Too Much

June 30, 2012

I want to begin by giving a disclaimer:  I want people to sing in my groups.  I want people to play instruments.  I want people to enjoy and express themselves.  I don’t mind if things get too loud sometimes.  

Recently, I had a session in the dementia unit of a nursing home I contract with.  I have been working on this unit for months and I am generally able to manage the large group well.  When folks get a little out of hand, aides and staff members usually remove them before I have a chance to say anything, but sometimes, circumstances are such that the person must stay.  This was the case this past week, when a new resident was brought into my group.  She was loud (presumably because she couldn’t hear very well), but she was also feisty and quite bitterly fresh with me. When I began playing any number of songs, she would either belt out the words to that song, but slower or faster than the rest of us (all 20 of us) were playing/singing it, OR she would sing a completely different song than we were singing – at full volume.  For instance, I was playing “On the Sunny Side of the Street” and she was singing “Baby Face” like her life depended on it.  I found this fairly distracting, but I am a professional, so it was no big deal.  UNTIL the woman next to her kept reaching over to “shush” her, and several people around the room were rolling their eyes and complaining quietly to their neighbors about the disruption in their midst.  I would have asked that she be moved to the adjoining room, where she could still listen, but not be quite as…loud.  However, the activities person exclaimed after one of these cacophonous counterpoints, “I have never seen her this happy!!” Judging by her affect, though, I’m not sure I would have called her “happy” – more like manic and pressured – but I was not about to explain my opinion, so she stayed.  Oh, wait…I’m not done.  Everyone in this session had a drum or shaker of some variety, and these residents are very focused on music to the point that when we end a song, they follow my cues flawlessly and everyone usually ends at the exact same moment.  This happened at one point during the session when this woman, M, was singing various strange lyrics to the tune of “Do Your Ears Hang Low,” which is not what the rest of us were singing.  When we ended the song, followed by a [usually wonderful] deafening silence, she continued with the phrase she was in the middle of, and ended (LOUDLY) with the lyric, “WITH HIS HANDS IN HIS POCKETS AND HIS DING DONG OUT!!” 

You might be wondering how one would react to this kind of thing.  Well, wonder no more.  I could not stop laughing.  It WAS funny.  It really was.  BUT, what do I do next time?  Her behavior was so disruptive to the other participants that I am inclined to let the staff know beforehand that she is not group appropriate, but I am also tempted to give her one more chance before she gets kicked out of my group.  If I were at this location for a longer period of time, I would suggest that I have a separate session with her, 1:1, before or after our group, but alas I am not, so a second chance she shall receive.

Though this happens frequently, it is still unfortunate that another fairly recent event led me to remove a perfect candidate for MT from a music therapy group.  H., an 80-something year-old man at another facility I work at can’t hear almost anything and was apparently quite obnoxious during his earlier years.  This has only been exacerbated since the onset of dementia.  He arrived during a group of mine a couple of months ago and began singing “You Are My Sunshine” at the top of his lungs.  We were in the middle of a song, and I will tell you that it was not “You Are My Sunshine.”  I took this first interaction with a grain of salt, then he proceeded to visibly anger every other participant in the group, so much so that three different women (at three separate times) said, “Get him out of here!”  His wife and granddaughter were present and when they tried to reign him in, he became more agitated and told them to shut up more than once.  He did not listen to a word I said when I asked him questions pertaining to our group theme, and instead sang lyrics to various cowboy songs I didn’t know.  This was frustrating for everyone in the room.  He no longer attends MT, but I learned he has a volunteer who comes in every week to sing with him in his room, and sometimes I come in early and sing a few tunes with him prior to my session. At least he’s getting some musical attention after I put the kibosh on his participation in my groups.  

What do we do when a client is too much to handle?  When we can’t redirect and the person is putting a damper on everyone else’s experience, how do we deal with the situation?  I generally give the person one chance and then talk to a staff member to make sure this wasn’t just a fluke.  If they suggest I try again, I try again.  

I believe in second chances.  I believe in MT for everyone.

I also believe in the greater good.  I believe in not making dementia-related agitation and anxiety worse for others.  If one person is not able to behave in a way that works for the whole group, they are removed.  

When too much is too much, then enough is enough.

How do YOU handle situations like these?

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One Response to “Too Much”

  1. Michelle said

    I had one resident who would belt out the first stanza to an italian song every time I ended a song. It would drive a few other residents absolutely nuts, so I finally learned the italian song, and we’d start the groups with that song so she could sing it a few times, this caused her to sing it less frequently during the session. When she did sing the song, I tended to try and follow it up with songs the residents who were agitated by it really liked because it helped their agitation to dissipate before it got to be problematic, that doesn’t help you really since your residents seem to be singing over you though. I recently left a job at a nursing home related to the “What do you do when too much is too much” question. In the past year the very large memory care floor was divided into 3 hallways and the people with behaviors were all moved together down 2 of the 3 hallways. In the one hall, there was absolutely no way for me to lead an effective group. There were so many of them who were disruptive and causing agitation to others by interrupting or talking over the music therapy sessions that it was counter-productive with them. When I tried to remove the typically disruptive people to other rooms, the nurses would just bring them back to me as soon as they got behavioral, even if I asked that they not be brought out for those particular groups. I would try and bring the people who really benefitted out to a different group instead, but sometimes they wouldn’t or couldn’t come with me to a different hallway, so then I’d feel guilty that not everyone was getting some kind of programming. I ended up being so frustrated and run down that I just couldn’t be effective there. Enough got to be enough. I just started a job in a different nursing home where the memory care neighborhood is much smaller and they don’t accept any severe behaviors.

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