TME Tuesday: Thinking About Treatment Domains and Goals for TMEs

I talked to my intern yesterday about my expectations for writing therapeutic music experiences (TMEs) and how to organize thoughts about what clients will address during each and every one of those TMEs. We had a good discussion about how I approach the idea of establishing goals and objectives through my TME development process.

I find that many new music therapists over-focus on one or two treatment goals when developing TMEs. For example, a client comes to see them that has a clinical treatment goal of learning letters. Every single TME that is developed for that client has a goal of learning letters, but the therapist often neglects the fact that clients in music therapy often have experiences that enrich skills in other treatment domains as well. So, an Orff, letter matching TME becomes fixed in the mind of the therapist as something to do when a client has a goal of learning letters, but not for a client who has fine motor goals or emotional/behavioral goals of developing impulse control through waiting to play until the client's letter is indicated.

My challenge? To milk every single TME for each and every possible treatment domain addressed by the TME and list all of them in my TME plan.

I think this outlook comes from working with diverse clients in group settings, trying to address 12 simultaneous client goals within treatment parameters. If I only do one goal-focused TME per person in the group, then what are the eleven other clients doing during that TME? Well, they are getting some therapeutic benefit, but they are not working with a therapist who understands that they are paying for treatment. They are paying for more than the three minutes of their particular TME that focuses on their goal.

I believe that every single therapeutic music experience includes more than one element of treatment. We know that being in the presence of music changes physiological responses. We are finding out that brains activate when music is present in the environment, so every single application of music has, at its core, an effect just by being there. (This is the reason that people use music as a therapeutic intervention without being music therapists - there are specific responses that happen when music is presented.)

Any time I incorporate an instrument into a TME, I am offering the client an opportunity to work on the motor realm of treatment goals. Every time I ask a question and want a response from a client, I am addressing cognitive, social, and communication goals. When I am asking a client to wait until cues, I am addressing impulse control which I place in the behavioral domain. So, the Orff TME described above is more than just a letter matching TME. It addresses motor skill development (fine motor, possibly crossing mid-line, coordination of bilateral movements, hand-eye coordination, motor planning, and control of movements) AND cognitive skill (interpretation of verbal or musical prompts). In addition, clients are working on academic skill (interpreting letters into music, symbol to sound representation), behavioral skill development (waiting to play only the letter indicated, waiting to play the letters that the client has in front of her), and social areas (playing with appropriate volume [which is also a cross-over with motor planning] to accommodate peers, playing at appropriate place in the music to make the group effort work). There is no reason to put this TME idea into a box labelled "Letter Recognition." There is so much more going on!

I've found that this type of global goal identification has kept me employed as a music therapist for many years.

In my first year at the facility where I am now, I worked with an occasionally snarky administrator. After a particularly nice spring day, he walked past me and stated, "I want to know what bubble blowing has to do with music therapy." We had spent the day outside on the patio, listening to music and blowing bubbles. Because of my global goal identification, I was able to state all the reasons that bubble blowing and music listening outside on a beautiful spring day was therapeutically beneficial to my clients and was an appropriate thing to do in the realm of music therapy. His comment led to a ten minute discussion about therapeutic goals and the particular clients who were present during the treatment session. I was able to demonstrate to him that I knew what I was doing and that each group member's specific treatment goals were being addressed, simultaneously, through bubble blowing. That administrator never challenged my session planning again, became a great advocate for music therapy services in his future places of employment, and now is the proud father of a music therapist. 

When I do anything within the parameters of my music therapy treatment sessions, I have to be able to justify what I am doing through my clients' identified treatment needs and specific goals and objectives. Every song I sing, every dance break, every instrument I pull out of the closet has to address every client's treatment goals, and it can be done! Shifting my thinking and approach to TME planning was the trick!

If you are interested in learning more about this, you can attend my AMTA concurrent session on November 18, at 8:00 am - From Many to One - where we will discuss this a bit further! If you can't wait that long, comment below, and I'll add you to my quarterly newsletter which will give you information about upcoming CMTEs and webinars that I offer occasionally. I'm also available to either prerecord this topic or to do some live discussions with educational programs or music therapy groups. All we need is a dedicated internet service - that's about it!

Happy traversing into the big, big world of treatment domains and goals!

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