paths that keep popping up!

Monday, September 09, 2013

Re-reading Those Old Textbooks

So, I make my interns read chapters from different textbooks of mine to illustrate specific ideas. These books are not always the most up-to-date, but they do exemplify specific ideas of music therapy.

One of my favorites is Bruscia's Defining Music Therapy. I was sitting in the only consistently air-conditioned spot in the other part of our school (my office doesn't have a vent, so no A/C there) reading the second edition of this textbook. I was sitting there, waiting for kids to leave for the day, reading this text and marveling at the fact that I get so much more from this text now that I've been a therapist for a long time than when I was in my undergraduate training. We read the first edition (yep, that's how old I am) way back in the olden days. It was interesting, gave me lots of things to think about, and formed the major part of our senior year discussions. Since then, I've read it about every five years. Each time gives me more insight into my life as a music therapist, as a musician, and as an internship director.

Today's chapters were about a definition of music therapy. Bruscia and I share the view that all three members of the therapeutic triad have to be present for music therapy to occur. I recently spoke about this to a group of interns who did not seem to agree with my ideas that the therapist, the client, and the music have to be interacting in order for music therapy to happen. I feel that they will eventually come around, but we shall see. 

I think this may be some of the problems that we music therapists have with all of the people out there who claim to be doing "music therapy" but who are simply playing music in the vicinity of a person or who are claiming to be able to prescribe specific sounds to affect specific symptoms. I think we feel that the role of the therapist is essential to the actual practice of music therapy.

Thank you, Ken Bruscia, for writing Defining Music Therapy. I will buy edition 3 if it ever shows up!

Sunday, September 08, 2013

Blogging Mission Statement

So, two days ago, I was talking to my current intern about self-reflection and the use of our journals during her internship. I brought up the subject of my blog, which has been in existence since 2006, and which has been generally my place to spew forth on anything that is challenging me at the time. As I was listening to myself talk about this blog, I was thinking, "What do I really want to do with this forum?" So, I'm going to work on a mission statement for this part of my social presence.

I'll start with this idea - this blog is my online journal. It is a place for me to write about music, therapy, and things going on with me. The posts that I submit are somewhat censored on my end. If my rants tend towards self-pity or too much disclosure, they do not make it to the blog. If things tend to be too self-promoting, the paragraphs don't make it (often!). As an introverted person, I feel comfortable sharing ideas and thoughts in this forum. That is why you will see me respond to things written about on Facebook group discussions here in this forum and not on the group page. It is a place for my opinions about things.

So, the blog is a place for me to talk about my ideas, opinions, and thoughts about music therapy.

Mission Statement of music, therapy, and me: My mission is to develop and publish my ideas about music, about therapy, and about music therapy to an audience of music therapy clinicians and others interested in music as a therapeutic modality. 

Now I need to think about how I will make sure that I can do this.

There is a need for every person who is out on the web to think about what purpose each forum will play in the bigger picture. For me, it is important to maintain a professional demeanor on Facebook, on the website, and on this blog. Personal information is not really something that I want tumbling out to a general audience at all times. The blog, however, is more personal to me.

I represent my facility, my school, and my profession every time I sit down to write a post. You may not know where I work or where I went to school, but you should know that I am a music therapist from the first blog post that you access!

This is my place to reflect on myself as a therapist, as a musician, and as a person.

Music, therapy, and me.

There you go! 

Monday, September 02, 2013

Shoulda, Coulda, Woulda Goblins...

Today, September 2, 2013, is the day that the US takes to recognize those who work. I find it a bit ironic that the very people that we started off recognizing are now working at special sales so their corporate bosses can earn more money, but I digress from my point. Happy Labor Day!

The best part about days like this is that there is no obligation to do anything! I do not have to work. I do not have to clean. I do not have to dress out of my pajamas. I don't have to cook. This is the best way to have a day off. I can do anything I want to do during the next several hours.

So, what will I be doing this Labor Day?

I look around my home and think, "I should..." Those little shoulda, coulda, woulda goblins start to take over my brain. Should be cleaning the kitchen. Could be organizing the craft room. Wouldn't it be appropriate to use this time in a productive manner rather than frittering it all away? If allowed to roam freely, these goblins start to fill the room, multiplying into tidal waves of questions, doubts, and guilt.

That simply will not do.

Each time I start to get overwhelmed by the shoulda, coulda, woulda goblins, I tend to avoid it all - not always the most healthy situation. To do something more productive, I am going to try making a new list - a should list and a get-to list.

Today's list:
  • Should wash pillows - - Get to make a file folder TME
  • Should wash dishes - - Get to eat ice cream
  • Should vacuum front room - - Get to watch television
  • Should cook food for meals this week - - Get to eat some!
There you go. I hope that this will turn my goblins into little bitty inconsequential things to do.

My goblins are not just present at home. I am the type of person who takes those goblins with her everywhere. I should be a better therapist. I could try to redesign my ineffective therapy sessions. I would do more if I had more money, time, interest, etc. Each time I start to doubt myself, the goblins come out and take over.

Currently, I have lots of goblins hopping over me at work. I am having some difficulty settling into our new routine and reality. Paras seem to have forgotten what they are supposed to do as part of the session. Kids are having some problems with the new format. I feel like I am constantly running and not engaging in anything meaningful during therapy. I leave some sessions feeling like the most ineffectual music therapist in the world.

Welcome back, Goblins.

The trick is to start to address each of the goblins directly to make things so uncomfortable for them that they go away.

So, how do I do this? I'll let you know. Right now, I am starting with getting the paras back into their expected roles in the music therapy session. This may prove to be difficult as my principal is not very supportive of me, but I will get them to be back in groups, participating with kids, and engaged. I will continue to talk to kids about why our sessions have changed so drastically and try to incorporate their ideas into session planning. I will continue to keep looking for ways to organize myself and get used to the new ways of doing things.

Okay, goblins - try to do your worst!