music, therapy, and me

Three days and sixteen sessions left before the end of the contract year, the end of the first summer session, and before my surgery. "That client" had another perfect session yesterday - not even a whimper and allowed me and peers to use materials without protest. That means that Wednesday's session will probably be a doozy, but I'll take it! The problem with having highly reactive clients is that the entire session is a tenterhooks situation for me. I am on edge the entire time "that client" is present - I cannot relax or drop my attention towards "that client." It is exhausting. I do not feel like we talk about the unintended situations and trauma that can come with being around specific client populations. It is not something that we often speak about in courses - being hurt by clients, being around clients who display aggressive or self-injurious behavior, being yelled at by clients. All of these situations are things that I work through on a ...

I cleared off my work desk yesterday, and spent some time working in my TME file and on several of my projects. It is pretty satisfying to be staring at a clear(ish) desk surface, and I am ready to concentrate on my current Tuesday theme - the return of TME Tuesday. Today's TME is going to be a work-in-progress as I haven't quite finished it all up, but I am working on it. As you know, I collect therapeutic music experiences (TMEs) in a database for my own use. My ideas are in my database as are the ideas of interns, students, fellow professionals, my Girl Scout leaders, and many others. This database is mine to use during my professional interactions with my students, and I have used this database since way before we used computers to organize these types of things. I used to use my index cards more than anything else, but now I use the computer more than anything else. You get the idea. Tangent. Today's post is all about developing a therapeutic music experience (...

I am a music therapist. I consider myself to be a music therapist who specializes in treating people with developmental disabilities who also have concurrent psychiatric diagnoses. Almost every single one of my clients has a history of traumatic experiences, and many of those traumatic experiences include sexual and physical abuse. Almost every single one of my clients has learned to remain safe in the world that they know through aggressive behaviors - "I'll hurt you before you can hurt me." This is the reality that I walk into every work day, and is the reality that my clients have. As someone who has chosen this population and continues to be part of the treatment of my students, I have learned to see behind and beyond the surface of the aggression to some of the possible causes of the responses and reactions. My current study of trauma, trauma-informed care (T-IC), and recommendations for treatment continues to enrich my level of understanding of what happens in...

I struggled with the same four clients yesterday that challenged me last week. The problem? Giggling, running around the room, and doing things expressly asked not to do is SO much more reinforcing than anything I have to offer that nothing gets accomplished except for lots of chaos and mayhem. Now, I've been through situations and classes like this before, but none of us were prepared for this type of response from these students. It is all because we have a new student in the class. This student was originally in a classroom where no one would respond when he got squirrely. Now he is in a class where EVERYONE responds when he gets goofy. They all join in! It goes from engagement to out-of-control in an instant. There are very few indicators that the kingpin of this particular response has any signs of approaching overstimulation - it just happens! BAM! So, yesterday's session included having assigned seats, but students could see each other, so I was not really able to ...

I work with some challenging clients. Every student who attends my school has been sent to that school program because they have failed in every other school environment. This often means that the group sessions that I have to do are full of kids who have learned to avoid undesirable tasks through aggression, tantrums, self-injurious behaviors, running away, and doing all sorts of things in order to gain attention or leave uncomfortable situations. Classroom groups are determined by people who never have to work directly with the students, and often group members are not very compatible with one another. At the moment, I have several groups that are complete messes. Imagine a group of 12 kids, ages 7-21 (yep, you read that right - we have that range of ages in the majority of our classes right now). Staff members are in all sorts of training at the moment, so there are never enough staff members to cover our basic ratios of staff to student interaction. Add to the environment the...

Yesterday, our BCBA guy came to observe me during a music therapy group. He's been at the facility since October and presented on a "school-wide program" that he had started that was not truly "school-wide" back in January. I got a bit frustrated by the attitude that something encompassed the entire school but did not include the entire school. He came into my room on Monday, during lunch while I was eating ravioli and watching my documentation television show (long story), to talk for "a couple of minutes." He stayed for 20. Yesterday, he arrived for one of my therapy sessions to count interactions and see what was going on in music therapy. After the session, we talked for an additional 20 minutes about his current data collection strategy and how music therapy does not fit. Now, since I left my internship many years ago, I have not been evaluated by a music therapist. I have had no information about whether my skills are appropriate as a therapis...

I found myself back into the writings of Mercedes Pavlicevic this weekend. I finished chapter eight (of thirteen - only five more weeks to go), and, as always, found myself thinking about what I do in a deeper manner. I wonder why I didn't read this book before now. It would have enriched my clinical education so much. Maybe I wasn't in a place to understand it until now. That's what I'm going to believe - I'm reading it when I need it the most. I am enjoying this book. Chapter eight, entitled "Songs without words: Music in communication," addresses how we, as humans, develop our communication skills outside of the musical environment (but with ramifications for music therapists). The majority of the information presented comes to us from infant and infant-mother research and includes articles that are familiar to me from my education in cognitive psychology and human development. I'll be re-investigating my article archive for the names Trevart...

The therapy week is finished. The therapy week is finished. Ooh, I like saying that this week. The therapy week is finished. (By the way, while I am reading that in my head, there is a soundtrack that goes along with it - music is played by a full orchestra and has majestic chords and cadences...hmm.) The therapy week is finished. I do twenty music therapy groups per week. Sixteen of these groups are convenience based, meaning that I have absolutely no say in who is in which group. Four of those groups are organized by the art therapist and myself which allows us to arrange our clients based on level of independence and appropriate relationships with others - that's the system I prefer, but the other teachers struggle with the idea that they can split their classes up into other groups - it's a control-type issue. Blah, blah, blah - long story short, I often feel like my services are viewed as babysitting/entertainment by some of my co-workers. Yesterday afternoon was a...

There was a question about working with persons with the diagnosis of Oppositional Defiance Disorder (ODD) on one of my social media links, and a friend of mine tagged me to respond. I started to think about the folks that I know who have come in with this label, and how I worked with them. In my years of working with children and adolescents with a variety of concerns, I have found that the way I work with those with the initials ODD as part of their mental and developmental health diagnoses is not that different from how I work with those without those particular letters. When I start to sit down and think deeply about what I want the therapeutic relationship to look like, I want my clients to make decisions about their own treatment. I want my clients to know that they have a say in what we do, and how we do it. I want to foster a mutual respect for the clients who come to music therapy with me. To that end, I find that there are times when my clients don't want to do what I h...

Last week, I finally finished the first level of Sear's outline about processes in music therapy. I am now moving onto the second level - experience in self-organization. The discussion on pages 39 through 41 is concerned with the concept that music offers humans the opportunity to indicate inner processes and ideas through participation in an external stimulus. Sears, one of the founders of behavioral music therapy, was very clear that inner responses could only be inferred from behavior - that is, that I, as a behavioral music therapist (at times), cannot know for sure what another person is feeling, but I can start to come to conclusions based on the behaviors that the person engages in during an interaction. Sears states, "A common goal in therapy is to structure experiences (objectively describable) so that the individual receives the satisfactions (inferred) necessary for him to seek more such experiences (objectively measurable), and to see that such experiences len...

It is Sunday again, and that means another trip into Music in Therapy , the first trip into music therapy theory that I ever took (way, WAY back). It is taking me a long time to get through this relatively short chapter, but I think that is because I am thinking deeply about this chapter yet again. Eventually, I will be finished, but that time has not come this week. This week's topic is "music evokes affectively ordered behavior" (p.37-38). In the paragraph that Sears spares for this topic, I find myself saying quite often, "Yeah, but..." Sears used this one paragraph to illustrate the responses of groups of clients to different categories of music. While not using the words "sedative" and "stimulative" music, those terms are definitely implied. He starts off by averring that: "Slow tempos, smooth (legato) lines, simple harmonies, and little dynamic change are characteristic of music that tends to reduce or sedate physical ...

It is Sunday again, which means another dip into the writing of William Sears. This outline is taking more time than I thought it would - must be because I am really thinking deeply, right? Anyway, last week I wrote about the first part of Sears' concept that music provides experience within structure and demands time-ordered behavior. I was privileged to see an example of this during our annual Talent Show last Friday. I have a client who has severe involvement with a diagnosis. This diagnosis impacts every area of life, but is most evident when the client is asked to respond in a timely manner to an external stimulus. We're seeing some decrease in processing time in music therapy (and in other conversations with me specifically outside of the session), but there is still a significant delay between prompt and response. Not so on Friday. On Friday, this client opted to swing dance in front of the entire school. The client was able to focus on the partner, perform the ste...

Yesterday was behavior management recertification day. It's a day that happens every four months, and it usually contains a quick review of physical interventions to assist in maintaining safety. Yesterday, it was different. The folks in charge of our training FINALLY realized that when you only review the physical interventions, that's what people remember and they skip over all of the other stuff - the VERY IMPORTANT non-physical interventions. As a result, our usually quick recertification stretched into a much longer time together. I really didn't mind at all. We reviewed lots of terminology contained within the system of behavior management. The problem? We haven't used ANY of that terminology in years. In fact, I haven't ever heard any of those terms before. We were penalized for not knowing these terms which I found to be unfair. I was in a group with four others - most of whom have been in this system from the beginning - and NONE of us were familiar w...

Ugh. Yesterday's sessions started with a headbutt to the nose which caused my nose to bleed off and on for about 45 minutes, led to tenderness, and the start of some bruising. It also led to worker's compensation forms, questioning from my dad, and lots of compulsive looks in mirrors to stare at my nose. The question that continues to plague me is, "Has my nose ALWAYS curved to the left like that?" Do we ever really talk about the marks that clients can make on us? I work with kids who have failed in every other education setting that they've been in. They tend to strike with hands, fists, and heads before thinking. They seem to have no awareness of what their actions do to others. Some of them do this out of a need for survival - they were taught that hurting others was the way to get something for you that meant that you didn't have to do something that scared you. Some of them do this because they can - that's the situation with the client yesterday...

I had a meltdown last night. I was frustrated, my computer decided to keep updating itself while I was using it to host a webinar, and I sliced off the top of my pinky toe in the middle of all of the other angst. As I was trying really hard to get my computer updated and back online for the webinar, I cried frustration tears, cursed a bit (mildly - I'm still afraid of my mother coming to wash my mouth out when I cuss), and had a mini frustration fit. I was able to compose myself and move back into the idea of being a presenter once the computer started up again. I had to remind myself to use my coping skills and that a computer that is interrupted from its job during its job is not a tragedy, it is really a gift. It was difficult to be mindful and appreciative in the situation itself, but I was able to find some humor in the situation once it was all over. I think that being able to adapt to whatever comes is an essential skill for a music therapist. I try my best to remember...

This was a rough week. It started with a day off - which is always nice - but that meant that we all went back to four days of being a bit off. The iPod had a meltdown, stopped talking to the computer and then stopped talking to me. Middle school clients were rioting, fists were flying, screaming was happening everywhere, but definitely in the music therapy room. There was some consolation in the fact that middle schoolers were screaming everywhere, but it didn't make things any quieter in my small, acoustically difficult space. What are your biggest group therapy challenges? How do you engage diverse clients into a common therapeutic music experience? I know what I usually do in these situations, but my current methods of interaction just aren't working these days. My philosophy about this is if the  clients aren't fitting to the current treatment service delivery model , then you change the delivery model to fit the clients. I spent the entire afternoon thinking ...