Getting to Know You

September 22, 2011

To my 5 faithful readers out there, sorry it’s been so long since I posted.  Here goes…

Ehehem…There are five major aspects of clients’ lives that I always try to learn first.

Names

One of the most challenging things about starting new jobs is learning all the new names.  I now work at 10 facilities a week.  That’s roughly 150 names to remember, and given the constant turnover in the hospitals I work in, and the turnover in AL and SNF facilities, it becomes…how do I put it…overwhelming.

Last week I started a new contract!  The group was pretty large – 15 people – and I was actually impressed with myself that I remembered everyone’s names ten minutes into the session.

I’m good at it.  Throw me into a social setting, and I’ll forget your name three seconds into meeting you (not something I’m proud of), but at work, I’m a champ.  People are often amazed at how quickly I learn names, and I always say “It’s part of my job.”  It’s incredibly important for the residents and patients I work with, that I never question their names.  If they remember me, I should remember them, and because I do, they might feel better about themselves because someone remembered something about them.  I try to repeat everyone’s name back to them while making eye contact.  That usually works, but when it doesn’t, I go to the nurses’ station and check the names on the white board, or ask one of the aides so I don’t have to let the client know I forgot his name.  If I’m mid-session and blank on a name, I say, “Remind me of your name?” but I try to avoid that.

So…getting to know people is important.

Songs

Usually, upon meeting a new client, there are many things to learn, but there is one thing other than his or her name that is somewhat important as a music therapist, and that’s their favorite song.  Or their favorite singer.  Or their favorite genre. Or their ethnic heritage at the very least.  Sometimes, it’s really hard for clients, particularly those with memory loss to think of just one song, so I play these guessing games until we come up with an answer and sometimes it takes quite a while.  When a person can’t give me an answer to an open-ended question, I give them a multiple choice (between two songs).  Song choices are a big part of my sessions – any former student of mine who’s reading this is probably nodding and smiling – and more often than not, that’s how I find out what someone’s favorite song is.

When MT’s are in training, something we learn is that age often determines what music someone likes.  This is not always the case, which is why we give song choices and begin conversations, etc., but it usually plays a large part in determining what music speaks to people.  It’s a familiar notion that the music from someone’s late teens – late twenties is usually the music the person is most familiar with.  Also, songs from musicals and movies are often exceptions to the “age” rule, as those were meant to entertain a variety of ages at their conception.  People who are 85-93 years old sometimes suggest songs from “The Sound of Music,” or “Cabaret,” even though those musicals came about when the folks were well into their forties or fifties.

Occasionally, someone will have a favorite popular song that makes no sense based on their age, but we figure it out, and play it with the person regularly.  It seems to make a client so happy, so validated, when someone knows their favorite song or singer and remembers time and time again.

Cultural Background

Sometimes the clients in my groups are from different countries, which can be a challenge, communication-wise.  I can certainly ask them in Spanglish or Frenglish or Portuglish what their favorite song is, but often even when a person is from the U.S. I have a hard time understanding his or her response because of a neurological condition, stroke, or missing teeth.  When you throw in a language barrier to those issues, it becomes almost impossible to understand the words a client is saying.  Even if I knew the language it would be hard.  SO… I find out what country they’re from.  I find out what songs were popular in that country when the person was a teenager or child, and I learn them.  I can more effectively give a song choice and find out what a person likes if I have a base to work with.

Sometimes a person’s culture is based on their ancestry or race.  Playing songs that you know a person would like doesn’t just stop with the song, however.  It’s how you play it.  If I have five African-American residents in a group and all of them came from the south, chances are when one of them suggests “Amazing Grace” or When the Saints Go Marching In,” I’m not going to play it straight.  It may seem like I’m sterotyping, but the truth of the matter is that culturally, the blues and gospel are really important to most of those southern folks, and they appreciate when I play the songs with a little soul.  On the other hand, I would switch up the style if a Bing Crosby-lover suggested Pennies From Heaven – in that case, I would probably not play Billie Holiday’s version of the song (http://www.youtube.com/watch?v=JxVXNWdHDq8) but instead, a moderate hybrid of different versions to make everyone happy.

Religious Background

I am not a religious person.  Over the years, I have become more comfortable with my own spirituality and am, for the most part, able to give people the support they need in that regard, but I am severely lacking in the hymn/gospel/praise music category.  If I know that someone belongs to a specific religion or sect, I generally will look up praise music for that branch and give the person choices based on my findings.

Difficulties arise when there is a spectrum of different religions and cultures in one group.  Devout Chrisitians love hymns and Christian praise music.  Jewish residents typically enjoy one or two Jewish hymns, but more often than not choose Yiddish folk songs instead.  Jehovah’s Witnesses do not participate in singing religious music or patriotic songs.  Sometimes there’s age-old discrimination and judgment made by certain residents about another’s culture.  This means that with the religious diversity in a group sometimes comes negativity and prejudice, so unless someone specifically suggests a hymn, we stick with secular music that everyone can relate to.  It’s a hard job, but those group dynamics are always there, and aren’t always conducive to progress.

Physical Abilities/Disabilities

Because I work with elderly clients mostly, I run into a lot of obstacles when finding the most appropriate instrument for someone to play.  If I know they’re strong and have the use of both arms and hands, I give them a drum.  If they can only use one hand, I have flat drums that sit on clients’ laps and the remaining hand can grasp a mallet.  Sometimes a person is severely overweight and doesn’t have much of a lap, so there are maracas for that.  What if a person can’t hear though?  Tambourine.  If a person has pain in their hand and can’t hold onto anything without becoming sore, I have wrist bells.  If I know a person has musical abilities, a flat lap, and the use of both hands and arms, I have a pentatonic marimba for them.  For residents who have dementia and constantly put down anything they’re holding, I have Djembes which stay on the floor and the person can tap with their hands or a mallet.  The list goes on, and over the past several years, I have accrued a myriad different instruments for different abilities, but sometimes the trial and error lasts much longer than I would like, and it’s easy to get discouraged.  When a person (especially a cognitively “well” elder) finds “their” instrument, it’s important for me to remember which one is their favorite in future sessions.

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With each person, there are hundreds of things to learn, and it takes a long time.

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I begin the supervision semester next week.  In my busiest semester, I had 11 students.  This semester I have five.  This means that there are five new people to meet.  Five more people to learn about: their personalities, learning styles, musical skills, sensitivities, emotional health, confidence levels, etc.  I love this part of my year, and it gives me an energy boost knowing that all the things I’ve learned about all the residents I work with, I can teach someone else.  All that knowledge about the little things doesn’t just get lost in the depths of my mind, and the awareness the students gain [hopefully] sticks with them about just how important it is to get to know someone you are working with.

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