TME Tuesday: The Essential Element of Every Single Therapeutic Music Experience!

After many, MANY years of being a music therapist, I FINALLY figured out what HAS to be part of every single Therapeutic Music Experience (AKA: intervention, activity, application, interaction - whatever you call what you do with clients within the structure of your music therapy sessions) - are you ready?

The DESIRED OUTCOME!

That's it. That is the essential element of every single TME - you have to know what the end goal is of this form of therapy before you can accurately provide experiences that assist the client in accomplishing that end goal.

I am embarrassed how long it took me to put this together. In my opinion, every single music therapy student should know this from the very first time that they sit down to write a therapeutic music experience! I have found that many of us know this thing a bit, but most of us don't realize the importance of knowing what the end goal is when we start the process of therapeutic intervention.

I often think about this from the perspective of someone who has been in both physical and occupational therapies as a client as well as a therapist who has a critical eye. Let's say that I am the mother of a child with a communication delay. Music therapy is recommended for my child's communication development, so I sign my child up for some group music therapy sessions. I watch the session and notice that my child is not being asked to communicate during most of the TMEs. I start to wonder if music therapy fees are really worth it because it seems that she only is challenged to use her communication skills during 5 minutes of the session. So, I might be paying money for her to play rather than move towards the goal. Often, rather than asking about goals and objectives, I will do what many people will do when receiving a service of any kind - if it does not fit my needs and expectations, I will leave to go someplace else.

As the music therapist, I want to ensure that this child is addressing her communication delays in every single TME. If those opportunities for skill development are not apparent to payers, then the payment goes away. I want to be able to demonstrate that we are challenging this child to work on her communication skills from the start through to the end of every session.

I hope that most of you are thinking, "well, duh, Mary Jane, that's THE most important element of EVERYTHING that I do with my clients. I am CONSTANTLY looking at my clients' long and short term goals when I plan every single thing that I do!" (That has not been my experience or the experience that I hear about from current interns from all over the place, so I am hoping that others have been exposed to this more than the folks that I have spoken to about all this...) If that's what you are thinking or teaching or doing, then please leave a comment below.

Perhaps we need to be more explicit in the thought that every single TME that we introduce into a music therapy environment has to be linked to why the person is in music therapy to begin with. Some theoretical constructs are more explicit in this than others. A music therapist who is working with a person who is rehabilitation knows that when their client reaches a specific point therapy is no longer needed. It fits into our model of assessment, treatment planning, treatment, reevaluation quite nicely. It becomes more difficult when the end goal is not clearly defined.

For example, my purpose for music therapy sessions at my facility is termed as "educational enrichment."

Random beach picture because, why not?  

There is no end to that particular goal. I cannot discharge a client from music therapy services based on completion of the goal because there is never a time when enrichment is finished. So, my goals for my clients have to be more temporary than the end goal will ever be. It makes it difficult to be able to figure out what you have to include in music therapy when you have no clear indications of where the clients need to move towards to be finished. So, there are no clear guidelines. This may be part of why it took me so long to realize what is needed for TMEs.

Now, just so you know, I do have some umbrella goals for my clients, but they are not finite. My residents are often referred to the entire program for work on social interactions, communication, emotional regulation, and impulse control. All of my clients work on all of those goals during music therapy sessions. So, I do have some guidelines about what to do during music therapy, but we never get to a point where someone "graduates" from music therapy due to completing the main goal. All of the TMEs that I use with my clients address all of these goals in different ways, but I also have the freedom to change things from my prospective session strategy to work in the moment with my clients wherever they are in their various states of existence. 

Without a clear idea of the desired outcome of every single client that comes into music therapy, how does the client know when it is time to move forward? How does the therapist know? Is the interaction really therapy if there is no end goal? These are the sorts of things my brain wrestles with as I get ready to write about various topics here on this blog...