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.
7. 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!
May 8, 2012
Last week, on the 30th of April, my boyfriend/partner and I celebrated our 5 year anniversary (by going out to a fancy dinner in the French Quarter of New Orleans). What does this have to do with anything, you ask? Really nothing. Except that instead of getting him a present, I spent months (this is not an exaggeration, but let’s say that I wasn’t spending a lot of consistent time) writing a parody of Bob Hope’s “Thanks for the Memory” and added many many memories – good and … iffy.
First, before I share my version, which I played for my boyfriend before we left for New Orleans, and which he was so touched by that he insisted upon video-recording it and sharing it with the world, check out the original version from the 1938 film, “The Big Broadcast of 1938.”
My version is obviously very personal, so you won’t understand references, but it was extremely therapeutic for me to do something like this for our anniversary, and I had a lot of fun with rhymes and meter. I talked about my love of parodies and my background with them in this post, months ago, and other than at work, I have written very few. I think that’s about to change…
I hope you enjoyed it, and are inspired to write your own!
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?
February 7, 2012
When I was in my internship, my co-interns and I learned a lot. I’ll write more about that in another post, but for our purposes now, I wanted to share with you an intervention that we used in group sessions occasionally, which turned out to be something I use in my work now.
On Friday, my melodic music day on the psych unit, I decided that we would try songwriting. I brought a couple of options just in case one of them wasn’t possible (due to low energy, or disorganized behaviors and thought processes) but I ended up having a pretty fabulous group using my initial plan.
The song is Proud Mary, and I use this as a group songwriting exercise, because most people I’ve worked with, no matter the age, know the tune and accept Creedence Clearwater Revival as an acceptable band to listen or sing along to.
When everyone had made it into the group room, we had a short check-in about why everyone was in the unit. There were three patients with major depression, who were all undergoing ECT Treatments and one with psychosis and manic tendencies (who was in and out of the group). All men. I facilitated a conversation about who is waiting for them at home, how it feels to be in a locked unit, and what they hope to achieve by being there. Then we started our song.
I sing the first verse of the song and one chorus with guitar accompaniment (encouraging people to sing along to get familiar with the rhythm and melody) and then repeat the first two phrases of the song…
“Left a good job in the city, working for the man every night and day”
And asked them to think of alternate lyrics, using what we had talked about in our check-in and pre-intervention conversation. “What or who did you leave when you came to the unit? What happened that made you come here? Now that you’re here, how are you feeling? What do you hope to get out of being here? What do you wish for yourself after treatment?”
I usually start the intervention by keeping the lyric,
“Left a ________ at/in/with (etc.)________,” and prompting the patients to fill in the blanks, and then just talk about what would come next as if we’re writing a story, rather than trying to rhyme and accurately fit words into the original rhythm. If there is more than one suggestion, we have a vote. We’re very democratic. After each phrase is written, I play and sing what we have written, and the patients give suggestions about how to adjust rhythms and lyrics at that point. While I no longer care about rhyming, my clients are usually sticklers, so if needed, I explain the original rhyme scheme if they want to do something similar.
Aside: On Friday, there was a Code Red in our building immediately after the first line was completed and we had to hang out in the milieu for twenty minutes while things got taken care of, (we continued to play music during that time) but surprisingly, that didn’t interrupt the momentum the group members had apparently gained. We went back into the room, got right down to business and they completed the song – one verse and one chorus – in record time.
Anyway, I prompt and encourage as much as is necessary throughout our song, but I rarely suggest words or phrases, and somehow it always works out and the patients really enjoy it.
Here’s an example of something similar to what we’ve written (these are completely my lyrics, which I wrote in two minutes, but you’ll get the point):
Left my home by the water, I was feeling lonely and depressed.
Came here to find out what’s going on, and hopefully I’ll get a little rest.
Doing this for me and my family, trying to get better…
Better, better, better off forever.
When we’re finished, I have the group members suggest possible titles for our song and we have a vote to determine which one should be used. The same goes for choosing a name for our songwriting team. I then pull out my trusty MacBook, we record our song on GarageBand (as many takes as it takes) and I burn CDs for everyone, write the necessary information on the disks, and put the CDs in their “personal belongings bins,” as CDs are not allowed on the unit.
Someone asked me why after this session, and I had to explain that it’s the same reason that no one has shoelaces. They seemed to understand.
What’s difficult about group songwriting in a psych unit, is that there are so many diagnoses to contend with, so writing a song that applies to everyone may not be possible. In that case, we do individual songwriting using the blues, which I’ll write about in another post.
October 26, 2011
**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.
October 24, 2011
And thus begins the series on lyric substitution!
(The header on this – Substitute – is a Gloria Gaynor/Ramones song, not to be confused with The Who’s song of the same title).
Today I had quite the enthusiastic session on the geri-psych unit. The unit has twelve beds, and it’s not always full, so sometimes my groups are very small. NOT TODAY!!! Not only did I have 9 patients, but I also had 9 family members and friends (on this unit, visitors are allowed all hours of the day, and are encouraged to go to groups with the patients, when appropriate). I’m on this unit three times a week, and on Sundays (yuck), I usually lead a casual type of sing-along with some songwriting exercises blended in. We sang some songs that patients suggested, and did The Great Day Song, which as usual got people talking, laughing and reminiscing. A patient’s son, a jazz pianist, performed sporadic songs (that I didn’t know) and we all generally had a wonderful session that was low-key and flowed nicely. At one point, a patient’s husband suggested the song, “He’s Got the Whole World in His Hands.” I of course know the song, and we sang the familiar verses, but I used it as an “in” for a second songwriting exercise, but just using lyric substitution.
After all the verses, I asked the group what else he has in his hands today, and over the next five minutes or so, I got a really nice variety of responses, and everyone in the room got involved and was supportive of one another. Some of the suggestions I received were the following:
He’s got the Middle East in his hands…
He’s got the U.S.A….
He’s got all of the veterans…
He’s got [the hospital we’re in]…
He’s got the navy…
He’s got the Marine Corps…
It was really nice to hear so many genuine responses so quickly.
Howevah – it’s not always that easy, and when it’s not, I try to find a more concrete question to ask residents or patients instead of “What else does he have in his hands?” I sometimes ask each group member “who or what would you like to pray for today,” or “who needs a prayer?” Often residents will name another person in the group, or themselves, and in that case, we sing that person’s name, and then we sing a verse about each person in the group. They always seem so happy to hear their own name in a song, and many have told me how comforting it is to know that we were all singing a prayer for them.
He’s got the whole world in his hands,
He’s got the whole, wide world in his hands,
He’s got the whole world in his hands,
He’s got the whole world in his hands.
Because the song is so repetitive, it’s very easy to successfully use this lyric substitution exercise with a group of people with varying cognitive abilities. We sing the substituted lyric for the first three lines, and finish with “He’s got the whole world in his hands.”
Anyway, that’s all she wrote. Today, I’d like to send a little friendly vibe or two in the direction of a resident I’ve worked with for several years and who is declining, somewhat rapidly, after four years of enthusiasm and an infectiously positive attitude toward everything in her life, despite hardship, loss and an aging mind and body.
Today, He’s got G. in his hands.
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).
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.
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!
September 29, 2011
Dear Mother Nature,
This is the third Thursday in a row that it has rained. Not only has this been inconvenient since I started a new contract on Thursday two weeks ago, but it’s also my busiest day, driving-wise. You know, traffic is always worse when there’s inclement weather. Can you please try and provide us with abundant rain, but maybe not on Thursdays for a while? That would be awesome. K, thanks.
I don’t enjoy rainy days. I know that rain needs to happen in order for many other things (that I enjoy) to happen, but I have a job where I’m constantly driving, constantly dragging instruments all over creation, and constantly having to exude ridiculous amounts of energy in each group in order to keep people engaged and participating. The rain is not conducive to driving, dragging around carts of drums, or anyone’s energy level.
So, I psych myself up. I hum songs about rain all morning before work, and in sessions, we talk about the rain in a really active way. On rainy days, I live the songs “Pennies From Heaven,” “Singin’ in the Rain,” and “Raindrops Keep Falling on My Head.” I try to stay positive, because if I let my low energy get in the way of my work or my clients’ mood, it’s very counterproductive. Coffee also helps, but I can’t rely on caffeine to fake enthusiasm.
A man in my group two weeks ago told me “If I was God, I’d make it rain, but only at night.” I told him I’d vote for him if the position is ever open.
Anyhoo, rain happens. I just have to make the most of it, and be glad that I don’t live in Texas, where rain would be welcomed, any day, any time.
September 13, 2011
I did not allow myself to get wrapped up in the 9/11-themed week that just ended.
Yesterday, I spent some time thinking and reflecting about that day, and certainly reminisced with co-workers about the whole “where were you that morning?” question, but I chose not to re-watch footage from that horrible event or get into all of the drama. I cleaned up my apartment, went to work, spent a few minutes with my mom, visited my boyfriend at a photo shoot he organized and then went out for sushi.
At the doctor’s office this morning, the nurse who administered my Tetanus shot (yay.) asked me if I paid any attention to the repetitious nature of yesterday. I told her I hadn’t, and immediately felt guilty for not being more interested until she said she hadn’t either. A short but effective conversation ensued about that clear, blue, devastating morning ten years and one day ago.
I was a sophomore in college and was not a fan of wake-up calls from my mother. Actually, I wasn’t a fan of waking up in general, and was not expecting a call at (gasp!) 10:15 AM on a Tuesday (I had probably been up late Swiffering the floor of my dorm-suite as I was known to do in those days). Anyway, my mother told me to turn on channel 7. I eventually tuned in after begging her to tell me why, unsuccessfully. The tower was on fire. I was speechless. The TOWER. Holy. Crap. There was only one tower there. The remaining tower fell before my 19-year-old eyes, several minutes later, and I spent the rest of that day hanging out with my roommates, crying, trying desperately to call my good friend at NYU and my cousin (who was/is a flight attendant for United), eating Chinese food and ice cream, and watching the planes hit the towers over and over and over and over again.
That’s my whole story.
Some people’s whole story is much different, and I felt silly and melodramatic when I told my “where were you?” story to several people when they asked yesterday. My story is ridiculous. After that day, I felt no ramifications. I felt frustrated with and was disappointed in the state of our world. I felt angry at our president, who I believed was to blame at the time. I felt helpless when I realized just how intolerant and hateful those terrorists were, and how intolerant and hateful so many people in my own country were. But I didn’t feel the loss or the pain or the real-life horror that survivors of the attacks and thousands and thousands of victims and all of their families and friends felt. My empathy for those people was substantial, but it was also inconsequential. I felt so useless.
Since becoming a music therapist, I experience empathy much more intensely than I used to, and have not watched the news regularly in I don’t know how long. When my boyfriend wants to tell me what he learned in the New York Times on any given day, I often can’t handle the information I’m given, because I’m just so overwhelmed. I see so much pain, every day, in all the clients I work with, that outside of work I don’t feel I need to absorb any additional emotion. I realize that this bury-my-head-in-the-sand technique is not necessarily healthy, and that it’s not helpful for anyone, but I prefer to dream.
I prefer to dream that people are generally good, honest, tolerant, altruistic, generous, considerate, peaceful and understanding. When I dream, I dream that Israel and Palestine will find some common ground and make peace someday. I dream that religious extremists – ALL religious extremists – will exclude intolerance, hate and violence from their teachings. I dream that children in this world will be born into societies that accept and nurture them regardless of their gender, ethnicity, religion and culture – societies that won’t preach that they’re right and that someone else is wrong. Societies that would never think of killing innocent people based on differences in politics or religion.
In reality, for those who aren’t a part of the conversation in my head, I do understand that chaos and peace have always been at odds. I know that since the world began, people have warred and blamed and hated and judged, and acted violently in the name of Jesus, G-d, Allah, or Shiva (among many others, of course). I know that there is absolutely no way that there will ever be complete world peace. I know this, because with every passing day, people seem to become more and more closed-minded, judgmental, greedy, dishonest, selfish and self-righteous. How can our planet, our Earth, succeed in achieving world peace with those negative personality traits? One can dream.
I have to dream. I have to believe that the world is a better place than it is. I have to sing “What a Wonderful World” with clients several times a week and I have to believe it. I have to see the beauty in the world and make “Que Sera, Sera” my mantra. When my elderly clients reminisce mournfully at the loss of millions of people during the Holocaust and WWII as if it was yesterday, I feel I have to tell them that things have changed so they can sleep at night. I celebrated almost too enthusiastically and outwardly at work when Obama won the election in 2008, because my elderly black clients (not all are of African descent) weren’t convinced that things had changed all that much since the lynchings in Birmingham in the earlier part of the last century. But genocide still happens, and racism and hate-crimes still rock communities all over the world. There’s beauty in the breakdown. Or something.
September 11th, 2001 was a terrible day. The truth of the matter though, is that I wasn’t there. I wasn’t one of the hundreds of people jumping out of windows trying to escape certain doom. I wasn’t the wife of a lost firefighter, or the daughter of a woman working on the fifitieth floor. I wasn’t a student in the wrong place at the wrong time, and I wasn’t on those planes. Those people are the people for whom this past week of remembrance was observed, and they are who I thought of and prayed for. I’m just another American watching the rest of the world on TV. I’m not picking up the pieces of a broken life.
So, I observed the tenth anniversary of the attacks in my own way – by living my life, which I’m so lucky to have, and by spending time with people I love. My head may be below sea level at times, but I know what really matters, and it matters every day.
August 27, 2011
Among the ten or so current ideas I have for blog posts, is the issue of early-onset Alzheimer’s Disease. It’s a tricky topic, and an unpleasant one for many people who have “lost” family members to this awful disease. The reason it’s coming up today, is because of a New York Times article I read yesterday.
I’m not a “sports person,” but that doesn’t matter in this case, because of my knowledge and experience in this subject. Pat Summitt, the women’s basketball coach at the University of Tennessee, was recently diagnosed, at the age of 59, with the early-onset form of Alzheimer’s.
59 seems young, doesn’t it? Well, the youngest person ever observed displaying symptoms of early-onset Alzheimer’s Disease was 29. Yikes. Early-onset AD, particularly the familial variety of the disease, appears to be caused by a genetic defect on chromosome 14, which has been widely researched, and defects on two other chromosomes, which can all be passed on to offspring. In fact, there is a 50% chance that the child of a person who has one of these genetic defects will also have the defect. Even scarier, there is a 100% chance that one with any of the three defects will develop the rare form of AD. You can get tested for this if you want to, which could be helpful in deciding the future of your family.
Alzheimer’s is a tough disease for anyone, for their families in particular. What’s tougher, though, about early onset (I’ll just call it EO from now on) is that the people who are diagnosed with it would have had, on average, about 30 more years to live, and have children my age and younger. They still have so much left to do. This means that in some cases, family members deny the possibility of their parents (mostly mom) having AD because “no one in the family had it.” Medicine wasn’t as advanced though back in those days, and scientists didn’t even have a name for the disease, not to mention that it wasn’t uncommon for people to pass away before they began exhibiting symptoms.
A diagnosis of EO basically means that you have two or three years left of being remotely able to live your life the way you want, and sometimes a person doesn’t even have that long. EO progresses faster than late-onset Alzheimer’s disease (my grandmother had LO for ten years before she forgot anyone’s name) which means that even though the brain has finished its functional life at some point, the body, which is a healthy 55-65 year old body, lives on.
There’s a reason we call it “the long goodbye.” Only when a person has lost the ability to eat, or forgets how to walk (sometimes after many years) and has a fall, does their body begin to shut down. In my experience, EO is very frustrating for family members in this way, and the saddest part of it all is that many people feel, after only two years sometimes, that their loved one is already gone, and then the waiting begins.
I read a book last year called “Still Alice.” It was about a 50 year old Harvard professor (told mostly from her perspective) who was diagnosed with EO. It goes through the process of her disease and, in my opinion, it does an amazing job of painting the EO picture. Toward the end of the book it is clear that the once-intellectually-driven linguistics professor has gotten to a point where she is happy – content – eating ice cream and listening to street musicians perform (it sounds pretty good to me too).
My bottom line here, if I didn’t already make a point, is that things are shifting. Things are changing in our world, and the dementia population is growing and becoming younger. What this has meant for me, as a music therapist, is that my music repertoire is shifting too. While the people on units I work in have normally been between the ages of 79 and 94 (making the early 1950s the absolute latest years most of my clients know songs from, and making Let Me Call You Sweetheart (1910) the most requested song), in the past two years, the number of 55 to 70-something year olds has increased, so the music has changed. Despite the terrible reason for the change, I must say that it makes my job a bit more challenging and I’ve enjoyed learning “new” tunes.
Some “more recent” songs that younger patients and residents (or their families) have suggested in the past few years are:
The Wind Beneath my Wings – Bette Midler
Sweet Caroline – Neil Diamond
You’ve Got a Friend – James Taylor
Blowin’ in the Wind – Bob Dylan
Fun, Fun, Fun – The Beach Boys
Blue Velvet – Bobby Vinton
Tie a Yellow Ribbon ‘Round the Old Oak Tree – Tony Orlando and Dawn
Yesterday – The Beatles
Unforgettable – Nat King Cole
No matter how much I love the old songs, it gets a bit old listening to myself sing “Down By The Old Mill Stream” over and over again. The more I get requests for more current songs by folks with EO, however, the more terrified I am that I’ll be one of those unfortunate souls whose cognitive skills leave them early, and who wants so much to request that my music therapist play “Roll to Me” by Del Amitri, but can’t find the words.