Systems in Music Therapy: Ensuring that All Therapeutic Music Experiences (TMEs) Address All Therapeutic Goals for All Group Members

Happy Systems Sunday!!

I am enjoying the process of thinking about the systems that I use in the course of my everyday music therapy existence. I am in the process of identifying these systems so I can write this series of posts. When you consider that any sort of routine can be a system, there are plenty of things that we all do every day that qualify. 

Today's system selection is my goal identification system. This is a crucial part of my therapeutic music experience (TME) format, and it helps me justify my selection of TMEs every single session. I use this system to ensure that every client in every single session is addressing the most important goal for that client, while all the other clients are doing the same.

Now, I don't know about you, but my music therapy sessions aren't organized so that every person in the room has the same music therapy goals. My session members are much more diverse in the goals that they are working on than would be convenient for me. I dream about a group where all the group members need frustration tolerance work rather than one person who needs work on that goal sitting next to another who needs work on upper extremity gross motor strengthening sitting next to another who needs work on academic skill development sitting next to another...you get the idea.

Since I don't have the ability to choose my group members for their treatment focus, I have to figure out how I am going to address diverse goals within the same session.

I am the type of therapist who recognizes that money is often the bottom line for how people choose therapy. If this hasn't occurred to you, then it needs to because money is the bottom line when it comes to how music therapists get, keep, and grow in jobs - both as a contractor/consultant and as an employee. 

Think about this. If you have a child with a diagnosis that needs treatment of some sort, you are going to have a treatment budget. How could you not? Treatment will cost money. That money may come from your own insurance, or from your own pocket, or you may get a budget from an organization that oversees treatment costs. Whatever way you get your monies, you are going to be looking for treatments that fit within the budget and that assist your child in gaining skill and reaching therapeutic goals. So, you find a music therapy group session that is pretty reasonable, cost-wise, and you sign your child up. You go to the group to observe, and you notice that, while your child seems to enjoy music therapy, there is only one TME that directly addresses your child's primary treatment goal in the entire session. You have paid the entire session fee for about three minutes of treatment for your child. You start to evaluate whether this is a cost-efficient treatment for your child.

In order to ensure that all clients get the type of treatment that they are needing during music therapy, it is important for me, the therapist, to design my sessions in ways that offer that treatment in all interactions with clients.

(Are you seeing why this is a system yet?)

In order to provide treatment opportunities for every person in my group throughout the session, there are two things I have to know - the group members' goals and objectives and the goals associated with each TME. Here's where my TME development system comes in handy.

When I sit down to write a therapeutic music experience (TME), I use a form that is somewhat based on the format that I learned from my undergraduate instructors, but that has morphed into significantly more information since I've been away from school. I just keep finding new things to include on that form (my poor interns!). One of the things that I do is keep a table at the top of my TME form that helps me to think through all of the different goal areas that are addressed in each TME.

It is a simple table - looks like this...

Purpose:

Motor	Academic/Cognitive	Social/Communication
Emotional/Behavioral	Musical	Other

I list all the things that I think about when I am developing my entire TME plan. 

This never is a completely finished portion of the plan, but it is something that I think about during my development process, during my first use of the TME, and when I adapt or extend things within the session. I am always amazed at how much I can identify during the original process of developing the TME itself, and then how much I can glean once I see what my clients do within the TME. It's staggering.
(If you notice, the table headings are the same as my color-coding headings... systems are supposed to work together, and this one DEFINITELY does! The only color code that isn't on this particular table is holiday - there was really no reason to include it).

So, let's say that I want to use the music notation cards that I've designed in a composition TME centering around coping skill development. I start to think about every single action, thought, possibility that we may address during implementation of the TME. Motor skills could include fine motor grasp/release patterns, wrist rotation, hand-eye coordination, visual tracking (these are the ones that I'm able to come up with at the moment - they go into the table.

This particular TME thought is chock full of academic/cognitive elements - symbol recognition, symbol to music meaning interpretation, matching, composition elements, tool for lyric development, symbol to instrument opportunities. I can decide to make this TME either an individual task or a small group task or a large group task - these decisions affect the social/communication goals somewhat, so I do need to think about these three different settings when I am deciding how to implement the TME with particular clients.

As you can see, the table fills up very quickly because, as we music therapists all know, music offers opportunities to address many different skill domains simultaneously. As I start to fill up the table, I am able to start making decisions about which groups will be able to use this particular TME, and I can also see which individuals may need some adaptations to be able to complete this TME.

It is all interconnected - that's the way systems work.

So, by thinking through all of these goal domains, I have the ability to demonstrate to the hypothetical client (the "You" scenario from before) how I am working with your child towards therapeutic goals while we are also working on the goals of the other clients. I can select TMEs that include all of the goals that my clients have, make adaptations to each TME to ensure that clients are being challenged to improve, and still offer TMEs that are relevant to every group member.

Isn't that something that all of us should want for our clients?? Isn't that what our clients want from their therapists?