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Intern Team

Your body is always touching SOMETHING. What an interesting thought that most people don’t spend too much time dwelling on. That’s because the brain with a well-regulated tactile sense only briefly makes note of the thing that the body is touching, and then ignores it in favor of more important thoughts and sensations it needs to process. But for a person whose tactile sense is out-of-sync, the textures of certain fabrics or presence of a tag on their clothing may be a source of extreme discomfort and the cause for much distress. Or they may lunge at you for a bear hug because they crave the feeling of deep pressure squeezes. Or they may not seem to notice that their hand is on a hot pan until they have a third degree burn. These are only a few examples, of course. The main point is, our tactile sense helps us determine what we are touching and if the things touching us at every moment of every day are harmful or helpful. An out-of-sync tactile sense may make a person overresponsive to stimuli, underresponsive to stimuli, sensory seeking, or a combination of these, or may make it difficult to determine what the tactile stimulus is or where it is touching.

How does this affect my work as a music therapist? I can start by considering the environment of my treatment space. What is the client’s reaction to the texture of the chair he/she is sitting in? For some of my clients with tactile sensory needs, sitting on a fuzzy pillow that buzzes provides the tactile sensations they need to be aware and in control of their bodies. For other clients, sitting on a rubbery and bumpy cushion serves this same purpose. What is the client’s reaction to the carpet? I have clients who prefer to have their shoes off during sessions. One such client likes having the afore mentioned rubbery cushion under his feet. From which direction is the air conditioning blowing and is it blowing directly on my client? I’ve barely scratched the surface of tactile elements to consider in the environment of the treatment room, but you get the picture.

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What about my choice of instruments I use with my clients? Does the client seem to want to touch textured things? I have many clients who are more engaged in our interventions when they play an instrument like the cabasa (picture below), which allows them to rub their fingers along the bumpy beads. Other ideas of instruments with great sensory feedback are guitar strings, chimes, hand drums, ocean drums, and resonator bells. The cabasa is one of my favorite instruments because it acts as a great massager, providing sensory input to arms, legs, backs, and soles of feet. For clients who are seeking tactile sensory stimulation, instruments like the cabasa can provide this in an appropriate way. Encourage the client to play the cabasa (or other instrument) and use it to provide sensory input independently. This way, the client is learning to self-regulate his/her out-of-sync sensory systems.

 

3317_cabasa_a.jpgOr for clients with an overresponsive tactile sense, choose instruments that don’t have a rough or uneven texture. Then encourage them to explore tactile sensations using the texture and vibrations of various instruments. This could help reduce defensiveness to certain tactile sensations.
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As with all other sensory systems, there are so many things to consider when your child or client has an out-of-sync tactile system. Hopefully the ideas and considerations discussed here have sparked some ideas and increased your awareness of needs related to the tactile sense. Now, I challenge you to stop every now and then and become aware of the sensations on your skin and the things touching your body. Then imagine what it would be like if you could not seem to get enough of or control one of these sensations. How would you fix that?

-Chiara

What a journey the past 6 months of internship has been!  One year ago at this time I had no idea I would be moving to San Diego and building a life here.  I had no idea how intense life as an intern would be or how exciting the process of stepping out of the intern shoes and stepping into life as a new professional would be.  These past 6 months have taught me patience, confidence, and what it means to be invested in your dream.  There have been many lessons I’ve learned throughout internship, and I did my best to summarize my top learnings below.

1.      Your therapeutic relationship with the client is most important
While this may seem obvious, it was a valuable lesson I was reminded of through my experience as an intern.  So often it’s easy to jump into sessions with clients and get so absorbed in the goals and interventions that you forget that you haven’t yet earned the client’s trust.  The therapeutic relationship is really what makes music therapy effective – it is 100% essential to the clients success within therapy.  With time, I learned to breathe, be more present, be more aware of the client’s responses/what they are giving me and became comfortable adapting in the moment.  I also learned a great deal about building rapport with a wide range of personalities and different individuals.  Some clients connect with you through silliness/cutting loose a bit, some through structure, and others simply with time.  I learned to get to know my client’s and give the relationship time to grow before expecting them to trust/listen to me.

2.      Importance of professionalism and communication with parents/families
My experience in the field so far has taught me the vital importance of professionalism and communication.  I value clear and open communication and have come to understand how important this is in the workplace.  I have learned to communicate clearly with parents and families and (when possible) always keep them in the loop.  Within this lesson, I learned the importance of consistency, timeliness, and honesty/transparency as a measure of communicating respect and professionalism to the families with which you are working.

3.      Know your professional values
I have held several jobs in music therapy since beginning my degree.  Each has taught me more and more about what I value as a professional.  Sometimes the administrative end of music therapy can be equally as important as the therapy itself.  Sometimes small, logistical details determine whether you will be happy and well balanced, or overworked and burnt out.  I am learning to advocate for myself in these areas as well as cultivate a reputation for myself based on my personal values as a music therapist.

4.      Actively build/expand your skill set
There is always room for improvement, or as my mom told me often growing up “Learning is a lifestyle”.  I realized throughout internship how easy it is to get into a groove or routine where you’re comfortable, you and your clients know the drill and you rarely feel the need to mix it up.  However, mixing it up is where you’re challenged and where you grow!  I am inspired to expand my skills (particularly on guitar) as well as my repertoire of music.  Because we are in such a unique and fun line of work, it is a joy to get to be creative every day in the way you lead songs, present information, and address goals.

5.      Love where you are –> trust the process
The universe kept hitting me hard with this lesson, especially throughout internship, until it started to begin to scratch the surface of making it’s way into my head.  Many times we wish we were someplace we’re not – gotta learn to love and accept where we are.  Even if I don’t have years of experience (one day I will!) or am not the most knowledgable on certain subjects, I have to remind myself to breathe and accept where I am and be gracious with myself.  This proved to be particularly tricky when dealing with families or facilities who also wish you had more experience than you do.  All in time, all in time.  The difficulties will pass, the knowledge and expertise will come with experience, just trust that you are where you need to be.  I am where I need to be.

While reflecting on these lessons, I was drawn to record a piano piece that in a way represents the ebb and flow of internship for me.

 

Here’s to the future and all that lies ahead!

-Marissa

Behavior serves a function.  From infants to the elderly, humans behave the way they do for a reason.  When it comes to our clients, addressing the reason can sometimes be the first step towards making progress in their goal areas.

Recently in symposium, Shannon Wallace and Maryann Le of AEFCT came to present to our staff on “Function of Behavior Training”.  (Find out more about AEFCT here: http://aefct.com/)  Their presentation opened my eyes to several important factors to consider while working with clients.

A key concept in knowing how to address the behavior of a client is understanding the function of the behavior.  I learned that this is a phrase commonly used amongst behavior therapists that basically answers the question: why is the client doing what they are doing?  Is their behavior seeking to gain the attention of somebody or to meet a physical need (are they hungry.. thirsty.. need to use the restroom)?  What is their specific purpose for what they are doing?  Sometimes this can be a very tricky question to answer.

Consider the fact that many of the behaviors we as therapists view as “challenging” are behaviors the client probably views as functional, because engaging in them gets their needs met in one way or another.  Maybe screaming at the top of their lungs in the store gets them the toy they wanted (mom gives in to alleviate the situation).  Maybe engaging in disruptive behavior in the classroom gets them out of doing difficult work (they are removed from classroom for disciplinary purposes).

The 3 functions of behavior are:

  1. Positive reinforcement (behavior produces an outcomes that is desired by the child)
  2. Negative reinforcement (maladaptive behavior like escape or avoidance)
  3. Sensory Regulation (maladaptive behavior occurs in order to regulate the level of input from environment)

First determining the function of behavior helps us understand how to appropriately address it.  According to Shannon and Maryann, “When we know the antecedents and consequences of behavior, we can intervene in ways that provide an appropriate behavior that achieves the same function.”  This was one of the biggest lessons I learned through this presentation: the importance of providing an appropriate alternative to undesired behavior.  Since this time, I have been applying this principal in many of my sessions.  This includes things like redirecting a client who hits the table vigorously with his palms to playing a drum in order to receive that sensory feedback as well as redirecting a client who constantly asks what’s next by helping them give positive compliments to other group members.  Always be thinking how you can provide clients with a functional, appropriate alternative.

One final important aspect to consider is being on board with the parents with your strategies and approach towards behavior.  It is important that you are handling the behavior in a way that is congruent with how the parents are handling it at home.  Although this is not always possible, when it is, it can be extremely effective for the client.  Discuss strategies and approaches with your client’s family in order to determine what is best for them.

I’ll leave you with a short story of how these ideas have manifested themselves over the past month of my internship.  I have been working for 5 months with a non-verbal 8 year old client who, ever since I started with him, will manage to have a handful of my hair at some point in almost every session.  I have worked so hard on developing my “mom” voice, being stern, changing my affect, letting him know that is not okay, singing songs about having “gentle hands” and practicing what that looks like, redirecting him to a drum or other instrument or ignoring the behavior.  Although some of these tactics have seemed to work in the moment, we had a session 2 weeks ago where we were in the middle of an intervention at the piano together and I felt like we were connecting more than we ever have – he was sustaining eye contact, following directions, smiling at me – we were communicating so much nonverbally to each other through our playing.  I look down at him and he’s smiling so huge and then suddenly he reaches out and grabs two handfuls of my hair.  In this moment I realized that my assessment of the function of his behavior may have been off all along – maybe the reason he is engaging in this behavior is because he wants to communicate something to me and doesn’t have a way to do so.  I didn’t struggle against him or whip out my stern voice and say “not okay”, I instead maneuvered my head so that I could make eye contact with him and just looked at him with a neutral affect, locking eyes – simply letting him know I was there and present with him.  After a moment, he let go, no words were said and we continued with the intervention.  Since this time, I have been motivated to give him absolutely every opportunity to make a choice, communicate with his device, and request activities in an attempt to provide him with a means to communicate whatever it was he was trying to say by grabbing my hair.  Through my clients I am learning countless lessons about the function of behavior, communication and human connection.

-Marissa

 

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This past week, Banding Together’s Spring season of Jam Sessions came to a bittersweet end.  Throughout the past 5 months of being an intern, Jam Sessions became one of my weekly highlights and I will treasure some very special moments and memories from my first season being a mentor with Banding Together.

This Jam season I learned to watch, listen, and learn (in that order!).  I truly learned so much from observing the mentors/volunteers interact with and encourage participants as well as from participants being genuine friends to one another.  In my experience as an intern, so often I am jumping into things – taking leadership and problem solving – that this experience proved to be a very important opportunity for me to sit back and learn from watching others.  The patience, wisdom, and gentle, humble leadership I observed in other mentors taught me to be more aware of myself and to consistently encourage clients to be the absolute best they can be.

Another highlight from this season, was having the privilege of seeing participants experience such excitement and sheer joy when Jason Mraz performed as a Guest Musician.  This was such a special night of sharing in music with someone who has touched the world with his message and gift.  Thank you, Jason!

Lastly, Jam Sessions proved to be a complete blast!  The dance moves, the drum circle grooves, the action leader skills, personalities shining through with solos or at the mic, the relationships deepened and laughs shared… for me it was a true expression of the power and joy of making music with others.

On a final side note, Chiara and I thoroughly enjoyed ourselves while taking the “Dress up as your favorite rock star!” prompt to heart.  Enjoy these pics of us as Jelena (Justin and Selena), Sonny and Cher, and Billary (Bill and Hillary).  (Oh, the many perks of being an intern!)

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That’s a wrap for our Spring session – here’s to another great one this fall!

Cheers!

-Marissa

If you are a music therapist, you know the feeling – you’re on an airplane or in an elevator when someone asks you what you do for a living.  The 30 seconds that follow have the potential to forever shape that individual’s understanding and view of the vast world of music therapy.  No pressure!

The vital importance of being an effective communicator and speaker cannot be over stated.  Whether your field is music therapy, marketing, or dog sitting, you have the power to help others understand the value and efficacy of your work.  So much about an individual brand or company is communicated in the initial, first-impression conversation and it’s crucial that you are prepared.

Recently in symposium, we discussed the (slightly overwhelming) topic of public speaking/presenting/communicating effectively.  Here are some helpful take aways if you’re looking to boost your ability to persuade, engage, and win-over others.

  1. Know your audience! Before you are able to effectively “sell” anything (whether services, an idea, a suggestion) to anyone, you first have to understand why it matters to them.  If you were speaking to a woman who has an 85-year-old mother with Dementia, do you think you would describe music therapy differently than if it were a man with a 4-year-old son with Autism?   Knowing your audience is so important to understanding how to effectively communicate with a variety of people.  When beginning a conversation, practice asking quick questions to get to know the person, where they’re coming from, and what they’re looking for in music therapy (or any other topic/field you may be discussing).
  1. Know your material. If you are educated, knowledgeable and well-rounded in your area of expertise, you are already set up for success to be an amazing communicator!  Remember, you are the expert.  Own what you say.  Use confident language like “we do” and “we are”, and be prepared to answer a variety of questions that might arise.  If you truly know your material, whether it is a 60-minute presentation, or a quick exchange in line at the grocery story – it will make all the difference in your confidence and will impact the other person’s quickly-forming opinion of you and of the field.
  1. Focus on the message, not on yourself. This is key!  As soon as we stop worrying about what the audience/other person is thinking of us, or how our voice sounds, or what our hair looks like, etc. etc., our message immediately becomes more impactful!  Focus on exactly what you want to communicate and on the power of your message.

For more helpful tips, visit Toastmasters.org.  They have a variety of free resources, from articles and videos to podcasts and conventions.  Some of the above tips were drawn from the following video:

And remember, haaaaave fun with it!

haaaaave fun with it

-Marissa

Neurologic Music Therapy group was led by Becca this past week in symposium.  She presented a TDM (Transformational Design Model) on one of her clients who is working on a speech and language goal of improved articulation.  She is using an OMREX intervention with kazoo as an initial step to address this goal area.

After Becca presented, the team got creative thinking of ways to expand this intervention to include language.  We discussed the importance of always tying breath support exercises with functional speech and language.  In order to put this into practice, we split into two groups and created interventions that focused on 2 bilabial consonants: p and m.  In less than 30 minutes, we created songs with visuals that focus on each of these letters.  The videos of our final products are included below, along with the chords/lyrics and visuals!

Screen Shot 2016-05-01 at 11.45.54 PM

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-Marissa

 

Neurologic Music Therapy group was led by Becca this past week in symposium.  She presented a TDM (Transformational Design Model) on one of her clients who is working on a speech and language goal of improved articulation.  She is using an OMREX intervention with kazoo as an initial step to address this goal area.

After Becca presented, the team got creative thinking of ways to expand this intervention to include language.  We discussed the importance of always tying breath support exercises with functional speech and language.  In order to put this into practice, we split into two groups and created interventions that focused on 2 bilabial consonants: p and m.  In less than 30 minutes, we created songs with visuals that focus on each of these letters.  The videos of our final products are included below, along with the chords/lyrics and visuals!

Screen Shot 2016-05-01 at 11.45.54 PM

Screen Shot 2016-05-01 at 11.48.00 PM

-Marissa

 

Before starting my internship, most of the songwriting I had done with clients was in mental health populations – mostly adolescent and adult drug and alcohol rehab and clients with eating disorders.  It got very heavy at times, but was often extremely therapeutic and cathartic for many clients.  I believe this shaped my view of songwriting as something narrow and used primarily for deep, personal issues within therapy.  That being said, over the past 3 months I’ve come to view songwriting as an amazing expressive outlet for many young children with developmental disabilities.  Even simple song re-writing exercises (like “All you need is love” for Valentines Day) provide an opportunity for the client to make choices (MEFT – Musical Executive Functioning Training), exercising their executive functioning skills.

What I’ve come to observe, is that many clients with disabilities have the majority of things done for them by parents and caretakers.  When they are given a choice between two activities/songs/etc. they will choose, but when left with an open ended question like “What should we write a song about?” they often have a blank expression on their face and no idea where to start without being given suggestions of different ideas.  But once you help them get the ball rolling, they are full of ideas, imagination, and creativity and the end product is amazing!  For some clients, re-writing the words to a favorite song of theirs is the best bet because they have a clear idea of where the song is going and already enjoy how it sounds.  Other clients have the ability to help write (or independently write!) a chord progression/melody, and this is where you can challenge them to exercise their creativity.  Below is a helpful chart of chords to use in a variety of keys that can quickly spice up any songwriting session!

Somewriting tips

 

When writing songs with your clients, remember that every answer is valid!  As long as what the client suggests is appropriate and relevant, there is no better answer as to what to put in the lyrics than what they give you.  After all, it’s their creation and masterpiece and should have their unique personality written all over it.  If you can, think ahead about the wording of prompting questions you might ask your client in order to generate ideas.  It’s also helpful to think about the goal of the exercise – for example, is your client’s primarily reason for songwriting to express themselves or to practice decision making or leadership skills?  Determine what questions you will ask and how you will go about the process with their particular goal in mind.  If they are practicing leadership skills, let them lead you through the process and if they are struggling, challenge them to find a way to figure it out instead of offering a solution to them.  If their goal is self-expression, validate every answer they give you and do your best to reflect the sentiment of their words in the music you create.  It’s also always a fun idea to record your completed songs and give your client choices of what instruments to incorporate and how they’d like the finished product to sound.

I trust that the joy in your clients face when you play back the final version and they hear themselves singing and making music will be enough to fuel many more rewarding songwriting experiences in your sessions!

-Marissa

We all know those kiddos – even when they are (miraculously) sitting in their seat for more than 2 minutes at a time, they’re still squirming, sliding down in their chair or moving their body side to side.  They are constantly seeking to interact with their environment.  Or maybe you can relate to leading groups every week and feeling the urge to bring in something new and different for the clients to experience other than instruments.  Lucky for us, the world of Neurologic Music Therapy has an answer in 4 simple letters: MSOT.  Musical Sensory Orientation Training.

Thaut, in Rhythm, Music and the Brain, describes MSOT as follows:

“Musical Sensory Orientation Training (MSOT) is the use of music, presented live or recorded, to stimulate arousal and recovery of wake states and facilitate meaningful responsiveness and orientation to time, place, and person. In more advanced recovery of developmental stages, training would involve active engagement in simple musical exercises to increase vigilance and train basic attention maintenance with emphasis on quantity rather than quality of response (Ogata 1995).”

Let’s all say it together now: MSOT is my friend!  It is so important to ensure that our clients are learning to self-regulate and getting the sensory input that their bodies crave.  Sensory integration is a neurobiological process that refers to the integration and interpretation of sensory stimulation from the environment by the brain.  Individuals with developmental disabilities often have either over- or under- reactive sensory systems, which can mean sensory input from the environment is not being organized properly in the brain.  This makes the sensory experiences we as music therapists provide for them particularly important.  Below are several MSOT strategies I’ve recently been exploring with clients – the possibilities are endless!

  1. Cabasa – I never understood the power of the cabasa until internship.  It is an easy way to take a sensory “break” while keeping the music and instruments going throughout the activity.  For my non-verbal clients I use a simple “I want ____” visual and have them choose a body part (i.e. hands, arms, legs, back) for where they want the cabasa.  You can make up a simple song or chant about where you’re playing the cabasa and use a background loop to free up your hands to provide that input for the client.  You can also use this same format but instead give deep pressure squeezes and simply substitute the lyrics to “I like squeezes on my arms”.

I want visual

2. Therapy Ball – I love using the therapy ball because it’s a great way to incorporate sensory integration into whatever intervention you’re working on (like Bi-lateral drumming).  This targets the the Proprioceptive System – helping our clients understand where their body is in space.

3. Get Creative – Have fun with exploring MSOT strategies!  For adult groups, my co-intern and I have been enjoying bringing in essential oils (stimulating olfactory system), fun themed props for Spring Holidays (tactile), instruments like chimes, cabasa, and drums, bubbles, scarves, and scented squeeze balls.  I hope you’ll find that this brings a fun, novel element to your groups.

Music making (with an instrument) naturally stimulates 3 out of our 5 senses (auditory, tactile, and visual).  If you can add some type of olfactory element, we have 4 out of the 5 covered – a great goal to aim for while session planning.  It’s great to have a variety of MSOT strategies in your tool-belt in order to adapt to what your client needs in the moment – get creative and have fun with it!

-Marissa

Our team recently met to brainstorm essential teaching components, strategies, adaptations, accommodations, methods, and resources for teaching adapted lessons. I want to share with you what I learned in the article “Ten Characteristics for Teaching Students with Special Needs” by Beth A. Bauer.

  1. Consistency is crucial. This consistency applies to the rewards we provide, routine, schedule, home practice routines, time of day and location of the lesson,.
  2. Adaptability, find something that makes sense in their world. Examples include; using stress balls to teach hand positioning for piano, or creating fun mnemonic devices to learn the notes of lines and spaces in the music staff.
  3. Flexibility is a MUST. This flexibility pertains to lessons plans, studio setup and pacing of the lesson. Some days a student may come into the lesson after having a rough day at school and have a melt down. As the therapist “you need to find a way to work on something that will redirect the student away from whatever is bothering them and still be applicable to the lesson.”
  4. Setting Expectations “for students with special needs should be no different from the expectations and goals for students who do not have disabilities. By setting consistent, high expectations for everyone, the students know that we believe in them and that we know that they can be successful.”
  5. Patience, is your  best friend. Patience with repetition, multiple methods, reinforcement and redirection, and patience with getting to know your students.
  6. Compassion. Tell the parents of your students what their children CAN do instead of what they CANNOT do. Treat the child as a person first, without regard for a disability label. Focus on the positive aspects of the lesson, even when there is a meltdown, there is at least one positive aspect to find and share with the parent.
  7. Have a Sense of Humor.
  8. Learn from your mistakes. “We should always try our hardest but know that you will make mistakes. Mistakes are acceptable and the important lesson is that you learn from those mistakes.”
  9. Lose the Ego. Perfection is not everything, and it is not about the therapist. We will learn far more from our students than they will ever learn form us.
  10. Have FUN!!

 

-Kristin