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Goal Writing Tips

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

Nerissa’s End of Internship

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

Lessons I Have Learned… and More to Come

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

Techniques for Cognition

One of the main goal areas targeted by Neurologic Music Therapy (NMT) techniques is cognition. Speech and language goals may include to improve attention and perception, to improve memory, and to improve executive function. There are several NMT techniques to address these goal areas, and I will share a short summary of each of them and how they may be used:

Musical Sensory Orientation Training (MSOT) – the use of music for sensory stimulation, arousal orientation, and vigilance and attention maintenance. This technique is appropriate for young infants, unresponsive clients (such as those in a coma), and older adults.

Musical Neglect Training (MNT) – musical experiences designed to have clients with right hemisphere ischemic infarction (due to traumatic brain injury in the right hemisphere) to redirect visual attention to the left visual field, and to stimulate movement on the left side of the body.

Auditory Perception Training (APT) – to train auditory discrimination through differences, matching, and identification of sounds (such as high, low, fast, slow, long, short, and instrument identification). This technique is to refine and develop acoustic perceptual accuracy.

Musical Attention Control Training (MACT) – to establish and maintain different kinds of attention. The five types of attention are sustained attention (continuous attention to one stimulus over time), selective attention (attending to one stimulus out of several), divided attention (simultaneously splitting attention between two or more stimuli), alternating attention (switching attention sequentially from one stimuli to another), and joint attention (to alert another person to a stimulus).

Associative Mood and Memory Training (AMMT) – to produce mood-congruent states to facilitate memory recall, to access associative mood and memory networks to direct specific memory access, and to enhance learning and memory function.

Musical Mnemonics Training (MMT) – musical exercises to memorize short chunks of information.

Musical Executive Function Training (MEFT) – improvisation and composition exercises to improve executive function skills such as organization, problem solving, decision making, reasoning, and comprehension.

Music Therapy and Counseling (MPC) – use of musical performance to address mood, expression, reality orientation, and appropriate social interaction.

-Nerissa

Steps for TIMP

This week in symposium, we went into further detail regarding sensorimotor techniques. We did demonstrations of the NMT technique TIMP, where we paired up in groups to choose a specific movement exercise to target and demonstrated how we would incorporate music to encourage the target movement with clients. For example, my group chose to focus on an older adult group and targeting dynamic weight shifting, having the clients reach across their midline. Clients will reach up to the diagonal on one side and swing their arms to reach up and over to the other side. Considering most older adult groups are typically seated, this movement can exercise their upper bodies while sitting down.

The first step is to have the clients do the movement without music and the music therapist takes note of their natural tempo (speed of the movement). Using a metronome or keyboard with various styles of beat, the second step includes choosing a style to fit the song and setting the tempo to match the group’s natural tempo. Once that begins playing along with the clients executing the movement, the music therapist can implement the third step, playing the song. Due to the dynamic weight shifting movement being a larger motion, requiring more time to reach up on each side, recommended instruments to play the song on are Autoharp or piano. These instruments provide a longer range for the music therapist to strum or roll the chord with the beat in which the movement occurs. The work in this movement is in the reaching up motion, so the strum or rolled chords should occur in a low to high range to encourage the upward movement further. Clients can hold onto scarves as well, providing sensory stimulation to motivate the movement more.

In conclusion, TIMP requires much planning on the music therapist’s end, but can be quite effective when executed properly. The music therapist must be completely aware of the clients and focused on their motion and tempo, while simultaneously playing a song, with a particular accompaniment pattern to encourage the target movement. This also requires that the music be high quality, considering the music therapist cannot be focused on what or how they are playing, but rather on the client and matching them. In a one-on-one session or a smaller group, this technique commonly uses instruments as targets for the clients to hit, providing auditory feedback when executing the movements. For the purpose of our demonstration this week, we chose to use scarves instead of instruments, but both are effective. Although the planning and execution of TIMP is detailed, it is well worth it to see clients engaged in the various movements because of the exciting musical experience involved.

Presenting

Last week’s symposium covered public speaking and giving presentations. The team discussed resources for improving public speaking practice, including the organization and website Toastmasters. Toastmasters offers many free short videos and articles with different tips on public speaking and knowing your topic. I found these to be interesting and good reminders of things to think about when preparing and giving a speech. Some of the biggest points that stood out to me were:

1. Know your subject and your speech. You are the expert in your field, so speak confidently about your subject matter!

2. Know your audience and your space. Depending on the audience, the terminology you use may vary – for example, teachers and parents want to know different information about music therapy than neuroscientists would. Knowing your space is something that I had not considered prior to our discussion – what materials do you need for your presentation? How should the room be set up? Will all materials be provided or do you need to bring your own? These questions, if answered prior to the speech, will make the entire experience a success.

3. Never apologize. While we sometimes think apologizing gives us a connection with our audience, we need to own our information. Be confident in yourself and in your topic.

4. Imagine yourself giving a great speech. This is something I think about when I perform on violin – imagine myself mastering the hard parts, rather than getting nervous as they approach. I never thought of applying this to anything outside of violin performance, but it makes a lot of sense! Following the philosophy of “fake it until you make it” – if you believe that you will give a great speech, then you will!

5. Focus on your message, not on yourself. Don’t worry about yourself during the speech. Focus on the words and what you want the audience to know, and your personality will naturally shine through!

-Nerissa

Sensorimotor Techniques in NMT

Sensorimotor techniques are another common area in Neurological Music Therapy (NMT). Music and rhythm can be used to enhance motor behavior and responses. Rhythm plays an important role by providing timing as a foundation for movement, while auditory stimuli activate the brain and triggers the different senses. Musical patterns and instruments are common within the sensorimotor techniques as a way of addressing various motor movements. Brief descriptions of the three sensorimotor techniques in NMT are included below.

Rhythmic Auditory Stimulation (RAS): Rhythmic motor cuing is used to help with a person’s movement development, such as gait. Patterns using a steady beat provide cues for the person to step with. Music in 2/4 and 4/4 meters are most common. The rhythmic cues can either be a steady beat provided by a metronome, or strongly accented beats in a musical pattern.

Patterned Sensory Enhancement (PSE): A variety of patterns are used for this technique, including rhythmic, melodic, harmonic, and dynamic-acoustical patterns. These patterns provide cues for temporal and spatial movements, as well as for regulating or developing functional movements. Rhythmic cuing, much like in RAS, helps with timing of movement, while melodic patterns can help cue the changing of spatial positions. Harmonic and dynamic patterns can stimulate the development of muscle tone by applying force.

Therapeutic Instrumental Music Performance (TIMP): This technique focuses on the use of musical instruments to facilitate exercises and functional movement. Instruments are used for the client to hit or play in an effort to exercise range of motions, endurance, flexion/extension, and strength. For example, clients may address arm extensions by having to punch a tambourine. The sound of the instrument provides an auditory stimulus for the client and can help motivate them to continue.

-Tara

Techniques for Speech and Language

One of the main goal areas targeted by Neurologic Music Therapy (NMT) techniques is speech and language. Speech and language goals may include to improve muscular control of the speech and respiratory apparatus; to improve articulation; to improve initiation of speech sounds; to stimulate speech production; to improve pitch, inflection, breath control, or volume; and to improve speech intelligibility. There are several NMT techniques to address these goal areas, and I will share a short summary of each of them and how they may be used:

Developmental Speech and Language Training through Music (DSLM) – the use of developmentally-appropriate musical materials and experiences to enhance speech and language development. This technique is appropriate for clients who have little to no functional language, children with autism, and children with disabilities that have a severe impact on language.

Melodic Intonation Therapy (MIT) – a three-level approach to improve fluent output of language for clients with severe Broca’s aphasia.

Musical Speech Stimulation (MUSTIM) – the use of musical materials (like songs, rhymes, and chants) to stimulate non propositional speech. This may be done by having clients with aphasia or any speech disorder filling in the blank at the end of a phrase.

Oral Motor and Respiratory Exercises (OMREX) – sound vocalization exercises and wind instrument playing to work on strength and coordination in making speech sounds. This technique is appropriate for clients with apraxia, cerebral palsy, and people with respiratory problems.

Rhythmic Speech Cueing (RSC) – the use of metric or patterned rhythmic cues to control speech rate, and to facilitate initiation of speech. This technique is appropriate for clients with apraxia, dysarthria, and fluency disorders.

Symbolic Communication Training through Music (SYCOM) – the use of structured experiences in instrumental or vocal improvisation to train communication behavior. This technique is appropriate for clients who may not develop speech, but could still master or re-gain language concepts.

Therapeutic Singing (TS) – singing activities to practice speech articulation and improve respiratory function. This technique is appropriate for clients with apraxia, dysarthria, and medical conditions.

Vocal Intonation Therapy (VIT) – controlled singing and other vocal control exercises to improve inflection, pitch, breath control, vocal timbre, and volume. This technique is appropriate for clients with voice disorders, medical conditions, and dysarthria.

-Nerissa

The Transformation Design Model

Learning about the Transformational Design Model (TDM) in the symposium allowed me to better understand the steps involved in creating an effective plan for clients. The TDM provides a template for sessions, where music therapists can clearly state the steps they will take to help a client achieve functional therapeutic goals. Beginning with assessing the client’s strengths and needs as step one, a goal is determined as step two. For step three, the music therapist describes what will hopefully be the results, determined by the goal. An important note about this step is that the result should be a nonmusical behavior. It is in step four that the therapist describes how he or she will incorporate musical experiences to help the client work towards the goal. Interventions and preferred techniques, such as Neurologic Music Therapy (NMT) techniques, are included in step four. Finally, the TDM concludes with ways the client will take what they accomplished musically and transfer it back to the real world in a functional manner. Step five requires the music therapist to fade out the music, and then the client will complete the goal on their own. This symposium topic was of great interest to me and now I understand the TDM more clearly. It is helpful to music therapists to provide structure in their session planning. But most importantly, it is beneficial to clients, due to the structure leading them to achieve the desired result in real life situations through the encouragement of music.

-Tara

The Transformational Design Model

This week’s symposium topic was an introduction to the Transformational Design Model and Neurologic Music Therapy techniques. The Transformational Design Model (TDM) sets a template to ensure that music therapy techniques are well-thought out and have functional therapeutic outcomes. The first step in the TDM is to state the client’s strengths and needs. Based on the client’s needs, a goal area is determined for step 2. The third step is to describe the desired result based on the gaol. This is what the client should be able to accomplish at the end of the therapeutic experience, and it should be a non-musical behavior. The fourth step is to describe the therapeutic music experience. This is where the music therapist describes what he/she is doing in sessions with the client to work on the desired goal area. This is also where a Neurologic Music Therapy (NMT) technique is listed and explained. The NMT technique should have functional, musical, and scientific logic that supports the non-musical goal. The final step is to describe how the client will be able to transfer this skill to real life outside of the session. In this final step, the music therapist fades the music and the client should be able to complete the desired result independently. The TDM ensures that music therapists are accountable for the interventions they are leading and can justify why it is beneficial to the client’s outcome.

-Nerissa

Songwriting

This week’s topic was songwriting: something that everyone can do, but that each music therapist, intern, and student has a varied amount of experience with. Songwriting is something that we as music therapists should utilize and view as something special that no other therapists specialize in! Writing songs to help clients with their specialized goal areas makes for an effective use of our creativity and musical training. Here are some tips for writing your own songs:

• Write your idea in the middle of the page. Then, draw arrows with reactions, related ideas, and ways to develop. Use your imagination and see where brainstorming takes you!
• Don’t change your chord until you change your attitude or thought – make the music match your message!
• Write the melody without an instrument, to ensure that it is memorable and easy to sing!
• As is true in most things, keep it simple! This will make the song easier to write and easier for the listener to remember!

-Nerissa