Thinking About Strategies...Again - It's Always a Journey
I spent time this week talking about something that I love to talk about - how I do things in the realm of music therapy session strategizing and thinking about all things therapeutic music experiences (TMEs) and client interactions!
Warning - I am a product of my own experiences and often state my opinions here on this blog as statements of strong conviction - things that I want others to know about. I figure that my blog is a good place to do that - if you don't like what I say, you are welcome to comment or to avoid me completely - it's up to you!
I work with interns, and I often find their mindset to be a bit constrained, especially when it comes to therapeutic music experience (TME) development. I think this is partially due to the natural developmental process of any and all music therapy students and partially due to the way they are taught to engage in session planning and TME development. I think there is a better way, and I share it with the folks who come to my presentations, attend my webinars, and who talk to me about it all. In fact, I often get so excited about sharing this that I just go on and on about it until my audience is ready for me to just stop already!
If you are still reading, then get ready for my discussion - here it comes - you can still navigate away from my page...
Still here? Okay then.
In my experience with interns from all over the world and all different ages and from all different programs, I have found that most of them do really well with developing TMEs based on goals. If you say, this client has a goal of upper extremity range of motion improvement, most music therapy interns can develop TMEs to work on that particular goal. The TMEs are designed around the goal, and everything works towards that one goal.
So, what's the problem?
In my experience as a clinician, I have spent more time providing group sessions than individual sessions. I may have one client who was referred to music therapy for upper extremity range of motion, but all the other clients in the same group have different goals. What I find to be prevalent among music therapy interns is a difficulty in developing TMEs for multiple, varying, and equally important goals so all clients work on their individual goals simultaneously in the same music therapy session.
Example? Client A has the upper extremity range goal. Client B has a goal for developing palmar grasp. Client C's goal is to improve impulse control through waiting for a cue before acting. Client D's goal is to acknowledge others in the group. Client E's goal is to answer questions.
So, all of these clients are sitting in the same group, expecting music therapy treatment. The people who are paying for this music therapy group are expecting that their client will be addressing the goals tied to that client in the group time.
What I have found is that many music therapists often go to the solution of one TME per goal present in the group. There would be one TME that focuses on the goal of Client A and another for Client D's goal.
I don't do that.
In my clinic, I want students to be involved in all of the treatment that they are attending - every single moment. Now, to be fair, the only real treatment goal that my administrators have assigned to me is "educational enrichment," so every TME that I do technically fits under that umbrella. I have my own treatment goals, of course, and they vary based on the students that are present in each of the groups. When I am thinking through my TME development process, I try to identify all of the domain areas addressed by every TME - and there is ALWAYS more than one!
I guess I go from a perspective of TME to goal rather than from goal to TME when I write my TMEs.
I also will adapt my TMEs to include elements that address all goals with the clients who are present. So, in the client group above, each TME in the session would work on upper extremity range of motion, palmar grasp, waiting for cues, answering questions, and acknowledging others. This can be done - easily - within every TME when you start to think about it. Every client will engage in every TME within every treatment goal and all clients will also be addressing their own treatment goals in every TME.
How is this accomplished? Brainstorming and thinking and adapting and reframing.
If I am starting with a material or an idea that is not specifically tied to a specific client, I brainstorm about that material or idea. I sit down, look at the instrument, and start to think. I recently found a great deal on frog rasps on the internet, and I bought three new ones to add to the five I already have. It's time to sit down and brainstorm what we can do with frog rasps.
First off - what is addressed when playing the frog rasps in the motor domain?
- grasp - palmar grasp and possibly pincer grasp as well
- bilateral independence
- meeting at midline
- hand/eye coordination
- moving through different planes
- counting
- large to small concepts/ordering
- patterning
- sound identification
- identifying others with different instruments
- playing together in set patterns
- this may be more dependent upon the type of music either created or collaborated on within the group... could indicate different emotions using the different rasps...hmm. Needs more thought on this area.
Therapeutic Music Experiences for Frog Rasps
- Five Green and Speckled Frogs
- Gunk Gunk
- Tom the Toad
- The Frog Game file folder activity
- Hear the Lively Song of the Frogs in Yonder Pond
- Froggy Went a Courtin'
- New Idea - Froggy, Froggy Wants a Fly, sticks his tongue out as they fly by. Catches a fly upon his tongue. Names the letter and "Chomp," he's done! - use fly pictures to identify letter sounds.
We'll start with the new idea first - just came up with it right now. None of my clients have goals on letter recognition or letter sounds, but that's okay when I am matching and shaping my TME to the goal needs of my clients. This is where the brainstorming comes in.
Are you ready?
The basic TME idea is that the chant will encourage clients to engage in the TME and will describe what the client needs to do to complete the basic task. For client A, we will have the fly pictures displayed above his head. He will need to move his arms up in order to catch the fly for his verses. For client B, the client will have to pick up the fly and hold it until "Chomp!" Client C gets to do something special during his verses when we get to "Chomp!," but he has to wait until we get to that word until he can do the special thing. We will change the tempo of the chant when it is his turn so that he can work on addressing that impulse until cued. Client D will choose the next person/frog that will catch a fly. Client E will identify letters and answer other questions, embedded into the chant, as cued.
Bam! A new idea that doesn't look like it would address the needs of any of the clients in the group, based only on therapeutic goals, that does indeed address every single one of the goals of the unique clients in the group.
If we get through our goals during this TME, but we still want to play the frog rasps, I have six other ideas that have been developed and that will support these client goals as well as other goals to use to extend the theme and/or the desired experience. If I run out of time, I can use any of those other frog rasp TMEs to complete our time together.
Is this something that others do? Is this something that I am alone in doing during my session conceptualizing? My interns are always a bit surprised to learn about this concept, and other interns have expressed the same - they don't think this way about the materials, the music, the goals that we use to base our treatment on every day with every client. It makes sense for me which is why I do this. It may not work with others, but that is okay - my blog, my opinions!! (Cheeky grin inserted here.)
Whew. I'm exhausted... I have to get dressed to go to the chiropractor and then I have a Skype appointment with a friend of mine. Happy first day of my second summer break!
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