Goal Focus: Getting as Much as You Can From Every Single Therapeutic Music Experience

It is time to revisit something that I tend to write about every year - finding as many goal areas as possible in every single therapeutic music experience (TME) to assist in group treatment and to provide clear indications of why you would select a particular intervention or TME for a particular client.

This form of thinking is something that I struggled with for a very long time and that is not something that I really was able to verbalize until I started working with practicum students. My thoughts and procedures were born out of frustration - students were coming to my music therapy treatment sessions with one TME to address each therapeutic goal. For stirring, we sang one song. For fine motor strengthening, we sang one song. For gross motor extension, we sang one song. Sessions were BORING! We played the same instruments at the same time every session. Clients were struggling, and I was struggling because the student had a script and just couldn't realize that there were other ways to get to the goal besides that one song!

I have never really thought of one song for one goal area. I have always been able to see several reasons to do every sort of TME possible. This is probably a skill that was first modeled by my Occupational Therapist mother who is very creative and who was my primary influence as a young child. I know that this skill was nurtured through my undergraduate training to some extent, but it really developed into a method of thinking about the music presented to and developed by and with clients after I became a supervisor of others. This has solidified into a justification for presenting specific TMEs in group treatment to address as many client goals as possible to justify the payment expected from clients.

Ooh, let me explain.

Let's say that you are a parent of a small child who is working on fine motor grasp. You see a music therapy group and decide that some of your therapy monies will go towards music therapy. You pay your money and go to the first group. Your child seems to enjoy singing and dancing, but you notice that the things that your child is doing seems to be focused more on letter recognition and number songs than fine motor grasp. They aren't encouraged to use their hands to pick up materials. You go through 20 minutes of a music therapy group before you finally see a 5 minute experience that includes holding an instrument with a grasp pattern. You leave the session feeling that it was a very expensive group - your child only received 5 minutes of treatment during the group. Sure, it was a good time for your child, but it didn't really seem to work on the things that your child needs to learn.

Now, music therapists are usually aware that one TME usually incorporates more than one goal domain. (I say usually because not everyone seems to know this...) We also know that our profession is goal-based. We need to know what our clients are wanting to learn or address in order to provide them with individualized treatment programs. It is easy to focus on individual client goals when you see the client in a 1:1 situation - all TMEs are focused on that one client. It becomes more difficult when you are planning for a group of clients.

If you are gleaning as many goal areas as possible from every TME that you develop or use in your sessions, then you can provide 30 minutes of fine motor grasp treatment to client 1 while also providing 30 minutes of letter recognition treatment to client 2 and 30 minutes of color recognition to client 3 and 30 minutes...you get the idea. It is important to identify the different goals addressed in every TME to allow for this type of treatment to occur - to demonstrate to those who (we need to) pay for treatment that their clients' goals are important and deserve to be addressed throughout the treatment process.

So, how do I do this?

I brainstorm, I revise, I add things to my TME plans all the time. I also use a chart to help me organize goals into my TME plan.

Purpose:

 

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

This chart is my way of figuring out what we address in each TME. I write a purpose statement - "to increase fine motor grasp strength" for each of the things that I identify and place in the chart. So the chart is often used for short identification of skills - "fine motor grasp strength - holding boomwhacker" or "fine motor grasp strength - holding mallet (adapted if needed)." Here is the completed chart for a fictional TME.

Purpose: To increase fine motor grasp strength through instrument use; to increase color recognition; to increase letter recognition; to identify group members (through gaze or name); to create structured music; to create improvised music; to address impulse control through taking turns; to address impulse control through waiting for musical cues; to address concepts of dynamics, tempo, and harmony.

Motor	Academic/Cognitive	Social/Communication
Fine motor grasp - palmar with Boomwhackers; palmar with mallets; Gross motor coordination - playing bars on Orff instrument; Crossing mid-line opportunities; Bilateral upper extremity coordination	Color recognition; Letter recognition; Symbol recognition; Symbol to music correlation; Sequencing and patterning	Playing in group; Interpreting symbols to complete music process; Group member recognition
Emotional/Behavioral	Musical	Other
Impulse control - waiting to play until cued; Turn-taking	Concept review - dynamics, tempo, harmony; Entrainment to group beat

So, as you can see, there are so many goal areas that this TME addresses. As a music therapist, I can see how I can use this TME for the group of clients described above. Client 1 will be working on fine motor grasp strength while client 2 will be able to work on letter recognition. This TME hits all of the treatment goals that my clients are working on. 

Now, as a music therapist, it is my job to make sure that all of my clients are working on all of their clinical goals during the entire session. So, every TME that I use during the session have to include the same goals so that my clients get as much from their therapy dollar as possible. That's my job.

How do you conceptualize this type of thinking? How do you organize your ideas into ways to access information for different clients? How do you strategize your sessions? There are as many different ways to think through this type of thing as there are music therapists, and I like to know how others think. Feel free to leave a comment about what you do - do you use colors? Charts? Filing systems? Do you have one song to address one goal? Let me know in the comments below!

I have been a bit of a music therapy blogger slacker lately - this is evidenced by my lack of posts and my recent trend of posts that have absolutely nothing to do with music therapy at all. It has been a rough year for me, so there have been so many more things to talk about that have been me-focused than music therapy focused. I am trying to change that, but no promises. This blog is what it is - all about music, about therapy, and about me. Thank you for reading what I write.