Back to School: How to Effectively Assess and Establish Goals

#3 Assessments and Goals:

A few months ago, I received my formal training in Neurologic Music Therapy (NMT). I had been taught and supervised by Neurologic Music Therapists throughout my career and had a fairly secure understanding of the techniques before arriving. What I unexpectedly experienced during this training was a bit of an identity crisis. I had not realized until that training how many of my mentors were subtly practicing from an NMT approach.

During formal NMT training, we discussed how to assess and determine goals for our clients. This seems like a standard part of music therapy and certainly not specific to NMT. What was discussed instead was a particular way to determine your goals, using the Transformational Design Model, which is the foundation to all NMT practice.

When you consider what you learn about writing assessments, goals, and objectives in undergrad, often what comes to mind for most students are session plans, formal assessments, and music-based assessments. I distinctly remember learning how to assess clients from a formal, music-based assessment form and revisiting that form after a few sessions of music therapy. Much of our practica work in undergrad is also based on group sessions, with little practica being offered for individual work. As a student, there are so many skills to learn and apply that learning in this way makes a lot of sense.

However, assessing clients inside of music or writing goals before arriving to our client does not always make sense for the real world. When I got to my internship, I was overwhelmed with the amount of information I was required to learn about an individual based on reading their medical chart, talking with the interdisciplinary staff, attending rounds, and maintaining this information solely in my head before meeting the patient. Alternatively, sometimes I knew absolutely no information about the patient before walking into the room to introduce myself. How in the world was I supposed to assess this patient without any previous knowledge and then implement a treatment plan in the moment without any planning time?

This is the greater reality to music therapy, especially within the medical setting. While at NMT training, our discussion of assessment and goal writing was facilitated by the NMT approach of the Transformational Design Model (TDM). TDM sounds like a really fancy and complicated way to describe assessment and goal implementation but it’s relatively straightforward. I, however, sat through the presentation entirely dumb-founded because the entire presentation put into words what I’ve been trying to explain to others (students especially) for years.

Using the TDM is how I practice music therapy. And I had no idea. There was a moment during the presentation when the audience was asked how often they arrive to a client prepared with their “bag of tricks [interventions]” that always work for them no matter what. Approximately half of the room raised their hands and I almost fell out of my seat. I immediately became alarmed, inwardly questioning how a music therapist is meant to address the needs of their clients in the moment if they instead apply a collection of successful interventions on them instead like a bandaid? What work is being done through this approach? I was confused in the moment because I had not only found the language to describe my approach to medical music therapy but I also felt that my mentors had neglected to inform me over the years that I was practicing under a specific music therapy philosophical approach without any knowledge of doing so.

When learning to balance how to assess a patient immediately when entering room, designing a treatment plan/goals in the moment, and implementing the treatment plan immediately, I was taught to make these decisions based on evidence gained in the moment. I could assess someone by reading clues around the room, asking questions of the patient and family, implementing an intervention based on my determined goal and making adaptations as needed in the moment. I could improvise, utilize original songs, adapt existing songs, and implement all of those music therapy interventions based on the needs that I recognized occurring at that time in the room.

While sitting in the TDM presentation, I learned that all of those factors had a name and an official order of processes. I just didn’t know them until that presentation. Below is a brief synopsis of how to implement the TDM (in my own words/understanding).

The Transformational Design Model:

1.Pre-assessment – Determine a pre-assessment to be used outside of the music before implementing any music interventions. Ask questions (gain knowledge), be aware of clues around you, gather information from the client, family, team members, use a pre-established non-music assessment form, etc.)

2.Goal: Establish a goal(s) based on the above pre-assessment. What are the needs that you identified from the pre-assessment? What goals address the identified needs in the moment?

3.Implement treatment plan: Provide music therapy interventions that directly impact the goal and need areas.

4.Post-assessment: Utilize the same assessment used during the pre-assessment to measure changes that occurred within the session. Ex. Measuring a pain level from 0/10 pre- and post-music therapy intervention and session if lowering pain was the identified need area and distracting from or establishing non-pharmacological pain management was the goal.

5.Transformation: Implementing the transfer of skills gained, changes made, progress to regular life or activities of daily living outside of music therapy. This is the key to the approach of NMT. How does what occurred in the session transfer to everyday life skills?

This particular model of practicing music therapy is the only application that makes sense to me. It is the only approach to implementing music therapy that I believe addresses non-musical goals with a transfer to every day life. It aligns with PT, OT, SLP, psychology, child life, etc. and how they practice. Why would we worry about making changes within and only within music therapy when the point of music therapy is to utilize music as the medium to facilitate change in everyday life? I believe the lack of practicing music therapy in this way is one of the biggest reasons why we have not moved forward further in our profession.

My work has lended itself more to an adapted version of TDM throughout the years, mostly because some populations blur the lines of the processes. In my opinion, this is perfectly appropriate because I consider myself to follow an eclectic approach, choosing to blend many approaches rather than adhere only to one. Adapting the TDM also fosters a more client/patient-centered and provides you as the therapist with flexibility.

I now teach my interns about the TDM a little ways into their internship. It can be an overwhelming phenomenon to learn about, especially since it is contrary to many things taught in undergrad. I give them this language to study and consider so that they can begin to see a shift in their thinking when they assess patients. I have seen the change in my students’ thinking and it alters their focus from addressing surface level issues with patients to being able to dive in deep and make significant therapeutic progress.

Transferability is key. We are not practicing music therapy to have our clients be great in music therapy. We are using the music to cause a therapeutic change that transfers into their everyday life. You do not need to be an NMT. You do not have to say you follow the TDM. You should however meet the needs of the clients in the moment and help guide them towards growth, progress, and therapeutic change all within the music.

Back to School: Asking for Help

Music therapy students often encounter similar trajectories throughout their internship as they begin to learn more about themselves and who they are as a music therapist. In my last post, I wrote about one aspect of internship that has been a common challenge for students, including building repertoire: Back to School: A Music Therapy Student Series: Pediatric Music Resources. Another aspect of internship that is crucial to consider immediately from the start includes utilizing supervision.

#2: Utilize Supervision


Supervision is an interesting component of internship, especially for students who may have only one or two supervisors. It is different than a student/professor relationship and that of an employee/employer. The nature of internship requires students to be supervised and observed for the majority of the hours spent working. For my students, time throughout the working week is well spent in debriefing, receiving feedback, and in discussion about the variety of experiences they either lead, co-lead, or observe. By the time “formal supervision” rolls around each week, many experiences have been dissected pretty well.

Formal supervision – or one hour of one-on-one, dedicated time a week – is a requirement for AMTA national roster internships. It is included to not only meet the needs of the students as they learn and grow throughout their time, but also to foster self-awareness, self-assessment, and to practice healthy processing of experiences. With the guidance of your supervisor, interns should be comfortably self-processing and implementing healthy coping skills to deal with the ups and downs of being a music therapist by the time they complete their internship.

Supervision is also a very individualistic experience. Depending on your personality, that time may be best spent verbally processing through feelings in the moment, or to discuss your self-reflections that you took notes on over the week. Each of us process through our experiences differently and that is always okay. Most supervisors are well equipped to adapt as needed and to provide supervision that best meets each individuals’ preferences and needs. The challenge to supervision, however, is that the benefits gained from it are largely the responsibility of the student.

One of the biggest takeaways I learned about myself as a student is that I am terrible about asking for help. I am a very independent person and do not often think to ask someone else to assist me because in the end I know I can eventually do it myself. In many cases, I would rather struggle through something and get there independently than impose or place a burden on someone else. Ultimately, I am a caregiver – I do not like to be cared for.

There is a belief that our greatest strengths are also our greatest weaknesses. One of my greatest strengths is in caring for others and displaying genuine empathy. The opposite weakness to that is that I struggle with asking for help. As an intern myself, this was an enormous challenge. Because I was unwilling to ask for help – and to not be a burden or impose on someone else – I missed a number of opportunities to seek guidance, wisdom, or clarity on things that would have made me a better student and music therapist. Missing these opportunities and then having to talk about these missed opportunities with my supervisors (pro tip: supervisors always know!) was both mortifying, frustrating, and painfully emotional. At the time, it felt like being asked to change who I was. It was difficult and humbling. With hindsight and perspective, I now see that my unwillingness to ask for help was an enormous barrier to personal and professional growth. Yes, being independent, caring, and empathetic were wonderful strengths but I was only going to get so far in life if I wasn’t also willing to admit when I needed help.

Many of us do not want to ask for help because it reveals a lack of knowledge. If I admit that I don’t know how to do something, people will realize I am a fraud! These are the irrational things we tell ourselves. Now that I am on the other side of this experience, I cannot reiterate enough to students that the questions we do not ask matter more than the questions we end up asking. Asking questions projects an attitude of engagement, curiosity, and openness to learning. Being unwilling to admit you need help in the moments when you are struggling will only create a wall between yourself and who you can be. As a supervisor, I can always see when a student is struggling or in need of help. It does not matter how much you pretend that you have it all together or that you can figure it out independently. It is our job to see through that facade and to provide you with guidance. This is different than the expectations a professor may have had and a future employer will likely dedicate to you. The uniqueness to this short relationship between yourself and your supervisor is what can make it so special.

What is of utmost importance for students to know is that the responsibility of admitting that you need help and asking for it is ultimately up to you. I can certainly point out to a student that it seems like they are struggling but the amount of ownership and growth in those moments will be significantly smaller compared to if the student had pointed it out themselves. Whether you embrace that you are limited in knowledge in certain areas is entirely up to you. Taking advantage of the experts in the room, both your supervisor(s) and other professionals is up to you. Presenting ideas for thoughts, opinions, and responses from others is up to you. Take advantage of someone who is solely there for 6 months to provide you with encouragement, feedback, challenges, and to answer your questions.

Arriving at internship after years of studying is certainly the light at the end of the tunnel. It can be easy to focus on simply completing internship in order to get to “real life.” I cannot stress enough to students that internship is a great opportunity to experiment while having a safety net. No other times in your career will you be given the opportunity to try things while having someone else be there as backup in case you fail. Take advantage of this time. Every missed opportunity to be vulnerable and admit uncertainty is a guaranteed unanswered question as a new professional when you are (likely) on your own.

Do not let yourself be prideful or assume that you are ready to be the best professional you can be, all independently. Know that your greatest strengths also are likely your greatest weaknesses. Be excited and proud of your opportunity to be given guidance and support towards your potential as you learn, grow, and push the boundaries of your comfort zone. Trust that supervisors have chosen to be supervisors because they care about students and the future of the profession. Embrace your opportunity ahead of you and know that you will ultimately be a different version of yourself on the other side regardless, so choose to take advantage of every opportunity to learn, fully.

Back to School: A Music Therapy Student Series: Pediatric Music Resources

There are 4 key points that I frequently teach music therapy interns during the first half of their internship. These are points that can be embraced by interns in any type of internship setting, but may directly apply more to those working with children.

Back to School

#1: Pediatric Music Resources

Often when students arrive to internship, the biggest challenge they face is in transferring their thinking from preparing themselves for a one hour a week practicum to multiple sessions a day. The change from spending more time preparing yourself for a session towards being in sessions all day can be a tough adjustment. A normal frustration of new interns is in feeling like they do not have enough preferred music to draw from in sessions. For my students, I send a recommended repertoire list ahead of their internship start date with songs that are commonly requested by patients and families and are solid music therapy songs. Since my list is specific to pediatrics, it includes a lot of current pop music, Disney songs, Contemporary Christian music, gospel, current country, and more.

Another challenge to this recommended repertoire list is the change in expectations of professional mastery of the music. Perhaps what was passable in practicum no longer is appropriate for the internship and future professional setting. There is simply not enough time in degree programs to dedicate to clinical musicianship. Once at internship, interns are often given guidance on new practice habits, stylistic singing, advice on authentic guitar playing, and more. Suddenly, learning a Disney song within these new parameters is not as easy as it was original thought in undergrad. [Pro tip: Disney songs are very complicated and much more difficult than meets the eye]! All of these added challenges and expectations often build upon themselves in the first couple of months of internship and interns can often feel like they have nothing to offer in sessions. 

Yes, being prepared with professional-caliber, preferred music for patients is ideal, but it’s not the only option as you are building your skills. I often encourage students to think outside of the box. If you do not have “Let It Go” fully mastered, what else can you offer to meet your goals and objectives in this moment? Yes, improvisation and original interventions are great ideas to implement here but are they the only answer?

No! Let’s stop trying to re-create the wheel and look to music history for our answer!

In these moments, I challenge interns to consider their knowledge of children’s music. How would they categorize the typical children’s songs they know? Children’s music, as a genre, was created for specific reasons and being familiar with these reasons can help guide you in choosing familiar songs to help meet a specific objective or over-arching goal. Children’s music can be divided by these different categories that also meet therapeutic objectives:

  1. Lullabies
  2. Nursery Rhymes
  3. Educational and Learning Songs
  4. Movement and Action Songs
  5. Silly Songs (Imaginative Play)
  6. Call and Response Songs

Perhaps it is difficult to remember all of these categories – so I’ve broken them into a visual to help. In order to remember each category, think of the purposes of these songs and at what developmental ages children may engage the most in these songs. This order is not exclusive, but rather a tool to help you remember the categories and the variety of songs that could be divided into them.

Screen Shot 2019-08-17 at 4.27.29 PM

If you consider and memorize these categories, suddenly, you have a wealth of music at your fingertips already pre-disposed to assist with a specific music therapy objective. Are you working with a kiddo who needs musical prompts to assist with gross motor movement? Perhaps a bit of “Looby Loo” will do! Does a child need assistance reaching their developmental milestone of animal knowledge? “Down on Grandpa’s Farm” is wildly better than “Old McDonald” as it sings about the animal, animal sounds, animal size, animal color, and where they live (at least if you change “farm” to pond, jungle, safari, etc.)!

These songs are often children’s folk songs from around the world. They are not necessarily songs that modern children are super familiar with but they are easily teachable. As a genre, children’s songs are created to support repetitive, predictable and singable features to encourage active participation. Additionally, the better you learn and know these songs the easier it becomes to be familiar with the musical structure and theory behind the music, ultimately leading you to create better and more effective, original children’s songs.

Perhaps you are now feeling like you aren’t sure where to find such songs? Again, remember that these songs are historical folk and popular songs. Certainly any children’s sheet music book will have a wealth of knowledge for you. But, to help get you started, here are some of my favorite resources to rely on:

There will always be music that you will continue to learn throughout your career. Do not be discouraged by not having “enough” music in your repertoire, but instead, challenge yourself to think outside of the box and “music therapy norm.” There is an abundance of music out there to choose from – what matters is how you use it.  

 

What’s the Correct Definition of Music Therapy?

What's the Correct Definition of Music Therapy_.png

The music therapy world is a small one, but it’s growing in size. Based on stats recently provided by our certification board (and organized by one of my colleagues), our profession has almost tripled in size within the last 10 years. The infrastructure created to help support our profession is scurrying to keep up with our booming growth and at times it appears challenging to follow everything that is happening within music therapy.

Because our profession is smaller in size, we are all relatively aware of the moving parts within our music therapy world. Even if we aren’t active in our regional or national associations, or we don’t subscribe to the professional listserve, we are all tied to one another in some way. We all have at least one “mutual friend.” That’s how small our professional world has been and we are continuing to connect with one another together in support as victories arise and challenges are faced.

With this close-knit camaraderie, it is still surprising to me when feathers are ruffled. It is within the nature of the working world to have professional differences. We are all human and have different beliefs, thoughts, mindsets, and understandings of the world. Despite accredited trainings, education, and internships to help streamline our practice, we will all have difference experiences. Even with similar personality types, desires to help our clients, and professional intentions, we will never be exactly the same. In fact, it would be terrible if we were. We would be a very boring profession.

Even if we agree that we are different, in my experience many music therapists are still sometimes unwilling to work together or to uplift one another. Forgive me when I boldly ask, but what benefit do we have as a profession in working against each other? 

Years ago, I was made aware that my TEDx talk had offended another music therapist. In my efforts in attempting to briefly describe many facets of music therapy I had not included one small detail. Even after years since I initially wrote, memorized, and gave the TEDx talk, I had no idea what I had left out would be offensive to anyone. Even still, years after I was made aware, the encounter still resonates with me.

My initial reaction to this particular information at the time was shock, immediately followed by defensiveness. In my mind, I had created this particular speech in order to help our profession and propel advocacy forward for our field. I was offended and hurt that other music therapists did not see this and had actually found it harmful to their work.

But, being a therapist, I tried to step away, reflect, and determine why I was reacting as I was. From the other music therapist’s perspective, I could understand exactly why they had defended their work and asked for me to clarify their work in future advocacy measures.

I understand.

I get it.

I ask the same thing of other people every day when I encounter someone referring to something as music therapy when it’s not. have been that person asking for clarification. Despite being generally open and willing to educate and advocate for our work, the reality is that we are always on our advocacy defenses.


I recently sat through an intern’s “What is Music Therapy?” presentation given to colleagues and students at our facility. After the presentation, one of my colleagues asked, “Do you ever get tired of explaining to people what you do?” The intern answered with enthusiasm and passion, communicating joy for being able to help other people understand music therapy.

I sat there and reflected on this response, thinking of how many “elevator speeches” I had given just that week in addition to all of the decisions I make daily that ultimately affect music therapy advocacy. My initial emotion was fatigue. My second emotion was confusion.

How do you teach about a profession that is so varying from therapist to therapist? How do you decide which aspects of your work are the most important to explain? My colleagues who sat through the same intern presentation as they do every few months still said, “I learn something new about music therapy every presentation.” How can we accept and normalize that fact that everyone may have a slightly different definition of music therapy without needing to correct one another? 


I think all music therapists will agree that every day is a bit of a fight to prove ourselves. Some days present large and small victories, other days present utter defeats. How we support one another as a profession will ultimately determine our profession’s success.

I practice music therapy from an eclectic philosophy. This means that I find value in and apply all philosophies of music therapy, as well as the variety of specialities and expertise that one can acquire. This philosophy is one of the reasons that I love music therapy as a profession – depending on the situation, experience, and background of both the therapist and the client, a certain “type” of music therapy may be more beneficial and effective than another.

Some people would disagree with this statement and I’m certainly open to being challenged. What I think is more important is the willingness to have the discussion. Yes, we are naturally defensive in regards to our work and our music therapy backgrounds. I too watch a news video with my hands covering my eyes until we’ve reached the sigh of relief that the news anchors communicated a correct definition of music therapy, or sit on the edge of my seat when I’m being introduced waiting to hear whether I’ll be introduced correctly. We have become defensive throughout the history of our profession because there still lacks an understanding of what we do. We have been trained to correct or re-educate rather than hear what has been captured accurately and to find joy in this.

So rather than constantly look for what is “wrong” or “false” with how we’ve been represented, let’s instead look for the bigger picture. Let’s celebrate the steps we’ve made to move us forward so that we can re-learn how to advocate without defensiveness. When we see the bigger picture and communicate our work with pride, the general public may be more willing to listen.


 

*Note: This particular post took me 3 years to write; not because I think it’s a flawless post but because I think it’s a difficult topic to address. It took me much thought and reflection to capture how I feel and to communicate some kind of takeaway. I truly hope it gives other music therapy students and professionals some food for thought.

How Trusting in Obliquity May Provide Direction

How Trusting in Obliquity may provide you Direction.png

I really love to learn. I never knew how much I enjoyed it until it was no longer forced on me. Once I graduated college and was finally no longer a student, I realized how much I wanted to keep learning. I recently attended an intensive continuing education course for music therapy. I had been looking forward to the course to get some questions answered and to be reinvigorated in my work. It was a very intensive few days and I loved every second of every long hour.

Like many continuing education opportunities, trainings, or conferences, I came back to work completely jazzed. I had a million thoughts a minute and couldn’t even set pen to paper because there were too many channels of overlapping connectivity in my brain. I couldn’t figure out how to start processing. So I went back to work with this mindset of: “let me process things through and then begin to tackle how I want to make changes.” It was meant to be a temporary mindset that would then be discontinued as soon as processing was completed. After processing-completion, I envisioned a total shake-up of my music therapy norm and that everything would explode into success!

But then, processing took a lot longer than planned and I continued to work in this temporary model of going back to how I’ve always done things. Suddenly, my “total shake-up” no longer seemed feasible. I began to have quiet existential crises about who I was and what I was even doing in my work. The glitter of the training had fallen off and the workflows of my current job became glaringly obvious to be in black and white and not the multi-color I was dreaming.

I began to question the integrity of my work and whether my focus on my “music therapy dream” was even ethical for the care I was providing to my caseload. If I chose to follow through in walking this path of my dream, was I really doing my patients’ justice? Was it ethical for me to take time away from patient care in order to focus on what I want to create for the music therapy program? It unexpectedly seemed like a question of not only limitations, but eliminations in order to find a better balance.

Is what I’m currently doing in my work just a lot of things done adequately, or should I scale back and focus on doing only a few things exceptionally?

It’s a question I think most people ask themselves in any profession. Assessing the amount and quality of our work is an important part of self-reflection. It also helps us evaluate whether our workflows or systems are how we want to keep doing things in the future.

I’m a firm believer in cycles. Everything happens in a cycle – including my questioning of my work and whether what I’m doing is the right thing. Upon reflection, this typically happens for me in an annual cycle. One thing I’m understanding more each passing year is that in addition to these life cycles, our accomplishments happen indirectly. Although I rationally know that about once a year, I question everything I’m doing at work, I also have the ability to see how with this year’s cycle the things that I accomplished had been set in motion prior to this cycle really beginning.

This idea of achieving your goals indirectly is depicted by economist John Kay in his book and lectures about “obliquity.” John Kay essentially states that when we directly attempt to achieve something, it is not nearly as successful or effective as when it is met indirectly. For example, organizations who make the most money are not focused on making money. Alternatively, when an organization focuses only on profit, this is when their successes tend to decline.

I’ve seen this aspect of obliquity numerous times in my life, but especially in my work. Throughout my annual cycles of determining my music therapy identity, I’ve focused on learning, challenging myself, and trying to be the best music therapist I can be, while attempting to remain open to feedback. I’ve tried to share these experiences along the way mostly because it’s helpful to me. Things that have occurred simply because I was willing to share my thoughts have included connecting with people all around the world to discuss music therapy, to hear music therapy-related ideas, and to collaborate with people who think music therapy can be a partnership in non-music therapy situations. I never once intended to directly obtain these specific experiences, but they occurred because I was focused on something else. This is obliquity.

It is this outlook that causes me the most struggle in finding what responsibilities to let go of. It is not a rationalization or an excuse, but more of an honest belief that the work I do may eventually provide a unique return or reveal an unexpected path. I don’t know what return will be and it doesn’t really matter. Pretty much nothing I do directly truly works out to benefit myself or anyone else, but I’m passionate about the process. The process is where we learn about who we are and why we are.

Unfortunately, being passionate about the process doesn’t actually resolve my day-to-day challenges with balance. It does, however, provide me with a better sense of grounding and trust. In the moments where I become frustrated with the status quo, the processes that are out of my control, and the confusion as to why I’m doing what I’m doing, I can remind myself of obliquity. Having concrete evidence of a success achieved indirectly can provide acceptance of all directions taken and all paths considered.


 

 

*Don’t feel like you fully understand John Kay’s obliquity? Me neither. It’s a complex mindset. I highly recommend his book: https://www.amazon.com/Obliquity-Goals-Best-Achieved-Indirectly/dp/1846682894 as well as his TEDx talk: https://www.youtube.com/watch?v=_BoAtYL3OWU for clarity and continuous learning.

Why We Burn Out

Add a heading.png

“How are you doing? Are you stressed?”

People keep asking me this question a lot. Each time I’m asked this question, I stop and do a mini self-assessment. Am I stressed? No, I don’t think I’m stressed. Despite my heavy work load, I’m doing what I love. That is the answer that I give to those who ask.

Except, people don’t seem to take my answer as the truth, which has lead me to really question my work load, decisions, and my personal goals. Am I doing everything I can to ensure that all of these things are things I really “need” to be doing? Are these people trying to tell me something I don’t recognize? I value the many people who continue to check in with me and their observations of myself and my work. I am not upset by being checked-in on, but it does leave me second-guessing a lot of my work-related choices, which I have realized ends up leading to mild feelings of disheartenment.

I have additionally realized that when my resiliency and coping mechanisms are questioned, I begin to overthink my strategies. Are the coping skills I have in place enough and are they working for me? Perhaps there are changes I should make or things that I haven’t realized about myself in the midst of the amount of work I’m doing.

But, to be totally honest, I already feel like I’m doing all of those things enjoyably.

It is true, I have a lot going on. I seem to only ever add projects and responsibilities, even when trying to scale back. But I like those projects. They bring me joy.  My work and personal responsibilities certainly take most of my time and bring extensive mental work, but if they didn’t bring me joy, I wouldn’t do them.


People often talk about burn-out with hushed tones and avoidance like it’s contagious. The problem with pretending like it isn’t there is that everyone can feel the weight of the elephant in the room. I know I have experienced burn-out in the past, both in personal aspects of my life as well as my professional work. Those experiences are why I’ve made a number of changes over the years; to help prevent/combat those feelings. It also makes me perceive burn-out easily when it is occurring with others.

Burn-out is something that exists in any profession, but especially so within healthcare. Caregiving, secondary trauma, lack of emotional outlets, poor culture, and many more can lead to burn-out, and it will sneak up on you faster than you could ever admit. Sometimes, a result of recognizing burn-out amongst a group of people can lead to quick changes that eventually look more like a band-aid rather than an actual solution. In the working world, this “band-aid” can sometimes look like a reduction of shared responsibilities, attempting to streamline a process, or eliminating the extra “stuff” that people roll their eyes at or complain about doing on a regular basis.

Except, sometimes that extra “stuff” is important.

One of the things I have come to understand through experiencing these band-aid attempts is that quick attempts to fix burn-out or reduce stress without true resolution diminishes the magic of the reason why you were there in the first place.

Dealing with burn-out is cyclical. Everyone goes through it and it is unavoidable. The things that bring me drive and excitement now will eventually becoming boring to me. Or I will become unsuccessful at it and that will cause me frustration and exhaustion. I will get to a point where something long-term will have to change in order to no longer feel burnt-out. That long-term change cannot be decided by anyone except yourself and there aren’t any right or wrong answers. You know when you are at that point when simply realize, “I can’t go on in this way any more.”

I believe the graph below describes this cyclical feeling of burn-out. Although made to reference technology, it is easily applied to anything we begin, especially within our work. When a change is made, we often feel the “trigger” of excitement, which can lead to a wild spike in our energy levels and expectations of ourselves and our goals. But naturally, over time, we find ourselves second-guessing these goals or questioning our worth, success, or value. Eventually, through self-reflection and an adjustment of our expectations (usually a reality-check) we figure out our groove.

 

Image result for hype cycle
The “Hype Cycle”

Sometimes this “plateau of productivity” can last months, other times years. There is no standard experience through this cycle but it is experienced by all. Finding the right groove for yourself and recognizing these feelings as they occur is what helps us determine how to combat and/or get out of burn-out. The enlightenment stage reveals to us the true magic of doing what we love. The key, I feel, is determining what it is that constitutes doing what you love.


I have a number of plates spinning in the air in my life and at work because it honestly feels magical. I not only find joy in the various things that I do, but it feels right. It sustains and provides passion and drive. The spinning plates offer a glimpse daily into my overall vision for myself and for my life. Sure, it can be exhausting, but more in a way that feels like after a long day out in the sun at the beach.

Don’t get me wrong. Not every day is completely fulfilling or without challenges but these challenges are what signal growth and growth fuels change and earns wisdom. It is a constant self-reflection in what is a challenge versus what is burn-out. Sometimes burn-out is just the challenge along the way and sometimes it’s the bottom-of-the-barrel moment to make that long-term change.

Either way, remaining open in recognizing and admitting burn-out may be vital to maintaining “the magic” for each individual, whatever their magic may be.

So am I stressed? Am I burnt-out? No, I don’t think so.

I think you’re just feeling the fire of my magic flame.

 

 

No, I Do Not Have a Machine Gun in My Guitar Case

January is the classic time of year to make goals. It’s a fresh start to try something again, try something new, or accomplish the things you’ve always wanted to. It’s fitting that January is the month where music therapists aim to promote the profession through sharing videos and stories of patient progress and music therapy experiences through social media. I had my own goals for music therapy social media advocacy month. I had a wonderful story that would showcase music therapy depth. It was going to pull on heartstrings and highlight the importance of the patient-family-therapist triad. It was a long time coming and long-awaited.

And then it wasn’t.

Suddenly, the goals and visions I had for what I would accomplish first thing in 2019 were no longer. I was back to the drawing board. I felt a certain expectation for myself to uphold advocacy intentions for the profession of music therapy. I needed to make a new plan and to accomplish other, but equally great things.

Now it’s past January 1st, and I have no ideas. I told myself that I needed to make some time to make new advocacy visions. But if I’m being honest, I’m utterly exhausted.

Three years ago, I took a leap and applied to present a TEDx talk. I talked about what I knew and what gave me verve. I am still proud of what I shared and I’m honored that it continues to educate and inspire others, but it also gave me a wildly tiresome expectation of myself and my “role” within music therapy. Not only did I begin to require myself to be a full-time music therapist, but I suddenly expected myself to be the leading authority on music therapy education and advocacy.

Which is weird, because most days I hate when people ask me what music therapy is.

“Oh – that must be a machine gun hiding in your guitar case.” Hmm…I’ve never heard that one before....

“Wow, I wish my job could be all fun all the time.” Oh yeah, it was totally fun having a patient scream in pain at my face for the last hour….

“So, did you study music then?” ….No, I just fake it.

no, i do not have a machine gun in my guitar case

I’ve recently been reading a lot of writing by music therapy students and I’ve noticed a recurring theme when students address their self-assessed weaknesses. What continues to be present in every response is learning about “self-care”. Self-care is the buzz word for combating exhaustion, burn out, and dissatisfaction; but like any word, the more you say it the less it sounds like a real word. Self-care. Self-care. Self-care. I read these student writings over and over and I began to ask myself, what does this really mean?

I’ve been participating in a launching of a new program at work that focuses on providing psychological first aid to healthcare employees, which essentially means being willing to listen someone without judgement for as long as they need in order for them to regain their assumed resilience to move forward. As you can expect, healthcare workers experience what is known as caregiver stress, which is largely disregarded by society when taking care of those who are chronically ill or dying. I believe that the caregiver is one of the most under-researched and under-supported areas of not only music therapy, but healthcare itself.

In this program launch at my facility, we candidly discussed amongst ourselves what it feels like to passionately do your job while also feeling like you have nothing else to give elsewhere in your life. I was deeply moved by hearing others recount stories of crying in their car because they didn’t want their spouse to know how traumatic their day had been, as well as others feeling immensely guilty that they gave so much to their patients that day that they felt they had nothing left to give to their own children when they got home. We discussed the importance of protecting our loved ones from secondary trauma by keeping information about our day from them for their own well-being, but the toll it takes on causing barriers and isolation. From these comments, I began to question how you are expected to leave work at work when often there is no where to “put” it. Instead, these feelings/thoughts build inside you until you are unable to process it healthily and begin to doubt yourself. These feelings of self-doubt ultimately lead to compassion fatigue and eventually, burn out.

Where was that self-proclaimed self-care in these situations? It wasn’t. Because these people were exhausted.

I believe that music therapists are well-trained and equipped for being able to process their own feelings appropriately, which is not always the case with other healthcare professions. However, I hope that incoming students and other new professionals do not expect themselves to be above feeling exhausted, fatigued, or overwhelmed because they have “self-care.” Instead, I hope they, and all music therapists, are open to being transparent, honest, and willing to discuss the challenges they face and the experiences they witness within their work. Only then can you truly expect to process your own feelings and grow in your abilities to continue to care for and support others.

Everyday, I advocate for what I do passionately. Although I often want to roll my eyes in response to music-therapy-lack-of-understanding, I don’t. I explain what I do when asked. I stand up for my patients. I take the extra moment to educate staff why I did what I did in a session. I insist on being at the discussion table. I spend the extra minutes listening to a family member. I continue to think of new strategies. New goals. New visions.

And most days, it’s exhausting. But that’s always okay.

“Oh – that must be a machine gun hiding in your guitar case.” Ha! I don’t think my patients will appreciate that as much as the real guitar in there!

“Wow, I wish my job could be all fun all the time.” Some days are easier than others, but mostly, it is a lot of fun! Join us next time! 

“So, did you study music then?” Yes. I have two degrees in music therapy.

And I love it. 

 

*(And for those who have no idea what I’m talking about in reference to the machine gun in a guitar case, please see here for a brief explanation of this common gangster movie trope).

Guest Post: Music Therapy is Easy, Right?

I have long sense touted that my husband is one of the best non-music therapist MTs. He understands deeply what my work entails and can advocate for it and explain it to others just as well as professional music therapists. He would be the first person to say that he does not have the ability to do what I do daily, but he nevertheless had an experience in the hospital where he thought he could implement some therapeutic music in order to help a patient. Below is his experience in his own words of what it was like to attempt to provide music therapy without any formal and certified training, and the lessons he learned from that experience.

I recently traveled back home to be present with my mom during a routine surgery. The surgery happened early in the morning and we arrived at the hospital around 4am, so needless to say the previous night’s sleep was not great. The surgery went well and was routine with no surprises. While she was recovering, they started her on a particularly strong pain medication but wasn’t anything out of the ordinary. Although they are still unsure exactly what happened, my mom ended up with more pain medication in her system than her body could metabolize and ended up having extreme difficulty breathing. This was exacerbated by her sleep apnea and the fact she had now been in the hospital for more than 24 hours on very little sleep.

During this uncertain time, there were many thoughts going through my head. Having spent very little time in hospitals before, it was an interesting perspective to gain since my wife works in healthcare. What I quickly learned was that the nurses can be hit or miss, some of them extremely caring and some simply doing their job. From my perspective and based on many different iterations of “let us know if there is anything we can do,” there were many different services all of which had the same goal: to make the patient feel better and decrease the patient’s length of stay.

Being the problem solver that I am, I immediately tried to use my own expertise of what I thought my mother needed to aid their quest. How could I help the nurse better understand who my mom is and be a catalyst to unlock the “answer” of her recovery? At each shift change I would pull the new nurse aside and explain what I thought was important to know about my mom in hopes that they could use that extra information, in addition to what they received during the shift change. Erin was not able to make the trip with me, so during the first few days I kept wondering, “Where is the music therapist?”

Asking the nurses and doctors at every opportunity – pre-op, post-op, recovery room, ICU – no one seemed to understand what music therapy was; an experience most music therapists and music therapist advocates I’m sure have grown accustomed to. I thought “I’ve spent the last 5 years learning about the realities of music therapy through my wife. Sure, I don’t have any formal training, but I’m a musician and I understand that my mother appears to be appropriate for music therapy. Why can’t I offer something helpful to her?”

So I offered to play live music to my mom. She is generally go-with-the-flow and has never turned down me playing music before, so she was game. First goal – asking the patient if they would like services… check. Next, based on my assessment, what did I think was most the appropriate for her and something I could successfully provide? The only options of instruments were a guitar and from what I assessed about my mom was that she needed to relax. She was starting to become restless from being in the hospital 3 days longer than anticipated and her symptoms were ones I thought music could help with: elevated blood pressure, some pain, general anxiety, lack of sleep and general discomfort. I’ve seen Erin provide a guided imagery before, why couldn’t I do that?

This is where I really started to question whether or not I was appropriate to provide this “service.” First, as her son, was our relationship one that allowed my mom to fully participate and reap the benefits? I don’t know. Second, the guided imagery I provided was about relaxing on the beach. Since I live in Florida, was this scenario actually relaxing to my mom or stressful because it reminded her that I no longer live in the same state as her? I don’t know. Third, the imagery was about walking on the beach and “feeling the sand between your toes.” Being in a hospital room, does this image remind her that she cannot do that right now and cause more stress? I don’t know.

Despite my questions, I attempted the guided imagery with live guitar playing and finished it 15 minutes later. My mom was still awake and it was unclear to me if this “intervention” was overall helpful or harmful. Or was it neither? Later, I considered that there were many variables to the situation and that I had no idea which were the most important to try to control. Some of the variables I couldn’t change were that:

  • I’m her son, so I clearly didn’t need to develop rapport; but does that personal relationship prevent music therapy from being effective?
  • Since I don’t have the opportunity to see my mom often, did I really have enough information to assess her current needs?
  • Was my mom willing to go along with whatever I wanted to do simply because she wanted to spend time with me?
  • Because my wife (her daughter in law) is a music therapist, did she feel that she had to say yes to my music in order to communicate her support?
  • I didn’t really have a full toolbox to draw from. My mom loves to sing. Should I have played something she could sing along to? Should I have given her an instrument? Should I have just played something I knew she likes but had no words? Was the guided imagery actually as appropriate as I thought?

In the end, I don’t think I was self-conceited to think I could just take all of what I knew about music therapy and immediately practice it effectively. But I clearly thought that it was easy enough to whip out a guitar, play some music,  and lower my mom’s pain perception and blood pressure. While I don’t think I was in a position to truly cause harm, because just spending time with my mom was beneficial, I can definitely see that had I offered to provide these untrained music therapy services to a stranger, all those safety nets I had would not be present. I think the gap between “knowing” that music has all of these immeasurable benefits and understanding what music therapy actually is is one of the reasons why it has such a difficult time being widely understood. This was even evident when I asked the nurses at the hospital if there were music therapists available and they responded with, “Oh yeah, the beds have the ability to play relaxing music.”

Music and therapy are both words that people have their own definition for. It’s difficult for people to come up with a new definition for what “music therapy” might be. Of course, music can be therapeutic, but the concept of music therapy is more complex than the two separate words convey on their own. The sum is greater than the individual parts.

Perhaps we should call it something completely different.

Words are hard.

I have always told my husband that I wished he could try my job out for day so that he could understand it from a different perspective than just based in my stories. I’m happy to report that his mother is doing well now and that his therapeutic music implementation is one of her favorite parts from her hospitalization, and the time he spent with her. But, I think it’s safe to say he will continue to advocate for music therapy and encourage others to leave it to the pros!

The Real, Eclectic Music Therapist

The Real, Eclectic Music Therapist.png

When I first started this blog, over three years ago now, I was working part-time for a music therapy private practice. I was still determining who I was as a music therapist, having only been in the field for a brief period of time. I moved into a full-time job a few months after that and began to work within mental health. During this time, I completed my master’s degree and began to really define and determine my own identity within music therapy.

I found that what I was writing about was resonating with others – whether they were music therapists, students, or simply people who understand music. I wrote a lot about what I was experiencing within the mental health field and how that related to what I was learning in my degree program. Since my master’s focused intensely on pathologies, integrative medicine, and neuroscience, it was easy to connect the dots between the book-learning and the real-life experiences within my work. Apparently those topics were things that people understood, because I saw an increasing number of people tuning in and using my thoughts and experiences as a resource to find their own answers to their questions about music therapy.

Without me really taking ownership of my identity as a mental health music therapist, I found that to be how I was considered by others. I started to receive many comments and emails from people as well as my work being referenced elsewhere. I was honored that people connected with what I had to say, and I was more than happy to respond and connect more personally when contacted. I like to be challenged by others’ thinking and their questions, and I found that the more other people reached out to me, the more I was truly considering the depth of my work and the reasons why music therapy works.

Except, I never considered myself to be a mental health music therapist. In fact, I knew very little about mental health prior to my start in the field, other than what I had studied in my undergrad degree, one practicum in child psych, and a rotation in adult psych during my medical internship. Sure, I had the foundational training that I needed in order to set myself up for success while learning more about the field, but it wasn’t the field that I was passionate about. I think many music therapists can understand the challenge in working in your most desired population versus working in a full-time job. I will be frankly honest in saying that I took my job in mental health because it was the only full-time, benefited job in music therapy in my area.

I was truly faking it until I made it when I started that job. I barely recalled information from the DSM-IV (because the V was not out when I was studying psych), I knew nothing about the mental health system within the state of Florida, and I knew of only a handful of evidenced-based interventions specific to psych. I was open to learning, I was excited that a hospital-system wanted a full-time music therapist, and I was dedicated to doing my best – but it was a population I was only mildly interested in. I knew that I would only do my best within this population for a period of time before I wanted to move towards my preferred population of medicine.

I wrote about my experiences within mental health because it was helpful to express what I was learning about this field. I grew a deep appreciation for the field itself as well as the people undergoing mental health crises. I began to learn more about the politics of mental health systems than I ever realized I would and my understanding of mental health began to branch into circumstances experienced in my everyday life. I took what I was experiencing and began to catalogue it into my understanding of the brain and of humanity – what makes up a person and how our pathologies affect our self-identity. I began to learn more about who I was as a music therapist and who I want to become.

Apparently the things I learned and wrote about resonated with others, and it is something I have been very honored to experience, but I began to feel guilty about being considered a “mental health music therapist” when I was looking to change my own music therapy identity. Almost a year ago now, a new music therapy opportunity opened up within a children’s hospital. I jumped at the chance to apply because that was my passion. Not necessarily just pediatrics – but the medical field as a whole. I have now been in this position for almost a year, and yet, this is the first time I have purposefully written about this change.

I still consider myself to be a resource on mental health music therapy. I think that my interests and desire to understand music and music therapy through neuroscience is a unique twist on mental health practices within the field of music therapy. But, my truest passions are in understanding that same depth for all pathologies and ages. In my current job, I have the opportunity to work with all diseases, pathologies, and disorders -mental health being one of them. I find the same amount of professional excitement when a teenager comes in for medical stability after a suicide attempt as I do with working with infants experiencing neonatal abstinence syndrome, or a child going through a bone marrow transplant. This is a the field for which where I feel I’ve been trained and prepared to provide services. I have always considered myself to be a medical music therapist – even during my time within mental health – but now is the first time that I feel that I am no longer misrepresenting myself.

My desire to be more explicit about these thoughts may not seem to be necessary, but it is important to me to express in order to truly own my new role within pediatrics. Our identity of who we are as clinicians and how we express that role to others can be crucial in advocating for our services. Having my blog align with the actual work that I am doing is essential for me in continuing to communicate what I’m learning about music, the brain, and life. I intend on continuing to always learn, to share what I’ve learned with you, and to maintain our conversations about music therapy.

Mostly though, I want others to feel validation in accepting positions within music therapy that are not their first choice population. It is okay to be unsure about where your passion lies and to be willing to try different areas. There is no reason why our music therapy identity cannot continue to evolve. I felt a sense of responsibility in maintaining my “mental health music therapist” identity for awhile, but my acceptance of my evolving identity has allowed me to let go of that expectation. My intentions here are to encourage growth and change for others. The more you understand about yourself and your own professional identity, the more eclectic and well-rounded clinician you can be to support a greater amount of people. That, in and of itself, allows for a greater sense of purpose and advocacy.

Redefining Boundaries

IMG_3524

Recently, I have found myself considering my personal and professional boundaries more and considering how I may or may not redefine them. In previous posts, I’ve shared my personal diagnosis of type 1 diabetes (T1D). I was not diagnosed with T1D until I was an adult and a practicing music therapist. I had historically been a healthy person throughout my life, so acquiring a chronic illness came as quite a shock. As I began to learn about this disease and my management of it, I chose to keep this information to myself for quite some time. Over the years, I’ve learned to become more open about it, especially with my co-workers, and particularly those who share close quarters with me.

One of the areas though where I’ve continued to keep this information to myself has been in my therapeutic relationships. I’ve written about this previously, especially in relation to determining how you balance being a healthcare professional while also dealing with your own health shortcomings. I’ve learned to figure out how to balance taking care of myself in ways that set myself up for success throughout my work day, despite often having incidences arise that you cannot prepare for (e.g. low blood sugar). While I feel I have fairly successfully found the right balance of my professional life and my physical health, recent patient situations have brought to light the imbalance of my professional life and my emotional awareness and self-reflection regarding T1D.

As my professional life has transitioned from adult mental health to full-time medical pediatrics, I’ve continued to come across more and more patients who closely align with myself when it comes to health. When I worked in mental health, patients who had T1D were not there because of their diabetes and it was easier to separate myself into a professional role without dealing with counter-transference. Now, however, working in pediatrics has revealed patients who are newly diagnosed with T1D, readmitted for diabetic ketoacidosis (DKA), or struggling with their own diabetes management. This has revealed a greater challenge in separating my professional self from my personal understandings and struggles with the disease.

I continued to wrestle with the ethics around personal and professional boundaries on my own for some time until an opportunity to receive clinical supervision from my co-workers opened up. During this time, I was able to share my challenges to my team, which gave us the opportunity to view this debate from a variety of perspectives. What I found to be the most helpful from this supervision was that the team agreed that my openness about my struggle with counter-transference and boundaries meant that I was ensuring the most ethical route moving forward.

While this was helpful, I continued to feel a little unsettled until I dialogued with my husband. This conversation was important to me because although he does not have T1D, he’s the person in my life who understands the disease almost to the level of someone who does. What our conversation revealed is the importance in determining my own emotional safety. As I toyed with the idea of opening myself up a bit to my patients in simply sharing that I also have the same disease they have, he reminded me that I have to ensure that I am protecting my own emotional safety and receiving the support that I need. In ensuring that I am emotionally supported outside of my work, my ability to rationally and therapeutically have difficult conversations with patients would remain stable.

As I considered these additional perspectives, I sought final guidance from my music therapy colleague. While I had received many suggestions and considerations, I wanted some closure to this internal debate and knew that only another music therapist could help me find that closure. What our conversation revealed to me is that our personal and professional lines are not set in stone, but can be fluid as we continue to grow, develop, and redefine how we connect with and serve our patients. She challenged my old, definitive line in the sand that said I needed to keep all of my personal details to myself in order to be an effective therapist. She instead made me consider the potential for rapport and therapeutic strength if I simply move my line a millimeter to have a patient simply know that they are not alone.

Through these many conversations, I have found myself redefining my boundary lines. While I have continued to choose to keep my diagnosis to myself in most instances,  I have found myself re-examining this decision in certain situations. While I ethically understand that sharing information with my patients about myself is typically not in the best interests of the patient, isn’t it also my duty to build rapport with patients and have them feel validated, heard, and supported?

I will likely continue to redefine my boundaries as I grow as a music therapist, experience more life situations, and encounter even more ethical challenges. But as it stands now, I will continue to reflect on my openness with my ethical wrestling, receive supervision, and dialogue with mentors. Only in remaining open to your own self-reflection can we ensure we are best meeting the needs of our patients. Hopefully, as I navigate these new boundary lines, I can help a patient feel less alone and more supported in a way that others may not able to offer. In this, I can accept the uniqueness of my situation and embrace its potential for serving my patients even greater than before.