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Symposium this week was all about the affects of improvisation on the brain and the various styles of improvisation music therapists can use with clients. We watched a TED talk with Charles Limb about improvisation and the brain. Limb presents information found in a study he conducted about neuroimages of the brain during improvisation. Using an adapted keyboard that fit on a person’s lap, they were able to examine musician brains while they were improvising melodies on the keyboard. It was interesting to see the areas of the brain that light up when someone is improvising and how those parts of the brain affect other developmental areas.

One of my biggest take-aways from this topic however was the discussion regarding therapeutic methods in improvisation. We learned more ideas of how to incorporate improvisation in music therapy sessions. Some of the various methods of improvisation include mirroring, matching, dialouging, and accompanying. Mirroring is when you do exactly what the client does at the same time. Matching is where you improvise music that matches the client’s style of playing, while maintaining the same tempo, dynamic, and other musical elements. Dialouging is the unique experience where the client and therapist communicate thorugh their playing, while accompanying is providing rhythmic, harmonic, or melodic accompaniment but remaining dynamically underneath the client’s music. This provides a role as a soloist.

There are many other ways to implement improvisation with clients; these are just a few that stood out to me. I look forward to the opportunity to try out some of these methods with clients in my upcoming sessions. With the knowledge of how improvisation affects the brain, based on the TED talk we watched, and now the information of therapeutic methods for improvisation, I feel more equipped to experiment with this for some of my clients.

Our symposium this week was actually a NMT meeting, where Becca presented a TDM over a client. TDM’s provide an outline of information for working towards a specific goal with a client. Becca’s TDM was thorough and provided us with more ideas regarding ways to work on cognition skills.

Becca discussed the first step of the TDM, an assessment of a client with choreoathetoid cerebral palsy, who demonstrates difficulty in sustaining attention and self-regulation. Her goal, presented in step two, is that he will improve cognition skills by participating in exercises such as social song stories, use of iPad social skills apps, creative process to write songs related to social skill topics, lyric analysis, improvisation, role-playing social scenarios, and modeling during group music sessions. Step three provides ways how a non-music therapist may address this goal. Becca gave several ideas, such as the use of videos to learn desired social skill behaviors. Step four gives appropriate NMT techniques that a music therapist might use to address this goal. Becca gave a great example of an original song she wrote to help the client learn how to use a quiet voice in social settings. The song is catchy, descriptive of appropriate times to keep a quiet voice, and focuses on the positive desired actions, rather than what not to do.

Finally, step five in the TDM explains how to generalize the information learned in step four back to the client’s natural environment. Becca stated that after the client learns the song, they could begin speaking the song in rhythm and eventually fading out the musical cues completely. By remembering the words to the song without having to sing it, the client can demonstrate his comprehension of what he learned about keeping a quiet voice. We discussed other ideas, such as sending home a recording of the song to practice at home, as well as creating a video to model the behavior. Following our discussion, the group did just that, make a video. In the video, we modeled the correct behavior of keeping a quiet voice while in the waiting room of the music therapy center. It was fun and can be beneficial to Becca as she continues to work towards this goal with this client.

-Tara

For symposium this week, we discussed insurance and reimbursement. I was only vaguely familiar with this topic from what I had learned so far in this internship, so it was helpful to discuss it in more detail. My overall takeaway from this topic is that receiving insurance reimbursement for individual music therapy is a long and difficult process, and typically does not happen in many cases. However, there are ways to make changes to this, but it is based upon individual states, which takes longer. Our hope is that one day in the near future, music therapy will be covered by insurance for all clients, in all cases, and nationwide.

I learned that if music therapy is a part of a health team in a facility, that it can be covered under insurance, due to the whole team being considered health services. Our discussion on this topic included CPT codes and learning that they are service specific, not discipline specific. In other words, music therapy can fall under some of the same CPT codes as other disciplines, such as speech therapy. These are important to note when attempting to receive insurance reimbursement. We also discussed current legislation that is attempting to help promote our field. One example is in California, where it is about to be passed that anyone who claims to be providing music therapy services and is not board-certified will receive a fine of up to $2500. More legislation needs to be passed to recognize our field as a licensed, professional health service, but some recent changes have been heading in the right direction.

-Tara

This week, we did not have our regular symposium because we hosted a special music camp for special needs children, called Camp Jam. The camp was designed to provide music therapy interventions in a fun and social group setting. We had such a great time, and seeing the kids’ faces light up throughout the day and hearing comments such as “I don’t want music camp to end” made all the hard work worth it.

Each day began with circle time, where we sang a hello song and our Camp Jam theme song, among several others that addressed social skills such as greeting others and keeping self-control. Then we divided up into groups for music therapy. This was one of my favorite parts because I had the opportunity to help lead the younger kids. We sang stories, had drum circle, played shakers and other instruments, among several other interventions. Throughout the group, we gave clients opportunities to be leaders and practiced taking turns, all to enhance social skills. Then the kids went to either movement group or craft time. I also enjoyed helping with the crafts, where we made our own instruments, such as decorating slit drums and making rain sticks. We had a snack time after these groups, followed by time on the playground. To wrap up the day, we had a calming down time and a concert by special guest musicians.

The whole week was filled with fun, energy, and great socializing opportunities. Our music therapy interventions also targeted cognitive skills and motor skills, all within an interactive, musical approach. It may have required waking up earlier than usual, facing traffic to get to the location, and lots of preparation, but none of that mattered as soon as I saw the kids smiling, laughing, singing, and making music together. I had seen a video about this camp on the Music Therapy Center’s website when I first applied for this internship and have been looking forward to it ever since. It was so exciting to be a part of such a wonderful music camp for these kids.

-Tara

This week’s symposium topic was songwriting. We discussed all aspects of the process, from chord choice to lyric writing. Many songwriters tend to use the generic I-IV-V chord structure for their songs. This discussion reminded us that while that may be easy, there are many more options, and re-harmonizing a familiar song can be a good way to practice this, even if the only change is to simply add the seven. Something as small as that can change the whole sound of a song and make it more interesting and engaging. Additionally, the chords you choose to use with your melody do not have to be predictable. The note in your melody does not have to be the one (do) or fifth (sol) of the chord, it could also be the seventh or ninth, or it could be a passing tone. Remembering little tips such as these that you learned in theory class can be helpful when trying to enhance your songwriting experience.

When beginning the lyric writing process, it is important to keep a few things in mind. First, use words that are specific and concise – less is more. The less “fluff” in your lyrics, the easier they will be to understand and the better they will convey any intended meaning. Choosing a single topic or theme and painting a specific picture around that is a good way to accomplish this. When working with a client, it is best to choose something concrete (season, color, object, etc.) as opposed to something abstract. Second, it is important to identify “I” (the narrator) and the “you” the singer/writer is speaking to (the audience). This will give the song direction and make it easier to understand and relate to. On that same topic, it is notable that there are two types of thinkers when it comes to songwriting/listening. The first type of person is one who thinks of a song as something they are singing to someone else, and the second type is a person who views a song as if it were being sung to them. Identifying which way you (or your client, co-writer, etc.) perceive a song will also help push you in a direction that will make your song more accessible and easier to relate to.

-Becca

Our topic for symposium this week covered various types of assessments that can be used for music therapy. We each presented on a different assessment and discussed what it addresses, the target age range, and how the assessment is administered. The main assessments we discussed were the ALST, the SRS-2, and the PEDI.

The Academic Literacy Skills Test (ALST) examines functioning levels of speech and language for children 11 to 18 years of age. A series of verbal and visual cues are included, prompting open-ended and yes/no answers to address three domains: Language use, language content, and language form. The purpose of the Social Responsiveness Scale (SRS-2) is to assess social skills among children of various ages. Four types of forms can be used depending on the ages of the clients: ages 2.5 to 4.5, ages 4.5 to 18, ages 19 and up, and an adult self-report. The assessment is administered in everyday settings, such as at home or in a classroom, and can be given by teachers, parents, and others with whom the client interacts with on a regular-basis. A quantitative scale is used to evaluate symptoms, which reflect the severity of ASD demonstrated by the client. Five areas are addressed in this assessment, including social awareness, social cognition, social communication, social motivation, and restricted interests and repetitive behavior.

Finally, the last assessment we discussed was the Pediatric Evaluation of Disability Inventory (PEDI). The purpose is to assess functional skills and performance in children with disabilities, ages six months to 7.5 years. The PEDI can either be administered by a professional clinician who is familiar with the child, or by a parent report and structured interview. Three domains are addressed, including self-care, mobility, and social function. It consists of a questionnaire, evaluating the child’s engagement in daily functional tasks within these three domains (i.e. brushing teeth, eating food, etc.). A child’s performance of daily functional skills are measured by the level of caregiver assistance needed to achieve the tasks.

In conclusion, assessments are a vital part of music therapy. They address non-musical domains in which a child needs help in, and provide a baseline for measuring progress when music is added. There are many other types of assessments that can be used outside of the ALST, SRS-2, and PEDI. The age of the child and the areas you are assessing can determine which assessment to use.

Last week, Tara presented on the transformational design model. It is broken down into five parts: assessment, goal, therapeutic plan, therapeutic music exercise, and the transfer of therapeutic learning into the real world. The assessment portion includes a summary of the client’s strengths and needs, as well as some basic diagnosis and background information. The goal is as it sounds – it is the specific and measurable goal that will be addressed through therapy. The therapeutic plan includes examples of ways the goal would be addressed by other therapies that do not use music, such as reading sentences containing words with the target sound or sounds. The therapeutic music exercise portion describes how to use music in a way that will work on those same objectives that a non-music therapist would be using to address the goal. Any relevant NMT techniques would also be included in this section. Where a non-music therapist might have the client read sentences that contain words with the target sound and model the oral motor process for them, a music therapist could write a song that describes the steps in the oral motor process (i.e. tongue behind the teeth for /t/ or lips together for bilabial syllables such as /b/, /m/, or /p/). Once the client has mastered the oral motor portion of making the target sound, the music therapist could then write or use a song with lyrics that contain the target sounds to practice it contextually and strengthen oral muscles needed for speech. It is repetition that builds the neural pathways in our brains, allowing us to learn and improve our abilities, and music is a great tool to structure that necessary repetition and provide opportunities to practice and repeat those skills we wish to improve. The last step in the process is to transfer (generalize) the therapeutic learning into the real world. Once the client can successfully produce the sound within a musical context, the music will be faded out and the client can begin to transition from singing to speaking by reading books or having conversations. This generalizes the skills learned and mastered through music into skills the client can use in their daily life.

-Becca

This past week in symposium, we reviewed tips for writing client goals. It was a nice refresher from all I have learned in my recently completed coursework in school. My biggest take-away from this topic was the acronym SMART; this provides an outline for things to consider when writing goals for clients. “S” stands for specific, meaning be specific about the desired action from the client. “M” represents measureable, meaning to specify how the action will be measured (i.e. using a stopwatch, 3 out of 4 trials, etc). “A” stands for achievable, meaning make sure the action and time frame are reasonable for the client and his or her functioning level. “R” is for relevant, which refers to making the goal relevant to where the client needs the most improvement. Finally, “T” stands for time limited, which means to set a time frame for when the client should achieve the goal. These are great tips to remember when writing new goals for clients.

Another important part of this week’s discussion was examples of things to avoid in goal writing. Goals should be specific, so it is wise to avoid using vague language, such as “client will improve his/her behavior”. It is important to specify the exact behaviors the client should improve on, such as “client will increase his/her ability to take turns” and then writing the intervention that will help with this goal (i.e. learning words to a taking turns song, taking turns with a friend or the music therapist playing an instrument, etc). For music therapy goals, musical experiences are used to address non-musical goals. Overall, it is important that the goals are specific, reasonable for the client’s age and functioning level, and that there is a clear way to measure the goal.

-Tara

It’s absolutely amazing how quickly six months has passed. It seems like yesterday that I moved across the country from Miami, slightly resistant to starting life from square one, but also excited to learn as much as I could before entering the world as a professional music therapist. There were so many highlights during my internship, including the joy of sharing music at Jam Sessions, the annual recital when my clients got to show off their hard work on various instruments, and a client’s CD release party which was maybe one of the most fun things I’ve ever attended, much less been a part of. I’ve been so inspired by my clients, who have shown me that even though they may have challenges, they are capable of so much and can accomplish great things. As my internship comes to a close, I would like to share some important tips and things I have learned in order to be a successful professional:

Timeliness. I have adjusted to the laid-back lifestyle in San Diego, but I still consider timeliness to be important. Arriving on time shows your clients and your team that you value their time and are ready to work. As a youth orchestra conductor once taught me: “Early is on time. On time is late. Late is wrong.”

Preparation. In internship, there are many session plans and various assignments to be prepared. It is important to use your time wisely in order to maximize your productivity. When you are prepared going into sessions, you can devote your entire focus on the client, and not on trying to figure out how to play a song as you go or what you will do next.

Organization. With so many clients on the caseload, and so many internship assignments, it is easy to get overwhelmed. It is important to develop an organization system that works for you so that you can plan how to use your time and how to organize the various documents, visuals, and instruments that are needed on a daily basis.

Now that internship is done, I am looking forward to my next adventure: a Master’s program in Art, Creativity, Education & Culture at the University of Cambridge! On to the next!

-Nerissa

Our symposium this week was a little different than usual. Our newest intern began her first day today so we spent time giving her tips and ideas on getting through her time here. This was a great opportunity for me to reflect on the past two months I have been here and I realized how far I have already come and how much I have learned in such a short time. I remember feeling quite overwhelmed with the amount of new information to learn in the beginning, including all the NMT techniques, getting to know clients, the paperwork, and more. Within the last couple of weeks, I have realized how I finally feel more settled in and comfortable with everything that once overwhelmed me. Of course, there are many more things to still learn, but it was really refreshing in symposium to realize how far I have come.

I am really enjoying getting to know my clients better and I feel more comfortable leading interventions each week. I am even feeling more confident in understanding the various NMT techniques (although I think that will always be a work in progress to keep learning). It is exciting to have a new intern and I am looking forward to passing on what I have learned so far, as well as learning new things together. Internship requires a lot of time and energy, but it has been worth it to see the progress and excitement in our clients. The power of music is evident in our clients, and it is such a joy to share in the musical experiences with them and see how effective it is.

-Tara