From a Distance

April 15, 2014

One year ago today, I started this post, but when I opened up this draft just now, dated April 15, 2013, I found it to be blank.

While words escaped me in the wake of the Boston Marathon bombings last year, the thoughts going through my head were erratic and racing, and while they have become fewer and farther between, today I can’t help but incessantly think of those whose lives have been forever changed.  As a city, we are strong, and we’re resilient, and did hate win? No. But as people, we are still human, and we experience loss and grief and physical harm the same as everyone else, and it is devastating, regardless of how unaffected we profess to be on the outside.

A couple of years ago, I wrote a post on my feelings about the ten-year anniversary of the September 11th attacks. I was in college in Boston, watching the news from my dorm room when the World Trade Center buildings went crashing to the ground. While it was a horribly upsetting, confusing, and game-changing time for people all across the country, ten years later I felt that it was not my place to discuss – people affected by the thousands of deaths and generally traumatic experience in NYC were the ones to be honored and the ones to be listened to about their experiences.

This felt different. Boston is my city. Our city. I have lived in many neighborhoods over the years, and just across the river. I have worked, studied, played and made hundreds of joyous memories on Boylston St., and even though I was far away on April 15th last year, I felt the emotional shock wave from the blasts, and it still lingers today. When I think of the horror that the bombs inflicted upon spectators, runners, volunteers, first responders, and passers-by, I still get upset and tear up (as I’m doing now). Those poor people innocently stood, celebrating, cheering – completely oblivious to what was about to happen, in places where I have also watched the event over the years, where I have eaten lunch or gone shopping, where I have walked with friends and felt free and safe.  It makes me sick every time I think about it. The photographs that emerged following the senseless attacks on April 15th, 2013 are stuck in my mind and in my dreams.

I waited to go to the makeshift memorial in Copley Square for several months – I just couldn’t bring myself to be there. When I finally visited, the ghosts of that day (panic, terror, pain, confusion, and grief) washed over me as I walked gingerly around the area that had been covered with blood and debris not too long before, to visit the hundreds of sneakers, posters, clothing, and many forms of tangible prayers and mitzvahs people had left along the sidewalk and in Copley Plaza.

As time went on, and after the alleged bombers were chased down, more and more stories came out (and still do) about people in my life – close friends, family members, colleagues, acquaintances – who had close calls that day. Who could have been right there. Who WERE right there five, ten, fifteen minutes prior to the explosions. I sit on my couch today, at a comfortable distance from anything that would have made a concrete difference in my life, but I feel changed. The remnants of that day in my life are not grief of a lost loved one, a lost limb, permanent disability, trauma, or horrible flashbacks, but the reality is that there is residue, as minor as it might be – frequent tears of empathy and movie-inspired visions of terror in my imagination have been joined by my loss of security, the brutal awakening to the fact that my city – my home – is just as vulnerable as everywhere else at the hands of cowardly terrorists, and the worst – my general feeling of anxiety about being in crowded public places. How different would my world look if I were just a little closer to the events of Patriot’s Day last year?

As real as my tiny little experience is, I am removed from what happened by several light years, it seems, which is a strange place to be, considering how connected I feel to what happened. I can’t even begin to imagine what it feels like to have been a spectator or a bystander that day, not to mention a medical volunteer, or a first responder, or a victim…or a victim’s family…

Thinking about the devastating things that happen in this country and around the world every day is upsetting and exhausting, and a small part of my hope for this world is crushed every time I turn on the radio, but what I hear and read doesn’t usually haunt my dreams. When something happens far away from me, I can’t picture myself there. It’s hard to feel as connected to a place you’ve never been, than the one you’ve lived in for half of your life. I think that’s what makes all of this much harder for me – for all of us in Boston – no matter how small the death toll was in comparison to other tragedies in our country or in the world, it happened at a sacred event, at home.

To end on a positive note…

Our city is moving forward. We will never truly get over this, but with every Spring, with every April that the world keeps spinning and the flowers keep blooming, I have hope that the marathon will begin to feel free and safe again. Time may not heal all wounds, but it might help those of us farther away from it all.

 

 

 

 

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More Than Words

March 30, 2014

If anything is true in our world, it’s this: The way you say something, matters. A lot.

Sometimes, the words we use start fights, mislead people, confuse others, and make us sound ill-informed or ignorant. Sometimes, though, when we are really intentional and actually think, our words can move mountains.

I have always known that in working with clients with dementia, words have to be carefully crafted in order for them to effectively process what I’m saying (simplicity is always better), and can be helpful in redirecting negative behaviors and validating feelings when the clients’ words are incoherent. In working with my patients in the psych unit, I know that I can never respond casually to someone’s comments (i.e. when someone is being discharged, I never say “Oh, great!” – I always ask how they’re feeling about it) because they might not be feeling what I think they are. In talking with my colleagues, it’s easy to communicate automatically.  When someone says, “How are you?” I almost always say, “I can’t complain,” or “Alright. How are you doing?” This is all fine, but when someone says, “Sorry I didn’t respond to your e-mail – I was in Florida last week,” what I have learned is that you should never, ever, ever, say, “OH, FUN!!” like you would with a close friend. That person might have been visiting an ailing relative, going to a funeral, or going to court, and none of those are fun. And you might end up feeling bad about the superficial way in which you responded. With people I know well, it’s easy to just say whatever flies out of my mouth, but there is sensitivity necessary in those situations too, and it’s important sometimes to take a deep breath before saying something questionable.

Finally, I recently started working with a group of toddlers, facilitating a Montessori-style family music class. I have never been more aware of what words are coming out of my mouth than when I talk to those kids. Reinforcing gender stereotypes and placing labels on kids is EXTREMELY easy to do when…an 18-month old little boy picks up an entire basket of instruments and says “Aarrgh!” my initial reaction is to say, “Wow! You’re really strong!” – WRONG.  When a little boy hides his face and won’t give me a “high-five,” my initial reaction is to say, “Oh, he’s shy…(smile/giggle)” to his mom – WRONG. When a little girl is wearing something frilly in her hair, or a pretty skirt, my reaction is to say, “Oh, you look so pretty today!” – WRONG.

Something that has become very clear to me in working with toddlers is that they. are. sponges. Every word I say, every song I sing, every interaction I have, carries about 10 times more significance for them than what I intended. Since they have limited language and processing skills, they might not understand that what I’m saying is simply superficial. The end.So, what I have started doing is really thinking about what I really want the kid to hear. Do I want to model superficiality?

Not that I don’t enjoy it when my fiancé calls me beautiful, or when someone tells me I have a nice voice, but the comments that stick with me and encourage me are ones that have to do with my kindness, my resiliency, my sense of humor, and my mental strength. When a little old lady says to a person next to her, gesturing toward me “That one – she has a heart of gold,” while I’m putting someone’s shoe back on, mid-session, I smile inside, and I’m so grateful that something so simple let someone see a part of who I really am. When I was 3.25 miles through a tiring 4-mile run two days ago and a 60-something gentleman said, “Keep up the good work, young lady!” I felt like I could run five more miles.

This tells me that people aren’t just seeing what’s on the outside, or what I project. Since I realize that words matter to me, I’ve tried to change my “reactions” into thoughtful responses, so my words can mean something positive to the little kiddos in my music class. I’m not perfect, so I still have my moments (don’t we all?), but…what I’ve started doing when little Arnold Schwarzenegger picks up a big basket of instruments is either not say anything or say, “Oh, are you helping me clean up? That’s very helpful!” (or, as I’ve heard this past week: “Good helping!” I don’t make any comments about the shy little kid when he doesn’t give me a high five. Instead, I give him space, and then I try to help his mom get him out of his comfort zone through music, movement, and art. In the past few weeks, he has gone from being completely attached to his mother’s leg and not painting at all, to giving me high fives and making me the “heart” sign with his hands. He also painted yesterday for the first time in the class. When a little girl (there’s usually only one or two in the class) is wearing something lovely, I try not to focus on it at all, and instead thank her for helping me clean up and try to reinforce positive behavior, just like I do with the boys.

Our words can make a huge difference in the way people perceive us, in the way people (particularly kids) perceive themselves and the world around them, and in how well we are able to be understood. I think it’s about time we start giving words their due.

 

Teach Your Children Well

February 13, 2014

I mentioned in the previous post that I have recently begun working with an early-childhood music program. O.M.G.

If you have been reading my blog for any period of time, chances are you have noticed that I work with adults. The end. I have not, since practicums in school, worked with anyone under the age of 18. So, naturally, when I was contacted by this business, I decided it was a good idea for me to jump in to work with non-adults by working with people who require me to be an entirely different kind of facilitator in a musical setting: Toddlers.

These are typically developing kids, and the music program is more of a world music and art exploration class, which is actually right up my alley (I love world music).  Parents are always present (though some have more than one child in attendance) for the entire 45 minute class, which helps with the wrangling and herding of the masses, and there is a ten minute art portion where an art teacher brings in some very creative things for the kids to paint with (on various surfaces – last week, they were painting on snow!) and they paint to whatever musical theme is explored that day. The classes run from September to June.

The first class (I keep wanting to say “session”) was a disaster. There were five children (all with parents present) and they were EVERYWHERE! The room had several structures, toys and props that were left out, which provided huge distractions, so I was definitely leading the parents in music for most of the time while the toddlers moved about the room so fast, I barely had time to get over to them with my guitar before they were on their way to another area.

The second class was better, as the administrators decided it might be helpful to remove some of the more distracting items from the room beforehand, and I actually had the attention of some of the kids!

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The third and fourth classes were both really nice, even with larger numbers of kids, and I find myself now enjoying not only the sessions, but also the minimal but necessary preparation before sessions – making playlists for the world music listening/art/free movement aspects of the class and learning SHORT songs and movement exercises that go with the premeditated world music and art themes – and getting to know the little ones. I can see, only in a few short weeks, that some are learning from our classes, those little sponges, and becoming more comfortable with me, which I appreciate, because they seem to be actively attending and participating more.  For a take-away, here are the last four mini session/lesson plans:

Waltz theme

Play “Blue Danube” before class while kids explore

  1. Learn names/introductions
  2. Greeting song
  3. “On top of Spaghetti” with Instruments
  4. Put away instruments
  5. “Chim-Chimeny” with pom poms
  6. Put pom poms away
  7. “Daisy Bell” with bells
  8. Put bells away
  9. Free movement with Scarves to “The Christmas Waltz” and “Lara’s Theme”
  10. Put away scarves
  11. Painting with coil whisks to “Waltz of the Flowers”
  12. Put away paints
  13. “The More we Get Together” – movement exercise
  14. Goodbye Song

Hawaiian Theme

Play Hawaiian music playlist* before class while kids explore

  1. Learn names/introductions
  2. Greeting song
  3. “Spread a Little Aloha” with shakers
  4. Put away shakers
  5. “Little Grass Shack” with instruments
  6. Put away instruments
  7. “I’ll Build a Bungalow” with pom poms
  8. Put pom poms away
  9. Free movement with Scarves to playlist*
  10. Put away scarves
  11. Playlist – painting with flower shaped sponges
  12. Put away paints
  13. “Lovely Hula Hands” – movement exercise
  14. Goodbye Song

Hawaiian Music Playlist

Pili Me Ka’u Manu – Israel Kamakawiwo’ole

Lovely Hula Hands (Instrumental) – Hawaii

Honolulu – Hawaii

Somewhere Over the Rainbow/What a Wonderful World – Israel Kamakawiwo’ole

 Southern African Theme

Play Southern African music playlist* before class while kids explore

  1. Learn names/introductions
  2. Greeting song
  3. “Hakuna Matata” with instruments
  4. Put away instruments
  5. “Izika Zumba” with shakers
  6. Put away shakers
  7. “Lion Sleeps Tonight” – puppets/animal sounds
  8. Put away puppets
  9. Free movement with scarves to playlist
  10. Put away scarves
  11. Playlist – painting with animal figurines’ feet (animal tracks)
  12. Put away paints
  13. No More Monkeys – movement exercise
  14. Goodbye Song

Southern Africa playlist 

Streetbeat – David Hewitt

Mbube – Mahotella Queens

Langa Mo – Aura Msimang

Kalimba – Dr. Victor

Sangoma – Bakithi Kumalo

Hendry – Tarika Sammy

Hello Hello – Mose Se Sengo

Cold Weather Theme (originally Icelandic, but no appropriate Icelandic music exists that I felt comfortable playing for toddlers)

Play Cold Weather playlist* before class while kids explore

  1. Learn names/introductions
  2. Greeting song
  3. “Frosty the Snowman” with instruments
  4. Put away instruments
  5. “Let it Snow” with pom poms
  6. Put away pom poms
  7. “Snow is Falling” – to the tune of “Frere Jacques” and with hand and body movement
  8. Free movement with scarves to playlist*
  9. Put away scarves
  10. Playlist – painting on fresh snow with brushes (blue and purple paint)
  11. Put away paints
  12. Goodbye Song

Cold Weather Playlist

All Souls Night – Loreena McKennitt

Dedicace Outo – Dead Can Dance

Between the Shadows – Loreena McKennitt

Crow Wing – Nakai/Demars

Tango to Evora – Loreena McKennitt

On the business side of things…I’m not getting paid my regular rate (what I make is based on how many kids are signed up in advance and then how many drop-ins there are, which all varies) and while that’s definitely not my favorite part of this experience, I decided before I even started that I would think of this as a class I am taking, since this is decidedly not my population (toddlers) or area of expertise (teaching). So, when I look at it that way, I am getting experience working (not as an MT) with a group of people that is COMPLETELY out of my comfort zone in almost every way, and I’m getting paid to do it, which is awesome.

Roll With the Punches

February 10, 2014

In December, I found out from one of my contracts that they needed to cut my hours in half. I was disappointed and thought that I could talk the new dementia unit recreation coordinator into reconsidering with my Jedi mind trick knowledge of how beneficial music therapy is for clients with dementia, etc.  I called a couple of colleagues for advice, and came up with a plan to meet with the woman in person, after a lot of negative thoughts and anxiety made their way into my brain.

I was sad and nervous and had been rehearsing with myself all morning. No sooner had I walked through the door the day of my meeting, than I ran into an activities employee I know who informed me that they had just hired a new Director of Resident Life (who hadn’t started yet), and that she is also a music therapist.  I asked who it was, and as chance would have it (eh – it’s a small world – who am I kidding…) it was someone I had met at our regional conference last year. I became more relaxed after my conversation with the activities person, and decided to throw my “plan” from earlier out the window. I decided to just talk with the new rec. coordinator about regular things and then explain my situation logistically, philosophically and financially when the subject came up in an organic way. This was a much better approach, and I didn’t feel as much on my guard as I had earlier. It turns out it was a budget issue, more specifically, that our weekly sessions were taking up literally half of the monthly budget, and that they wanted to have a bit more variety on the unit.  I guess sometimes things just don’t work out! I was still somewhat frustrated though, and to add to that frustration, I had been doing a lot of cold calls in order to get my sub more work and I hadn’t heard back from any of them (even after following up) so I was a little defeated in general, especially after so many months of doing really well in that regard.

Over the next couple of days I had some moments of negativity (which is not common) but on Sunday, I just sort of accepted things and thought to myself…”with every closed door, comes an open window.” I decided to be okay with my less than successful month of job-getting, and get back into my regular mindset. Maybe something would come up?

On Monday, I signed in to my LinkedIn account to write a message to the music therapist/Director of Resident Life at the facility that was cutting my hours, just to say hello and tell her that I work with the facility she’s starting work at. When I logged in, I saw her name on the screen and was very confused as to why this person’s name was on my screen when I hadn’t done anything to bring it there, and then I realized that she had written ME a message (that same morning). Her message stated that she was leaving her private practice, and asked if I had any interest in taking on her clients (if they were interested). UM. Yes Please.

I wrote her back and told her the bizarre circumstance under which I signed on to LinkedIn to begin with, and then agreed to take any clients who wanted me. I received e-mails from three of the several contracts, and am therefore now working with an early-childhood music program (not MT, and if you’re familiar with my blog, then you know it’s not my population either), a Day Program near the hospital I work at, which includes adapted piano lessons for one – soon to be two – adult men with special needs, and an assisted living facility within the same company as others I contract with. Through the latter, I have also gotten e-mails from administrators in other facilities under the same umbrella. So basically, stuff is happening.

Also in December, a music therapist I spoke on a panel with last year got in touch with me about an opportunity working in a special needs classroom. I am not taking on much in the way of new work because my schedule is pretty full, so I asked my sub if she might be interested.  She started last week and though there have been some minor kinks to work out, I think it’s going to be a good experience for us all, and she really seems to be enjoying it.

This is such a crazy adventure in self-confidence and acceptance of the things I cannot change. I have to remind myself not to take anything personally, to continue to foster good relationships with everyone I meet, and to never never let anything keep me down for long, because something awesome is waiting around the corner if I just believe it’s there.

Reflection

February 5, 2014

It has recently come up on a social media group I belong to, that some people are feeling disrespected, attacked, and had their expertise questioned by others in our field.  This is disturbing to me for many reasons.

I myself have been questioned on this forum, and not even for anything questionable.  Last year, well – 2012, I was entering into my first experience having full-time interns. Not only had it been a pretty strenuous process to get through the red tape and bureaucracy of the hospital and the affiliated university, contracts, trainings, etc., but I also had to figure out the logistics: scheduling, planning assignments, communicating with staff in every facility I work at; and then actually implement all of it. To save myself some time and frustration, I reached out to the wonderful people in my field to ask if anyone had any favorite research studies or interesting literature on music therapy in a few different populations, so I could assign recommended material to my interns. A couple of responses were concrete and helpful, but there were several individuals who questioned why I was asking for help, told me to look at the source list at the bottom of the fact sheets for those populations on the AMTA website (which was decidedly not helpful), asked me if I was a student, and had generally abrasive and rude tones in their responses to an innocent question. I clarified my role and my needs following these comments and was still questioned.

Since then, I have let that experience go and continue to post and comment on these forums, but I have witnessed numbers of other credentialed professionals and students be attacked or dismissed for asking similarly simple, but also more complicated questions.

Why is it that adults – let alone, therapists – find it so difficult to form questions, statements, responses and answers in a diplomatic way to one another?  This is worrisome to me simply because I wonder if those therapists are using similar judgment in their clinical work.  I hope they aren’t. I also wonder if those people know how destructive their statements can be to their own practice and professional relationships. We see each other at conferences, give encouragement and recommendations to students for internships all around the country, and work together on research and textbooks. We advocate for the same respect and acknowledgement from our communities, our states, and the federal government, and we have the same goals. How can some people not see how their professional (and interpersonal) relationships are affected by negative attitudes and careless commentary?

I am not a grudge-holder.  I don’t rememberer or care who the people were who commented negatively on my own question last year. There are several individuals though, who have shown time and time again that they are not capable of friendly or productive discourse, but instead make very blunt “hit-and-run” type comments that aren’t only unproductive, but sometimes offensive. I hate to admit it, but I (a non-grudge-holder) will most likely not attend courses or sessions those people facilitate at conferences, and I will not approach those people for opinions or advice, as I might others. Imagine what people who do hold grudges will do or not do based on how they have been treated by others!

On a slightly more positive note, there are so many people I have come in contact with via Facebook, or other social networking sites, who I feel are the epitome of diplomacy, thoughtfulness and intention (you know who you are).  Those are the people I may actually reach out to privately for collaboration on something someday. Those are the people others may reach out to as well.  A wise woman once taught me about the power of positive thinking. I think positive “doing” is equally as powerful though, and I strongly believe that if the people we come in contact with think we are doing something right, good and positive, that will be rewarded somehow. 

I feel that we have a responsibility to each other to be thoughtful and diplomatic in our communications with one another, no matter what fields we’re in, or something unpleasant is going to come and bite us somewhere uncomfortable someday. Our conversations in social media are reflections of ourselves, and if what we’re sharing with the world is not some version of productive, or at least respectful, our reflections look pretty bleak.

 

Working for the Weekend

October 23, 2013

Recently, a couple of things caught my eye.

One of these things was a commentary in “The Onion” about life and passion and time.  Read it.  It’s funny and poignant at the same time.

The guys who wrote it jokes sarcastically that we should definitely keep working at a job we don’t like and do the things we love the most after a long, exhausting day for about five minutes before going to sleep (rinse, repeat).

The second thing I saw was a commercial.  I don’t even know what it was for, but it centered on a mountain bike tour guide whose voiceover explained that he once worked at a job he didn’t like and spent most of his time making other people’s dreams come true. AND NOW?  He works as a mountain bike tour guide in an awesome place.

____________________________________________________________________________

Yesterday, I was cleaning up the “mess” after a large and rowdy music therapy group at a nursing home, and a new staff member asked me if I have a job “other than this.” Regardless of what this curious woman meant, what I took from her question, was “Do you have a real job?”

I’m sure many of us are asked those kinds of questions on a regular basis, and while a big part of me really really wants everyone in the world to understand that music therapy IS a “real job,” and not ask me that question anymore, I ALWAYS am happy to inform my inquirers that this is a part of my full-time job as a contracting music therapist and business owner.

It’s a hard job.  A FUN job.  A rewarding job.  A job that requires worlds of patience, optimism, knowledge, and integrity, and a job that is uniquely conducive to a full life.

I find this work ever changing.  I began working as a music therapist in 2006, and my “job” has morphed many times since then.  Every time I have found myself getting tired of the same old songs, the same old groups, something changes.  I started supervising undergrads, I got new contracts, I quit a part-time job MT job, I started blogging about work, I got some more contracts, I started a contracting agency with a friend, I did presentations, I started an internship program, I got some more contracts, and finally, I hired a subcontractor.  During the summers, and for about a month in the winter, self-imposed diminished scheduling allows me to work on things I normally wouldn’t have time for, and that. Is. Glorious. There are so many things that make my job interesting, that I AM excited about work.  I like the variety and I like the ability I have to shift things when I get antsy. It doesn’t even matter that I spend ungodly amounts of time in my car every week – it gives me a chance to catch up on world news and events on NPR, and maybe even listen to an audiobook.

Now, getting back to the Op-Ed I read this week, and that commercial I was talking about earlier in this post…

When I was in elementary school, I wanted to be a hairdresser for a minute.  Then a singer.  Then a movie star (this was just so I could marry Elijah Wood). In middle school, I wanted to be a surgeon (this was before I found out about the educational requirements).  Then I wanted to be a social worker.  In high school, I completely lost track of what I wanted to be.  I didn’t like school very much, and nothing except for classes in the music department kept my interest for very long.  So… I went to college for musical theatre.  I am happy to say, that if it weren’t for that very poorly reasoned decision, the two years of wasted time, and the tens of thousands of wasted dollars, I never would have discovered music therapy, I never would have transferred schools, and I would not be where I am today.

What do I want to be when I grow up?  Now that hindsight is 20/20, I’ll change that up a bit and say, what do I want to DO when I grow up?  (Ahh…if only guidance counselors had all the answers).

I want to work hard enough so that I can continue to have a good career, but not so hard that I don’t have any balance in the rest of my life.  I want to want to go to work, and have variety in my week so things don’t get stale.  I want to make my own decisions about my job, and I don’t want to have to ask someone for permission before I take a vacation.  I want to be recognized for the passion I have for my work, and I want the people I work for and with to respect and support me. I want to make music with other people on a regular basis, and I want to make others feel good. I want to be able to see my friends and family regularly, and I want to be able to do what I WANT to do the same amount of time as what I NEED to do.

I am almost there…

It’s so cool to meet other people who love their jobs, and I am virtually surrounded by those people, but not everyone is surrounded by positivity, and I think most people don’t love their jobs.  Does our culture put too much emphasis on quantity of labor, and not quality?  When I look at European culture in some areas, I wish that our culture could be more like that.   We’re so rigid here, and there are so many expectations we put on ourselves, and so many rules for life that don’t make sense. We are working for the weekend, and that’s a shame. A friend of mine from high school once told me when her older brother got a job out of college, he said, “I’ll work there for 40 or 50 years and by the time I retire, I’ll have a good amount of money in my 401K, and I’ll have a lot of fun in retirement.” She was horrified, and so was I.

Let’s save all the fun for retirement?  Puhleease.  A wise person once said, “Life happens when you’re making other plans.” Or, more spiritually, “When you make plans, God laughs.” What happens if when you retire you have a terrible accident which leaves you paralyzed?  What happens if you develop early-onset Alzheimer’s?  What happens if that money gets squandered by an irresponsible family member?  Saving fun (and more importantly LIFE) for when you retire is just a bad idea.  End of story.

If you are able to work at a job where you are still able to have a fulfilling life on the side, OR…shhhh even LIKE the work you do, you can have fun RIGHT NOW!  You can live your dreams at this very moment!  Despite the fact that money is certainly an object for most of us, there are ways to make at least some of your dreams come true, even if it wasn’t just how you had imagined it in fourth grade.

It all starts with a direction.  And some courage.  And some patience. And a positive attitude. And maybe at some point, you will find yourself working, playing, and living the dream all at the same time.

L’chaim! To Life!

Till There Was You

October 23, 2013

Wow!  It’s been a while – Sorry about that…

I have never been interested in working with individuals.  Since my internship, and since I started working in 2006, 95 percent of my work has been in leading groups of various shapes and sizes.  I have worked with some individuals, but I always felt that the clients I worked with (in facilities where I also led group sessions) needed a little something extra, and I could only use music when working with them, because that is, after all, my job.  So…I left the places that required me to do individual sessions and have not turned back.  Until this past May.

An Expressive Therapist friend of mine had been working with client L. for a while, and he asked me if I would be interested in taking over once he started his new full time job.  I had to think about it – It was going to alter an otherwise ideal schedule and I was definitely not a fan of working with individuals, but she sounded cool, and the work environment was different than any I had been in before. So I decided to take the leap.

L. lives at home with her husband, is in her late eighties, and suffers from Alzheimer’s Disease.  She has been singing and playing piano since she was a tiny child, so she is an excellent candidate for MT services, and is just a fabulous person all around.  Her son is extremely supportive and is a huge supporter of MT, and I am therefore working in a comfortable family home for four hours a week.  And it doesn’t feel like work at all.  Who knew?

I think part of it, is that it’s not all music.  We work together to maintain her skills (musical and non) and we address her goals, which are to increase engagement, brighten mood, increase energy and motivation, increase communication, maintain decision making and verbal skills.

Our loose schedule for the two hour session is as follows:

1. L plays her favorite song on the piano “Till There Was You”

2. We sing our Hello Song – A song from a 1950s movie that I adapted for L (she knows the tune, so we use a lyric sheet with my adapted lyrics). The original song and my adaptation include her nickname.

3. Per the request of her son, I encourage L to maintain focus for twenty or thirty minutes at the piano while we read notation of several songs, some of which she remembers the refrain, but not the introduction. I bring in at least one “new” song (that she doesn’t know well) for her to sightread each session. Each day, I choose several songs that are in the same key, and we play the scale together several times before the songs are played. This requires her to visually focus and actually read the notes instead of playing by ear (which she tends to default to). She loves Barbra Streisand, musicals, ballads, and songs that have a sort of unpredictable and difficult melody, which means I have learned several new songs! When she gets frustrated, she plays Till There Was You again, and I always sing along.  The most times she has played this song in a session was seven.  So far. I also recently learned that she plays “La Vie En Rose” somewhat skillfully as well.

4. We switch places, and for about 15 minutes I play melodies on the piano and have her “name that tune.” We sing each song after she has either told me the title or sung some of the lyrics.  We then walk over to the treadmill.

5. Music Assisted Exercise: We have recently begun doing this after L’s son told me they were having a hard time motivating her to walk on the treadmill. Since she has broken both hips, it is uncomfortable for her to walk for any length of time, and it is dangerous for her to be unsupervised doing this, so her private aide helps us out and spots her while she’s walking.  For three minutes, she walks at a challenging speed (for her, this speed is .7 miles an hour) and I play tunes such as “Zippity Doo Dah,” “There’s No Business Like Show Business,” “Beer Barrel Polka,” “MacNamara’s Band,” “Hava Nagila,” “It’s a Long Way to Tipperary,” and “Seventy Six Trombones,” which all have a similar beat and tempo. She marches on the quarter beats while I march with my guitar in front of her. After the three minutes, we take a short break while she’s still standing, and we sing a song that she might want to dance to (holding on to the treadmill rails) such as “Sentimental Journey,” “Que Sera, Sera,” or “Bei Mir Bist Du Scheyn.” We do two more minutes of walking/marching after our break, which is about all L can do without falling off the treadmill from fatigue.

6. We then walk to the kitchen, sit at the table, and read.  Her son has purchased several Dr. Seuss books, and we read one story each day for about twenty minutes or until L is antsy.  The rhyme scheme in Dr. Seuss stories allows her to sound out words that are more difficult or unfamiliar, and she is able to analyze language. This may be a coincidence, but it seems like her reading skills are much better following exercise than not.

images7. We play a picture matching game.  The game is called Zingo, which is supposed to be a “Bingo-esque” game, but instead of playing the intended way, I line three “Zingo” cards up in front of her, and I tell her that our goal is to fill all the spaces in ten minutes.  I hand her the little picture tiles (which also have a word beneath the picture) for the first three minutes, which seems to get her into the swing of things faster, and then for the remaining time, I cue her to pick the tiles up on her own.  She matches the pictures, and seems to be really happy when we fill up a card.  She usually comes up with a song for each picture, particularly the “Smile” tile, so we hum together while we’re playing the game. Before we put away the tiles, I begin the next exercise, for which I use the tiles in a different way.

8. The Great Day Song – A rhyming song, where I give her the first part of a rhyming phrase and she comes up with the second part spontaneously.  Sometimes the phrases are based on a theme (weather, holiday, season, food) and sometimes they are based on things she is doing or wearing.  When I say, “It’s a great day for being with you,” she often replies with “And it’s a great day for being a Jew!”  She always gets a kick out of herself on that one (she is Jewish). Sometimes I add movements into the first phrase, and she almost always follows cues like, “It’s a great day for clapping your hands…” followed by a clever rhyme of some kind. Since she is unlikely to give me spontaneous suggestions for the first halves of the verses, and I want her to be involved, I have recently started using the picture tiles from the previous exercise to give her ideas.  For example, I will take the tile that has a picture of the sun and the word “Sun” is underneath it, and after I sing, “It’s a great day…” she will finish the phrase with something like “for looking at the sun” or “to sit in the sun”, after which I’ll sing, “And it’s a great day…” and she will finish it with a rhyme such as “for getting it done.” We do this with all tiles that are easily rhymed with, and then the song is over.

9. We do a few theme related songs.  I ask her to choose a color marker she likes (out of about ten markers) and then I choose a different one. I will write down partial song titles on a sheet of paper, and have her fill in the blank with her marker.  Sometimes she fills in the blanks or spells things incorrectly, but this is more of an assessment tool to figure out if she is maintaining her skills or declining.  We then sing the songs that we have talked about without lyric sheets.

Alternatively, We also sometimes do an expressive exercise where I will draw a picture (pictionary-style) with many different colors and I ask her what comes to mind (anything she says, I have her write down below the picture).  I end up drawing about six pictures of animals, people, flowers, hearts, symbols, etc.  Sometimes she comes up with a song related to one of the pictures, so we sing that as well.

10. Song choices.  I give her several choices, each between two songs.  For some particularly wordy songs we use lyric sheets (her son wants her to practice reading) and for some, she uses her memory.  When she wants to sing both songs, I ask her to choose which song we should sing first, and at this point, she can still make a decision about this.

11. Our final task is the goodbye song.  She and her expressive therapist sang a slightly jazzed up “We’ll Meet Again,” as their goodbye song, so we have continued with that goodbye song, and it is clearly a good one, because once I start playing it, she usually makes a sad face and says “Awww…” because she knows that’s the end.

L is one of my favorite contracts at the moment. I think this is because I am able to have a very personal clinical experience with her and her family, and they give me direction if they would like me to try something new.  I also like the flexibility I have to change the session plan around if necessary.  For example, there have been a few times where I have gotten to the house and she was watching her favorite musical on DVD.  Taking this woman away from her musicals is equal to cruel and unusual punishment, so I watch it with her for a maximum of ten minutes, sing along, talk about the characters, and then after a song has finished, I pause it and reassure her that we will turn it back on after I leave.  Other times, though not often, she DOES NOT want to stay at the piano for more than three songs.  I can’t make her stay, and I certainly don’t want her to get agitated, so we just move on to something else.  Yesterday, she wasn’t feeling well, so the entire beginning of the session had to change, but after a few songs, and some conversation about Irving Berlin paired with some pictures I showed her by connecting my laptop to their TV (I’m amazed they had the dongles and cables necessary for this) her energy level increased and we eventually not only completed our “piano time” but she also made it through three minutes on the treadmill before needing to sit down again.

While I don’t think I want to work with more individuals, this experience with L has opened my eyes to a different kind of work, and has not only been good for L, but good for me as well.  I’m inspired to try some new things!

Heal the World

February 25, 2013

Helping others can be a healing experience, particularly when you’re feeling blue.  Here’s a little blue stream-of-consciousness post for you.

A few weeks ago, I was taking a walk with my mom and my dog, and we came across a duck-ish bird limping down the street. It was dark and cold. The bird would take a few steps down the street and then lay in the road.  The dead end street headed toward the ocean, where we usually enjoy the view for a moment, but we never made it there, because I decided that we must rescue this animal from certain death.  The short version of the rest of the story goes like this:

I took the bird to my parents’ house after catching it with my jacket (which I took off in 30 degree weather :/), put it in a cat carrier, took it home, and in the morning brought it to a wildlife clinic an hour away from my house.  I went on vacation after that, and when I returned, I got a call from the wildlife clinic telling me that “your bird” is ready to be returned to the wild.  Here are a couple pictures of him on the way to freedom:

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I’ve been struggling with some minor seasonal blues, and this made my day – my week.  I felt so capable and calm, and on top of things.

And it felt good.

I think as long as there is good in a person, helping feels good, and will make people want to do it more.

I see it every day in my clients with Alzheimer’s; I say, “Can you hold these [maracas] for me?”  They almost always say yes, even after I have asked them if they want to play an instrument, and they decline because they “won’t be good at it.”  When I frame it in a way where the client is able to help me, they are immediately ready and willing, even if they “won’t be good at it”. For some reason, they are willing to risk [perceived and imagined] failure and humiliation in order to help someone by holding maracas.  I might also add that these usually end up being the people who most surprise me with their rhythmic abilities – but I digress…

When a person has lost so much, they are still able to naturally help – to give.

In the psych unit, when patients help and support each other, it is heart-warming, and so telling of human instinct.  When there’s a patient who is having a particularly difficult time, others will often encourage and prompt that person, even when they themselves are in the midst of turmoil and sadness.

The phrase, “when life gives you lemons, make lemonade,” is something that comes to mind when I think of a dear friend of mine who was abused as a child and now has made it part of her own journey and healing process to help others find peace in their own similar experiences through a blog talking about pain, vulnerability, relationships, and spirituality.

It is incredibly rewarding to help others, because we can see ourselves in the people we’re helping.  Because we would want to be helped. Empathy is a powerful thing.

I lead songwriting exercises in some of my groups.  A few times, I have asked clients what makes them feel good/happy as the “theme”.  “Helping others,” is a popular response. In the psych unit, we talk about coping skills sometimes, and “helping others” often shows up on the list as well. We are hard-wired to help others – maybe because we all have weaknesses.  If we are able to help someone – whether it’s helping an elderly person with a door, a busy colleague with some papers she dropped, returning a cell phone or wallet (intact) to it’s rightful owner, rescuing a limping bird, or helping someone find peace within themselves out of trauma  – it can give us strength.

Finding strength (through whatever journey) allows us to do remarkable things, and it can change us.  It can change the whole story.

Keep it Together

January 29, 2013

As you may have guessed from the name of my blog (or if you know me, then you definitely know), I live in (more specifically, across the river from) Boston.

The Back Bay form across the Charles

The Back Bay from across the Charles

You may also know that at one point, I lived in sunny and mild San Diego, but chose to COME BACK. To one of the oldest cities in the country, and home to not only the most puritanical culture, but also some of the most progressive ideas.  I love this place.  I have lived in Massachusetts nearly all my life (with the exception of the San Diego stint) and have lived in the Boston area for twelve-ish years.  When I decided to come back from San Diego, I decided one thing: that I wasn’t going to complain about the snow or rain anymore.  This is New England, and unpredictable weather goes with the territory.  While most New Englanders I know complain about the weather as a side job (in the summer, it’s too humid, in the fall it rains too much, in the spring, there are too many allergies, and in the winter…oh the winter), I chose to see the beauty. I told myself that in place of complaining about the snow, I would decide that shoveling would be exercise, and when there was a snowstorm, I’d drink hot cocoa and then take my snowshoes and walk in the woods in the powder.  What a nice idea!

December, 2010

December, 2010

Winters in New England before last year’s historic fallwinter (where there were 65 degree days in January, and only a total of four inches of snow, two of which landed on Halloween) were picturesque: branches with a crest of snow highlighting each twist and turn, snowmen dotting lawns everywhere… Well, that’s what I saw, at least.  And it’s one of the main reasons I came back to Boston from warm and consistent San Diego, where things didn’t change quite enough for this New England girl.

This Winter is a little different.  We have had snow, but LAME snow.  One inch here, another two inches there – and more often than not, it all gets washed away by cold, bitter rain before I can say slush.

Note the spotty grass below my skiis...

Note the spotty grass below my skiis…

The problem with this, is that there is no shoveling for exercise.  There is no fun winter excursion into the beautiful Middlesex Fells Reservation.  There is no beauty.  Only cold, wet, dry, barren landscapes, and compromised immune systems.  And my emotional health has taken a hit.

In the past few years, I have had some self-diagnosed issues with seasonal depression (otherwise known as SADD or Seasonal Affective Depressive Disorder).  Around mid-January, I start feeling down, for no apparent reason, and despite otherwise good circumstances.  The thing that stinks about this reality, is that there’s nothing I can knowingly do about it save taking pharmaceuticals.  I am outside periodically throughout the day driving and walking from one place to another, so I do see daylight and sometimes sunshine, and I do get exercise (though not enough recently because of the negative degree temps) which can help.  But the past two winters have been rough.  There has been no real snow, which means that my winter coping skills have needed to change along with the climate.

The one decent snow we've gotten this winter

The one decent snow we’ve gotten this winter

So, what’s a girl to do?  I eat healthfully, I take vitamins (and St. John’s Wort and Ginseng presently), and I get to see the sun.  What that means to me, is that I need to put on my big girl pants and deal with it.  Which I do.

My daily intake of vitamins and herbs.

My daily intake of vitamins and herbs.

However, feeling more tired and less alert in general does not generally mix very well with this line of work, and it is difficult to find the motivation to deal with certain things.  Plus, there are these two young ladies who spend an awful lot of time with me and depend on me to be on top of my game.  Yikes.  Furthermore, I was talking with one of my interns yesterday about how people often brush off these types of feelings because they are not completely pervasive or acute, like other more serious mental health diagnoses symptoms can be.  But!! They still should be addressed, especially if your job and clients depend on your usual enthusiasm and energy to last, even through cold, wet winters.

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Where is the line between putting on your big girl pants, and seeking help?  I have never needed to act on that latter step in the past, and with any luck a tropical vacation I am going on soon will curb some of the ennui I am feeling, but if it doesn’t, where is the line?  For those of you working as therapists or caregivers in health care or other areas, does seasonal depression affect you?  What are your solutions to that problem?  Are there any holistic treatments that have helped you in the past?  Please share your self-care techniques with me and the other readers, and we’ll make it through this, I swear! 

Heart of Glass

January 20, 2013

Disclaimer: This is a controversial topic, but something I have touched on before.  It also has nothing at all to do with Music Therapy.

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“Mom’s doing great. She did have her defibrillator replaced and she came through with flying colors.  She’s having issues with swallowing, which is a part of the latter stages of Alzheimer’s, but overall she’s doing extremely well.”

This is quote I heard in June of last year on an NPR program called Family Matters.  The program followed three caregivers of elderly relatives over two months and covered important issues spanning the topic of elder care in the home.

When I heard the quote, my gut reaction was to call in to the show, but I refrained and instead ruminated on it for a year.  It’s not about the woman who said those words, or her mom, or my opinions.  It’s about the system, and about our collective inability to let go of ailing and aging loved ones, even at the natural end of life.

In preparing to write this entry, I looked up “stories about elderly people being kept alive with pacemakers” “difference between a pacemaker and an implantable defibrillator,” and several other phrases that I thought would help.  Here’s what I found:

A pacemaker (taken from this website) “[keeps] the heart beating at the proper rate and from beating too slow. You can adjust the pacemaker so that it can be suitable for either the top or bottom heart chambers or both, depending on what type of pacemaker it is and the needs of the patient. It also will only work if it is needed, it doesn’t work all the time.

An implanted defibrillator is a bigger device. It is there to prevent death from a cardiac arrest. The device shocks the heart if it needs to be shocked, because of a life-threatening rhythm disturbance from the lower chambers of the heart. It can correct this rhythm. Because it has a pacemaker built into it, a defibrillator also has the capability of stimulating the heart like a pacemaker, to help stop fast rhythms, at times, and to prevent the heart from getting too slow.”

So, what I’m taking from this is: Ida, the 89 year-old woman with end-stage Alzheimer’s who is having trouble swallowing, just had her defibrillator (a piece of technology which restarts the heart if it stops and regulates heart rhythm) replaced.  Because this conclusion is ginormously disturbing to me, I looked up what kind of  procedure one must endure in order to have one of these lifesaving devices.

Here’s what I found:

It is a minimally invasive surgery which only requires local anesthesia and has few risks.  The risks are, the defibrillator not working or not working correctly, a person having sensitivities to the device itself, and infection.

I also found this:

ICDs are “moderately cost effective in preventing sudden cardiac death,” according to a report in Circulation: Journal of the American Heart Association.  Every ten years, it’s “only” $24,900.

While I would love to believe that Ida’s daughter was the one who decided that this was a good idea out of love for her mother, I believe there was something else at play.

This forum shares several individuals’ stories about this very topic, and most of these guilty souls had been told by doctors and medical professionals that prolonging a declining relative’s life was something to seriously consider, regardless of the quality of life.

What happened to letting someone die with dignity?  What happened to letting someone die, period?  The heart can do amazing things, and medicine can do amazing things to keep the heart working, but when a person is going through the natural aging process, which sometimes (and unfortunately) includes disease, when do we decide to let the body do what it’s supposed to?  I’m sure it’s different in every case.

A year-or-so ago I read an Op-Ed on this topic.  I searched far and wide for this story, and finally found it here.  It’s a brilliant story of a family’s tortured ambivalence about their patriarch who is kept alive far longer than necessary all because a cardiologist would not perform hernia surgery without previously inserting a pacemaker to correct an age-related slowed heartbeat.  Toward the end of this article, the author mentions the same forum I referenced two paragraphs ago, and talks about issues we should all be aware of.  I beg you to read it.

It also prompts a different question…When do we ignore doctors’ recommendations?  If they are good enough at coaxing, they make a lot more money, regardless of what they believe in their heart of hearts is the right thing to do.  We trust doctors to help us survive, remain healthy and give us sound medical advice, but we also trust them to make the right suggestions for our overall wellness.  In our culture of greed, some doctors might as well be Wall Street bankers. Advising a family to consider life-prolonging surgeries and devices when what the device is doing is delaying the inevitable at an emotional and financial cost, is a tricky thing – it often causes guilt in the family and can cause more pain and suffering for everyone involved.

And another question: Who gets to decide what quality of life is?  My idea of a good quality of life is much different than someone else’s I’m sure, but there must be an objective answer somewhere.  I was recently talking with my boyfriend’s mom about this issue.  She told me that my boyfriend’s late grandmother, his father’s mother, had an ICD implanted and replaced two different times.  When she first had it implanted, she was in her 60s and had a good number of possible years left of life.  Though she was never in great health in her later years, before she passed last year she was in rough shape and had had several other health problems that kept her from living her life the way she may have wanted.  BUT, it was her choice.  She had decided that she wanted to be kept alive at all costs, so what can you do?  We have to honor our loved ones wishes, but the problem occurs when families haven’t talked about these issues and caregivers are forced to make difficult decisions for their disabled parents or loved ones.  The amount of love, guilt, and feelings of responsibility for someone else’s life can really get in the way of making appropriate decisions, which may or may not have been why our friend Ida (from the first paragraph) just had her ICD replaced, and may or may not be the reason why people with advanced dementia or a terminal health situation receive triple bipass heart surgery, liver transplants, or even CPR (which I wrote about in THIS post).

I’m glad that I have talked about these issues with my parents and the people around me.  I’m glad that my parents recently rewrote their wills and advance directives and don’t want there to be any unanswered questions.  They recently made me their Health Care Proxy, which will give me (and my brother, who will also have access to their documents) the ability to make decisions based on what they want in the future, if their hearts stop beating, and when life starts to do what it was always meant to: to end.