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!

Advertisements

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.

__________________________________________________________________________

“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.

Wake Me Up Inside

April 23, 2012

Last night I finally watched the video of Henry, a man who suffers from frequent seizures and doesn’t respond fluently to questions, but for whom music is an extremely therapeutic tool.  The activity leader at his nursing home found that having him listening to music from his era with headphones was effective in improving his posture, affect, energy, his ability to connect with others, and when the headphones are taken away, is still able to engage with others and answer questions enthusiastically for a bit afterwards.  Oliver Sacks participates in this video, which is actually a clip from a new documentary.

For those of us (music therapists) who see this kind of response every day, the clip is nothing new.  OF COURSE music has the ability to wake us up – to reach places within our brains that we weren’t able to get at with other therapeutic methods.  I’m so glad that people continue to publicize the power of music, and I’m glad that influential scientists like Dr. Sacks are continuing to write books and compile research supporting what I do.

That being said… (you knew this was coming, didn’t you?) the documentary, “Alive Inside” seem to focus on the power of recorded music.  There is nothing wrong with recorded music.  Let me say that again – There is nothing wrong with recorded music.  We have favorite recordings of songs, and favorite singers.  There is nothing wrong with making playlists of our favorite tunes and being able to listen to them immediately.  There’s also nothing wrong with playing recorded music for patients or residents, or them having their own iPod to listen to on a regular basis. Nothing wrong at all.  Except when you call it music therapy.

For those of you reading this who are not music therapists, you may not fully understand the pains we go through on an all-too-regular basis to inform people of what it is that we do.  What is music therapy?  My version is this: Music therapy is the scientifically-based use of music as a therapeutic tool between a clinically trained music therapist and a client in order for the client to reach non-musical goals.  Therapeutic music activities are something that can be provided by anyone, and enjoyed by many.  I have nothing against other people using music therapeutically in their jobs.  I do however, have a viscerally negative response when I hear people talk about music therapy as something that happens when you listen to music in your car.  Or when a care assistant sings with a patient while walking them down the hall.  Music has been around since the dawn of humanity, and many different cultures have found it therapeutic and spiritually enlivening among many other things.  Music therapy, as we know it today, has been around since the first accredited college degree program opened in the 1940s.  It is an official profession.  It is something you must have a degree in to practice.  It is scientifically based.  There is research supporting benefits of music therapy, and I could really go on all day being defensive about what it is that I do every day, but instead, I’ll move on.

After I watched the 6+ minute clip of Henry, I listened to an NPR segment two people sent me the link to about the power of music with people who have dementia.  It mentioned the “Alive Inside” clip for several minutes, which to me seemed coincidental, considering I didn’t know the two were connected. The guest speaker, a social worker, Dan Cohen who runs a non-profit called Music and Memory and who the documentary follows, talked about how his organization got funding to buy hundreds of iPods for a nursing home, so that the residents could have musical experiences (that obviously benefit them) on a regular basis.  A question was posed about isolation and how people already lost in a solitary world can sometimes withdraw when alone for extended periods of time, and he answered by talking about how people who listened to music alone were stil able to connect with their peers following individual music listening sessions, and talked about artists, songs and other information regarding what they had just heard.  That’s so wonderful, right?  The power of music is going viral!?!?! I thought there must be some mention of music therapists in the documentary, or in the clip. It turns out that the woman who hosts the program “All Things Considered,” asked the social worker the following question: “I think the responses that you’re describing are something that music therapists have talked about for years, not just with dementia, but also with say, traumatic brain injury.  What does science say about music and the effects on the brain?”  His response was, “Well…I’m not a neuroscientist. I come in as a social worker and I have sort of a working knowledge of applying this and watching the results.  My goal is to make this a standard of care…” and goes on to say that caregivers could use this program with good results.  I was glad that she gave a shout out to music therapists in her question, but he didn’t mention us at all in his answer.

So, I Googled, “Alive Inside and music therapy” “Alive Inside and music therapists” and a few other variations.  What I found actually made me cry a little.  There were articles, reviews and commentaries about the viral clip of “Alive Inside” that all talked about how powerful music therapy is for these patients.  Remember how music therapy is the process by which a music therapist and a client are working together to meet non-musical goals?  The articles meant well, but the idea behind “Alive Inside” is not music therapy, and there were no music therapists.

You may be thinking, “Hey, you’re missing the point!  This is further evidence now on the benefits of music on folks with dementia and seizure disorders!”  I know, I know… For once, though, I wish that we didn’t always have to fight for our validity.

Music awakens us all in one way or another, so why are most Americans just finding out about it now?

We Got the Beat: Part 4

March 4, 2012

This may be my longest series!

Sometimes clients need to be empowered.  In my psych setting, my clients are mostly dual-diagnosis, but at times there are more acute cases, and often these patients want to be in control, take charge and monopolize my groups.  In other settings, I have to be more flexible and go with the flow, but in the psych setting, everyone deserves a balanced music therapy group. On the contrary, in my dementia settings, people are usually hesitant to participate openly for fear that they’ll do something wrong, so I try to help them feel more confident whenever possible.

I empower people in an organized fashion in all settings with rhythm leading exercises. This type of exercises can be used anywhere, but here are two settings where I have used rhythm leading:

________________________________________________________________________

Psych Setting Rhythm Leading

I begin this exercise after “check-in” and some sort of directed drumming intervention.  I usually introduce it by saying something to the effect of “The next thing we’re going to do, is have each of you lead us in a rhythm. You can pass if you would like.  Would anyone like to volunteer to go first? I’ll give you more direction when someone volunteers.”

When I get a volunteer, I ask them to choose an instrument they would like to lead with.  The leader is allowed to take whatever instrument he/she wants, even if someone is holding it already.  That person is then asked to orchestrate what the rest of us play as well.  He or she can give specific instruments to each participant, or if they don’t care what other people play, participants can choose whatever instruments they want.

The leader can give specific musical direction if they are so inclined, but most people feel the most comfortable just playing a rhythm for the others to follow.  If they have trouble getting started, I tell them that they should just play “whatever comes out of your hand.”

Before a person starts playing, I tell them that the only thing they need to do after they begin playing, is stop playing when they want to, “and hope that everyone else is paying attention.”  I encourage others to pay close attention to what the leader is doing so they don’t miss any cues.  If a person goes on for more than two minutes, I give a quiet reminder to them that they can stop whenever they want to, just in case they have forgotten the directions.

When the leader has stopped, I ask him/her to give a title to their creation, and always thank the person and praise their title.  If they have difficulty coming up with a title, I ask them if the group can help us, and then ask the other group members to come up with some potential titles, and the leader is able to choose which one he/she likes the best.

Rhythm Leading in Dementia Care

This can work in one of two ways.  One, is the above explanation (without the person being expected to remember to stop on their own).  The second way is as follows:

Often, when I am leading a drumming check-in with folks with dementia, they continue to play, not remembering that others have just played a short rhythm to explain how they’re feeling.  SO…I allow the person to keep playing, and encourage others to play along with the leader.  After a minute or two, I do a stop cut (4, 3, 2, 1 STOP) as if that was what was supposed to happen, like in the other drumming interventions we do.  I then have the leader title their work.  Most of the time, folks will give titles like “Music,” “Rhythm,” or “Noise,” and I give praise for their titles no matter what they are.  If someone can’t think of a title, I do what I explained above, and have the other group members help the person (if they have confirmed that it’s okay for others to help).

This intervention can also be combined with a check-in, as an adaptation.  In that case, I would ask each person to play a rhythm that speaks to how they’re feeling (without having to give a word for that feeling) and encourage others to play along.  I allow them to stop on their own, or I facilitate a stop cut if necessary, and then I have them give their rhythm a title, etc.

_________________________________________________________________________

I hope this post was helpful!

We Got the Beat: Part 3

February 14, 2012

So, now that I’ve introduced the instruments and checked in with everyone, we can begin with the fun stuff.

For those of you who came from Musicworx like I did, or who have training in Drum Circle Facilitation, this technique will be familiar.  I call it “sculpting,” which I picked up somewhere along the line, but the following descriptions are variations on a theme because of the populations I work with and the size of groups.

When I was in internship (It feels like yesterday, but I finished in June of 2006) we worked in a 28-day substance abuse/addiction program once a week.  One out of every four sessions was an “active music making” session, where we would facilitate drum circles and lead chants for an hour.  There were usually 20-30 people in the circle, so this exercise took quite a while and often had many different layers to it.  There was often very little direction that needed to be given, and the participants followed non-verbal cues well.   In my groups, this is not the case. I have also led drum circles outside of my clinical settings, and it’s a different ballgame altogether.  Enjoy this video by Kalani if you are not a music therapist or DCF and are wondering what on earth I’m talking about.

1, 2, back to the groove…(inside joke?)

I encourage participants to choose an instrument to play, and explain that they needn’t mimic the rhythm I play, but rather find a creative way to play their instrument while I provide the structure.  I begin playing a rhythm on my drum (usually in 4/4 time) that is easy to improvise on and everyone plays with me.  After we’ve been playing for several minutes, I do a stop-cut (“4, 3, 2, 1, STOP”), and we continue with the cue, “1, 2, everybody(3) play(4), and -“.  I usually do three stop-cuts before we begin sculpting, so everybody is familiar with what that means, and once the group members have gotten the hang of it, I explain what we’re going to do while we’re still playing our instruments.

________________________________________________________________

Set up for the psych unit group

1. For psych unit drumming  – The group I have is usually fairly small (4-7 clients) and we are seated in a small circle (with instruments in the center), so I do not stand and physically facilitate.  I tell the patients: “I’m going to say someone’s name.  If I say your name, I would like you to keep playing the next time I say ‘stop’.”  I then choose a client with good cognitive skills (when possible) and a good grasp on rhythm (when possible) to start.  I reiterate and say, “Joe Schmo, when I say stop, keep playing.” and shortly thereafter I do another stop-cut and Joe takes a solo for seven measures. On the eighth measure, I count everyone back in.  I do this with each client, (some needing more prompting than others) until everyone has had a turn, and then do the same thing, having two clients play at a time until every person has played a “duet” with every other person in the group.  Sometimes I have each client choose the next person to take a solo, as well, depending on the cognitive skills of the group.  We end on one final stop-cut, but if the clients don’t all end with me, I try again until we’re successful.  I don’t care if we accurately end a drum circle, but the clients really enjoy it when they have a nice strong ending.  They seem proud of themselves, which means a lot.

2. For Assisted Living drumming – As I’ve said in many posts, including one from the other day, the assisted living facilities I work in are specifically for people with dementia, so the residents typically require more direction and prompting than even my psych unit group does.  For starters, I do not place drums in the center of our circle for many reasons.  Confused residents may walk through the group and trip over the drums, participants may not be able to bend down to pick up the instruments (and if they tried, they might fall), and if the previous two reasons were not valid… there would be too many options if I put all of the drums in the middle – it would be super overwhelming for them to make decisions, and they might be distracted from all the extra visible stuff in the room.  So…I take each drum and instrument out of my cart, and one by one, I announce what the drum is and simultaneously demonstrate how to play it and what it sounds like while saying, “Who would like to play the buffalo drum?” while striking it, and I give it to the first person who raises their hand or gestures affirmatively.  I do that with all of my instruments.  If no one wants the one I’m demonstrating, I put it back and take the next one out, etc.  If there is a person who has not raised their hand to claim a drum (possibly because of cognitive issues) I bring two instruments over to the person and have them choose one.

I introduce the aspects of the session the same way as in the psych unit drumming group, except that I do not say people’s names.  I do a few stop-cuts until everyone gets the hang of it, and then I walk over to my chosen starter while playing my drum (my big djembe), I squat next to them and say, “So-and-so, when I say stop, you keep playing.”  I clarify this as many times as necessary, and then AS SOON AS POSSIBLE, count down to “stop,” and remain with the person until I’m sure they know what to do.  I count everyone back in after seven measures and we jam for a bit until the next person is cued/prompted.  We continue this until everyone has had a turn.  I only sculpt with more than one person if the two people are sitting next to one another, to reduce further confusion.  If I happen to have a student in this percussion group, I have them do their solo first, so the residents don’t misunderstand what is happening when someone keeps playing after the stop-cut.  I end the exercise in the same fashion as in the psych unit, until everyone stops together.

________________________________________________________________

I hope this was helpful!  Stay tuned for We Got the Beat: Part 4.

Try to Remember

February 10, 2012

I have publicly reminisced quite a bit about an AL I used to work at that was designed specifically for people with dementia.  There are two units, one early-mid stage and one mid-late.  When I left, I had a hard time explaining to the early-mid stage residents why I was leaving, what I was leaving for, and where I was going instead, so I haven’t gone back.  While I missed them a lot, I didn’t want them to go through the good-bye all over again and feel deserted, so I never visited.  Since then, I have been supervising students at this location (without being an employee there) and we have a fabulous time on the mid-late stage unit, which is coincidentally the only floor which fit into my hectic and scattered schedule.  Until now.

Today I had my first session on the early-mid unit in almost two years.

Two residents, both of whom have non-Alzheimer’s type dementia, remembered my name.  I was shocked.  One other resident, who I was once very close with, and who was my original Jewish music and language influence, didn’t seem to remember me at all, which I wasn’t surprised or hurt about.  Before the session (which happened to be based around drumming – I can’t get away…) I said to the entire group, “My name is ____, and I actually used to work here a long time ago, so if I look familiar, that’s why.”  Out of the corner of my eye, I saw this resident, G, looking at me and nodding her head enthusiastically.  I felt relieved for some reason – not that it would matter if she hadn’t recognized me – and it made my day.

What made my day even better after that, was at the beginning of our drumming group hello song, “Funga Alafia,” when the three residents (including G) who I had known two years ago remembered the words without so much as a tripped syllable.  I taught them that song four/five years ago, and they still remembered it after possibly not hearing it for two years.  The brain is an amazing thing.  Everyone else in the group eventually picked up the melody and lyrics as well, but it was G who surprised me the most.  We did the “Great Day” song which I posted about here, and she remembered my lyrical adaptations, and the rhythmic cadence following each verse.  We did a sculpting exercise (which I’ll post about in my next group drumming series post) and despite an obvious decline since I last saw her, G was able to participate fully and without prompts, as if the last time we had done that kind of thing was last week.

My favorite thing about today, was that it reminded me of a myth that needs major busting:

“People with Alzheimer’s can’t learn new things.”

Jaded

November 14, 2011

Hello.  We haven’t met.  I’m Jaded.

Unfortunately, when you work in a specialized field and deal with so many diagnoses, ethics, symptoms, clinical interventions and realizations, it’s difficult to suspend disbelief in instances when your education knows better.

I finished the book Sing You Home by Jodi Picoult, about fifteen minutes ago.  In short, the book is about the struggles of three individuals, told from each of their perspectives, regarding spirituality, gay marriage, divorce and a custody battle over frozen embryos.  It “stars” Zoe, a 40 year-old Rhode Island-based music therapist.  For this book, Jodi Picoult did loads of research on many subjects including music therapy (Berklee shout-out!) and for the most part, it was accurate and interesting, but I have a small bone to pick.

As a freelance, contracting music therapist (like Zoe) I completely understand the fractured work days, the ethics issues and the instability this type of employment can sometimes necessitate.  Howevah…I know many, many music therapists, and most do not work with seven different populations over the course of a work week.  Having done my required 1040-hour post-coursework internship in a place where I feel like I worked with almost every population, I came out of that experience knowing what I wanted to focus on the most.  Most of my MT friends and colleagues work with one or two populations which leads me to believe that the “average” freelance music therapist has a couple of preferred populations and sticks with them for the most part.

Zoe isn’t an “average” music therapist though… She works in burn units, NICUs, in Pediatric Oncology, in general medical settings with all ages, in nursing homes, with autistic kids, with suicidal teenagers, and also played music at the time of death for at least one family.  Something about this screams: “I’m trying to force as much about music therapy as I possible can in the space of nearly 500 pages!”

I think part of what threw me off is that Jodi Picoult did some of her research in Boston, and I was aware of her work with area music therapists while it was happening.  I know almost all of the music therapists named in her “Acknowledgments” and I also know that one of them is THE music therapist at Shriner’s Hospital (which specifically deals with burn victims).  Another two of them work with kids with autism, and four were my professors when I was at Berklee.  I know too much!

I’m sure someone reading about music therapy for the first time has no idea that this is the case, but I do, and it was very discouraging and distracting.  I actually had a really hard time getting through the first chapter (I put it down and picked it back up probably six times before continuing to read) because it seemed like Picoult was trying too hard to explain MT to the general public. Don’t get me wrong, we need all the help we can get, as most people think we’re volunteers, and either don’t know what music therapy is, or think it’s a new age-y crock, despite decades of research and almost 70 years of music therapy as a legitimate field with a requisite of at least a Bachelor’s Degree to practice.  BUT it still seemed forced.  And then I realized this jaded thinking is a pattern with me.

The Notebook.  Eh.  Everyone I was friends with when that movie came out though it was amazing and cried throughout the whole thing.  In the beginning, I focused probably too much on the diagnosis of Alzheimer’s Disease the main character received.  At the time, I was still in school and had just learned about AD in depth.  In 2004, there was not a thing could be done about finding out if someone ACTUALLY had AD until after they passed away, and that very definitive diagnosis bothered me.  Also, the likelihood of a person with advanced Alzheimer’s (who gets so confused and agitated that she needs regular PRNs) all of a sudden being able to remember and discuss whole parts about her life because someone reads her a story is absurd.  I believed that even then, and now I’ve been working with folks with an AD diagnosis for years.  The absurdity is all the more obvious now.

A few years ago, a co-worker whose mother-in-law had advanced AD, recommended a film to me about Alzheimer’s.  At the time, I still had hope about art documenting real life in an accurate and realistic way.  Away From Her is a movie about a woman who develops early-onset Alzheimer’s Disease.  I thought I was going to love it, but I couldn’t even get through the first hour.  It’s been a few years since I tried watching it, so I won’t go into detail for fear that it will be inaccurate, but I remember being embarrassed for everyone involved in the movie.  It was actually nominated for several Academy Awards, including the main character for Best Actress.  Clearly the “Academy” was not aware of many things.  The woman, very quickly goes from getting lost while cross-country skiing by herself, to deciding that she needs to go into a nursing home to ease the caregiver burden on her husband (let’s face it, people, the financial burden of going into long-term care is huge and that’s usually the last resort).  Within 30 days, she strikes up a relationship with a non-verbal man who is also married.  I won’t go elaborate on the plot, but it was not good.  I think it may have been good for someone who didn’t spend 40 hours a week with 60+ people in varying stages of Alzheimer’s, but I did, and everything about the movie was disappointing.  I have realized after seeing several movies featuring characters with dementia that really no one does a very good job of acting like they have AD, and it’s super-duper obvious to me because I see it every day.

See?  I told you.  Jaded.  These are supposed to be beautiful films about beautiful relationships. I couldn’t stand them, and I thought the actors were questionable.  Unfortunately, not every small budget indie film can get Meryl Streep, Leonardo DiCaprio or Kevin Spacey to play a compromised individual, and they’re probably some of the few who would do it well.

There is hope, though.  I did, for the most part, enjoy Sing You Home after the first couple of chapters.  I watched The Music Never Stopped without picking it apart (I was most impressed by the hard-core 1980’s art direction choices) and I read Still Alice, a book about a woman with EOAD, from start to finish and enjoyed it!!  And recommended it to others!!  And thought it was extremely well done!!

There is hope.  But there is also the possibility that people are realizing that they need to do a better job.  That they need to do their research.  That just because a character has dementia does not mean that three weeks into the diagnosis she will be outside sweeping the lawn or putting her purse in the freezer.  That real life cant always be copied well.  That not all of the information a writer gets about a topic needs to be squeezed in.  AND…That for goodness’ sake, not every book needs to be turned into a movie.

If only someone making those choices would read this.

**This post has been edited slightly due to substitutions that work a bit better. Enjoy! 

Welcome to Volume 2 of my lyric substitution series!!!  For those of you who aren’t music therapists, this information might not be very helpful to you, but you never know when this type of creativity might find its way into your life…

I have used this song seemingly hundreds of times in various facilities, with different populations, different ability levels and using different themes.  What’s great about this particular song with the elderly population is that it is super familiar, and it repeats each phrase a bazillion times, which makes it really easy for people with significant cognitive impairments to follow along.

Another wonderful thing about this exercise is that you can use pretty much any topic.

Here are some ideas:

Halloween – “What do we think of when we think of Halloween?” (responses: dressing up in costume, trick or treating, witches, carving jack-o-lanterns, playing scary pranks…)

Thanksgiving – “What do we do/eat on Thanksgiving?” (responses: giving thanks, take a nap, eating turkey, baking pumpkin pie, spending time with family…)

A Glorious Fall Day – “What do you like to do on a glorious fall day?” (responses: take a walk, rake leaves, drink apple cider, look at the foliage, take a hike…)

Friendship – “What do we like to do with friends?” (responses: go to a party, go on a trip, talk on the phone, play board games, have some beers, go to a movie…)

Anyway,  you can really use any theme with this song, and you can adapt lyrics as necessary.  For instance, for the fall theme, every line can end with “in the fall” instead of “when she comes” so you’re singing, “We’ll be drinking apple cider in the fall, we’ll be drinking apple cider in the fall…” etc. The same goes for “With our friends,” “When it snows,” “In the sun,” “When it’s cold,” “When it rains,” and “On Halloween.” If it’s difficult to find a way to make a theme work lyrically, you could always say something like, “We’ll be baking pumpkin pie on that day, we’ll be baking pumpkin pie on that day…” etc.

Play the song at a slow enough tempo so that each verse isn’t a complicated tongue-twister for disadvantaged participants, but fast enough so the energy in the group is maintained.  What’s also nice about using this song, is that it can also spawn little conversations between group members – usually during conversations about food (I love talking about food with my clients, and I think they enjoy it quite a bit too) people get pretty animated reminiscing about what they used to eat during the holidays, or even just what they like to eat on a rainy/cold/hot/snowy day.  It’s a very concrete type of conversation which means that usually everyone who is verbally able can participate in one way or another, even if you need to give someone a choice between two options.

Have fun!!

On Top of Spaghetti

October 22, 2011

Last Friday, I had the pleasure of going to a Weird Al Yankovic concert. Between the costume changes (which we were distracted from with vintage Weird Al video footage on giant screens behind the stage), polka medleys and crazy dance moves, I can’t think of anything I would have changed.

It was amazing. I grew up listening to his albums, and have continued to admire and respect him over the past decade or so for such gems as “The Saga Begins,” “Amish Paradise” and “White and Nerdy,” and more recently for songs like “I Perform This Way” and “Party in the CIA.”  He is brilliant, if you care to check out his work, and read his life story, if you’re not already familiar.  Anyway, the fantastic concert last week prompted me to write this post about…

The song parody!!

Since the beginning of western music, there have been people writing parodies, whether they be humorous parodies of serious songs, serious parodies of regular songs, or everything and anything in between.  If you look up “Parody Music” on Wikipedia, you’ll learn quite a bit, but I won’t bore you with that information in this forum.

I grew up in a house where creativity with themes, lyrics and melodies was encouraged.  I can recall my father (a great pianist and songwriter) writing a parody for my mother for her 40th(?) birthday to the tune of “Mame,” and it went to gain many accolades from the neighborhood adults present at that party.  In addition to that and other personal inspirations, my dad also helped produce musical comedy versions of “Hamlet,” “Julius Caesar,” “MacBeth,” and “The Scarlet Letter,” at the high school he taught english at two decades ago.  I was raised among parodies, and have continued to enjoy them to this day.

In my work, I do quite a bit of songwriting.  I facilitate songwriting groups and exercises comfortably, and there are always great results.  With the onslaught of easy recording that comes with present-day technology, it’s also really easy for me to record a group’s or individual’s composition on my laptop, and then burn copies of the song they write to disk for those who want one.  We write blues songs, original non-blues songs and most of the time (because most of my clients are non-musicians, and also have dementia) we write parodies.  A couple of my favorites are “You Are My Lifeline” (to the tune of “You Are My Sunshine,” about a credit card), “Lonesome Tear” (to the tune of “Tennessee Waltz,” written by an elderly man about his deceased wife) and “An Invitation” (to the tune of “Mame,” about a rich and handsome man, inviting a woman he likes, “Babe,” to a fancy dinner party).  I love songwriting with my clients, particularly when there’s an already existing tune to work with (I’ll write about my adventures in original songwriting in another post).

________________________________________________________________

Songwriting Group:

Materials needed are: Dry erase board, dry erase markers, an eraser or tissues, a sense of humor, flexibility.

I usually begin these groups with some sort of rhyming exercise to get people’s “brain’s moving,” and then, if a group needs me to, I suggest an already existing song we can use as a background for our own lyrics.  We sing the “real” song through one time, and then I have the group suggest topics we can write about.  I write the suggested topics on the white board and we hold a (very democratic) vote to decide which one to use. After a topic has been chosen, I create an “idea box” in the bottom corner of the white board, where we brainstorm different things that may apply to our topic.  Especially when people have dementia, it helps a lot to have the ideas written down so they can see what they’ve already said.  When we’ve exhausted our “idea box,” we begin the song.  I play only the tune to the first line of the song and ask if anyone has an idea for a “poetic first line,” which is only sometimes successful.  If no one has an idea right away, I usually will write down the first line of the “real” song, keeping it the same, except for a couple/few words which I leave blank.    This is a good way to start, and usually, the clients will begin to have more ideas the further we get in the song.  Starting is the most challenging thing, but if all else fails, just write down the original lyrics and keep some words blank.

One of my favorite funny parodies my clients came up with (on their own)!

If you’re not used to leading these groups, and you’d like to try writing a song with a group of clients, a great song to start with is “My Favorite Things,” a song with lyrics that are also a list.  You can use the ideas from the idea box (getting input from the clients about which words and phrases should go where) so the clients don’t have to come up with entire phrases and ideas, which can be difficult.  Most of them have never written a song in their lives, so even if you think what you’re doing is elementary, they will usually think it’s the greatest thing since sliced bread.  In these groups, if I don’t know the clients very well, I will usually assure them that we can rhyme certain phrases if they want, but that we don’t have to.  It frees their creative energy if they know there aren’t any rules, or any right or wrong suggestions.  For those of us who are particular about lyrics in our own songwriting, it can be difficult to help clients write a song that doesn’t rhyme.  We need to get over it, because it’s not about us.  And I mean that in the nicest way 🙂

When the song is finished, I have the group suggest possible titles for our song and we vote to make the decision.  If possible (it usually is in the facilities I work at) when working with groups that change session to session, as in an inpatient setting, I then type up the completed song on an available computer, crediting those who were present for the group, print out the song, and give everyone a copy.  If the clients are independent enough to own and be able to operate a CD player, I will often record all of us singing our completed song, and then burn each client a copy of it.  They usually are thrilled to be able to actually keep a concrete representation of their newfound songwriting prowess.  Sometimes, when working with a more cognitively “well” group, songwriting can take more than one session, and that’s okay.   It’s a great way to have a group work together to create something, though this type of songwriting can obviously be adapted for individual sessions as well.

Finally, I always encourage clients to write their own parodies outside of group sessions.  It’s a fun way to be creative, and it can make us feel good to share our parodies with others too.  A well elder I work with, S., shared with our group a song she wrote about her favorite food, Kugel, to the tune of “My Favorite Things,” a few weeks after our group songwriting experience, and it was hilarious.  She was proud of herself, and the group really enjoyed it.

At an AL for people with dementia I used to work at, my songwriting group (which met once a week, and was comprised of people with early-mid stage dementia) completed over thirty original songs, and twenty-something parodies over the course of our work together.  I put all of our songs in booklets, and every now and then, we’d go back and sing the songs we wrote.  They were always so proud to have  accomplished something so creative.  A quick tip: if you create booklets like that in a dementia-specific setting, leave out the client’s names, because people get very confused when they see their name on something but don’t remember being a part of the group.

_________________________________________________________________

One of my favorite  songwriting exercises (exercises don’t take up entire sessions, just five or ten minutes) I use frequently, I call “The Great Day Song,”  This is to the tune of “It’s a Good Day,” by a singer from the 1940’s named Peggy Lee, and I use themes like weather, holidays, seasons, travel and friendship (among others) to find out what clients would choose to do on whatever great day we’re talking about.  The first line of a verse is the client’s suggestion, and the second line, we leave open for rhyming suggestions from other group members.  Here’s my explanation of the exercise:

I can’t take credit for “Great Day,” although I might be able to take a bit of credit for it’s Northeast U.S. popularity among my students and colleagues.  I learned this songwriting exercise during my internship from a San Diego music therapist named Alice who was my supervisor at a Day Program for folks with dementia.  This exercise is always a hit, and it’s a good way to encourage socialization and support from peers, given the hilarious phrases people come up with.

If you don’t already use song parodies in your work (if you’re in a clinical music job) I strongly recommend doing it.  I also strongly recommend sharing already existing parodies with your groups.  If it’s a tune they know, with an “adjusted” topic that they can understand, they will probably get a kick out of the song, as I’ve found in using “On Top of Spaghetti” to introduce songwriting.

There are many other songwriting techniques and exercises I use but I’ll save them for future posts.  In the meantime, take some chances and write some songs!

Shelter From the Storm

October 4, 2011

I love drumming.  I particularly love participating in a drum circle with lots of people in it, but drum circles can’t always happen.  The benefits I experience from drumming end up happening exclusively in my percussion-based groups, and then it’s not for me, but I still love it.

There’s a particularly wonderful drumming exercise I use occasionally (usually on rainy days) in percussion groups, and it has a name.  It’s called “The Storm.”  I have been told that this exercise was created by an influential music therapist named Deforia Lane, though I can’t be sure.  If it was ethical (or legal) to videotape one of my sessions, I would post a video of this exercise.  Unfortunately, you’ll have to use your imagination.  Maybe I can kidnap some friends to recreate it at some point…

This exercise doesn’t need quite as much explanation in some settings as the amount I give in my groups, but I find it’s helpful to give the clients as much information as possible so they dont get confused.

A small set up of my drums before a percussion group on the psych unit

Sometimes, before or after the session, I begin a discussion about “the storm” as a metaphor for difficulties in our lives, and invite clients to speak about their own personal storms for as long as they want.

I start by turning off/down the lights in the group room and I ask participants to chose a percussion instrument.  We talk about the different aspects of a storm, and try to recreate those sounds with our instruments.  I explain that there aren’t any real guidelines, but I almost always have to remind clients that this isn’t a rhythm exercise, and that talking isn’t allowed until we’re finished.

After our initial exploration, I invite the group members to close their eyes and take a deep breath, followed by a loud sigh.  I tell the clients that we’re going to start with wind (as storms tend to do) and we’re going to end with wind, but that anything that happens in between is up to them.  I also explain that if a person wants to stick with one aspect of the storm for the whole exercise, that’s okay, or if they want to try different sounds, that’s fine as well.  With everyone’s eyes closed (except for mine – I peek to make sure nothing goes awry) we create a unique storm of our own.  Sometimes there’s more rain than anything else, sometimes there’s more thunder, and sometimes, it takes a while for people to allow the storm to taper off.  It’s always different, but people always report that they feel relaxed following this exercise.

I learned this activity at a conference a couple of years ago, and I liked it so much I have used it in the psych unit, in a dementia-specific assisted living facility, and with well elders in independent living complexes.

Something to remember: Even if storms are frequent or long, they always eventually end.