Relationship Development During Prebereavement with Longterm Caregivers

Found you in a corner
Why’d you close your eyes?
I see you


 Longterm caregivers (individuals who have been the primary caregiver for at least 10 years) often experience a profound isolation from themselves and their various communities that can evolve, especially when the carereceipient received end-of-life care, into an existential crisis that calls into question their life trajectory. Longterm caregivers are often thrust into this role due to sudden and unforeseen developments, e.g. devastating accidents, massive CVAs, sudden diagnoses of late stage asymptomatic diseases (such as pancreatic cancer), and diagnoses of diseases that frequently manifest midlife (such as MS or ALS) or have an early onset (such as Alzheimers). As suddenly and dramatically as these developments alter the logistics of daily routines and quality of life, they irrevocably alter the means by which two (or more) people relate.

If we understand a relationship to be a composite of intersubjective roles assumed by each member of the dyad, then there is considerable danger in the caregiver role subsuming or outright replacing other roles (lover, friend, mentor, confidante, etc…) and becoming the primary identify. Now, the individual who once related to their loved one as Spouse, Partner, Sibling, or Child is only able to truly relate as Caregiver. Two significant dangers can develop as a result. The first is lost or confused motivation: when the caregiver becomes exclusively Caregiver and does not invest in the relationship as a devoted wife or husband, or loving son or daughter, then the caregiver becomes detached from the meaning-making that had defined the dyad up to that point. Once detached, the carerecipient is at risk of becoming an object to complete tasks for, rather than a loved one for whom to provide an act of service. Care in the pursuit of improved quality of life and meaningful shared experiences are reduced to basic functions, such as providing a bath and changing clothes, that are bereft of meaning. The second danger is caregivers losing sight of themselves and ultimately their own needs. Their compassion and empathy is poured into others with none left to promote their own emotional and spiritual wellness.

Always in the corner
I hear them telling lies
I see you

Given this limited means of relating and damaged process of relationship building, my first step upon first meeting a caregiver is to be with them in the moments between the moments. For me, this means not simply sharing in the physical space but listening to what is not being said, seeing what is not being shown, and making space for the emotional/psychic content that is not being shared.

To provide myself the means by which to access this level of sensitivity and awareness, I have accepted as a fundamental tenant that never before has this singular person lost this other singular person to death. Even if I have lost a spouse, parent, sibling, or child, those relationships (and losses) were my own; my empathy will be just as limited as if I had not experienced that loss at all. This unique being has developed a relationship with this other unique being that has never been before and will never be afterwards. Thus, the experiences of prebereavement during the dying process, loss during the death event, and grief in the coming days and months are all wholly unique from all other prebereavement, loss, and grief experiences that have ever taken place.

What do you see from the corner?
Is it bigger than the sky?
Show me now


 Understanding this frees me from attempting to empathize, or “feel with” those distinct experiences. Instead, I can access (to the best I’m able) the basic human condition that informs these experiences, where an emotion is more of a state of being unattached to any particular stimulus. Using sadness as an example, if I access the well of sadness that we all draw from, I can be in touch with the state of being that is shaping that caregivers experience and providing a lens for the caregiver to perceive and understand what is going on around him/her. If I can be in touch with the energy that sadness carries with it, I’m provided a starting point for accommodating my awareness of what that caregiver’s unique experience with sadness is in that moment.

Always in the corner
They don’t see your sky
Show me now

Caregivers are responsive to this effort to avoid defining their experiences by either my own or those of other clients. Without a concrete framework of grief and loss or constructs of “right” and “wrong” to feel forced into, they build a safe space for their own complicated experience to be whatever it needs to be in that moment. Similarly, by avoiding “feeling with” their distinct experiences, I can limit any unconscious projections of these undesirable elements into the process.

 It is this type of collaborative process where wellness can begin to be explored by tapping into music’s malleable, intersubjective qualities that construct meaningful shared experiences between therapist and client. These jointly constructed shared experiences, so filled with individual meaning derived from their intrapsychic world, have often been missing from the caregivers’ life. It stands in stark contrast to the rudimentary completion of caregiving tasks by providing caregivers the opportunity to construct personal, self-oriented meaning through explorations of their world and their place in the world. Here, they can become reacquainted with themselves and their needs, desires, and wants. They can gain greater access to their long ignored emotional centers, and experience and move through the long suppressed emotional content. Particularly potent themes that have emerged in the past are anger at loved one for getting sick, sadness at their isolation from their communities, and shame mixed with relief at the thought of their loved one passing away and relieving them of the burden of care.

Take me to your corner
Watch your sunshine rise
Beautiful

When this content begins to flow, the music’s role shifts from stimulating the caregiver’s center of being and eliciting meaningful intrapersonal content to holding and conforming to the shape of the space as the caregiver constructs it. At the same time my role, as a being distinct and removed from their unique experience, is to bear witness. To be a witness is to be an active “being” rather than an active “doer”.  I have to be willing to step into the world they have constructed within the therapeutic space that day. Bearing witness also requires making room within my Self to receive and be shaped by the caregivers emotional and psychic energy. I want to make sure to hold that content for as long as it wants or needs to be held, but without absorbing it into my own being. If I absorb it, then I’m assuming a part of their experience for them; instead, it is my intent to reflect it back so that they can move through their experience themselves.

 Through this collaborative effort, the caregivers’ internal world, so frequently neglected for the perceived benefit of the carerecipient, is validated and put first. They can reacquaint themselves with what it means to experience rather than mute their emotional and spiritual needs. The arrested development of the Self that began when they assumed caregiver as an identity can cease, and they can once more be a dynamic being. Once more activated as a being, they are able to receive the carerecipient as a loved one, and appreciate the whole person and not simply treat the illness by which they were previously defined. The relationship that helped set them on their life course has the opportunity to be successfully completed at the end.                       

Together in the corner
We will close our eyes
I see you

*Corner Girl, by Abigail Washburn

To contact Noah: Email: npotvin@gmail.com

Bio:

Noah Potvin, MMT, MT-BC, is a music therapist at Seasons Hospice in Delaware, and an alumnus of Temple University. His current clinical focus is on work with caregivers through the prebereavement and bereavement processes and understanding aesthetic experiences at the end-of-life. He currently serves on the CBMT Exam Committee, the MAR Public Relations Committee and as an alternate for the Assembly of Delegates, and was the 2009/2010 co-coordinator for the MAR Passages Conference for students and new professionals. He has presented nationally and regionally on clinical work with those impacted by death and the dying process.

 Advocacy is all Part of the Gig…  

Advocacy is vital to the future of music therapy. It helps to inform communities, clinical sites, potential founding sources as well as the consumers. In addition, it helps in sustaining enrollment in music therapy degree programs. As a profession, it is our obligation to ensure that the public understands the value of music therapy. How can we ensure that the future will include the profession of music therapy? How can we ensure that the music therapy job market will exist and be able to keep up with the graduating music therapists of today and tomorrow? Can we be certain that funding sources for music therapy will be available in the future? Or that music therapy degree programs will thrive and grow in the future? To that end, we need to ask, as a profession, can our voices sustain themselves while inspiring others to sing in order to make certain that we (music therapy) have a sound future? How can we do so? – Advocacy

In our work as music therapists we advocate every day by doing what we do: engage our clients in musical experiences, educating and supervising future music therapists, engaging in research opportunities, publishing and the list goes on and on. We do it (advocacy) with every note we play, each melody we sing and every life that we help to enrich through the power of music therapy! That being said, it’s so important for us to bring the work, the stories, the tales, e sights and the sounds into the ears and eyes to others.

What is the State Recognition Operational Plan and why is it important to music therapy?

The State Recognition Operational Plan is a national initiative being implemented jointly by CBMT and AMTA to obtain state recognition of music therapy and the MT-BC credential. This collaborative effort between AMTA Government Relations staff and CBMT Regulatory Affairs staff provides guidance and technical support to state task forces throughout the country as groups of music therapists work toward recognition as defined by their particular state.

The Plan involves increasing awareness of the music therapy profession and of what it means to be board-certified. The ultimate goal is that, in all situations, the MT-BC be a minimum requirement as a service provision in every work setting.

 Can I Advocate? Do I have the Time?

Advocacy can happen anywhere at any time at every level, from grassroots in your community to state agencies and governors to national legislators. In fact, any opportunity and conversation is a way to advocate for the profession.  Each day when we walk through the doors of our work place a new possibility for advocacy waits. Whether it’s dropping off brochures at a neighboring office, providing an in-service, trading a guitar lick with an MT colleague, training a MT student, having an informal conversation with a school teacher or other colleagues, writing a quick post on Face Book or twitter, or simply having a chat with a parent of a child that you are working with advocacy is happening.

 Vignette:  Jason is a seven-year-old boy diagnosed with autism who has been participating in individual music therapy sessions for six weeks at The Rebecca Center for Music Therapy. Following Jason’s sixth assessment session, a parent meeting is scheduled to discuss the assessment findings and develop an intervention plan.  During the parent meeting, the therapist, Michael, prepares a video presentation and a written assessment report. Michael begins the meeting by orienting mom and dad on the Center’s overall music therapy approach within the context of their son, Jason. He also reviews and orients mom and dad to the assessment protocol, operational definitions, scoring system and the treatment planning process. In addition, Michael provides mom and dad with a verbal overview of how Jason has been doing throughout the first six assessment sessions during his music therapy sessions. Mom and dad appear to be interested and attentive while they listen, however, asking no questions.  Michael then presents the parents with a series of clinical video vignettes. Mom and dad are fixated on the computer screen waiting for the video to play, seeming almost nervous of what they will see (this will be the first time that they actually see their son, Jason, in music therapy). The video plays. Within 30 seconds they begin to smile. Mom has tears rolling down her smiling lips. After the first clip, lasting about 3 minutes, both mom and dad, with full grins on their faces,  express that they have never seen their son, Jason, so engaged in anything like he was on the video in music therapy (Hey, my music therapy friends, how many times have we heard that before?). After the video presentation, both mom and dad continue to point out how incredible it was to see Jason so connected to someone in a related and engaged manner. They both commented on how seeing Jason engaged in music therapy was like seeing an entirely different boy in the music room (if we music therapists had a nickel for every time those words were spoken we’d have a whole lotta nickels!).

As the parent meeting continued, Michael asked mom and dad about Jason’s other therapies.  Mom explained that Jason has occupational therapy (OT) 3 hours per week, speech therapy (ST) 4 hours per week, Applied Behavioral Analysis (ABA) 15 hours per week and now music therapy (MT) 30-minutes per week. (Jason’s parents pay out of pocket his music therapy services while his other therapies are reimbursable by the school district). Mom stared at the ceiling for a moment and began to emphasize that if you add up all of the hours for the year (based on 40 weeks) that Jason is in therapy the breakdown would be:

Occupational Therapy = 120 hours

Speech Therapy = 160 hours

Applied Behavioral Analysis= 600 hours

Music Therapy = 20 hours

Michael and Jason’s dad both seemed amazed by the breakdown in numbers. Michael said, “ya know, I never thought of it like that before.” Dad replied with, “It’s amazing. Jason is in music therapy for only 30 minutes per week and he seems to get so much out of it in such a short period of time. ““Why it is it so difficult to find reimbursement for music therapy services when it clearly helps kids!”Michael replied, “That’s a great question, and I think that it’s one worth asking Jason’s district as well your friends and family. Parents can be terrific advocates for our profession.” Mom replies, “Yeah, absolutely. I think we need to have a conversation with the district this week.”

How many music therapists have experienced similar stories in which parents or colleagues from other disciplines are amazed by the work that we do? – Too many to even count!

Every minute of the day, throughout the globe, a music therapy session is enhancing the lives of countless individuals. It’s amazing! We are so lucky to be a part of this awesome profession.

It’s our job to ensure that tomorrow’s music therapists have their opportunities to work in music to promote health.  The work speaks for itself. It speaks volumes. And we get to breathe it and sing it every day! Let’s get others excited about it, too…

Thanks for reading!

Oh, one more thing…if you have a minute, check out the Music Therapy Advocacy Quiz to see your advocacy profile.

I hope this post finds you all well and that each and everyone of you are having a wonderful holiday season! It is my to pleasure kick in the new year with another guest blogger, friend and colleague Dr. Nancy Jackson. Nancy, thanks so much for sharing your thoughts and ideas on this blog!

LISTENING AS A COMPONENT OF RELATIONSHIP IN MUSIC THERAPY

In mental health practicum the other week, a student asked how it is that one decides what to focus on in a session when the clients have so many different problems and limitations that need attention.  My reply to him was something like this:

“At every moment, your clients are telling you what they need. But this means that you must truly be listening. Listening doesn’t just happen with your ears, though. You also listen with your eyes, with your intuition, with your e-countertransferences, really with your whole being. You must listen deeply to what the client says, to what he doesn’t say, to what he tells you through behaviors, through affect, through interactions, and through the way he musically expresses himself and communicates. It is when you deeply listen to the client and respond to what he is telling you from moment to moment that you are truly engaged in therapy with the client.”

As an educator, I often struggle with how to teach undergraduate students about the less concrete but undoubtedly integral aspects of music therapy practice – things such as authenticity, trust, being “in the moment”, etc. Listening, I believe, is also one of these less concrete and yet integral aspects, and it is something that the profession as a whole doesn’t really discuss much. I don’t ever recall in my undergraduate education having a discussion about how to listen, or what listening really means. In fact, I don’t remember the last I time talked with my own students about this type of listening before the other day. But isn’t that ironic – that we don’t spend much time talking about listening, which is a necessary component of a modality that is based in sound and relationship?

Students spend a lot of time developing music listening skills at the undergraduate level: theory and ear training, music literature and history, etc. This knowledge and skill does not seem to automatically transfer into the clinical setting, however, and doesn’t always help with the type of listening that has to do with understanding another human being. I do often talk with my students about listening, listening and listening more to music to increase the ability to recognize styles, songs, voices, and to expand their repertoires. I wonder why I have always stopped there? Why haven’t I spent at least as much time talking about the type of listening that is necessary for working with another human being within music engagement?

Perhaps the heavy focus on “observation” presupposes the need to teach, learn and develop listening skills. While we certainly must sharpen our observation skills to be an efficient and effective music therapist, observation skills without real listening skills results in identification of behaviors without any of the personal context that allows for accurate interpretation of those behaviors and flexibility for response in the moment. True observation cannot happen without attention to all the aspects that are not necessarily objective and measurable. We know this to be fact if we believe in the power of music to express, connect and change. Listening deeply allows us to truly observe our clients in order to respond to the needs that they reveal to us moment by moment.

Listening is also the foundation for the development of relationship, whether that is relationship between individuals in daily life or between therapist and client. It is in listening that we come to know and understand another human being. In music therapy it is listening musically which allows us to know another in an even more complex and revelatory way. It is listening that allows us to respond to our clients in ways that reach the heart of what troubles them and keeps them from functioning at their highest potential. When the client feels she is truly heard, she knows that she is valued and respected, and will continue to seek out that interpersonal connection. This human connection is a necessity for our very survival, and when it occurs in music, the healing potentials multiply exponentially.

So, when I gave my student that response in class, I “heard” the light bulb go on for him and for several others, but it also went on for me. I am fortunate that my music therapy “up-bringing” in internship and in graduate school taught me to listen to my clients, even if it has become so second nature that I don’t consciously think about. Perhaps it is time for me to more consciously listen to my students in the same way. They too are telling me, from moment to moment, what is it they need for their learning and development as future music therapists. And I must listen…

Nancy A. Jackson, PhD, MT-BC, is a board certified music therapist with more than 19 years of clinical experience in areas including music psychotherapy and medical music therapy in both group and individual formats. She received both her Master’s in Music Therapy, and Doctor of Philosophy in Music Therapy degrees from Temple University. Her research interests include the understanding of anger and other emotions within the music psychotherapy process, creativity and self-expression as a component of health in music medicine, experiential learning in music therapy education, and professional supervision. Dr. Jackson frequently presents at conferences and teaches workshops at regional, national, and international levels. She is Director of Music Therapy at Indiana University – Purdue University Fort Wayne. She can be reached at jacksonn@ipfw.edu

It is my please to introduce my colleague and friend, Suzannah Scott-Moncrief, MA, MT-BC, LCAT. Thanks so much Suzannah for sharing your knowledge and expertise. I really appreciate your contribution to this blog!

 BUILDING A HEALTHY RELATIONSHIP TO MUSIC
As a psychodynamically-oriented music psychotherapist, I am constantly considering the client-therapist relationship, the musical processes that develop between us, and the counter-transferential material that emerges, as a central component in the client’s growth. However, in large part due to my own personal and transformative experiences in Guided Imagery and Music, it turns out that the relationship that I am most interested in right now, is the relationship between the client and the music. The more I work with both active and receptive methods of music therapy, the more I’m convinced that my primary role is to bring a person into a deeper relationship with music. And, as I understand it, the process of coming into relationship with music parallels a client’s very journey toward health.
So, here’s my concern about the assumptions we make about music therapy: In our profession I see a tendency to promote music therapy with the claim that people easily and naturally engage in music experiences. (No doubt we have all experienced that one client who thrives in the music, often in stark contrast to other areas of their lives.) But I would argue that the majority of my clients over the years have struggled to enter into the music with ease. Much of our work consists of making the therapy environment – the relationship, and the experiences – safe enough for the client to engage in some kind of basic way with the music. Whether it’s a client who is ashamed of making a “wrong” sound, or a client who doesn’t sustain the music beyond a minute in length before being distracted, or a client who talks all the way through a fellow group-member’s music, many clients don’t find being in music as easy and natural as we like to advertise.
The following are just a few examples of things that prevent our clients from experiencing the music, deeply:
•    Illness (e.g. the client with autism who struggles with relating to the therapist’s music);
•    Words (e.g. the client who is good about intellectualizing their experiences but can’t connect easily to their feeling world);
•    Compulsions (e.g. the client who plays in a reflexive, unintentional manner or as a form of self-stimulation);
•    The inner critic (e.g. the client who can barely make a sound for fear of being judged);
•    A previously damaged relationship with music (e.g. the musician client who has suffered from performance anxiety);
•    Lack of listening skills (e.g. the client with ADHD);
•    Trauma (e.g. the client who suffers flashbacks if the music is too loud or staccato).
As Kenneth Bruscia (1998) writes in Defining Music Therapy, “There are…times when clients are not emotionally ready to experience music to the fullest…Sometimes, even the best music presents a world of experience that a client cannot handle – physically, emotionally, or mentally.” (p. 95) And, just because a client is beating a drum, it doesn’t mean that they’re experiencing the music, fully, or in a meaningful way, right?
In my own work I like to envision myself and the music interacting like a relay-team. I hold the baton at first (the client-therapist relationship is primary in the client’s growth), and then I pass it off to the music (the client-music relationship becomes the primary agent of change). The first relationship that develops is the one between the therapist and the client – developing trust, developing a creative rapport, and learning how to make music together. The therapist’s job is about bringing the client into the music in deeper and deeper ways. Eventually, the therapist begins to hand off the relay-baton to the music, encouraging the client to relate, primarily, to the music. Lisa Summer talks about “getting out of the way of the music” in a GIM session: the client experiences it as an attitude of letting go to the music, and allowing themselves to become completely absorbed in the music experience.  A deep relationship with music like this ultimately means a deepened relationship to the self.
When music therapy services terminate, I want to know that music therapy has deepened the client’s relationship to music and that music can continue to be a resource for them in their lives outside of the therapy room.  A deep, fulfilling relationship with music can mean the difference between an anxious individual and an individual who can self-soothe. A deep, fulfilling relationship with music can mean the difference between an isolative, non-communicative teenager and a teenager who has something to share, socially. Or the difference between a traumatized adult with no feeling life and an adult who can identify their feelings, and experience tears and laughter without fear.
Ken Aigen proposed in his book, Music-Centered Music Therapy, that music therapy, like other therapies that treat deficits (e.g. speech therapy treats deficits in speech etc.), might be about treating a deficit of music in a person’s life. Let’s start thinking about this seriously – what do our clients need from us that they don’t already have, in order to come into the deepest, most transformative, receptive relationship to the music? And of course, this begs the question – how are we as clinicians relating to our own music? Are we allowing ourselves to relate to music in a deep and transformative way? How do we turn a musical deficit into a musical surplus for ourselves and our clients?

Suzannah Scott-Moncrieff MA, MT-BC, LCAT, has a private music psychotherapy practice in New York City working with adult individuals, couples, and groups as well as providing supervision for professional music therapists. She also facilitates music therapy for young adults with intellectual disabilities in a special education setting. Suzannah is adjunct faculty in the music therapy department at New York University, and a clinical supervisor for Level 1 and 2 Guided Imagery and Music trainees at Anna Maria College in Massachusetts. She was recently invited to speak on this subject of the client-music relationship at EWHA Womans University in Seoul, Korea and as keynote speaker at the Atlantic Association for Music Therapy in Canada. For more information you can email Suzannah at musictherapist@gmail.com, or visit her website at www.asoundspace.com.

Hello all,

I hope this post finds you well.

I have a bunch of new things going that I would like to share with you all. So, if you’re interested check out what’s happening…

GUEST BLOGGERS!

Guest Bloggers Writing on “Relationship in Music Therapy”

I have a line-up of various therapists who have graciously agreed to share their knowledge and expertise on the topic of Relationship in Music Therapy. The first series of guest bloggers will feature music therapists, Suzannah Scott-Moncrieff, MA, MT-BC, LCAT and Nancy Jackson, Ph.D., MT-BC

Suzannah’s blog is entitled “Building a Healthy Relationship to Music,” while Nancy’s focuses on  “The importance of Listening.” Stay tuned to read both blog posts…

 EVENTS

New York Yankees legendary Center Fielder, Bernie Williams and his band will be performing a benefit concert for the Rebecca Center for Music Therapy! We are VERY exciting about this event and we are extremely grateful to Bernie Williams and Molloy College for supporting such an event. For more info: http://madisontheatreny.org/bernie-williams.php#top

TALKS

The IMCAP-ND: Understand Relationship in Musical-Play, American Music Therapy Association’s National Conference in Atlanta Georgia on Saturday November 19^th. For more info: http://www.musictherapy.org/assets/1/13/Mini_Prelimi_7-25-11.pdf

 Musically Conceptualizing Clients in Musical-Play: The Encounter, the Interaction, the Intention,Temple University in Philadelphia on February 24, 2012.  For more info: http://temple.edu/boyer/ResearchCenter/NewsEventsMain.htm

 PUBLICATION

If you’re interested in learning more about DIR/Floortime and Music Therapy check out a chapter that was recently published in: New Developments in Music Therapy Practice: Case Study Perspectives by Barcelona Publishers: Addressing Core Features of Autism: Integrating Nordoff-Robbins Music Therapy within the Developmental, Individual-Difference, Relationship-Based (DIR)/Floortime^TM Model. http://www.barcelonapublishers.com/developmentsinmusictherapy/

 NEW PROJECTS/PROGRAMS

Supervision & Clinical Musicianship Tutoring for Music Therapists. This is available through video conferencing as well as in-person meetings. For more information email developmusic@gmail.com

This blog entry was inspired by a chat that I recently has with a music therapy colleague, which then carried over into a discussion with and occupational speech therapist. I would be interested in knowing your thoughts….

What is indigenous (and intrinsic) to music therapy? What do we offer, as MTs, that is unique and specific to our medium and discipline? And, are we, as MTs, clinically utilizing those very things that are specific to only music and music therapy in our clinical work and writing, such as aesthetics and the relational properties that are unique to music making. Or, are we simply using the byproducts of music?- This would be the equivalent to using a book as a door stop, a sculpture as a paperweight, music as “white noise”, a painting to hide a hole in the wall, etc.

Do we use music as a motivator? Is that unique to MT?

Do we use music because it’s non-threatening (is it really always non-threatening??) way to work with clients? Is being non-threatening really unique to only music therapy?

Do we use music for non-musical goals, such as speech, physical, etc.? is that unique to MT?

Is using music unique to what music has to offer??

Thoughts??

Best,

John

In jotting down some ideas based on music domain areas, I came a across a couple of questions that I would love to have some feedback on. The ideas are grounded and based on the idea that musical are clinical goals. Can they be? Let’s say it’s within the context of relationship in music therapy. Can musical goals be clinical in the context of relating and developing deep relationships (looking solely at the musical)?

The following is based on the idea that when writing a music therapy goal plan, musical domain areas are not stressed enough, yes? No?

If music therapy is our area of expertise, and, the identity that we have chosen when deciding a profession, why do we, music therapists, focus on other domains areas outside of the musical when crafting a treatment plan? I do see, however, the importance of understanding and adapting to biological (including emotional) challenges that may interfere with a client’s ability to engage and relate and music, and musical considerations would have to be implemented based on each client’s individual differences, yes, I completely understand that, and I employ that idea into my own clinical work everyday. In the end, however, when crafting the goal plan, why do we not refer to only musical domain areas? Isn’t that the area that no other profession can claim? Isn’t that what separates us and makes us valuable on a treatment team that already consists of therapies focused on motor, speech, etc.? Why is our treatment plan not based on the musical?

To that end, my next questions are:

1) Are back-and-forth affective and robust interactions necessary for social-emotional development through the span of life (there are different levels of this, based on development. Adults require the same, just with more reflection, introspection, etc.)?

2) Can music therapy experiences, purely in the musical, facilitate back-and-forth affective and robust interactions necessary to engage in a range of musical experiences?

3) Can engaging in a wide range of music therapy experiences, purely in the musical, provide back-and-forth affective and robust interactions necessary for social-emotional development?

4) In your clinical work, in attempting to provide your client with the support that may facilitate robust interactions, where “is” your client musically? What is his/her musical process in the context of relating? What is the musical process between you (therapist) and client? What does it sound (uses only musical terms)? And, what would it sound like if he/she were able to accomplish this musical goal (using again, only musical terms)? Furthermore, what would be your musical objectives that you would implement in the treatment plan, in thinking developmentally, that may help lead your client into accomplishing such a sophisticated musical goal?

So, in determining your responses to question 4, wouldn’t the clinical goals musical goals? Wouldn’t your interventions and objective also be musical Yes? No? Maybe? If yes, why? If no, why? If maybe, why?

I would love to other chime in and share their ideas.

Thanks for reading!

Best,

John

How Important are Music Skills for the Music Therapist?

As an educator and clinical supervisor, the question regarding the importance of music skills on the part of music therapists continues to repeat itself. How important is it for the music therapist to have a high level of music skills? And, what does high level mean? And furthermore, are functional skills enough? And, what does functional mean? I have experienced a huge divide in how music therapists view these questions. This topic and these questions have nothing to do with clinical orientation or philosophical beliefs, and yet there is a huge discrepancy in how we (music therapy profession) view the importance of music skills on the part of the therapist. (Please note that I’m using the term music skills as opposed to musical skills; which is a completely different skill).

Because we as MTs are using music, and all of its dimensions, does that not also give us the clinical responsibility of understanding the language of music, theoretically and practically? How can we fully understand the clinical potential of music if we are limited in the area of musicianship? To that end, if musicianship is somewhat lacking, does that mean that sessions may be being built around the therapist’s musical strengths, weakness, and preferences? And, if so, whose needs are we meeting? Is the music client-centered or therapist-centered? (Aren’t there some ethical implications that need to be considered here?)

In pondering questions regarding therapists music skill level, I think about how I might feel if I were a client in talk therapy, and the therapist had a difficult time expressing him or herself in words, and because of this, he/she also had a hard time understanding my verbal and non-verbal expressions. How would that alter the therapy process? How would the therapeutic relationship unfold if I’m unable to trust that I’m being heard, understood and/or listened too? In addition, how would I feel if the therapist was building the sessions around his communicative strengths and weaknesses?  And finally, if this process is occurring, what’s going on with the therapist, emotionally? Is he/she feeling this pressure due to a lack of understand and expression? And if so, how does that play out in the therapy process? 

Within the field of MT I can certainly see how there can be various clinical views, orientations, beliefs, “truths” and philosophies regarding music therapy, however, how is it possible to not see eye-to-eye on the importance of music skill level for MTs? Yes, I know that we have musical competencies that accredited universities and colleges abide by, however, is it really enough? The Board Certification Exam includes music theory questions; however, how do those questions evaluate music skills? Simply put, how important is it that music therapists can play and understand music? And, at what level????

Thanks for reading. I look forward to your reply!

Musically,

John

If we assume that MT interventions can be prescribed, are we saying that all clients respond to certain musics in the same way? Is that even possible? Do we all really connect to the same music in similar ways? How can this be? Is my reality your reality? Can you find two IPods on the planet that are loaded with the same music??

When visiting a music store, when we actually left the house to buy music (and music buying was social activity), I remember how the stores would categorize music by styles or genres: Aisle 1, Pop music; aisle 2, Rock; aisle 3 Jazz music; aisle 4, Classical music; aisle 5, Rap Music; and aisle 6, Relaxation music- what’s wrong with these categories? Well, what first strikes me is that they are indeed styles of music, except for one…”Relaxation” music. Relaxation isn’t a style, it’s some kind of cause-and-effect based on listening to music. So, in other words, when you listen to this (relaxation) music, you should become relaxed. This is a huge problem for me- being that the very music that is classified as being relaxing has the opposite impact on/in me. In fact, when I listen to “relaxing” music, it sometimes makes me anxious, bored, and I do anything I can to remove myself from it. This is not to say that others don’t feel or become relaxed when listening to this music. I’m only suggesting that music may impact humans in different ways based on their emotional and personal make up- the very make up that makes them (us) unique as people. Do we experience things the same? Is my reality the same as yours? Doesn’t this relate to musical experiences? AND, if we can remove ourselves from this musical experience and say, “when you feel this way, play this…,” why then even have live musical experiences in music therapy? Just use CDs all day, yes?

How does the above example relate to music therapy? Or, does it all? How do we match musical experiences to client needs? Is there a special music that “goes with” autism? Is there a special music “goes with” cancer care? And so on…can it all really be that “simple”?

So, how do we “match” musical experiences with/to/for clients? Are we “matching” musical experiences for clients: Based on pathology (core deficits of that pathology)? Based on the client, as he/she behaves (how they look and act; behaviors)? Based on the client’s needs (how pathology impacts his/her quality of life)? Based on our musical likes and dislikes (whose needs are we meeting)? Based on the why’s and how’s of the musical interactions (focus on here-and-now interactions)? Or, Based on past evidence, that has nothing to do with this particular person (can we remove the person from their unique cognitive, social, musical, etc. abilities?)

I think that the above questions apply to all music therapy methodologies and approaches. Thoughts???

Thanks for reading and I look forward to your ideas and thoughts.

Best,

John