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!