We're moving...

Well, not physically...well, unless you count moving to MY OWN STUDIO!!! (SQUEEEE!!)!!! But that's another story. I'm actually moving this blog, dormant though it has become, to THIS address... https://midsouthmusictherapy.wordpress.com/ I hope to see you there...and I'm trying to be more prolific. Well, we'll see.

Of Parents, Attachment, and Surprise Outcome, Part II

A friend asked me recently, "How do you work with the children you have and not get attached?"

Oh, this is such a good question. It takes me back to my earliest undergrad classes, to my earliest work experiences where the mantra was "Keep your distance. Don't get attached."

I will admit, a certain amount of detachment is clinically necessary when one is assessing and treating a client, whether child or adult. You can't let your wishes for that person cloud the very objective data of what he or she is truly capable of at that moment, even if it is far below where we wish they were. That's why we do therapy; to increase their levels of functioning to an optimal level. I once had a tender-hearted freshman music therapy student who was having trouble separating a child from his disability. In her youth and inexperience, she felt that making note of "negative behaviors" or "inability to perform certain tasks" was a personal affront on the child as a whole. I tried to explain to her that the objective, clinical words were what we used to describe the manifestations of the disability, not the child as a person, but I could tell she wasn't buying it. It took some weeks, and a lot of processing, before she could even begin to think of separating the clinical versus the personal. In one supervision session, she almost defiantly told me, "But I'm still going to like him. That can't be changed!"

Well, of course not. I assured her that it was more than acceptable to like this little boy, and in fact, that made me feel confident about her ability to eventually work with him therapeutically. The trick, I told her again, was to be cognizant of her subjective feelings, and to remember to keep her clinical judgement first and foremost. Difficult? Especially for the novice, yes. Doable? You must. If you cannot separate your "wishlist" for the client from what is reality, you will be ineffective as a therapist.

Back to the aforementioned mantra from my bright but emotionally disconnected first music therapy prof: "don't get attached...don't get attached." Um, are you for real? If I did not get attached--in other words, if I didn't care beyond my goals and objectives for each client with whom I came into contact, exactly what good would I be? Does that mean that I am going to develop a symbiotic relationship with the client, and his or her family? Of course not. That would be counter-therapeutic.
So is it counter-therapeutic to enjoy my clients, to be moved by their personalities, their cuteness? No, not as long as I remember why I'm there. Have I had my heart torn out? Absolutely. I've lost tens of children over the past 12 years. I've seen horrible abuse, cruel injustice. For sure, it will happen again, and again. I accept this as part of the package. So I try to keep myself healthy, to find colleagues with whom I can trade reality checks, and to have as solid a marriage and social support system as I can. When something bad happens, I have to face the bad feelings, and yes, the grief. Then I have to move on and continue to be a therapist. To me, that is the most honest thing to do.

Of Parents, Attachment, and Surprise Outcomes-Part I of II

Well! Happy New Year! Months have gone by since a coherent blog has been posted. Blame it on trying to get the practice up and running, or grant researching and writing, or whatever...Good old writer's block and a lack of inspiration is the culprit here. Hopefully the New Year will bring more inspired topics to the table!

Thanks to an SOS call that I put out on Facebook, that renowned digital town square, I was gifted with some topics that my would-be readers requested to see here in the Studio. So in order to respond to everyone's feedback, here is part one of two...actually, it's more of a hodgepodge of topics that I have gladly embraced (thank you, Tonya and Bob!)to start a conversation again about music therapy.

Part one of this "series" is actually just my tribute to parents of special needs children. Next to military wives, these people are my heroes (If you happen to be a military wife AND the parent of a special needs child, you rank quite close to sainthood, in my book!).

I've sat in my share of tense IEP meetings, watching the battle lines being drawn. Parent vs, SPED director, parent vs. principal, and most unfortunately, sometimes, parent vs. teachers and/or therapists. Sometimes it's just barely civil. Sometimes it's openly ugly. Sometimes one side is the aggressor, other times the hostility is mutual. It's always agonizing.

Over the years, though, I've become tenderized, if you will, to the parents. Yes, even the hostile, aggressive ones. Certainly I understand budgets, program limitations, funding dead-ends (Music therapy is often the first thing to go in the SPED arena, when budgets are crunched). I understand the frustration of not having the right staffing, the right equipment, the proper training to give a child what they so desperately need. It's frustrating...and it is a helpless feeling to have to look a parent in the eye and say, "I'm sorry. We can't provide that (service, one-to-one assistant, increase in service time, etc.)" I know that we cannot, realistically, meet every single need in the school setting. It's an imperfect system. I get that.

But-the frustration and feelings of inadequacy pale in comparison to what parents of special needs children experience on a daily basis. I can only imagine the day to day struggle for every little thing. Going shopping is a major undertaking, whether you have a child on the autism spectrum who melts down because of the hustle and bustle of your local grocery--or a multiply-handicapped child who requires a wheelchair, needs to be tube-fed and diapered before you walk out the door, and who might have a grand mal seizure (or many) without any warning. Having a moment to enjoy the adult company of a spouse, relative or friend is a luxury. A full night's sleep? Forget about it. Not if you have a child who doesn't sleep--or has MORE seizures. AND--isn't it funny how some friends and family step back after a diagnosis? Hmm. So the support system is cut down even more drastically. On one hand, this does separate the wheat from the chaff...but that pruning is always painful. It leaves scars.

Add to that the never-ending medical appointments, therapies, hospital stays. Insurance claims, denials, re-submission of said claims, and fighting with yet more people who don't know your child who are making decisions based on a bottom line. Are you kidding me?

At last, there is the school system, once the child turns 3. And no, I'm not bashing, nor biting the hand that feeds me and my family. I love working in school settings, and I've met more dedicated professionals than not. However, consider the IEP process...more people involved in the care and education of your child. More assessments, more talk about deficits and needs and behaviors, and the list goes on. It's enough to make your head explode!

When all has been peeled away, I don't care who has the PhD, or the title. Yes, we all may be the experts IN OUR FIELDS, but you, the parent, are the expert on your child. We, as the experts in our chosen disciplines, need you. We need your input, we need your partnership. Of course there will be disagreements here and there--but it is my hope and prayer that you all find the best educational settings for your children. AND--my hat is off to you, for the situation you are in is most likely not of your choosing, yet you tuck your chins, move forward, and fight like warriors for the most precious people in your lives. May we, as professionals, treat that with the respect and care that it deserves.

Transcending Disability

Last Tuesday's preschool music therapy group turned out to be one of those pivotal sessions in which the children appeared to come out of their disability and into the music. I found myself wishing we'd had a video recorder on hand, just so that we could all relive the moments over and over, and marvel at what is truly inside each of these children.

Normally it is a group of 3 children, two girls and a boy. Today it was just the girls, one accompanied by her mother, one accompanied by both parents. In such a small group, the absence of one can be disconcerting (probably more to the therapist than to the child), so I was wondering what direction therapy might take today. Yes--out goes the loosely planned set of activities, and on to thinking on the fly. No problem. In 12 years of practice, I've learned just how important it is to be clinically flexible...you know, to be able to do "clinical backflips." :)

I'll describe the girls: Both these little girls have Rett Syndrome (RTT). In short, RTT is a neurological disorder caused by a mutation on the X chromosome. It robs the children (mostly girls) of hand usage, communication skills, other motor skills, and the list goes on (check out rettsyndrome.org for more information). What RTT DOESN'T do is rob these chldren of their personalities, their lovability, their desire to just be children. They are also, nearly without exception, remarkably responsive to music therapy, which makes them joys to work with. I might add that another common thread in children with RTT is their beautiful faces, and eyes that communicate everything their voices cannot. In my 12 years of practice, in which RTT became my unexpected specialty, I've worked with 13 girls (C. was my first girl after graduation, described in the post, "Tears, Healing and the ISO Principle). I must say that they have all been strikingly, sweetly beautiful. These girls are for sure no exception!

Now on to the session. After I made the mental shift from planning therapy for 3 children, I took a step back and looked at the girls. They were both in exceptionally good moods. Okay. Let's support that. Both girls, both ambulatory, appeared to want to move. Great. Let's capitalize on that. And what's this? Wow, they were interacting with each other! Lots of eye contact, huge smiles...okay, it's time to get down to business here! Following the tempo of their "dancing," I started the "Hello Song." The girls circled each other, made eye contact, smiled at each other. They ventured close to me and grinned. One of the girls batted wildly at the guitar, and was pleased when her action was rewarded with sound. YAY for purposeful hand usage! They both engaged with their parents, and there was some vocalization. Both responded to their names being sung by looking directly at me as I greeted them in song. We had the makings of a ROCKING session here! Basically, it felt no different than it does in a music class with typically-developing children.

Later in the session, we worked on songs using a voice output device that is activated by hitting a switch. I had pre-recorded the ending phrases to a song onto the switch, and the girls, in essence, by hitting the switch, were able to "sing" the song with me. This required motor skill, attending skill, and turn-taking. The motor part is normally the most difficult part for girls with RTT, but they were both amazingly accurate in their responses on this day. We also sang another song using the switch again, but this time we added the visual/cognitive element of picture symbols to identify parts of the song. Once again, they both responded with unusual quickness and accuracy. I was impressed at the fluidity with which they both were able to move to access the switch.

It all has to do with sensory integration. Movement, auditory stimulation, visual stimulation, tactile input; all crucial for the children's success. The girls were given the chance to move and explore at the very beginning of the therapy session. This gave them a whole array of sensory experiences. I am convinced that this impromptu mosh pit experience helped their nervous systems get organized enough to attend to the tasks I offered. In other words, rhythmic stimulation is good for balance and attention. Prolonged rhythmic stimulation has been shown to increase voluntary hand usage in girls with RTT, as well as to help them use their hands more purposefully. Singing, rather than speaking, is often beneficial for children with RTT. The result is a decrease in response time, because the music/lyric combination stimulates parts of the brain that are often underdeveloped, due to the nature of the disorder. The systematic application of multi-sensory music and music activities (which is what music therapy is) on this day was enough to help bring each child to a higher level of functioning; every activity was offered with the goal of challenging the girls, but not to the point of frustration. It is important to make each activity accessible and gradually increase the difficulty in order to facilitate that growth and change that we are seeking. Buoyed by the "rush" of music, they had no idea how hard they were really working. This was a session in which they truly transcended their syndrome. With just a few minor adaptations to accomodate the girls' motor needs, they simply became little girls, like any little girls, learning new skills, seizing the opportunity to grow and develop in the enjoyable container known as music.

Chalk one up for the power of music! Onward and upward. I can't wait to see what all my young participants are capable of over time. It is humbling, and an honor of which I am not worthy, to work with each one of them.

Stay tuned...

So What is this Music Therapy of Which You Speak?

I'm glad you asked. Well, I know you really didn't...but for the sake of public education, I'm going to pretend that you did, and post some common Q's and A's about the art and science of music therapy.

Q: Is Music Therapy a new field?
A: No, it is an established allied health profession that has its genesis back around WWII. When professional and amateur musicians volunteered to play music for hospitalized war veterans, it soon became evident that there was a marked and positive response to the music, both physically and emotionally. Following the music listening sessions, patients in general reported decreased depression; they made fewer requests for pain medication, and many experienced improvement in appetite and quality of sleep. This response was so dramatic that it awakened interest in the use of music to promote health and recovery. However, it also became evident that people would need training to accomplish this, and so was founded the first music therapy college curriculum at Michigan State University in 1944.

Q: So what exactly IS Music Therapy? Do you just play nice music and cheer people up?
A: Well, it IS therapeutic for many people to hear good music, and certainly it can change your mood for the better. However, it's much more detailed than that! Music Therapy is an ACTIVE process, which means the client must take an active role in what happens. An active role could be singing, playing, listening, talking. It is not the kind of thing where the therapist puts on a CD and walks away. There is dialogue, there is support--and there is challenge to grow and change. That's therapy!

Q: How do you determine growth and change?
A: Through a detailed assessment, and through documentation of progress. The therapist observes a client in a music therapy session, may ask questions, will look at the client's records, if there are any, and will create a treatment plan, with goals and objectives, based on the client's needs and strengths and likes and dislikes. The reason that the client is seeking therapy is also taken into consideration. For example, if an otherwise high-functioning adult is seeking music therapy because of a trauma or temporary stressful situation, the course of therapy may be shorter, and more directed towards the goal of resolving or adapting to the stressor. However, if you have a young child with multiple disabilites, what you may be looking at is a longer, more intensive course of therapy, and probably one that will be part of a multi-disciplinary approach to help the child develop in the special education milieu.

Q: What is an example of a music therapy goal for a child with physical and cognitive disabilities? How about a music therapy goal for a depressed but otherwise high-functioning adult?
A: An example of a music therapy long-term physical goal for a child with developmental delays might be one like this: (Child's name) will increase his fine motor skills in music therapy. The short-term objective for this goal would be more specific: (Child's name) will use an adapted mallet for 2 out of 4 entire activities by (date). The significance of using a mallet? Well, developing skill with the mallet will hopefully carry over into other areas of his life, perhaps help him use eating utensils, and help him develop eye-hand coordination, which actually is important in developing literacy skills. All those abilities, motor and cognitive, are tied together neurologically. Cool, isn't it?
The goals and objectives for a high-functioning person experiencing depression might look like this: (Client's name) will report decreased depression using a number scale (0=none, 10=severe)by the end of the second month of music therapy treatment. The objective paired with that goal could be something like this: (Client's name) will choose 2 coping skills learned in music therapy, and use them outside of therapy to help alleviate depression, as evidenced by journaling, and reporting to the therapist each week. In each case, the goals and objectives must be clear, obtainable, and measurable, even though they are tailored to very different situations and clients. It is important to note that someone with multiple issues may have more than one goal in music therapy- agoal and objective to meet each need as the therapist sees fit.

Q: What is a typical music therapy session like?
A: Just as there are no typical music therapy clients, there really is no typical music therapy session. There are elements that are usually in a music therapy session, such as greetings/check-ins, activities for warm-up (or ice-breakers), then things that focus on the major therapeutic issue at hand...and of course, cool-down and closure activities. It depends, really, on the population a therapist is working with, whether it is a group or an individual session, and the therapist's own personal style. Most of my work has been child-driven; in other words, I may have a general idea of the music I want to use, and what need areas I wish to work on--but if the child comes into therapy in a completely different state than I had anticipated, my session plan goes out the window. I then have to "drop back five and punt" to meet that child where he or she is at that point in time.

Q: Can a school music teacher provide music therapy for a child?
A: Unless the school music teacher is also a Board-Certified Music Therapist, and has clearance by the school or district to also work in that capacity, no. If the music teacher IS a music therapist, but only working in an educational capacity, music class does not count as music therapy.

Q: Can Music Therapy be included on a child's Individual Education Plan (IEP)?
A: Music Therapy is a related service under the Individuals with Disabilities Act (IDEA, formerly PL 94-142), and can be added to a child's IEP, after a formal assessment by a Board-Certified Music Therapist. HOWEVER--the child has to meet criteria to have this service; either by virtue of being so significantly handicapped that extra supports are not only beneficial but necessary, or because the child consistently performs at a higher level in music therapy than anywhere else in his or her special education program.

Q: Is there an agency that oversees credentialing in Music Therapy?
A: Yes, the Certification Board for Music Therapists. The mission of CBMT is "to define the body of knowledge that represents competent practice in the profession of music therapy; to create and administer a program to evaluate initial and continuing competence of this knowledge; to issue the credential of MT-BC to individuals that demonstrate the required level of competence; and to promote music therapy certification." (CBMT website, www.cbmt.org).

Q: How can I find a music therapist?
A: You can find a music therapist who can meet your needs in your area by calling CBMT at 1-800-765-CBMT (2268) or e-mailing them at info@cmbmt.org. You may also call the American Music Therapy Association at
(301) 589-3300, or by e-mailing them at info@musictherapy.org.

The website

My private practice website is now up. It is definitely a work in progress, and it will be tweaked and added to as the creative bug bites me. :) Please visit me on the web at www.midsouthmusictherapy.com.

Quiet, Please! (or: Hurry Up and Wait!)

Shhhhhhhh.
Silence is golden.
You could hear a pin drop.
Quiet as a mouse.
Whatever cliche you use, never underestimate the power of silence. Yes...even in music therapy. No, I'm not contradicting myself (the woman who often explains that music therapy can be loud and chaotic). There is a place for silence in music therapy. Or at least, relative quiet.

In my work with children with auditory processing issues,and/or apraxia (the neurological disorder that shows itself as an inability to perform speech or motor tasks despite having the cognitive awareness to do so), I have learned to "hurry up and wait" while they process a directive. Something that we find simple, such as striking a drum, is a real challenge to children with apraxia. I like to explain it this way: Remember learning how to drive a car with a manual transmission? You needed to really think about how much gas to give with your right foot, and how to let up JUST the right amount on the clutch...aaaaannnnd...STALL!!! Oops, gotta start all over again! It's much the same with these children. I've learned to give a directive ONCE--either spoken or sung, and WAIT for the response. If you prompt too quickly after the first directive, the child has to process the whole thing all over again. In a sense, she stalls, then she must start the engine again, find that balance between gas and clutch, if you will, and hopefully, finally perform the task at hand.

In group music therapy, when I have parents or other therapists or assistants present, I ask them to please refrain from prompting after I have given the initial directive. Am I a control freak? Actually, no. It's to give the child time for the message to get from the brain to the muscles...and if that takes up to a full minute, so be it. I realize how difficult it is to not try to hurry the process up...we all love instant gratification. I promise, though...give it time, and the rewards will be even greater than you can imagine. Not the least of these gifts is the thrill of accomplishment, the "I DID IT!" feeling that every child needs, and those children with significant challenges, even moreso. As time passes, and the child is consistently given adequate processing time, there may be a quickening of response time. Yes, there will be good days and bad days, but always, the point of therapy is to build skill over time. It's never a steady upward climb. There will be ups and downs in the therapeutic process. So remember, when working with a child who has apraxia, or an auditory processing disorder, silence is golden, and less (talking) is more!

Stay tuned!