TME Tuesday: The Way I Do This - Therapeutic Music Experience Development

One of the things that I find when I speak to interns and music therapy students is that there isn't much classroom time devoted to learning about how to put together a therapeutic music experience (TME). [Just so you know, this is the term I use to refer to what I do with my clients in their sessions - I was first introduced to this term by a music therapy intern from Western Michigan University and it resonated with me as a way to think about what to call what I do.] So, here is what I do and how I think about each piece of my TME file as I am developing the things we do.

Purpose:       This is where you identify all of the therapeutic skills and elements that you will be addressing. (e. g., To increase eye contact; name recognition; peer identification; fine motor control; entrainment; impulse control) This needs to be a complete list. Follow the brainstorming process explained in consultation.

Source:       This is where you cite the source of the application. You need to completely reproduce all information about the composer, the lyricist, and the person that first presented the application to you. Make an effort to find the original composers of all songs – look songs up on the internet for potential source material. If the application/song is your original work, then protect yourself by affixing a copyright symbol to the music that you compose. Include a date. If there is ever an issue with someone else taking your music, you have affixed the copyright and left it with me. I can testify that the song is your original work.

Materials:       List all of the things that you (or future therapists who are replicating this application) will need during the session. Do not forget accompanying instruments, specific CD titles and track numbers as well as CD players, electricity, etc.

Song/Chant/Words: Insert a picture of your music manuscript. If you cannot insert your manuscript, then add a hyperlink to the file so it is easily accessed by others. Also, if you cannot add your manuscript, include the lyrics and the chords to the song.

Procedure: R=Reinforcement opportunities; C=Redirection/Cue opportunities; A=assessment

1. This is the section where you perform a task analysis of the application.
2. You need to think through all of the steps that you will take, that the client will complete, and the possible responses that you will have as options.
3. Write them down.
4. Most procedures are very long.
5. Include times that you will provide reinforcements and times when you will provide redirections

Therapeutic Function of Music:       Describe why you would use music to accomplish the tasks/purposes identified at the start of the TME. What elements of the music itself assist you in completing the skill development of clients? What elements of the music have to remain constant in order to be effective in accomplishing the goals? What elements of music can change to accommodate the ways clients interact with you and with the music? Can this TME be used with different forms/musical pieces? If so, what are the criteria for choosing music for this TME?

Melody	Pitch	Rhythm	Dynamics	Harmony

Form	Tempo	Timbre	Style	Lyrics

Chart adapted from Hanson-Abromeit, D. (2010). A Closer Look at the Therapeutic Function of Music. Presentation at 2010 American Music Therapy Association National Conference: Cleveland, OH.

 Adaptations:       What could you, as the therapist, do to make this TME work with different populations? If a client enters the session on his/her first day, what can you do to make sure that the client is successful? How do you need to change the TME so all of your clients are able to complete the tasks?

 

Extensions:       Imagine that the clients are able to complete all of the tasks that you have identified in this TME in two minutes, and you still have 30 minutes left of the session. How could you change the TME to provide more practice without boring the client? What is the next step in skill development? What would be a natural “next step” to the TME.

Treating individuals in a group setting is often a challenge for music therapists. How do you address the individual client’s needs when that client has 12 peers who each have individual needs of their own? It is the mandate of the clinician to address all of the needs of all of the clients the majority of the time. It can be done, but it may take a shift in your ideas about how to lead group sessions.

At Lakemary, all clients receive group treatment sessions. This is one of the most effective ways of ensuring that all clients receive music therapy treatment. It also allows us, as a department, to maximize the amount of time that clients are participating in sessions. With a group treatment mandate, the therapist has the additional responsibility (as compared to a therapist who only treats clients in individual sessions) of addressing all treatment goals and objectives.

The majority of the clients at Lakemary Center have the same primary treatment goal. The exceptions to this rule are some of the students in Rooms 2, 4, and 8/1. The primary treatment goal at Lakemary Center is impulse control. All applications in the music therapy session MUST have a focus on impulse control. If you define the term, you will find that most Therapeutic Music Experiences (TMEs) do incorporate impulse control in one form or another.

In addition to the primary goal of impulse control, many students have goals in the social domain, specifically in the realm of developing appropriate relationships with others. As this is a secondary goal, it is not as necessary to include this aspect in every session element and experience. Tertiary goals include increasing music history knowledge, music theory knowledge, music appreciation, motor coordination, cognitive and academic skill development, communication skill development, behavior management (often agreed to be a part of impulse control, but may be different) and awareness of emotion.

So, how do you do this in the middle of a session while you are attempting to address the goals of every client? It is not easy, but it can be done.

The first thing that you do is to focus all of the TMEs that you write on the primary goal. Ask yourself the following questions when you are developing a TME:

1. How does this TME address impulse control? (Do students have to raise their hands for attention or a turn? Do students have to listen for a musical cue to respond? Do students have to complete an entire pattern before progressing? These are just suggestions, there are many more ways to define impulse control that I cannot list here)
2. What are the additional skills and goals that you are addressing? Does the TME work on any of the secondary or tertiary goals that are listed above? Does it address other skills or goals? WRITE them down!
3. What are the expectations that you have of the clients? (These include: what level of functioning does the TME need for successful completion? Where will clients be in the music therapy room?
4. What are the prerequisites for the clients to be able to participate in the TME? (What do they need to know before they will be able to complete the TME? Are they going to have to sit? Will they need to wiggle a while before they can concentrate on the TME?

 

How to write TMEs

This is not intended to replace any information that you have learned in your coursework, but it is intended to clarify some of the elements of application/TME design that you may either not be familiar with or that will make implementation a bit easier on you.

Components of Therapeutic Music Experiences (TMEs)

Applications are comprised of several parts, all of which need to be planned prior to the session. These components include the purpose, the desired outcome, materials, the environment, the client, the therapist, the music, and the therapeutic relationship. Each component is as important as the others.

Application/TME Plans: Plans define the process of the application/TME, provide a framework for the therapist, and illustrate the use of music and the influence of music on the client.

Purpose: This is the goal portion of the application. Why would you use this application in a session? Is it for a specific purpose? Does the application serve to indicate the start of a session? How does this TME address impulse control? Does it also encourage motor development, communication, social interaction, emotional development? What domain does the application address (motor, social, emotional, communication, academic, cognitive, behavioral, musical)?

• List all of the domains that are addressed by the TME under the purpose statement
• Goals are the big picture – umbrella topics
• Be specific with your purpose statements – “To increase motor development” is not as complete as “To increase upper extremity range of motion” or “To increase fine motor pincer grasp.”

Desired Outcome: This is the objective portion of the application/TME. Why would you want to use this application with a client? What skill will the client be able to demonstrate when this application is completed? Why is this skill important for the client? Is this skill important for the client? If not, then why are you bothering using the application in treatment? Goals are the large picture, while objectives are specific for each client and are designed to change over time.

• Target behavior to determine when the client has completed the task – “Clients will demonstrate pincer grasp and release pattern four times during the TME.”
• There may be several outcomes depending on the number of purposes that you have identified in the first section. This will allow you to use the same TME in groups allowing you to address many goals simultaneously.

Materials: What will you need to have to successfully run this application? Do not forget electronic equipment, power sources, instruments, props, visual aids, and/or alternative materials.

Environment: Where do you want the clients to be? Do they need to be in specific places in the room? Do you need lights or darkness? Do you need clients sitting in chairs or on the floor? Are there any other environmental aspects that you will need to change?

Music: What music will be used during the application? Is it original music? Is it prerecorded music? What CD, what track, and what performers? Where did you get the music? Where did you learn the music? If someone else composed it, include all the details – who, what, when, and where you can locate the original. If you composed the music, include all of the information located above with a copyright symbol © with the date of composition.

Therapeutic Function of Music: What function does the music serve in the application? If the music would disappear, would the client still be able to complete the application and reach the desired outcome? If so, is the presence of music necessary for the TME? If the presence of music is not necessary, then why would you use this application in a music therapy session? (It may be appropriate to use the application, but this is the time to think about why it is important to make music an integral part of every activity/intervention.)

The Client: What type of client will be able to complete this application? Will many different clients be able to participate the way the application is designed? Will some clients find this application too difficult? Too easy? How can you change the TME to accommodate many different clients? How can you change the TME to accommodate different learning styles and interest levels? How much of the TME will be decided and directed by the client?

The Therapist: What do you need to do before you can run the TME? Where do you need to be located during the application? Will you need to move around the room? Will you be able to remain in a chair? What music do you need to have memorized? Where will you need to place materials so you can access them during the application? What alternative applications or materials do you need to have prepared just in case? What tasks do you have to do during the application (data collection, preparation for the next TME, switching CDs)? Where is your focus? When will it be important for you to encourage the client to make decisions? When will it be important for you to make decisions for the client?

Procedure:

• Step-by-step instructions for leading the TME with clients
• Remember to include the music when it enters
• Remember to reinforce desired responses
• Include a data element – what will you be evaluating? When will you evaluate? How will you evaluate? How will you record the data?
• What will you do, as the therapist, to facilitate the TME?
• What do you expect the client to do? What will happen if the client does not do what you expect? How will you get the client to complete the task or outcome of the TME?

I think of this procedure as a flow chart. This concept helped me understand exactly what the folks at KU wanted me to write. I was not able to complete this task until I stumbled upon this visual format. If the flow chart idea interests you. Ask me for an example. I have a couple of applications/TMEs diagrammed in this manner. It takes a long time to diagram, but if you are a visual learner, it makes sense.

I hope this works for you. Let me know if I am missing anything that you do on a regular basis. I always like to learn from other people to strengthen my own clinical skills...