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!

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Heal the World

February 25, 2013

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

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

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

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

And it felt good.

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

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

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

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

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

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

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

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

Sweet Emotion

October 2, 2012

I am a crier.  I cry all the time.

I recently cried while watching “The Blind Side,” “Crazy, Stupid Love,” a random “Friends” episode and almost cried when listening to a random movie theme.

Truth be told, I have been meaning to write a post about emotion for quite a while, but the interns started a couple of weeks ago, and things have been a little crazy.

Here we go…

To be in this profession, empathy is key.  We all know that.  We need to be able to make the right decisions about how to handle a situation based on our ability to read someone, and putting ourselves in someone else’s shoes is how we do that. Duh.

There are situations when our own emotions come out at unexpected times, and I think we have to be okay with that, at least for the most part.  One of my interns said to me recently something to the effect of…the more we cry at movies and weddings and Hallmark commercials and anytime anyone else is crying, it reflects how empathetic we are as people.

I agree.  But sometimes we miss the boat.

Last week in the psych unit, we had a group singing session.  I have piles of lyric sheet copies which are laid out on a large table for patients to choose from (I know there’s a better way to do this) and a few tissue boxes.  I encourage patients to choose a song that speaks to them or that they enjoy, and to take the entire pile of copies to hold on to.  Each person shares their choice, and I ask them why they chose that particular song.  Sometimes there’s a deep and meaningful story attached and sometimes they “just like it,” but regardless, we sing the song (sometimes using small percussion instruments, if the person wants us to) and when we are finished, I thank the person for choosing that song and we move on to the next patient’s choice.

Last week during our group singing session, a patient began to cry during “Bridge Over Troubled Water,” which was a song chosen by another patient in the group.  I thought to myself (during the song) that I should process with her when we had finished, but I stopped myself.  I didn’t know this person, and since another patient had chosen the song, I didn’t want to make the other patient feel that her choice wasn’t honored.  We finished the song and I moved onto the next patient’s choice.

Following the session, when we were all processing, the intern I mentioned above posed an extremely good question, wondering why the tearful patient was crying during that song.

I forget sometimes…I forget that crying is an individual’s situational outpouring of emotion or pain or joy, and that in a psychiatric unit, it might be something worth asking that person about.  So many people cry when music is present (especially in those forums) that I forget how new it is to my interns, and how much better I should be about making sure I process those feelings with patients.  Not only that, but spending the time at least asking the person if they want to talk about how they’re feeling, which I have done in the past, but didn’t that day.  I forget that not everyone is attention seeking, like a patient who was in the unit several weeks ago.  I forget that crying can be significant, even if it’s an every day occurrence in my life because of sitcoms and pictures of cute animals and human interest stories that turned into movies.

After I responded to my intern’s question, I went out to the milieu and, sitting down next to the crying patient, asked her if she was okay.  She responded with “Yeah, I’m fine – that song always makes me cry – I have it on CD…but I’m okay.”  I thanked her for coming to the session and told her I hoped that she would come to the drumming group on Monday if she was still there (she did).

I thought about my lack of good judgement in that moment all weekend and realized that I got lost in the structure of my session and forgot the important parts.  Having tissues on the table is not enough.  Surely, some people just want to be alone with their tears and are crying for no reason in particular, but what if someone was crying about something very specific?  What if someone was crying for the first time in years?  What if someone was crying for attention? Or out of frustration? Or anger? Or despair?  The significance of any of those may not ever matter.  We don’t have to pry if we think the person may need that solitary safe space to cry in, but we should at least ask.

Everything seems new-ish again with my interns asking simple but poignant questions, and I feel so happy that I’m able to share my knowledge with them, even if I make mistakes sometimes.

I’m so happy, I could cry 🙂

(But I won’t because I met my quota today during an old episode of “How I Met Your Mother”)

The Voice Within

September 18, 2012

Last summer, I decided I was going to take a huge risk and audition for NBC’s “The Voice.”  Let me give you a hint about what happened:

I got super super nervous and completely butchered “Bridge Over Troubled Water.”

My first problem was choosing that song to begin with, and if I am ever compelled to put myself through that kind of torture auditioning again, I will choose something fun and impressive, not slow and moving.  But I digress…

I have been watching that show since the very first episode.  I love it.  It is the only performance-competition show I have ever watched, and the banter between the coaches makes me laugh at the end of long days. I have been catching up on my DVRed episodes this week, and just watched tonight’s episode, during which I had a moment of “YES!” and felt I needed to share.

There is a teenager on the show named Jocelyn whose story is this: She was born prematurely, which caused a latent neurological disorder preventing her from keeping up with her peers developmentally.  Her parents took her to a specialist because at the age of four, she hadn’t spoken at an age appropriate level, so he…GUESS WHAT HE DID?  He prescribed music!  Granted, he didn’t prescribe a music therapist, BUT WHO CARES!?!?  I love that her story was just on national television, and that her neurologist knew his or her stuff. The girl has a fantastic voice (she is 17) and seems completely well adjusted and developed.  Go Music!

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There is a woman I work with at one of the nursing facilities I contract with, D, who I wrote about in this post.  She is in her seventies and a few years ago, had a major stroke which left her with speech impairments  and the inability to use the right side of her body.  She comes to my music groups every other week and sings like a bird.  She is able to process information, has a great sense of humor, and when she speaks (however incoherently), you can just tell that she knows exactly what she wants to say, and I think she believes she’s saying it so I can understand.  This is obviously all very subjective and just my perspective, but I would be surprised if it isn’t true.  When she sings, though (this is an outcome I know most of us are very familiar with) she sings the words “as clear as a bell” (as the activities director says), and a few times, in a very Gabrielle Gifford kind-of-way, she has spoken words clearly in the context of music, to the delight of us all.

One day, I asked her to make a choice between two songs: I Left My Heart in San Francisco (one of her faves) and Side by Side.  She had never successfully chosen a song before, since her verbal skills are so compromised, but I always try.  That day she said something to the effect of, “I would like to sing… I Left…San Francisco.”  Clear as a bell.  It made my day.  Before then, and since, she has also sung AND spoken “Hello” as we’re greeting each other in the group (and with very little prompting). The activities director’s face takes on a emotional quality every time this happens – I know that there are few times that D’s real speaking voice has been heard, but it’s there, and I feel so lucky to be a part of those moments.

Music is so powerful, and those moments of amazement are what keep me doing this work day after day.  I hope that no matter how emotionally draining being a music therapist can be, we all take some time once or twice a week to be amazed at what we are able to bring out of people and accomplish using an art that we love.

Keep Talking

May 8, 2012

This will be a short one for those of you who know that I am usually quite wordy…

Yesterday I had a session at a nursing home I work at.  There is a resident there who has been in my groups since I began working there – a sweet woman from California who had a stroke a few years back and lost most of her verbal skills.  She is still able to process information, but can’t respond coherently, and when she says words, they are accompanied by a jumbled salad of sounds and other parts of words.  It’s no surprise to me that she is able to sing entire songs without exhibiting even a hint of the turmoil hidden within her brain.

Yesterday, after about a half hour of group drumming, shaking, singing and conversing, I asked her to choose between two songs, knowing that it may be more of a guessing game for me, depending on how unclear her speech was.  I said, “D, should we sing Side by Side or I Left My Heart in San Francisco?”  What came out of her mouth shocked me and made my day simultaneously.  She said, in slow motion, but clearly…”I would like to sing…I Left…San Francisco.”  The activity director and I enthusiastically validated her success, and after the concerted effort and intention she put into her words, she seemed so happy with herself, I wanted to cry.

I am at this particular location every other week and I don’t have a lot of background or treatment plan information, so she may be seeing a speech therapist or going through some other treatment I’m not aware of, but that kind of result is similar to what happens when someone goes through Melodic Intonation Therapy.  I have never used those techniques, but is it possible that the consistent singing has helped her to find her voice again?  It may just be a fluke, but whatever the reason, D’s surprising verbal breakthrough made me so glad to be a music therapist, and to be making a difference in people’s lives in a visible and meaningful way.

Do you have any success stories on this subject?

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:

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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.

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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.

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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.

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

We Got the Beat: Part 2

February 8, 2012

For those of you who aren’t music therapists, students/interns or people in a related field…I apologize.  A little.

I try to write about all different aspects of my job, but when I get going on a series like lyric substitution or percussion, I realize some of you may not find this interesting.  That is unfortunate, but alas, this is an MT blog after all.

So…

The next thing I’d like to talk about in my group drumming series is the “check-in.”  I have many instruments I use for percussion groups, as you may have read in the last post, but my favorite is my Djembe.  I love it.  In fact, I just took it out of it’s case to take a picture for you.

So I love my drum.  I got it several years ago at a regional (NER-AMTA) conference from a Berklee alum who had gone to Ghana, had a bunch of djembes made, and came back with drums to sell. Because I love it so much, I tend to be quite protective of it, particularly in the psych unit.  I went in a couple of years ago to find that one of the unit djembes (much smaller and of lesser quality) had been stabbed – right through the hide by something that left a pen-shaped hole.  Poor drum.  From that moment on, I really only let the patients there play my Djembe during check-in (and one other intervention that I will explain later in this series).  Anyway, I lead all of my drumming groups with this drum.  It’s super loud and resonant, and seems to hypnotize people make for easy entrainment.  It’s a special drum, and when patients ask me if they can play it, and I say, “sorry, this is the drum I’m using right now,” they accept my denial and move on.  They must know how much I love it.  Or something.

Anyhoo…I have a couple of adaptations on the drum-based check-in.  Here they are:

1. After I introduce the instruments, I explain that we’re going to wait a couple of minutes to choose instruments (so people don’t get all excitable) and I demonstrate how to use a djembe (off the ground or tilted diagonally while grounded, middle of goat skin makes a deep sound and the rim makes a higher pitched sound).  I then say this: “What I’d like you to do, is say your name and how you’re feeling right now.  Then, play a rhythm or make a sound on the drum that symbolizes that feeling.  I’ll go first.  My name is Foxy Brown and I’m feeling energetic right now (insert frenetic rumble).”

Then I pass the drum to my right or left and prompt the person if they have forgotten what to do.  When they’re finished, I thank them, regardless of what they have said.  If someone wants to “pass” on the check-in, I still ask them how they’re feeling, but don’t force them to play the drum.  The drum makes its way around the circle (we are always in a circle) and when everyone is finished, I have them choose instruments.

2. Sometimes when people do not speak or have very disorganized thought processes, they are not able to participate in the verbal part of the check-in, so I simply ask them to play a rhythm or make a sound on the drum that speaks to how they’re feeling.

3.   Because my drum is heavy and awkward to pass, I sometimes bring the drum to each person and hold it off the ground while they say/play their piece.  This way works best for elders I work with in other settings, but I’ve had to adapt at other times as well, as we all have to.

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When I walk into a room and ask a patient how he or she is, the words I hear are “okay,” “good,” “fine,” or “alright” sometimes followed by a “how are you?” – words I say when I pass an acquaintance in the hall on my way to wherever. When someone is in a locked psych unit, chances are pretty good that there is more to that story, so I encourage people to give me intentional and honest answers in place of polite ones, in any check-in – drumming or not.

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Any other drumming check-in ideas? 

Proud Mary

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.

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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.

Video Killed the Radio Star

January 28, 2012

Yesterday I had intended to do a songwriting group on the psych unit, but since it was a very small, subdued group, I opted to play the session by ear (har har).  I did a check-in with the three patients, and sang a couple of slow psych standards with guitar accompaniment hoping to ease everyone into music, but even after encouragement, no one sang with me and the music was met with blank stares and silence.  I began asking the patients their musical preferences and though it took some effort to get a response, a couple of them gave me vague answers.

One patient, whose speech was pressured, disorganized and repetitive due to a stroke, suggested an Air Supply song.  I’ve heard the song many times before but was not able to play it, so I pulled up a video of the song (with edited-in lyrics) on YouTube and my patient was able to not only hear her favorite song, but also sing along with it.  She sang it entirely by herself, and following the song reminisced (clearly, without pressure or repetition) about the difficult time in her life when that song was the most significant for her.  The other patient (who is around the same age) gave her support and validation and the two of them began socializing.  Together they suggested several more songs to look up on YouTube (to sing along with) and became enthusiastic during a Lady Gaga song we also watched (a.k.a. read lyrics on the screen to the music).  After the session, one said, “Awwww, it’s over?” and both said how much they enjoyed the session.

I use recorded music with some of my clients for certain interventions, but have never used YouTube videos as a tool for therapeutic purposes (I have used YouTube to find music, but never to show clients video).  It was certainly not my plan to lead a YouTube-based singing group, but I had my computer for my intended songwriting group (I burn CDs for the patients) and it turned out to be exactly what my clients needed at the time.  It was not my most shining moment (I’m a music therapist who prefers live music) but I feel good about my choices based on the situation and the clients’ responses following the session.

When people are disorganized or depressed or simply dont know how they feel, just sitting and talking can be overwhelming.  For those patients, finding words to say can sometimes be a task, not to mention trying to think of a favorite tune.  AND for some, not knowing the words to a song adds to anxiety and uncertainty, feelings I’m sure they’d rather not be exacerbated.

I may never use YouTube videos again (who am I kidding?) but if it comes up, I know that it can do the trick if the situation needs it to.