Monday, February 29, 2016

Leap Day! Leap Day! Take a Leap!

I was interested in this Leap Day thing, so I went over to Wikipedia and found lots of information. (I know, there are lots of academic-types out there screaming, "Wikipedia is not a dedicated source!! Why would you look there for any type of information!!! Aaargh!," but I always start with Wikipedia to get an idea of what else to look at. Sorry, professors!) You can find the link I started with here

Did you know that some calendars add an additional MONTH during leap years? I am very glad that the Gregorian calendar doesn't add an entire month. 

I am fascinated by our planetary journey around our sun, our sun around the galaxy, and our galaxy around the universe. I always have been fascinated by such things. Leap Day reminds me to think a bit more deeply about these concepts and events.

This day is a day when some traditions allow women to propose marriage and a fine be paid to any woman who is refused by the man of her choosing. Leaplings get to celebrate a long-awaited official birthday on this day. (That's not me, by the way.)

For us, this is just another day.

I think that's a shame. I think an extra day should be a day of celebration. A day of planning and contemplation. A day to take a leap into a new idea or way of life or something else profound. So, I am going to take some time today dreaming.

Take a leap today, friends. Leap into the unknown.

Sunday, February 28, 2016

Supplemental Sunday: Beyond the Visual Aid

Sundays are the days that I write about visual aids; things that I have made to supplement my music therapy experiences for my clients. I got into this habit because there really isn't anyone else talking about visual aids and music therapy, and I like making things for my clients. It occurs to me that my writing about these things may indicate a skewed view of what I do with my clients.

NOTE: I do not believe that every music therapy experience has to have a visual aid or a prop. In fact, I believe just the opposite!! I think a good therapeutic music experience has to be sound without a fancy picture in order for it to be considered "good." There HAS to be some logical and music-based reasoning behind the idea first and foremost. A pretty visual aid will not make a crap TME a great TME. Please don't think that everything I do with my clients has visual aids. Most are done without visual stimulation... I just write about these things on Sundays...
 
I often write about making visual aids for use with my clients, but there are so many things that I use that aren't just for the visual sense but that have tactile, auditory, proprioceptive, and vestibular sensory elements as well. Today, we are going to go beyond the visual aid into a world of other types of supplements to music therapy treatment.

Early in my career, I was trained as a sensory integrative therapist - one who attempts to provide opportunities to engage as many senses as possible to assist clients in interpreting and managing sensory information. As a result of that early training, I look at all parts of the sensory system when I am looking for things to supplement my music therapy treatment.

Consider the lowly bean bag.
  • Visual: you can see the bean bag, you can see its color, you can see its location, you can see its shape.
  • Auditory: you can hear the sound of the beans as they collide with one another, you can hear its landing, you can often hear it as it moves through the air or on the ground during movement
  • Gustatory: I guess you COULD lick the bean bag to see how it tastes, but that's not often encouraged. If it does happen (and, in my environment, it often does), there is benefit to gaining this sense as well
  • Olfactory: you can smell the bean bag to see what odors it has collected
  • Tactile: you can feel the covering of the bag, you can feel the weight of the beans, you can feel the individual beans or peas or beads or pieces of rice
  • Proprioceptive: you can feel the weight of the bag in relation to different body parts, you can place the bag on arms/legs/etc. to develop body awareness, you can feel the impact when the bag lands on body parts
  • Vestibular: you can feel the movement and force required to throw the bean bag, you can feel the motions to engage with the bean bag, you can feel the air displacement as the bean bag moves past you
As I think about using bean bags in my Therapeutic Music Experiences (TMEs), I have many options and areas of focus to justify their use. The list above only considers the sensory benefits for using bean bags - there are many more social, cognitive, academic, behavioral, motor, and musical benefits available as well. I haven't even started to think about those things.

If I have written a passing song (which I have - check out the post from last Tuesday here), it needs to be an engaging type of song to catch the attention of my clients. It also needs to be something that I can do with just about any object. It is highly enriched in a sensory manner if I add bean bags or shaker eggs or another multi-sensory object for clients to pass.

People may ask (and they do) things like, "How is passing a bean bag something to do in music therapy? We can do that in our class." When I have started the process of thinking through all of the things that I can do with a simple bean bag, I am able to link the use of a bean bag in a passing song with client goals and objectives. For example, "we are working on coordinating our grasp and release rhythms to improve fine motor skills" or "we are using music as an entrainment figure to assist us in making our movements in a time based pattern." By this time, they realize that I have therapeutic reasons for just about anything and don't often challenge my TME choices again.

(Did you notice that each of the examples given were rooted in a musical element? That's the key, folks!! We HAVE to show how music plays a part in every thing we do with our clients. Oops, gonna get off my soapbox now...)

I have lots of visual aids in my files, but I also have balls, scarves, bean bags, squishes, feather boas, brushes, soap mitts, stuffed animals, card games, boxes, bags, dice, Musini, round bells, and many more things that have served to supplement my TMEs over the years. Each one has been carefully considered before being included in music therapy treatment, and each one enhances TMEs in ways that allows clients to move towards their therapeutic goals.

Have a good Sunday, all.
 


 

Saturday, February 27, 2016

Falling Behind in Everything

This week's intern webinar was Self-Care for the Music Therapist. We talked about the importance of taking care of yourself. All of this discussion was happening as I was running a temperature, coughing, and settling into a laryngitis, bronchitis, possibly pneumonia funk. It's kinda ironic that I was leading a discussion about trying to avoid illness and burnout and compassion fatigue while showing that I wasn't able to do those things at this point right now. I was being an example of what NOT TO DO!

I go through something like this every winter. I'm not sure what starts it up or what makes it keep going, but it starts like an allergy attack and then mutates into a bacterial infection. I know that this happens during each winter, but I cannot avoid it. It is inevitable.

Usually, I take a couple of sick days off in order to get over the worst of this involvement, but I can't take time this year. My time is gone, so I went to work yesterday and quarantined myself in the music therapy room. (That's not difficult to do on Fridays since I have no music therapy groups.) I saw four people yesterday who all mentioned that I looked and sounded horrible. I canceled a Skype meeting and a webinar for this weekend because I can only really squeak right now.

I am falling behind in all of my chores, professional responsibilities, and projects. I am exhausted and just want to sleep. I have a major project due for release on March 10th, and I haven't done nearly enough work on it for my liking.

Self-care is such an important thing to think about, not only when I am ill, but all of the time. Self-care encompasses everything important about being human - health, well-being, emotions, relationships, cognition, exercise, social interactions, you name it!

One of the reasons that I talk to others about the importance of self-care is that I need reminders about the importance of self-care. I like to be busy. I want to do it all! I like to push myself to do as much as I can, but my body doesn't like it as much. I have learned about listening to my body before I get to a crisis, but crises happen anyway. A big part of self-care is having a strategy for what you will do when you are sick or stressed to the point of not being able to do what you want to do or need some extra time for yourself.

My self-care strategy for the moment? A cup of herbal tea with honey and lemon. Sitting down to do my work for the one meeting I need to be at this morning. Planning to go to the doctor as soon as that meeting is finished (thank goodness for walk-in services at a primary care physician!!) and starting whatever medication they deem necessary. There will be some shopping at Wal-mart while I wait for my medications to be finished. I'm going to buy some ginger ale, oranges, and cake. After that, I'll be working on the project for March 10th, from my bed, in-between naps and medication.

What will you do to take care of yourself this week? Do it without guilt or shame. Take care of yourself first - always first!

Thursday, February 25, 2016

Thoughtful Thursday: The Dalai Lama

I think this quotation encompasses many of the things I want to do and see in this world. It doesn't take much time to be kind when dealing with other people, but it does require a bit of empathy. To be kind, you have to be aware of how the other person may interpret your interaction and change how you are interacting to support their responses and emotions.

I was recently in a situation where the other person pretty much presented an idea that I didn't agree with, and I was told that I would do this without question if I wanted to continue to have a particular role. The expectations were not revealed until I had made a commitment to the role. Then, it was "Okay, but you know you are going have to do this, this, and this if you want to stay. Oh, by the way, I talked to this person and this person about this situation, and they are SO excited about how this is going to happen." I walked away.

During and after that interaction, I felt that the other person really hadn't thought about me or my responses at all. She had an agenda that she wanted to push through and it really didn't matter if I had an opinion of my own. My feelings were hurt, and I felt that I was being bullied into a way of doing things that did not match my own ideas or comfort. I felt I had no other option but to leave. So I did.

Once I left, all of a sudden, she tried to "explain" what she had actually meant. She apologized for talking about me to all of the other people and for arranging things without speaking to me about it. I don't care about apologies now, and I have to move on.

I think that kindness has to be the mark of a good leader. You have to be aware that the people that you are attempting to lead have to be part of the vision that you have in order to make that vision a reality. A good leader talks with people and not to people. A good leader acknowledges and strives to understand different points of view. A good leader remembers that kindness has to be part of any interaction. A good leader can also be firm when situations warrant it, but still displays kindness.

This is probably all spilling out right now because of my difficult Wednesday group which was compounded by a staff member who seems to think that I cannot maintain my group and keeps INTERRUPTING me to tell kids, in a VERY loud voice, to listen to what I am saying. He has completely missed the processes of iso-priniciple, entrainment, and subtlety that I employ and appears to think that I can't do my job. I am going to have to speak to him about it because he is doing this more and more and it completely resets the entire group dynamics - it does more damage than good. It is not therapeutic, it is jarring and intrusive - it resets me as well as my clients, and we all have to start over again in our mood-vectoring process. When I ask him to stop, he has "to go to the bathroom" and disappears for the rest of the session.

I don't like confrontation. I like this staff member. I think he has good rapport with the students in his classroom, but he has gone from being an affable, kind guy to INTERRUPTING man! I don't know what else is happening in his world, so I will need to go into our conversation about expectations and processes in a way that is kind, that recognizes and supports his humanity, and that seeks a win-win solution to this problem.

In light of my recent conflict where I felt I was treated unfairly, I am going to be hyper vigilant about this conversation.

Be kind whenever possible. It is ALWAYS possible. 

Wednesday, February 24, 2016

I Keep Trying to Make it Be a Thursday

I had a bit of a fitful night last night. I fell asleep before I turned off the light so slept in the full light of my room. I woke up several times for unknown reasons (probably having to do with the light on), but was able to flip over and fall asleep again without too many problems. I did wake up convinced it was Thursday and getting my Thursday routine started in my head. I think this was influenced by one of my anxiety, medication dreams that seems to be something about how I forgot an intern webinar (which I have only done partially once, but which I NEVER want to do again) on self-care. I was relieved when I awoke that it wasn't Friday (that would mean I had missed the webinar), so started thinking it was actually Thursday.

Here's a sample of my script. "Take a shower. Write a Thoughtful Thursday post. Check over the powerpoint for the intern webinar tonight. Make a post-it reminder for the intern webinar. Do your stretches. Take water to work. Finish session plans. Take out something for dinner. Feed the cat..." The list of things that goes through my head in the first two minutes after awakening can truly be frightening sometimes.

It wasn't until I was halfway through my shower that I realized it was actually Wednesday.

Full stop.
Reset.
Bleargh!!

My list of things to do today had to completely change. There will be no intern webinar this evening. I have physical therapy today instead of doing my stretches. The groups I see are very different, requiring a different set of skills and focus. I will leave work, go to therapy, go to my part-time job, and then stagger home. I don't need to get anything out for dinner, but I do need to stop by the bank to get money so I can pay for something to eat in between all of my other stuff to do today. Being in Wednesday means something completely different from being in Thursday.

I am now trying to get into the Wednesday mindset.

I wonder if this type of discombobulation is what my clients go through. Does my client who is actively hallucinating feel that the day he anticipates is not actually the day he is experiencing? Is this the reason that some of my clients with diagnoses of Autism Spectrum Disorder rely on a set pattern in a daily schedule? Being able to know what comes next is important to some, irrelevant to others.


I hope that I remember how this felt the next time one of my clients struggles with their own reaction to schedules and changes. It is important to keep some understanding when working with those who cannot always express their own confusion or struggle. I know how to regulate my response and reaction. I know that thinking it is one day but actually isn't that day is something that I can negotiate with some humor and cognitive training. I know how to fix the problem. My clients do not know how to fix their problem, so I have to be able to show them an appropriate example. I have to be the model for how to fix a perception without panic, aggression, significant behaviors of concern, or melting down. A little bit of empathy helps to find a way into solving a situation.

I think that is the task of the therapist, whether they be music, occupational, physical, talk, or art therapist... to find empathy for each client who sits in front of us. To strive to understand what our clients feel and experience and to move from within that understanding to empower our clients to move towards their desired outcomes and goals. 

I will strive to do that task today as part of my Wednesday.

Tuesday, February 23, 2016

TME Tuesday: The Passing Song

I occasionally have clients who are working on body awareness, coordinated movements, and completion of one-step directions. How to address these things? Voila! Write a song!! (Of course, writing an original song is my answer to almost every thing - that's one of the things I love about music therapy! Don't have a song that prompts every thing your client needs? WRITE YOUR OWN!!)




Therapeutic Music Experience
The Passing Song
Mary Jane Landaker, MME, MT-BC
 
Purpose: To promote motor planning; to provide opportunities to practice motor skills; to address palmar grasp development; social interaction; completion of one-step directives

Source: Original song. © 6-13-2012 by Mary Jane Landaker, MME, MT-BC.

Materials: small handheld instrument or object for each group member (bean bag, shaker egg, squishy ball); OPTIONAL: guitar

Environment: Group members sitting in a circle to facilitate passing. Therapist or song leader outside of the circle to assist group members in completing the task

Song/Chant/Words: Passing Song.pdf

I                               IV                          V7                       I           V7
I have a shaker egg in my hand. I pass with one hand as fast as I can.

I                               IV
Pass with one hand, pass with one hand,

  V7                               I         V  I
I pass with one hand as fast as I can.

Replace underlined words with other words to change the targeted movements:
·         With my left hand
·         With my right hand
·         Tossing gently
·         With my eyes closed
·         Fast
·         Slow
·         Low
·         High
·         Others as appropriate

Procedure: R = Reinforcement opportunities; C = Redirection/Cue opportunities; A = Assessment
  1. Pass out objects or instruments to group members
  2. C= start singing the song, demonstrating the desired movement if possible. (If not possible for MT to demonstrate the movement, recruit a model for the behavior to show the group)
  3. A=assess which group members are completing the task as specified
  4. R=reinforce group members who are completing the task as directed by the song lyrics. Redirect group members who are not completing the task as specified.
  5. C=continue to sing same verse until all group members are completing the skill as desired
  6. Repeat steps 2-5, changing lyrics to provide opportunities for group members to address different motor skills.

Therapeutic Function of Music:
Music coordinates, directs, and shapes the desired outcomes of this experience. The lyrics are repetitive in nature, offering group members a measure of predictability which encourages entrainment to the macrobeat. In addition, the lyrics have elements which are easily adapted to accommodate differences in motor development. The lyrical elements which are adapted occur in the same place in the song every time which also promotes entrainment to the macrobeat. The lyrics remain predictable for the majority of the song. The pitch, timbre, dynamics, and tempo are variable, offering the therapist many options to adjust and adapt to engage clients in the desired outcome of motor skill development. The melody covers an entire octave, so the key of the song must be chosen carefully. The rhythm is primarily on the beat rather than syncopated.

Melody
Pitch
Rhythm
Dynamics
Harmony
Repetitive, variety of scalar and stepped patterns – covers entire octave so key must be chosen carefully.
Variable to accommodate client ranges
Limited syncopation – most figures occur on the beat or in eighth note patterns
Variable to engage attention of group members
Major tonality

Form
Tempo
Timbre
Style
Lyrics
Limerick form – A,A,BB, A
Variable to accommodate client motor skill development
Vocal with optional guitar
Children’s song type
Repetitive, embedding directions into lyrics, variable based on clients’ motor needs and issues
Chart adapted from Hanson-Abromeit, D. (2010). A Closer Look at the Therapeutic Function of Music. Presentation at 2010 American Music Therapy Association National Conference: Cleveland, OH.

Adaptations:
·         Continue to repeat one movement, but use different direction locations to reinforce direction concepts.
·         Change object to increase stimulation to hand or to adapt the grasp required.

Extensions:
·         Ask group members to fill in the lyrics after watching a role model demonstrate desired movements.
  • Use as clean-up prompt, asking entire group to pass to a targeted area (box or bag for storage). Objects move around the group circle, ending up in the box/bag.
 
As always, dear readers, if you would like a copy of the sheet music for the song, please contact me through the website

Happy Tuesday.

Monday, February 22, 2016

Research-Influenced? Or Research-Informed?

I am working on intentionally using research to influence/inform my clinical practice. This is a marathon of a process, not a sprint, so I am moving slowly into this as a way of thinking about music therapy and what I do with my clients. Right now, I am struggling with what to call my process - should it be research-influenced or research-informed music therapy? I think that I am leaning towards informed, but I have been using both terms in my thinking and writing processes.

What's the difference (are you thinking like I've been thinking lately)? That's what I want to write about today.

Dictionary.com uses this definition of "Influence."
influence
[in-floo-uh ns]






noun
1.the capacity or power of persons or things to be a compelling force on or produce effects on the actions, behavior, opinions, etc., of others:
He used family influence to get the contract.
2.the action or process of producing effects on the actions, behavior, opinions, etc., of another or others:
Her mother's influence made her stay.
3.a person or thing that exerts influence:
He is an influence for the good.
4.Astrology. 
the radiation of an ethereal fluid from the stars, regarded as affecting human actions and destinies.
the exercise of occult power by the stars, or such power as exercised.
5.the exercise of similar power by human beings.
6.Obsolete. influx.
verb (used with object), influenced, influencing.
7.to exercise influence on; affect; sway:
to influence a person.
8.to move or impel (a person) to some action:
Outside factors influenced her to resign.
Idioms
9.under the influence, Law. less than drunk but with one's nervous system impaired:
He was driving while under the influence.
Also, under the influence of intoxicating liquor
Merriam-Webster.com defines "influence" in this way...
influence
play
noun in·flu·ence \ˈin-ˌflü-ən(t)s, especially Southern in-ˈ\



Simple Definition of influence

Popularity: Top 10% of words



  • : the power to change or affect someone or something : the power to cause changes without directly forcing them to happen

  • : a person or thing that affects someone or something in an important way


Full Definition of influence

1 a :  an ethereal fluid held to flow from the stars and to affect the actions of humans b :  an emanation of occult power held to derive from stars
2 :  an emanation of spiritual or moral force
3 a :  the act or power of producing an effect without apparent exertion of force or direct exercise of command b :  corrupt interference with authority for personal gain
4 :  the power or capacity of causing an effect in indirect or intangible ways :  sway
5 :  one that exerts influence
under the influence
:  affected by alcohol :  drunk under the influence 

Here are definitions of "inform" from the same two sites...

(Dictionary.com) 

inform1
[in-fawrm]



verb (used with object)
1.to give or impart knowledge of a fact or circumstance to:
He informed them of his arrival.
2.to supply (oneself) with knowledge of a matter or subject:
She informed herself of all the pertinent facts.
3.to give evident substance, character, or distinction to; pervade or permeate with manifest effect:
A love of nature informed his writing.
4.to animate or inspire.
5.Obsolete.
  1. to train or instruct.
  2. to make known; disclose.
  3. to give or impart form to.
verb (used without object)
6.to give information; supply knowledge or enlightenment:
a magazine that entertains more than it informs.
Verb phrases
7.inform on, to furnish incriminating evidence about (someone) to an authority, prosecuting officer, etc.:
He informed on his accomplices.

(And Merriam-Webster.com)

inform

play
verb in·form \in-ˈfȯrm\

Simple Definition of inform

Popularity: Top 40% of words
  • : to give information to (someone)
  • : to be or provide the essential quality of (something) : to be very noticeable in (something)


transitive verb
1 obsolete :  to give material form to
2 a :  to give character or essence to inform modern teaching>
b :  to be the characteristic quality of :  animate informs her work>
3 obsolete :  guide, direct
4 obsolete :  to make known
5 :  to communicate knowledge to <inform a prisoner of his rights>
intransitive verb
1 :  to impart information or knowledge
2 :  to give information (as of another's wrongdoing) to an authority <informed on a member of his own gang>
 
I am thinking that I will stick with research-informed rather than influenced. While my music therapy may be influenced by what I read, I think that much of what is out there doesn't really have good transfer from the research environment to the clinic. By being informed, I know about research and use it to strengthen my current music therapy practice rather than changing my music therapy practice to reflect all the different forms of music therapy research out there.

Alright - from now on, this occasional blog series will include the term "research-informed" music therapist. (You may certainly use whatever term you want, but I find that naming things helps me to understand concepts better than being vague.) So, the Music Therapy Perspectives, 32(1) and I are going to work for some planning time together so I can become more research-informed in my role as a music therapist.
Today's intentional task is to figure out what I want to get from reading all of these articles. I am going to use my super-sticky post-it notes to help me organize my thoughts and to see if there are any trends to what I find interesting. That will help me organize myself further.
Thanks for reading - comments, questions, concerns are always welcome!!