The Intentional Use of Music

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Over the past few years, I’ve had the opportunity to witness and experience our local professional orchestra in various ways from masterworks concerts, pop series, family concerts, and other community engagements. My husband has worked on staff for a number of years, and it’s been an interesting experience to attend concerts and programs, hear about the inside work from the staff and musician perspective, and witness it all as a music therapist. My husband and I are both dreamers when it comes to the use of music and how it benefits others. We share many points of view, despite my work being within the clinical use of music in healthcare, and his work in helping the orchestra enrich the culture of our community. For the first time, my husband and I were able to collaborate together between our organizations in a joint community event. The orchestra came to support my hospital in providing a free concert to our outpatients, families, and staff.

In addition to the concert, a few musicians volunteered to play on the units for a short period. The concert and on-unit performances are something the orchestra had done in the past, but was not something I personally was able to experience as one of the hospital’s music therapists. In the many years of dreaming, scheming, and collaborating , my husband and I were able to witness together something that fell into our vision for the intentional use of music within our community. One of the things that I think is incredibly important, but often neglected, is our support of the caregiver when it comes to music therapy. As a music therapist, we are not there to only support and take care of our patients, but we support the entire family unit. This is the heart of family-centered care. But even outside of the family, the caregiver includes the nursing staff, physicians, allied health professionals, and the support staff. Every person who works within a hospital is someone who cares for the patient, despite their role.

This is a phenomenon that is not always recognized, especially for those who do not work in the hospital. It is often difficult to see how an environmental services person supports a patient until you witness the care they provide in taking care of the environment, a patient’s room, and the relationship they build with the patients and families. It then becomes clearer when you consider how much this staff person witnesses a decline of a patient from the day to day, or the success of their recovery. It is easy to see how a nurse is affected by their care of patients over time, but this same sense of fatigue, heartbreak, or overwhelming sense of compassion can be felt by all employees within a hospital.

If you consider the importance of how the caregiver cares for the patient, how important then is it to care for the caregiver?

While I accompanied one of the musicians from the orchestra to one of our units, I warned her that we would need to check in with the nursing staff before she began to play. I had already spoken to the charge nurse in the morning, explaining to him what we would be doing and for how long. He was hesitant, stating that they currently had a patient on the unit who was very sensitive to stimulation. Over-stimulation can become dangerous for patients who are critically ill, and I reiterated that my role as the music therapist was to be a liaison between the musician and the hospital, and that we were happy to make adjustments as necessary. The charge nurse agreed and we planned to play on the intensive care unit. When we arrived to the unit, I again checked in with the staff, and they were hesitant. They reported today had not been going well for that particular patient, and they were worried the volume of the instrument would be too over-stimulating. The musician attempted a few notes, and the staff immediately agreed, the music would be too much for this particular patient at this time.

Luckily, our musician was incredibly flexible and understanding. I escorted her to another unit and explained to her why the staff had requested us to not play at this time. We instead went to our general medicine unit, where I chose an end of the unit I knew had patients and families who would benefit from hearing the musician play. I had already worked with one of the families earlier in the day, and knew how well that particular patient responded to music. The musician began to play, and immediately the unit was filled with ambient sounds of her cello, playing various children’s and folk songs. One family came to the doorway, with a sibling giggling and playing hide and seek with the musician. The family I had worked with earlier in the day opened their door and gasped in surprise. Despite being unable to communicate verbally and feeling so anxious that he was engaging in some self-harming behaviors, music provided an outlet for this patient to relax, feel comfortable, and find some normalization in his environment. The family thanked me, the staff, and the musician for coming and told us that this experience had brightened their day.

As I walked the musician back to the lobby, I explained to her that her music gave this particular patient an opportunity to express. In the day full of stress, confusion, and limitations, her music allowed him an outlet to relax, find joy, and have a moment of normalcy. His experience of the music also allowed his family to find respite and relief while also experiencing the music directly for themselves as well.

As I reflected over the experience, I thought of the conversations my husband and I have had over the years on the role the orchestra plays within the community, and the role it could play in the future. I was again struck of the power of intentional music. When we use music intentionally, whether for ourselves personally, or clinically within music therapy, music shifts from entertainment towards purpose. Intentional music becomes a tool that serves our health and well-being.

The Continuity of Person-Centered Care

IMG_3183I’ve recently had the opportunity of working in both mental health and pediatric medical care. In my transition to adding pediatric medical care to my workload, many people have asked me how I feel about working with a more “difficult” population, meaning children with acute or chronic medical needs or with children who are dying. Although this isn’t a surprising question and I understand why people are asking, it has instead emphasized to me the miseducation and misunderstanding of our mental health system and the population as a whole. In working only part-time at my mental health facility, it has given me an opportunity to step back and be reminded of the challenges this clientele faces every day. Often when you work in the midst of it, you find yourself becoming jaded or detached from their realities as a way to better cope.

In this opportunity of working in both populations, I’m often left with a sense of comparison. This comparison has nothing to do with any one person or the facility itself, but instead the systemic issues that create this disparity.  As you can likely expect, society loves to donate to children. These donations come in time, money, gifts, events, services, and more. Consider the area you live in. How quickly can you think of the name of your local children’s hospital? How quickly can you think of the name of your closest mental health facility? The stigma that mental health faces, whether in children or in adults, prevents society from considering our marginalized members of healthcare. In my time at my previous facility, we struggled to obtain some of the most basic items of human dignity for our patients, many of which are easily donated elsewhere in the community. A number of these items were incorporated into our facility’s budget of course, but some items were deemed less than crucial and were not included. Some of these items were, but were not limited to, clothing, Bibles or other religious texts, books, magazines, board games, recorded music, puzzles, and more. Although none of these items are required for mental health care, they certainly were necessary for basic human dignity. In comparison, the pediatric facility has entire rooms dedicated to donations alone. In addition to donated items, I personally struggled as the music therapist to find one person who was interested and willing to be a volunteer musician at the mental health facility in my entire time of being there. At the pediatric facility, I receive calls weekly from those wanting to come and volunteer for the children.

I don’t say this to devalue any one population’s worth, and by all means, I don’t mean to dismiss any one patient or family’s experience, but I’m not the first person to say that we marginalize and dismiss those with mental health disorders because of stigma and because of a broken system. Recently, I read a special report about homeless men and women who died in our area, and their stories that accompanied their path to homelessness. While reading the article, I began to recognize the people, not because I knew them personally, but because I recognized their stories. I can stand on my soap box and state my opinions left and right about how we care for those in mental health compared to all other areas of healthcare, but I choose instead to challenge myself and my own role as a music therapist.

As I read the article about those who died in homelessness, I wondered about the people who had cared for them at various points in their journey. Some of these men and women had received mental health care, others had received medical care, while others benefitted from the VA. In their time within the healthcare system, did these people meet anyone who showed them patience and kindness? Did anyone stop to listen to their story, asking them, “what has your journey been like”? Did anyone recognize their resiliency?

In thinking about these questions, I’m left with these considerations for music therapy:

  • How does music therapy reflect this person-centered care?
  • What can music therapy do to ensure person-centered care that honors an individual and inspires hope?
  • How does music therapy extend the continuity of care past the direct care each patient is given while they are in your facility?
  • How can music therapy continue to challenge the systemic issues within our healthcare system as whole?

As a music therapist, we have the unique opportunity to support and validate patients despite their history, background, or current situation. It does not matter if our soap box is focused on mental health disparities, or the stigma of intellectual and developmental disabilities, or in the dignity of serving older adults with dementia. We are a person- and family-centered profession, and it is our duty to continuously question how we serve our patients and how that service affects our patients past our time working directly with them. Despite the resources you may have, whether rooms full of donations, or hardly one volunteer, these are the questions we have to continue to ask ourselves. When people ask me how it is that I work with such a difficult population – children who are medically compromised or dying – I remind them that these children are supported by the community. It is the populations who are neglected or ignored that are the most challenging to serve as a member in healthcare.

At the end of the special report on deaths among the homeless, a woman who scatters the ashes of the people who were left unclaimed out to sea was quoted as saying to them, “I’m sure you graced this world with a lot of beautiful things”.

May we be the proponents who inspire those ‘beautiful things’.

How Saying “Yes” Leads to Advocacy

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In the music therapy world, there’s an unspoken feeling among colleagues of being movers and shakers and big risk-takers in the healthcare world. Conversation between music therapists eventually lead to discussions of program proposal dreams, advocacy work, and general convincing of music therapy’s effectiveness to others. It’s with our advocacy that we create opportunities for ourselves and our profession. It’s our dedication to tirelessly giving our elevator speech that opens doors and conversations. It’s our passion that drives us to take leaps of faith and open ourselves up to taking a risk. It’s our altruism that fuels our desire to see patients cared for in effective ways.

January is music therapy social media advocacy month. In the past, I’ve shared my own passions for music therapy advocacy from the educational standpoint of teaching the public about music therapy. This month, however, I’ve been considering not what my advocacy has done for music therapy, but what my advocacy has done for me as a music therapist.

Advocacy can have two layers. You can publicly advocate for music therapy as a profession and you can personally advocate for yourself as a music therapist. When I stop to consider how I have personally advocated for myself as a music therapist, I realize that it mostly boils down to saying, “yes” to the big questions asked of me. This doesn’t mean that I don’t know when to say, “no”, but simply that I’ve said yes when given an opportunity, despite my comfortability (or lack thereof) with the question at hand. In other words, I’ve said yes to taking the risk.

Some of these risks have come in the form of questions such as, “Will you give a program proposal”? “Could you give a presentation on music therapy and this population”? “Are you willing to be the only music therapist at this this facility”?

When asked these big, risk-taking questions, the process of answering has never been easy. With each big question, I understood it as a risk because I felt nervous, afraid, and ultimately that I had no idea what I was doing. Why would I be willing to answer with a yes, you might wonder, despite these negative feelings?

Because, advocacy.

If I answered yes to these big questions, I was ultimately answering yes to music therapy, and more of it. Within this drive for advocacy, I could rely on a few characteristics that allow making “yes” a little easier, despite any fear or uncertainty. For me, these characteristics have been:

  1. Confidence. I distinctly remember my first program proposal as feeling like flying by the seat of my pants, despite my preparation and practice for it. I felt grateful for the resources that I had, but I truly felt like I had no idea what I was doing. However, I trusted in confidence. I was confident in who I was as a music therapist and in the vision I had for myself. 
  2. Determination. I don’t like when people tell me “no”. This knowledge of myself has ultimately manifested into determination. It also gives me fuel to practice, whether it be musical, or rehearsing of presentations, or writing and constantly re-writing, as well as focus and dedication to the thing I am advocating for or saying “yes” to.
  3. But on the other hand, I have always reminded myself to Surrender. This sense of surrender has not meant give up, but to simply let go. Once I have confidently done what needed to be done to the best of my ability, whether interviewing, offering a presentation, or putting myself out there for others to judge and assess, I eventually reach a point where I must let go, which often leads to:
  4. PatienceAfter letting go comes a point where you have done what you can and that is all that can be asked of you. Sometimes this patience looks like waiting for an acceptance letter, waiting for the right timing, or it looks like knowing that you simply can’t have all of the answers at this time. Patience is ultimately waiting to see if tomorrow may have a different opportunity.

With these characteristics, taking a risk, or saying yes, begins to feel more comfortable. And the more comfortable you are with saying yes, the more you are advocating for yourself. Every time you step out of your comfort zone and advocate for yourself, you may not be opening a door for yourself directly, but you’re opening the door for another music therapist. You begin to make your advocacy personal. It gives people a story with which to connect. It starts the conversation and brings the profession to life in a tangible way. Often, new opportunities come about because you had initially said yes.

January reminds us to continue our advocacy for our profession, but maybe it also provides us an opportunity to re-consider how we advocate. Maybe this year could provide new opportunities to advocate for ourselves as music therapists personally, which will ultimately enhance our advocacy story as a whole. Let’s make 2018 the year of saying, “yes”.

Mental Health Session Ideas #4

Last week, I posted some additional therapeutic revolution ideas for the mental health settings. Read below for some more of my original and adapted ideas.

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THERAPEUTIC REVOLUTION #17

Mood Playlists

Goals: Elevate mood; increase positive coping skills; increase emotional awareness; increase mood regulation

Therapeutic Revolution: I borrowed this idea from a colleague, and adapted her idea to fit my own style. You can read her original idea here, as the rest of this info is my own adaptation (with her permission). What I love about this idea is that it presents a therapeutic revolution that encourages patients to create their own adaptation as a tool for recovery. During this session, I present a playlist of songs (all recorded) that evolve from a particular emotion and transition into a desired emotion. During this therapeutic revolution, I ask the group to share any feelings, emotions, or moods the song is trying to evoke or evokes from them personally. While we listen to each song on the playlist, I write all ideas on the board. At the end of the playlist, I have the group go back and select one word from the list for each song, simply for clarity. I then ask the group to determine if there are any patterns or connections between the chosen emotions. What I aim for the group to see is the evolution of feelings from one mood state to another, hopefully with a gradual change.Mood Playlists I guide the group from a discussion around the purpose of changing our mood and how we might use this as our own tool within recovery. I offer a handout where patients can create their own playlists, with mood change suggestions such as: sad->happy; lonely->peaceful; tired->energized, etc.

Considerations: This exercise works well for all functioning levels. I choose songs that are immediately recognizable and tend to exaggerate a certain emotion, for teaching purposes. This conversation can revolve around concepts such as iso-principle, emotional awareness, mood regulation, and positive coping skills. This conversation can also lead to discussions around music preference and how certain songs/styles can make us all feel differently (which is always okay).

Adaptations: This is my own adaptation on someone else’s idea! I’d be curious to know how you would adapt for yourself 🙂

Takeaway: This exercise can allow patients to consider their own music choices and how their mood is affected by those music choices. The main takeaway would be for patients to consider how they might be able to alter their choices in music listening for the purposes of mood regulation.

Source: http://www.themusicmentality.com/single-post/2016/10/06/Iso-Principle-and-Mood


THERAPEUTIC REVOLUTION #18

Self-Care: Intro to Music Relaxation

Goals: To increase relaxation, decrease anxiety/agitation, educate on positive coping skills

Therapeutic Revolution: Rather than focus on one type of therapeutic revolution for relaxation purposes, I guide a group through a few short music relaxation exercises. I first start the group with a discussion on self-care and what that means to them. This conversation can vary depending on the group, but I guide them towards considering a “new level” of self-care during this group. I then ask them to rate their relaxation state on a scale from 1-10 prior to starting any exercises. I then instruct the group to prepare themselves for relaxation (finding comfortable position, closing eyes, focusing on a spot on the floor, etc.) The exercises then follow this format, using live music (I tend to use keyboard for this):

  1. Singing and/or music listening – with a focus on the imagery of the lyrics; attempting to picture what is being described within the song
  2. Music listening – (same as above)
  3. Music and breathing exercises – guiding the group through music assisted breathing exercises
  4. Music assisted relaxation and guided imagery – closing the exercises with a short guided imagery script set to purposeful music

Considerations: I use keyboard for these exercises, as I find that easier to support the exercises musically compared to guitar (which is personal to me). I also choose very descriptive songs for the first 2 exercises, such as Country Roads, Somewhere Over the Rainbow/What a Wonderful World, etc.

Adaptations: I often adapt the exercises based on mood and overall feel of the environment, remaining flexible to the unit (e.g. interruptions made by staff, patients entering/exiting for various reasons, etc.). This is where improvisational flexibility is key and remaining adaptable to the varying circumstances that arise within the hospital setting.

Takeaway: What I love about this structure is that it presents an “intro” to music relaxation and various relaxation exercises. I challenge the group at the end to consider how these exercises relate to the idea of self-care and how they might incorporate one of these exercises into their own routines.


 

These are what have been successful for me recently. Please comment below with any questions or feedback. I’d love to hear if anyone tries out an idea and how they work out for you!

Mental Health Session Ideas #3

It’s been a busy year for me, despite having finished my masters degree. I took on some additional non-music therapy related projects at work, which took most of my creative juices, but I’ve still been hit with the occasional “revolution-ary” idea for session plans and therapeutic revolutions. I’ve found that session ideas have proven to be what others are seeking when searching for music therapy and mental health resources. I am a firm believer that we, as music therapists, need more resources and creative ideas to help banish burn-out and spark our own creativity. I’ve done my best in previous posts to consciously reference the places where I adapted an idea or highlighted an idea I really liked. With that being said, I hope in posting my own original ideas I’ve inspired other adaptations or given other music therapists an additional resource to work from. These ideas below are free to you to adapt and implement within your own work, but I do hope you reference this source as where your idea came from. These ideas are specific towards mental health clientele, but can certainly be used within other populations.

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THERAPEUTIC REVOLUTION #15

Dealing with Stigma/Empowerment

Goals: Education on stigma; increase emotional expression; increase sense of self-worth/empowerment

Therapeutic Revolution: This session begins with a discussion on “what is stigma”? We discuss our own understanding of stigma and I share the dictionary definition. This conversation feeds into a lyric analysis around Matchbox 20’s song, “Unwell”. This song features vivid descriptions of mental health symptoms, including visual and auditory hallucinations, anxiety, depression, delusions, and more. The lyric analysis for this song pairs with an educational resource I created that applies 6 “Steps towards Empowerment“, which I adapted from NAMI’s blog post here. MH Empowerment

This session is education based, but allows for open discussion and emotional expression. Depending on the direction of the session, I end with inferential drumming around the idea of feeling judged, misunderstood, or facing stigma and support the group with a chorus featuring ideas of being empowered and having a voice within the world.

Considerations: Stigma is a more abstract concept to discuss, so keep this in mind when considering this session plan for your group. It often can lead to off-topic, but related conversations, so stay strong with your intentions behind this group and always come back to the music.

Takeaway: Patients often face stigma even within the hospital setting. I have used this session plan when addressing frustrating with hospitalization itself in order to better support the patients and to help give them a voice. We often discuss the importance in advocating for yourself, which ultimately comes back to education. Many times patients do not have the language they need in order to advocate for themselves and their treatment, so this session plan and discussion can be critical for patients when they feel their rights have dwindled within the hospital setting.


THERAPEUTIC REVOLUTION #16

Human”/Catharsis

Goals: To increase self-acceptance, emotional expression; educate on ‘catharsis’

Therapeutic Revolution: This session focuses mostly around a lyric analysis of “Human” by Christina Perri. Within this lyric analysis, the focus is on what it means to be human, how that relates to hospitalization, and the importance of appropriate catharsis. Within the song, I chose 4 distinct lyrical phrases that offer varying emotions and feelings (reference photo). With each lyric phrase, I chose a corresponding image and cut slips of humanpaper including the image and the phrase. I then lead the group towards choosing one image/phrase to reflect on and have the group journal any thoughts, feelings, or emotions that are evoked from that particular phrase. I ask the group to be honest with their thoughts but to not become attached to these slips of paper, as they will not be keeping them. I then transition the group into a short discussion on appropriate catharsis: what that means, what it looks like, and the difference between appropriate and inappropriate catharsis (crying or laughing vs. cutting). I then ask the group to take their journal slips, tear them up, and throw them into a trash can as a physical act of catharsis or letting go. The session closes with the song, “Let it Be” by the Beatles.

Considerations: Catharsis is a more challenging concept to describe and discuss, so use this session appropriately with your clientele. I have also found that this session can build rapport rather quickly within the group, so it may be a good initial session to use with a new group.

Adaptations: Often I like to incorporate these processing tools, which are essentially stress balls in the shape of various body parts. With these tools, I created related questions to go with each shape, to allow patients to choose one they connect with in order to share their answers (E.g. “What has been difficult to process” for the liver or “What is something you’ve recently learned about yourself” for the brain). I start my group with these tools, to check in with patients and to get them on the theme of being “human”.

Takeaway: My personal aim with this group is on educating about the appropriate ways we can experience catharsis. This is a delicate topic for anyone who has a history of cutting or self-harm, but has the potential to be very important. The song “Human” is a very relatable song and can certainly help support the goal of this therapeutic change.


 

Stay tuned next week for some additional therapeutic revolution ideas for mental health sessions.

The Realities of Inpatient, Psychiatric Music Therapy

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I’ve had the opportunity to work within the same acute inpatient psychiatric facility for two years. It’s not a long time in the grand scheme of a career, but it’s enough to collect some insight on how things work in our world. When I started this particular job, I had a certain assessment of who I was as a person and as a music therapist. I was confident in this assessment and in my experiences that had led me to this point. This confidence propelled my implementation of a music therapy program and resulted in some great feedback from patients and staff alike. But recently, as I’ve settled into what I’ve created, I’ve been asking myself, did my personal understanding of music therapy hinder my approach to working in an inpatient, crisis stabilization program? 

When I started working at my current facility, I was very comfortable with the clientele, my knowledge of psychiatric disorders, and the realities of a locked unit and society’s view of that. Excuse the jargon as I go on, but I took my Crisis Prevention training to prepare myself for healthy de-escalation techniques and to learn “safe holds”; I brushed up on common psychotropic medications and their side effects; I learned about trauma-informed care; I double-checked that my equipment would be considered “psych-safe”; and I made sure to be vigilant of “elopement risks” when entering and exiting a unit. I was well-prepared. My education had trained me for this.

So I began to formulate a vision of what my role on this treatment team would look like. I created session plans around themes of self-esteem, emotional expression, positive coping skills, mood regulation, identifying support systems, and more. I implemented these sessions and received positive feedback from patients and staff. I followed our structured schedules to ensure patients received the most out of their hospitalization. Patients thanked me for my time, offered positive comments, and told peers to make sure to attend my groups. I saw myself doing what I had been taught and it was successful.

Until it wasn’t.

It’s not that my music therapy groups stopped being helpful, it’s that one day I simply walked into the hospital and suddenly asked myself, “what am I really doing here?” The bubble that held my beliefs of what my role was — popped.

My internal struggle became clearer to me when a colleague presented a case to our clinical team. This colleague was frustrated with the lack of help we were able to offer to this particular patient due to our limitations as a crisis stabilization unit. This patient was a complicated case and would require intensive therapy for most of their life due to their particular dual diagnoses. I realized that my own internal struggle was feeling the same helplessness and frustration with the system; not with who I am as a music therapist, but who I have to be within the system. I began to see that despite our ability to recognize how a patient may benefit from a multitude of therapies and treatment plans, we have to accept the realities of what we do and the systems in which we work before true progress can be made.

This realization was something education and training could not have prepared me for. I had to discover the realities on my own.

The reality is: that when someone is undergoing a mental health crisis and presents as a danger to themselves or others, they are admitted against their will into a stabilization facility.

The reality is: the facility is not meant to provide intensive, individual therapy.

The reality is: patients are only meant to be hospitalized for a couple of days.

The reality is: the psychiatrist does not spend time getting to know the patients because their focus is on providing medication stabilization.

The reality is: our mental health system is dependent on outpatient therapies to provide the brunt of the therapeutic work.

The reality is: those of us who work on a crisis stabilization unit have limitations as to what we can do to help.

The reality is not: that we do not want to help our patients or that we don’t know how.

The reality is: sometimes we simply can’t.

And it’s not an easy reality.

As a music therapist, I had to change the way I viewed myself as member of the treatment team through this new lens. I had to change the way in which I assessed a “successful” day.  I had to change my expectations for my colleagues and how we support the patients who return. And return. And return. I had to realize that I am now a part of the system and music therapy is no longer floating along as a shiny, new attraction to my patients at my facility.

Suddenly, it seemed crucial to change my session themes from the abstract towards the more proactive. I stopped asking, “What goals do you have” but instead asked “What can we do now that will make you more successful when you leave”? I saw myself as a resource more than anything else and began to question how my role works within the overall mental health crisis process. I began to see that who I was as a person in and outside of my music therapy work was more important than any theoretical framework or thoughtfully planned session would ever be.

Inpatient, stabilization, psychiatric facilities are not for the faint of heart.

I came into my facility with a vision of who I was as a person and as a music therapist, but I’ve since had to give myself a humble ego-check. My patients are not shy in letting me know when something isn’t working, but it’s more difficult to address when the problems are systemic, rather than personal to you. With these challenges, I’ve had to re-assess myself and who I am as a part of the system in order to determine how music therapy can prevail in order to continue to bring hope, humanity, and understanding to a system that is imperfect.

And that’s my current reality.

 

 

The Original Musician

I often don’t listen to a lot of music at the end of my workday, allowing myself a break from my musically analytical mind. It’s something that I do that is specific to me, but is what I’ve learned that works for me to allow for some separation from my work-mind and my home-mind. My husband is also a musician, and though he works in the music industry, doesn’t have the opportunity to engage in music-making like I do every day. For him, listening to music throughout the day allows him to engage better in his work and often leaves him itching to play music when at home. When he starts to play various albums and playlists, I internally (okay, externally) groan and roll my eyes. For me, I need a break, but for him, he needs to express. So the other day, when he began to play an old playlist, I was shocked by the strongest nostalgia of music I hadn’t listened to in 10 years.

I had long thought I had lost this particular playlist amidst the many transitions my iTunes has taken over the years from computer to computer. But when faced with this playlist again, the memories of the music came back with intensity. I began to think about the amount of time I spent curating this playlist, among countless others, when I was growing up and before I became a music therapist. The purity of the connection I had with that music brought tears to my eyes.

All I could think was, “Where did that musician go“?

I think about music very differently these days. Last month, I graduated alongside my incredible cohort with my Master of Arts in Music Therapy from Berklee College of Music. The week leading up to graduation was intense, emotional, and overwhelming. We had worked so hard for two years and had watched one another transform into stronger music therapists. Many of the master theses and projects that were created as a culmination of our studies were highly intellectual and clinical. I was in awe of the clinical protocols and research that had been created, all surrounding music therapy and the current needs within our profession.

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For the past two years while in this program, I have been thinking about music in ways similar to:

  • How do I support music’s efficacy for this particular pathology?
  • How can I explain what has happened neurologically with the patient during our session to the physician?
  • Is there a way I can educate my patients on the neural processing of music to encourage their understanding of the benefits of music therapy?
  • What do our music preferences reveal about music cognition and the depth of our unique perceptions?

Before I became a music therapist, the extent of my music thinking was generally, “Wow, I love how that song sounds” or “This is how this album makes me feel.” I connected to music deeply and passionately, but the connection was pure. Mysterious. Profound. I didn’t worry about what was happening neurologically. I didn’t even really think about how others responded to the same music other than trying to convince my friends that this band was the best band, and therefore they should love them too. My love for music was all-encompassing.

And then I decided to study it.

There is a process identified first by art therapists known as the “clinification syndrome.” This clinification occurs when “someone neglects their own creative process to a point when it is something they only do at work” (as defined by Ami Kunimara, MT-BC). The art therapists define this phenomenon as the gradual decline of making art the more they focus on their clinical skills.

To me, it sounds a little like growing up.

I first wanted to study music therapy because of these playlists I had curated. The way in which those songs transformed me founded my desire to help others transform through music. I wanted to share what it felt like to create music through live music-making experiences because I understood what it felt like to express the music that was locked into your soul. But the deeper I began to study the clinical, evidenced-based, peer-reviewed protocols, the farther the mystery of the music seemed to get. Being able to explain the neuroscience behind the music changed my perception of the role music played for me growing up. The power behind the mystery of the music began to shift.

Music had become less like magic and more like science.

During one of my classes, we watched the PBS documentary, The Musical Brain, which featured neuroscientist Daniel Levitin studying the musical brain of Sting. Spoiler alert: After Sting engaged in a few studies, Dr. Levitin asked him his thoughts. While I’m paraphrasing here, Sting generally responded that he was unsure whether he wanted to know the scientific depth of his musicality, because it felt like erasing the power of his connection to music. He added that knowing the depth of music scientifically took away some of the allure and mystery, and he was unsure if he wanted that taken away.

When I heard this, I couldn’t help but understand.

I don’t regret having music in my life transform into a more scientific realm because that is my job. It was what I wanted to understand. It was what I decided to dedicate my life to. It is my job to take the pure connection my patients have with music and to help guide them towards the therapeutic goals and tools that my expertise can explain. I understand music’s profoundness, because I’ve experienced its therapeutic power firsthand. But knowing music as a science gives me very different eyes when looking at the role music plays in our daily lives and allows me to be a better music therapist.

Despite two degrees of music therapy under my belt, I’m now left wondering how I can get back to that musician I once was, but with the understanding that my perception has changed. Mostly, I am trying to figure out how to reconcile my expertise with my passion. Some days, it’s a bit melancholic to remember the musician I once was, who very much lacked a scientific and clinical brain. But then, I remember that the musician I once was focused inward and towards the self. Now, my musicianship extends outwards, focusing less on how I can be better, and more towards how I can help others feel better.

The pure musician is still there. Underneath the clinical brain lies a foundation of authentic music connection. Occasionally, the clinical mind simply needs to be reminded of those original, curated playlists that started it all.

Music & Therapeutic Revolutions

An analog clock consists of a fixed-numbered dial and moving hands. The hands are composed of hour, minute, and second hands. Graduations along the clock face indicate the minutes and the hours, while the various clock hands cycle through each graduation of time, making one revolution around the clock face for every minute, hour, and 12-hour cycle.

There are two definitions of revolution. A revolution can mean both a cycle or rotation, or a transformation or change.

When I originally named this blog two years ago, I wanted to name it after a joke I share with my husband. In college, while working on music therapy session plans, studying various courses, or going out to practicums, my now-husband would humorously ask, “Oh, is it music therapy time”? This joke has continued throughout our relationship, and remained humorous to us because phrasing music therapy in such a way made it sound more like “play time” or “nap time”. It was a mild way to poke fun at how the public often views music therapy as entertainment, rather than as a therapeutic engagement within music between a client and a therapist. “Music therapy time” was especially humorous to us, you see, as my husband is one of the most articulate and informative non-music therapists on the profession. “Music Therapy Time” began to represent the realities of music therapy within a place of warmth and humor. This phrase encapsulated my intentions behind writing a blog.

But as Music Therapy Time has grown as a blog space, I’ve come to understand that phrase within a newer and much deeper context. I began to think about what “time” represents in life, especially as I internally celebrated my own victory of keeping a blog up-to-date for the past 2 years. There is specific terminology associated with time and clocks that have become a bit antiquated, including the analog clock itself. But the original design of the clock was well conceived. Each hand on the clock makes it ways around the various intervals, continuously making revolutions as time moves forward.

These revolutions made by the clock hands are not that different from the revolutions we experience within our own lives. Our lives fulfill various cycles including seasons, our own physiology, and life itself. With clients, additional cycles are often experienced, rotating through illness and health. Through these cycles, we experience the other definition of revolution, such as transformation, change, and innovation. Within therapy, one could consider these cycles and transformations to be therapeutic revolutions.

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Logo by P. Murphy Design

Moving forward, I’d like to consider my music therapy ideas, interventions, activities, or exercises as therapeutic revolutions. Music therapy is meant to be a musical facilitator of change. It is more than just activities or exercises, and the word “intervention” is often accompanied by a negative perspective. Music Therapy revolutions will take into consideration the reality that our lives are not linear and that we sometimes cycle back to the place we were before, but always moving forward in time. Music Therapy revolutions will represent the tangible work that takes place within music therapy, from the perspective of both the client and the therapist.

Music Therapy Time is not only a lighthearted play on words, but it is a space where ideas can be gathered, innovation can be documented, and revolutions can take place. I’d love to hear your thoughts on this framework, terminology, or any other takeaway’s, so please comment below.

I’m looking forward to Music Therapy Time’s 3rd revolution.

For Music Therapy Students: Building a Resume

When I was an intern looking at job applications and attempting to prepare myself for the workforce, I was at a loss with how to prepare. I did not feel there were many resources available to music therapy students in order to figure out where to find jobs, at what point we should start looking, or how we should tangibly prepare for our job search. imagesReflecting back on that it seems so straightforward to me, but at the time, transitioning from student to employee was a challenge.

Besides the obvious challenges of: with what population do I want to work? Where do I want to live? When will a job opening become available?, there were other details I never would’ve considered. These details are specific to music therapy, but I think it’s important to address because we don’t have obvious resources available to us (that I’m aware of).

One of the biggest challenges I dealt with in my job search was determining how to care for my resume. Luckily, my music therapy program required me to meet with a career development staff person at my university before graduation. This allowed me to learn about formatting resumes, how to structure descriptions of previous experiences, and other generally helpful information. I am very thankful for that appointment. To any students who have not taken advantage of their college’s career development center, you absolutely need to do so!

But there are things about resumes that I’ve come across since being in the workforce that need some serious addressing. Many of these things are relevant for any field, but music therapy students should really take note. The first thing you may be wondering is if you should create a CV or a resume to use for your applications. This is understandable as many jobs will take either, and they can be a little confusing as to the differences and for what purposes they serve. In short, a CV is a document that covers your career history, and is meant to highlight your achievements and awards. It is generally much longer than a resume. A resume is a 1-2 page document that covers a brief glimpse into your career history. It is highly customizable and should be catered to the job you are applying to. As an incoming professional, it is my opinion that a resume should be created to reflect your early job experience. Think of a CV as something you can begin to create as your start your first job. It can be something you build as you gain experiences, such as research projects, presentation experiences, etc. The recommendations I want to highlight below are specific to creating a resume.

Even though resumes are shorter than a CV, they are trickier because they are customizable and don’t have official rules that need to be followed. However, in my experience, there are general strategies that allow your resume to pop and provide less frustration to the employer when they are searching through multiple resumes. Overall, you should remember that resumes are meant to capture the most concise version of your best self. It will take time and effort to create a fitting resume for yourself.

Here are some thoughts you should consider when building your music therapy resume:

  • Do not simply define what you did in your previous experiences. Describe what makes what you did special and unique.
  • Be concise.
  • Provide relevant information.
  • Similarly, aim to create a one page document. Unless you’ve been in the field 30 years, you likely do not have that much information that is relevant to the job you are applying to. You can make a concise, one-page document by also:
    • Using a basic, but modern font.
    • Be consistent in your formatting. Create aligned tabs.
    • Understand how your resume flows visually. How does the spacing look? Does it help or hinder?
    • Spend time choosing a unique look. People notice creativity and details. (Google unique resume formatting for inspirtation)!
  • Use 2-3 bullet points for each job description. More bullets may not be read by the employer (too wordy) and may waste space. 2-3 points keeps the “concise” theme going. Also:
    • Mix up your verbage. Use a thesaurus to highlight your bullet point starter words (e.g. “created, implemented, defined, utilized, focused, developed”, etc.). This will make it easier and more compelling to read.
    • For positions you are no longer in, write in the past tense.
    • Make sure what you have said you’ve done, you can back up in an interview!
  • Do not include a definition of music therapy. This is unnecessary.
  • Take away your list of practicums after you’ve become a professional. An employer cares about your work experience, but generally not your experience as a student. (But maybe listing practicums is okay for your first job in order to help fluff things out).
  • Don’t include how many hours a week you worked at previous jobs. Employers are mostly looking to see whether you gained experience in a related field/position.
  • Include your certifications with your name at the top. I mean, seriously. You worked so hard to earn MT-BC. Put it first thing with your name!
  • HAVE SOMEONE PROOFREAD WHAT YOU’VE WRITTEN. What makes sense to you might not make sense to someone else.
    • Spell check. I really did read “music lesions” on a resume when they meant music lessons. Yikes!
  • Ditch “references upon request”. Employers assume you have them and will ask if they want them. (See “be concise” above).
  • Please submit as a PDF. And “save as” smartly. Do not submit a file labeled simply “Resume”. This should seem obvious, but it happens. Often.
  • Finally, allow your cover letter to do your most persuasive talking. Use this space to be more detailed in your reasons for why you are the right person for this job.

P.S. People will look you up on social media and Linkedin from their personal devices. Make sure that information is capturing your best version of yourself!

All in all, every employer is different, but at least make sure that your resume is ultimately a condensed version of who you are as a person. Just make sure it’s the BEST version of yourself!

 

How Music Can Be Harmful

In my last post, I discussed questions I received from high school students during a Q&A. One question that stood out to me was: You said in your TED talk that music can be harmful. How is music harmful and why?

This question caught my attention because it addresses a big misconception about music therapy – that it’s simply entertainment or that anyone can do it. We all can agree that music is helpful, but not everyone is qualified to use music as a therapeutic tool. Music therapists become protective about how music is used in healthcare and educational settings because we want to protect our clientele from further damage. In many situations, music can be unhelpful and potentially harmful if you do not have the understanding of a person’s emotional, physical, physiological, mental, and spiritual responses to music.

There are many elements to music, and each element needs to be heavily considered within the context of therapy. Here are a few key elements I wanted to highlight to better your understanding of the depth of the music within music therapy, but know that it won’t cover the extent of this issue. This is something that music therapists dedicate their education to, and frankly, requires a lot of study and training.

Elements of Music That Could Lead to Physical, Emotional, Mental, Spiritual, or Physiological Harm:

1. The Lyrics: One of the more obvious ways music could be harmful is within the lyrics. This harm is not necessarily in terms of “negative vs. positive” lyrics, but more in the sense of how the lyrics make you feel. Lyrics in music therapy are first meant to validate and affirm your own feelings and build rapport. Then, the music therapist may use lyrics to create conversation, challenge your thinking, address an issue, problem-solve a situation, or form a direction for your therapeutic goals. The music therapist is very mindful of what the lyrics may be conveying and how they affect the patient.

For example: What if a you were a homeless patient and are unable to pay for medications. How would you feel if someone played the song, “Don’t Worry, Be Happy” by Bobby McFerrin? Is it possible that song could make you feel isolated, guilty, and/or frustrated? That song might convey to the patient that you don’t understand them or their situation. Or, what if you were recently diagnosed with cancer, have no family support, and someone plays the song, “I’m Gonna Love You Through It” by Martina McBride? Is it possible that song would increase your sadness over being alone during this difficult time, or more importantly, push you towards feelings you are not comfortable addressing yet?

Words can be harmful, which means lyrics can be harmful. Music also lends to vulnerability, which increases your chances of experiencing harm. It’s the music therapist’s job to know what to say and how to say it within the music at the appropriate time.

2. The Sound: There are many factors regarding the sound of music, including the volume, timbre, acoustics, and the types of instruments used. Sound connects deeply with stimulation, which generally refers to a  person’s physiological state (heartbeat, respiratory rate, movement, etc.). When someone experiences overstimulation, it can be unproductive towards therapeutic goals and can sometimes be harmful to the patient depending on their condition.

When a typical adult is overstimulated, they might feel discomfort, agitation, anxiety, or physical distress. Often, if an adult is overstimulated while experiencing music, they might simply ask you to stop or they will leave. Think about this in terms of attending a concert that you consider is too much. You might feel that the volume is too loud, the bass thumps too strongly in your chest, and the patrons are too crowding over your personal space. What does this all of this feel like? Overstimulation. Most adults are equipped to deal with this overstimulation, but it becomes an issue when experienced by those who cannot advocate for their needs. Two examples of this are those who have developmental disabilities or babies in the NICU. For these patients, they are often unable to express their overstimulation in a way that is typical, so it is up to the therapist to assess their responses to the music to prevent feelings of discomfort, neurological distress, or increased agitation. The therapist makes decisions about their responses and adjusts as necessary, such as decreasing the volume, changing their instrument or the quality of their singing voice, or closing a door. When overstimulation occurs with those who are fragile, the outcome could be more damaging than helpful.

3. The Implementation: I’ve written about a music therapy concept called iso-principle in the past, and it remains a difficult concept to describe briefly.Similarly to sound, iso-principle is a phenomenon that requires constant awareness and assessment of responses. In simplest terms, I think of iso-principle as being a technique that allows the therapist to meet the patient where they are at and move them towards their goal, all within the music. This technique is important to develop because it prevents harm of a patient. For example, if you do not meet a client where they are at within the sound quality, tempo, lyrics, and overall manner of which you enter a room, a patient is first, likely to be turned off towards music therapy and second, possibly at risk for harm.

Picture this: A musician enters the hospital room of a pediatric patient recently diagnosed with cancer. The family is present, they have no experience with this type of cancer, and they only learned of this diagnosis a few hours ago after a terrifying experience of their child becoming very sick. They have been feeling shock, fear, and worry about the future of their child, while their child currently remains feeling sick and scared. The musician loudly announces her arrival, exclaiming she’s there to play music for the child and family in order to lift their spirits. The musician stands tall over the child lying in bed, presents an animated smile on her face and begins to play an upbeat, loud version of the song, “Happy” by Pharrell.

How does this scenario meet the family and child where they are at? Everyone has good intentions and music often helps people feel better. But in this scenario, the musician put her own needs first (to get a job done) and was unaware of the needs of the pediatric patient and family. This is evident from the way she entered the room, the song she chose, the way in which she played the song, and the lack of understanding of the situation at hand.

The harm was not in the music itself, but in how it was implemented. 

This question of how music can be harmful is especially pertinent today, during #FloridaMusicTherapy week. Currently, music therapists in Florida are working to pass a legislative bill to create a registry of music therapists that would protect the consumer by ensuring that only board-certified music therapists offer music therapy in the state of Florida. Music therapists are the first to agree that we do not hold a monopoly on music – that is someone everyone is allowed to enjoy and experience. But it is our responsibility to advocate for the safe and proper use of music as a therapeutic tool.